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At least 19 recordsLinked to original sources
PubMed2001

Medicaid program; modification of the Medicaid upper payment limit transition period for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Final rule.

This final rule modifies the Medicaid upper payment (UPL) limit provisions by establishing a new transition period for States that submitted plan amendments before March 13, 2001 that do not comply with the new UPLs effective on that date (but do comply with the prior UPLs) and were approved on or after January 22, 2001. This new transition period applies to payments for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services.

Ambulatory Care↗
PubMed1998

Medicare program; prospective payment system for hospital outpatient services--HCFA. Proposed rule.

As required by sections 4521, 4522, and 4523 of the Balanced Budget Act of 1997, this proposed rule would eliminate the formula-driven overpayment for certain outpatient hospital services, extend reductions in payment for costs of hospital outpatient services, and establish in regulations a prospective payment system for hospital outpatient services (and for Medicare Part B services furnished to inpatients who have no Part A coverage). The prospective payment system would simplify our current payment system and apply to all hospitals, including those that are excluded from the inpatient prospective payment system. The Balanced Budget Act provides for implementation of the prospective payment system effective January 1, 1999, but delays application of the system to cancer hospitals until January 1, 2000. The hospital outpatient prospective payment system would also apply to partial hospitalization services furnished by community mental health centers. Although the statutory effective date for the outpatient prospective payment system is January 1, 1999, implementation of the new system will have to be delayed because of year 2000 systems concerns. The demands on intermediary bill processing systems and HCFA internal systems to become compliant for the year 2000 preclude making the major systems changes that are required to implement the prospective payment system. The outpatient prospective payment system will be implemented for all hospitals and community mental health centers as soon as possible after January 1, 2000, and a notice of the anticipated implementation date will be published in the Federal Register at least 90 days in advance. This document also proposes new requirements for provider departments and provider-based entities. These proposed changes, as revised based on our consideration of public comments, will be effective 30 days after publication of a final rule. This proposed rule would also implement section 9343(c) of the Omnibus Budget Reconciliation Act of 1986, which prohibits Medicare payment for nonphysician services furnished to a hospital outpatient by a provider or supplier other than a hospital, unless the services are furnished under an arrangement with the hospital. This section also authorizes the Department of Health and Human Services' Office of Inspector General to impose a civil money penalty, not to exceed $10,000, against any individual or entity who knowingly and willfully presents a bill for nonphysician or other bundled services not provided directly or under such an arrangement. This proposed rule also addresses the requirements for designating certain entities as provider-based or as a department of a hospital.

Ancillary Services, Hospital↗
PubMed1998

Medicare program; prospective payment system for hospital outpatient services; extension of comment period--HCFA. Notice of extension of comment period for proposed rule.

This notice extends the comment period for a proposed rule published in the Federal Register on September 8, 1998, (63 FR 47552). In that rule, as required by sections 4521, 4522, and 4523 of the Balanced Budget Act of 1997, we proposed to eliminate the formula-driven overpayment for certain outpatient hospital services, extend reductions in payment for costs of hospital outpatient services, and establish in regulations a prospective payment system for hospital outpatient services (and for Medicare Part B services furnished to inpatients who have no Part A coverage.) The comment period is extended for 60 days.

Ambulatory Care↗
PubMed2001

Medicaid program; revision to Medicaid upper payment limit requirements for hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Health Care Financing Administration (HCFA), HHS. Final rule.

This final rule modifies the Medicaid upper payment limits for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. For each type of Medicaid inpatient service, existing regulations place an upper limit on overall aggregate payments to all facilities and a separate aggregate upper limit on payments made to State-operated facilities. This final rule establishes an aggregate upper limit that applies to payments made to government facilities that are not State government-owned or operated, and a separate aggregate upper limit on payments made to privately-owned and operated facilities. This rule also eliminates the overall aggregate upper limit that had applied to these services. With respect to outpatient hospital and clinic services, this final rule establishes an aggregate upper limit on payments made to State government-owned or operated facilities, an aggregate upper limit on payments made to government facilities that are not State government-owned or operated, and an aggregate upper limit on payments made to privately-owned and operated facilities. These separate upper limits are necessary to ensure State Medicaid payment systems promote economy and efficiency. We are allowing a higher upper limit for payment to non-State public hospitals to recognize the higher costs of inpatient and outpatient services in public hospitals. In addition, to ensure continued beneficiary access to care and the ability of States to adjust to the changes in the upper payment limits, the final rule includes a transition period for States with approved rate enhancement State plan amendments.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1984

The demand for hospital outpatient services.

