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Medicare program; schedules of per-visit and per-beneficiary limitations on home health agency costs for cost reporting periods beginning on or after October 1, 1998--HCFA. Notice with comment period.

This notice with comment period sets forth revised schedules of limitations on home health agency costs that may be paid under the Medicare program for cost reporting periods beginning on or after October 1, 1998. These limitations replace the limitations that were set forth in our January 2, 1998 notice with comment period (63 FR 89) and our March 31, 1998 final rule with comment period (63 FR 15718).

Budgets↗

Ryan White Care Act requirement--Secretary's determination on HIV testing of newborns--CDC. Notice and request for comments.

Section 2626 of P.L. 104-146 (42 U.S.C. 300ff-34), the "Ryan White CARE Act Amendments of 1996", includes a requirement for the Secretary of HHS to make a determination whether a set of activities prescribed in section 2627 of the Public Health Service (PHS) Act (42 U.S.C. 300ff-35), have become routine practice in the United states. In making this determination, the Secretary is required to consult with the States and other public or private entities that have knowledge or expertise relevant to the determination. The purpose of this notice is to request comments from States and such other public or private entities with knowledge or expertise relevant to the practice of activities (1) through (4) in section 2627 of the PHS Act (42 U.S.C. 300ff-35). After consideration of comments submitted the CDC will provide a summary of comments received to the Secretary as part of the process leading to the Secretary's determination required by Section 2626 of the PHS Act (42 U.S.C. 300ff-34).

AIDS Serodiagnosis↗

Medicare and Medicaid programs; recognition of the Commission for Accreditation of Rehabilitation Facilities--HCFA. Notice with comment period.

This notice announces and invites comments on the receipt of an application from the Commission for Accreditation of Rehabilitation Facilities for recognition as a national accreditation organization with deemed status authority. The Social Security Act requires us to publish this notice in which we identify the national accreditation body making the application, describe the nature of the request, and provide a 30-day public comment period. The intent of this notice is to solicit public comment as to the advisability of recognizing the Commission for Accreditation of Rehabilitation Facilities as a national accreditation organization with deeming authority to survey and accredit comprehensive outpatient rehabilitation facilities for participation in the Medicare or Medicaid programs.

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

Rethinking maternal sensitivity: mothers' comments on infants' mental processes predict security of attachment at 12 months.

This study investigated predictors of attachment security in a play context using a sample of 71 mothers and their 6-month-old infants. We sought to rethink the concept of maternal sensitivity by focusing on mothers' ability accurately to read the mental states governing infant behaviour. Five categories were devised to assess this ability, four of which were dependent on maternal responses to infant behaviours, such as object-directed activity. The fifth, mothers' Appropriate minded-related comments, assessed individual differences in mothers' proclivity to comment appropriately on their infants' mental states and processes. Higher scores in this fifth category related to a secure attachment relationship at 12 months. Maternal sensitivity and Appropriate mind-related comments were independent predictors of attachment security at 12 months, respectively accounting for 6.5% and 12.7% of its variance. We suggest that these findings are in line with current theorising on internal working models of attachment, and may help to explain security-related differences in mentalising abilities.

Adult↗

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2001. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

This final rule with comment period makes several changes affecting Medicare Part B payment. The changes include: refinement of resource-based practice expense relative value units (RVUs); the geographic practice cost indices; resource-based malpractice RVUs; critical care RVUs; care plan oversight and physician certification and recertification for home health services; observation care codes; ocular photodynamic therapy and other ophthalmological treatments; electrical bioimpedance; antigen supply; and the implantation of ventricular assist devices. This rule also addresses the comments received on the May 3, 2000 interim final rule on the supplemental survey criteria and makes modifications to the criteria for data submitted in 2001. Based on public comments we are withdrawing our proposals related to the global period for insertion, removal, and replacement of pacemakers and cardioverter defibrillators and low intensity ultrasound. This final rule also discusses or clarifies the payment policy for incomplete medical direction, pulse oximetry services, outpatient therapy supervision, outpatient therapy caps, HCPCS "G" Codes, and the second 5-year refinement of work RVUs for services furnished beginning January 1, 2002. In addition, we are finalizing the calendar year (CY) 2000 interim physician work RVUs and are issuing interim RVUs for new and revised codes for CY 2001. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule also announces the CY 2001 Medicare physician fee schedule conversion factor under the Medicare Supplementary Medical Insurance (Part B) program as required by section 1848(d) of the Social Security Act. The 2001 Medicare physician fee schedule conversion factor is $38.2581.

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

Medicare program; revisions to payment policies and five-year review of and adjustments to the relative value units under the physician fee schedule for calendar year 2002. Final rule with comment period.