In an investigation of the role played by hospital outpatient services in medical care delivery, objectives were to identify the factors which influence the demand for these services; and to determine the relationship between outpatient service volume and the availability and price of alternative sources of care, particularly office-based physicians and hospital inpatient services. Data were from a merged national data set containing population, socioeconomic, health services, manpower supply, and cost information. Two methods were used to examine demand for hospital outpatient services. The first replicated the earlier work by Davis and Russell using more recent (1978 versus 1969) and more geographically defined (Health Service Area versus state) data. The second extended this work, using the improved availability of data to estimate demand equations, distinguishing between emergency room and other outpatient visits. The results confirmed and extended the findings of earlier efforts. The level of hospital outpatient services appears related both to the availability and the price of other sources of care, as well as to insurance coverage and other factors. These findings have implications for reform of hospital outpatient reimbursement, for cost containment under Medicaid, and in related areas.

Catchment Area, Health↗
PubMed2000

Office of Inspector General; Medicare program; prospective payment system for hospital outpatient services. Health Care Financing Administration (HCFA), HHS, and Office of Inspector General (OIG), HHS. Final rule with comment period.

This final rule with comment period implements a prospective payment system for hospital outpatient services furnished to Medicare beneficiaries, as set forth in section 1833(t) of the Social Security Act. It also establishes requirements for provider departments and provider-based entities, and it implements section 9343(c) of the Omnibus Budget Reconciliation Act of 1986, which prohibits Medicare payment for nonphysician services furnished to a hospital outpatient by a provider or supplier other than a hospital, unless the services are furnished under an arrangement with the hospital. In addition, this rule establishes in regulations the extension of reductions in payment for costs of hospital outpatient services required by section 4522 of the Balanced Budget Act of 1997, as amended by section 201(k) of the Balanced Budget Refinement Act of 1999.

Ambulatory Care↗
PubMed1990

Hospital outpatient services under Medicare, 1987.

Presented in this article are data related to hospital outpatient services provided for aged and disabled Medicare beneficiaries during calendar year 1987. Trend data are also presented for selected calendar years 1974-87. Hospital outpatient covered charges and Medicare program payments (in total and per enrollee) are the statistics employed to measure the use of hospital outpatient services. The data contained in this article should provide information to help identify trends and patterns of care for monitoring the Medicare hospital outpatient services.

Aged↗
PubMed1991

Hospital outpatient services and Medicaid patients' access to care.

This article examines the relationship between the use of hospital outpatient services by Medicaid patients, Medicaid physician fees, and the use of office-based physician services. Past research has indicated that the use of outpatient facilities by Medicaid patients substitutes for care by private physicians and might be reduced by raising physician fees, but these studies may be estimated at too high a level of geographic aggregation and include many outpatient services that are not substitutes for office-based physician care. The results in this study, which are estimated using LISREL on county level Medicaid claims data from the state of Illinois, provide little evidence that outpatient care substitutes for care by physicians or that raising physician fees would reduce inappropriate outpatient usage by medicaid patients.

Attitude of Health Personnel↗
PubMed1992

Medicare hospital outpatient services and costs: implications for prospective payment.

Medicare expenditures of hospital outpatient department (HOPD) services are growing rapidly, prompting congressional interest in a prospective payment system. In this article, the authors identify frequently provided services and examine service volume and charges in the HOPD. Relatively few services drive Medicare HOPD spending, and volume is dominated by visits, imaging and laboratory tests, whereas surgery accounts for a large proportion of charges. Hospital-level variations in charges, costs, case mix, and outliers are also explored. There is substantial variation in charges and costs across hospital types. However, after case-mix adjustment, all hospital types have average costs within 6 percent of the national average.

Ambulatory Surgical Procedures↗
PubMed1988

Use and cost of hospital outpatient services under Medicare, 1985.

Presented in this article are program data on the use and cost of hospital outpatient (HOP) services rendered to aged and disabled Medicare beneficiaries during calendar year 1985. Trend data are also presented for calendar years 1974-85. The data shown in this article focus on charges, reimbursements, and reimbursements per enrollee as a means of measuring the cost of HOP services. The data provide information to help identify trends and patterns of care for monitoring the Medicare HOP benefit and for evaluating the impact of the inpatient hospital prospective payment system (PPS) on the use and cost of HOP services.

Ambulatory Care↗
PubMed1988

Medicare program; changes to the return on equity capital provisions for outpatient hospital services--HCFA. Final rule.

We are revising the Medicare regulations to eliminate the allowance for a return on equity capital for outpatient services furnished by proprietary hospitals as required by section 4065 of the Omnibus Budget Reconciliation Act of 1987 (enacted on December 22, 1987). Section 4065 prohibits recognition of any return on equity capital with respect to hospital outpatient departments effective January 1, 1988.

Aged↗
PubMed2000

Medicare program; prospective payment system for hospital outpatient services: revisions to criteria to define new or innovative medical devices, drugs, and biologicals eligible for pass-through payments and corrections to the criteria for the grandfather provision for certain Federally Qualified Health Centers. Health Care Financing Administration (HCFA), HHS. Interim final rule with comment period.

This interim final rule with comment period changes one criterion and postpones the effective date for two other criteria that a new device, drug, or biological must meet in order for its cost to be considered "not significant" for purposes of determining its eligibility for transitional pass-through payments. It also changes the transitional pass-through payment policy to include new single use medical devices that come in contact with human tissue and that are surgically implanted or inserted in a patient whether or not the devices remain with the patient after the patient is released from the hospital outpatient department. These policies represent a departure from those presented in the April 7, 2000 Federal Register final rule with comment period entitled, "Prospective Payment System for Hospital Outpatient Services." This interim final rule with comment period also corrects a trigger date for grandfathering of provider-based Federally Qualified Health Centers (FQHCs) to conform with the intent not to disrupt existing FQHCs with longstanding provider-based treatment that we discussed in the April 2000 final rule. Under the criteria in the April 2000 final rule with comment period, FQHCs are treated as departments of a provider without regard to the criteria for provider-based status in that document if they meet other criteria and were designated as FQHCs before 1995. Under this correction, facilities that meet those other criteria and were designated as FQHCs or "look-alikes" on or before April 7, 2000 would continue to be treated as provider-based. In addition, we are clarifying how the requirement for prior notice to beneficiaries is to be applied in emergency situations. Also, we are clarifying the protocols for off-campus departments in emergency situations.

Ambulatory Care↗
PubMed2000

A survey of hospital outpatient services for chronic diseases in Gauteng.

OBJECTIVES: The rapid evaluation of hospital-based services for chronic non-communicable diseases, in particular aspects of the organisation of services, and indirect indicators of patient care. DESIGN: A postal survey of services for asthma, epilepsy, diabetes and hypertension at nine hospitals. Assessment over 1 week of single blood pressure (BP) and blood glucose readings at the hypertension and diabetes clinics at one regional hospital. SETTING: Nine community and secondary hospitals in Gauteng. RESULTS: Eight hospitals responded. Most did not provide specific clinics for each condition. None of the professional staff had received additional training in chronic disease management, and 7 considered their services to be understaffed. On average, nurses managed 33 patients per day (range 19-50), and doctors 53 (20-80). Mean consultation time was 9 minutes (4-20 minutes). Management guidelines were used for all conditions in 5 hospitals. Modern routine assessments were seldom employed. Estimates of regular patient attendance ranged from 25% to 75%. At the single hospital surveyed, hypertension (N = 233) was controlled in 42.5% of patients using World Health Organisation criteria (BP < 160/95), but in only 24.5% of patients by The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC6) standards (BP < 140/90). Random blood glucose was satisfactory (< 10 mmol/l) in 45.2% of diabetic patients (N = 157) while hypertension (N = 100) was well controlled (< 140/90) in 10% of hypertensive diabetic patients. CONCLUSIONS: Services for chronic diseases at non-academic hospitals in Gauteng were characterised by perceived inadequate staff numbers and training, short consultation times, infrequent use of management guidelines and standard assessments, little patient education with regard to self care, and perceived low rates of regular attendance (and hence compliance with medication). At one hospital there was a low rate of hypertension control, and unsatisfactory rates of acceptable glycaemic and BP control among diabetic patients. There is an urgent need for restructuring of services for chronic diseases and for more detailed outcomes research.

Asthma↗