This final rule with comment period makes several changes affecting Medicare Part B payment. The changes affect: refinement of resource-based practice expense relative value units (RVUs); services and supplies incident to a physician's professional service;anesthesia base unit variations;recognition of CPT tracking codes; and nurse practitioners, physician assistants, and clinical nurse specialists performing screening sigmoidoscopies. It also addresses comments received on the June 8, 2001 proposed notice for the 5-year review of work RVUs and finalizes these work RVUs. In addition,we acknowledge comments received on our request for information on our policy for CPT modifier 62 that is used to report the work of co-surgeons. The rule also updates the list of certain services subject to the physician self-referral prohibitions to reflect changes to CPT codes and Healthcare Common Procedure Coding System codes effective January 1, 2002. These refinements and changes will ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 modernizes the mammography screening benefit and authorizes payment under the physician fee schedule effective January 1, 2002; provides for biennial screening pelvic examinations for certain beneficiaries effective July 1, 2001; provides for annual glaucoma screenings for high-risk beneficiaries effective January 1,2002; expands coverage for screening colonoscopies to all beneficiaries effective July 1, 2001; establishes coverage for medical nutrition therapy services for certain beneficiaries effective January 1, 2002; expands payment for telehealth services effective October 1, 2001; requires certain Indian Health Service providers to be paid for some services under the physician fee schedule effective July 1, 2001; and revises the payment for certain physician pathology services effective January 1, 2001. This final rule will conform our regulations to reflect these statutory provisions. In addition, we are finalizing the calendar year (CY) 2001 interim RVUs and are issuing interim RVUs for new and revised procedure codes for calendar year (CY) 2002. As required by the statute, we are announcing that the physician fee schedule update for CY2002 is -4.8 percent, the initial estimate of the Sustainable Growth Rate (SGR) for CY 2002 is 5.6 percent, and the conversion factor for CY 2002 is $36.1992.

Fee Schedules↗

Dental assistants of Indiana: comments from the front lines.

During the summer of 1996, a random sample survey of 1500 Indiana dental assistants licensed in radiology by the Indiana State Board of Health was conducted. Surveys were mailed to participants, and follow-up postcard reminders were sent out a few weeks later. There were 569 surveys returned, representing a 38 percent return rate. Numerical data were coded and entered in an SPSS program, and written comments were analyzed independently by the co-authors. Major demographic data and many categories of open-ended comments are summarized and analyzed in this paper. Results from this survey underscore the necessity for wages being improved in the dental assisting field. Comments underscore the fact that many dental assistants are not satisfied with their jobs and therefore may not be committed to either their careers or their employers. Office climate and relationships with the dentist are also described as being very important.

Adolescent↗

Medicaid program and State Children's Health Insurance Program (SCHIP) payment error rate measurement. Interim final rule with comment period.

This interim final rule sets forth the State requirements to provide information to us for purposes of estimating improper payments in Medicaid and the State Children's Health Insurance Program (SCHIP), as required under the Improper Payments Information Act (IPIA) of 2002. The IPIA requires heads of Federal agencies to annually estimate and report to the Congress these estimates of improper payments for the programs they oversee and, submit a report on actions the agency is taking to reduce erroneous payments. We published a proposed rule on August 27, 2004 to propose that States measure improper payments in Medicaid and SCHIP and report the State-specific error rates to us for purposes of computing the improper payment estimates for these programs. After extensive analysis of the issues related to having States measure improper payments in Medicaid and SCHIP, including public comments on the provisions in the proposed rule, we are revising our proposed approach. Our new approach incorporates commenters' suggestions to engage a Federal contractor by contracting with that entity to complete the data processing and medical reviews and calculate the State-specific error rates. Based on the States' error rates, the contractor also will calculate the improper payment estimates for these programs which will be reported by the Department of Health and Human Services as required by the IPIA. This interim final rule sets out the types of information that States would need to submit to allow CMS to conduct medical and data processing reviews on claims made in the fee-for-service (FFS) setting. CMS will address estimating improper payments for Medicaid managed care and eligibility and SCHIP FFS, managed care and eligibility at a later time. This rule responds to the public comments on the proposed rule, sets forth the requirements for States to assist us and the contractor to produce State-specific error rates in Medicaid and SCHIP which will be used as the basis for a national error rate, and outlines future plans for measuring eligibility, which may include greater State involvement than the level required for the medical and data processing reviews.

Child↗

[A proposal of ready-made interpretative comments applicable to serum protein electrophoresis].

Zone electrophoresis for separation and quantification of serum proteins is useful in numerous pathological situations to make clinical diagnostics, to follow the evolution of a disease or to evaluate the efficiency of a treatment. The biologist must apply professional recommendations according to the official nomenclature of biological analysis. He must attach a comment to each result in order to help the physician to perform the best interpretation of the results. To answer those needs, a work of standardization of these comments has been realized by a group of biologists. They are members of the national college of biologists (CNBH). All the commentaries are assembled in a thesaurus which could be a base of ready-made comments, favouring the interpretation of serum protein electrophoresis results.

Biology↗

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2007 rates; fiscal year 2007 occupational mix adjustment to wage index; health care infrastructure improvement program; selection criteria of loan program for qualifying hospitals engaged in cancer-related health care and forgiveness of indebtedness; and exclusion of vendor purchases made under the competitive acquisition program (CAP) for outpatient drugs and biologicals under part B for the purpose of calculating the average sales price (ASP). Final rules and interim final rule with comment period.

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs to implement changes arising from our continuing experience with these systems, and to implement a number of changes made by the Deficit Reduction Act of 2005 (Pub. L. 109-171). In addition, in the Addendum to this final rule, we describe the changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. We also are setting forth rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the IPPS that are paid in full or in part on a reasonable cost basis subject to these limits. These changes are applicable to discharges occurring on or after October 1, 2006. In this final rule, we discuss public comments we received on our proposals to refine the diagnosis-related group (DRG) system under the IPPS to better recognize severity of illness among patients--to use a hospital-specific relative value (HSRV) cost center weighting methodology to adjust DRG relative weights; and to implement consolidated severity-adjusted DRGs or alternative severity adjustment methods. Among the other policy changes that we are making are those changes related to: limited revisions of the reclassification of cases to DRGs; the long-term care (LTC)-DRGs and relative weights; the wage data, including the occupational mix data, used to compute the wage index; applications for new technologies and medical services add-on payments; payments to hospitals for the direct and indirect costs of graduate medical education; submission of hospital quality data; payments to sole community hospitals and Medicare-dependent, small rural hospitals; and provisions governing emergency services under the Emergency Medical Treatment and Labor Act of 1986 (EMTALA). We are responding to requested public comments on a number of other issues that include performance-based hospital payments for services and health information technology, as well as how to improve health data transparency for consumers. In addition, we are responding to public comments received on a proposed rule issued in the Federal Register on May 17, 2006 that proposed to revise the methodology for calculating the occupational mix adjustment to the wage index for the FY 2007 hospital inpatient prospective payment system by applying an adjustment to 100 percent of the wage index using new 2006 occupational mix survey data collected from hospitals. We are finalizing two policy documents published in the Federal Register relating to the implementation of the Health Care Infrastructure Improvement Program, a hospital loan program for cancer research, established under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This final rule also revises the definition of the term "unit" to specify the exclusion of units of drugs sold to approved Medicare Competitive Acquisition Program (CAP) vendors for use under the CAP from average sales price (ASP) calculations for a period of up to 3 years, at which time we will reevaluate our policy.

Diagnosis-Related Groups↗

Legislative comment: nursing home patients' rights in Massachusetts: current protection and recommendations for improvement.

Several Massachusetts laws, including the recently enacted Patients' Bill of Rights, protect the rights of nursing home patients. Although these laws address many of the problems that such patients face, they do not adequately meet all of the unique needs of this vulnerable group. This Comment discusses safeguards afforded by current Massachusetts law that are particularly important for nursing home patients, and recommends improvements that would secure more adequate protection for their rights. The Comment also analyzes some of Massachusetts law's shortcomings in implementation and enforcement, in forum selection and in limitations on standing, and suggests improvements in these areas. Finally, the Comment proposes the enactment of a comprehensive Bill of Rights for Nursing Home Patients in order to address their unique needs more adequately, and to eliminate the duplicative, vague, and confusing provisions contained in current law.

Aged↗

Reply to comments on "Derivation of numerical values for the World Health Organization guidelines for recreational waters".

The contribution addressed reveals an optimistic design philosophy likely to systematically underestimate risk in epidemiologic studies into the health effects of bathing water exposures. The authors seem to recommend that data on the 'exposure' measure (i.e. water quality) in such studies should be acquired in a similar manner to that used for regulatory sampling. This approach may compromise the quality of the epidemiologic investigations undertaken. It may result in imprecise estimates of exposure because it ignores the fact that regulatory timescales and spatial resolution (even if artificially compressed to a bathing day) can mask large spatial and temporal variability in water quality. If this variability is ignored by taking some mean value and attributing that to all of those exposed in a period at a study location, many bathers may be misclassified and the studies may be biased to a 'no-effect' conclusion. A more appropriate approach is to maximise the precision of the epidemiologic investigations by measurement of individual exposure (or water quality) at the place and time of the exposure, as has been done in randomised volunteer studies in the UK and Germany. The precise epidemiologic relationships linking 'exposure' with 'illness' can then be related to the probability of exposure to particular water quality by a 'normal bather' using the known probability distribution of the exposure variable (i.e. faecal indicator concentration) in the regulated bathing waters. We suggest that any research protocol where poor sampling design for water quality assessment is justified because regulatory monitoring is equally imprecise may be fundamentally flawed. The rationale for this assessment is that the epidemiology is the starting point and evidence-base for 'standards'. If precision is not maximised at this stage in the process it compromises the credibility of the standards design process. The negative effects of the approach advocated in this 'comment' are illustrated using published research findings used to derive the figures illustrated in Wymer et al. [2005. Comment on derivation of numerical values for the World Health Organization guidelines for recreational waters. Water Research 39, 2774-2777].

Environmental Exposure↗

Educational level, socioeconomic status and aphasia research: a comment on Connor et al. (2001)--effect of socioeconomic status on aphasia severity and recovery.

Is there a relation between socioeconomic factors and aphasia severity and recovery? describe correlations between the educational level and socioeconomic status of aphasic subjects with aphasia severity and subsequent recovery. As stated in the introduction by, studies of the influence of educational level and literacy (or illiteracy) on aphasia severity have yielded conflicting results, while no significant link between socioeconomic status and aphasia severity and recovery has been established. In this brief note, we will comment on their findings and conclusions, beginning first with a brief review of literacy and aphasia research, and complexities encountered in these fields of investigation. This serves as a general background to our specific comments on, which will be focusing on methodological issues and the importance of taking normative values in consideration when subjects with different socio-cultural or socio-economic backgrounds are assessed.

Aphasia↗

Family rituals--from research to the consulting room and back again: comment on the special section.

This article offers a comment on the special research section on Family Routines and Rituals from the point of view of a family therapist who has made the use of rituals a specialty in clinical practice. Ways that the research usefully informs clinicians seeking to use rituals in therapy are highlighted. A critique of the articles, particularly in the area of ritual definition, is offered. The comment concludes with several suggestions for future research.

Ceremonial Behavior↗

The role of oral language revisited: a comment on the NICHD Early Child Care Research Network (2005).

This article comments on the discussion of S. A. Storch and G. J. Whitehurst's literacy development model in the article by the National Institute of Child Health and Human Development (NICHD) Early Child Care Research Network (ECCRN). Specifically, this comment focuses on concerns raised by the NICHD ECCRN that Storch and Whitehurst's model does not afford an important role to oral language in the development of early reading skill. Four important issues are presented that provide a serious and careful challenge to the model and conclusions of the NICHD ECCRN's report.

Child↗

Strangers at home: comment on Dirkzwager, Bramsen, Adèr, and van der Ploeg (2005).

This comment summarizes the findings of the article by A. J. E. Dirkzwager, I. Bramsen, H. Adèr, and H. M. van der Ploeg (2005; see record 2005-06518-006) and notes that it can serve as a reawakening about the immediate and long-term psychosocial consequences of war, not only for those troops who are deployed but also for the loved ones who await their return. The lessons learned once again--that the mental health of the returning peacekeeper parallels that of his or her partner, that partners of traumatized soldiers report more posttraumatic stress disorder symptoms, somatic and sleep problems, negative social support, and low marital morale than partners of nontraumatized soldiers--are consistent with systemic traumatology theory. This comment traces the historical and theoretical foundations that underlie the concept of secondary trauma (i.e., compassion fatigue) and discusses the implications for family psychology practice in helping veterans and their families recover from their ordeals.

Family↗

Concept of and preliminary trial protocol for adjuvant treatment of mediastinitis with immunoglobulins after cardiac surgery (ATMI): response to comments and criticism.

During the consensus-based process of protocol development external experts were invited to comment on a proposal for a trial protocol on adjuvant immunotreatment of patients with wound infection after median sternotomy (ATMI). Controversies and arguments can be divided into five main areas: 1) rationale and objectives; 2) criteria for patient selection; 3) adjuvant treatment; 4) measures of efficacy; and 5) course and timetable of the study. We present and summarise the experts comments and criticism as well as the result of the final discussion of the study group with respect to these areas.

APACHE↗

Reply to "Comment on 'Power-law correlations in the southern-oscillation-index fluctuations characterizing El Niño'".

Earlier [Phys. Rev. E 63, 047201 (2001)] we studied the southern oscillation index (SOI). Our findings tended to favor specific physical models for the El Niño description. The Comment by Metzler [Phys. Rev. E 67, 018201 (2003)] on this publication does not give any argument in favor of another El Niño physical model. In contrast, the Comment points out that statistical properties of the SOI data can be explained with a model based on a linear autoregressive process, but such a modeling does not help in identifying the relevant physical mechanisms.

Comment↗