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This final notice with comment period sets forth an updated schedule of limits on home health agency (HHA) costs that may be reimbursed under the Medicare program. This updated schedule of limits applies to cost reporting periods beginning on or after July 1, 1988.
As required by section 4049 of the Omnibus Budget Reconciliation Act of 1987, this interim rule with comment period sets forth the relative value scale and the methodology for determining fee schedules upon which Medicare Part B payment for radiologist services will be determined. This method of payment will be implemented for services furnished on or after April 1, 1989.
This interim final rule with comment period implements the provisions of section 4007(c) of the Omnibus Budget Reconciliation Act of 1987, as amended by section 411(b)(6)(C) of the Medicare Catastrophic Coverage Act of 1988, which require that the Secretary conduct a demonstration project to develop a uniform cost reporting system for hospitals under the Medicare program. Under this rule, all hospitals in the States of California and Colorado are required to participate in this demonstration project. For the duration of the demonstration, those hospitals are required to submit the cost report currently required under Medicare regulations and additional worksheets specifically developed for the demonstration in a uniform, electronic format.
This notice describes the data, standards, and methodology that we will use to establish fiscal intermediary and carrier budgets for fiscal year (FY) 1990. Intermediaries and carriers assist in the administration of the Medicare program by performing numerous functions related to paying for medical services and equipment. This notice implements section 4035(a) of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203). Section 4035(a) requires us to publish for public comment in the Federal Register data, standards, and methodology we will use to establish budgets for Medicare intermediaries and carriers.
This document corrects a technical error to the interim final rule with comment period published in the Federal Register on July 26, 1982 47 FR 32390) on Medicare supplemental policies. That publication incorrectly stated that the office of the Federal Register maintains a copy of the National Association of Insurance Commissioners (NAIC) Model Standards available for public inspection.
Title IV of Division A, Social Security Administration, of the Omnibus Consolidated and Emergency Supplemental Appropriations Act, 1999, Public Law 105-277, directs the Commissioner of Social Security to expend $6,000,000 for Federal-State partnerships which will evaluate means to promote the Medicare buy-in programs targeted to elderly and disabled individuals under titles XVIII and XIX of the Social Security Act (the Act). Administration of the Medicare buy-in programs described in titles XVIII and XIX of the Act is the responsibility of the Administrator of the Health Care Financing Administration (HCFA) in the Department of Health and Human Services. The Commissioner of Social Security is responsible for the Social Security and Supplemental Security Income (SSI) programs described in titles II and XVI of the Act. The Medicare and Medicaid programs are statutorily linked to the programs administered by the Social Security Administration (SSA). Because of this linkage, SSA provides certain Medicare- and Medicaid-related services to HCFA, the States and to SSA's beneficiaries. Among these services are public service information activities about the Medicare and Medicaid programs, categorically needy Medicaid eligibility determinations in most States and referral activities for certain Medicaid benefits in all States. The scope of SSA's involvement in the Medicare and Medicaid programs is defined in the Act and in agreements between SSA and HCFA and between SSA and the States. The demonstration project specified in Public Law 105-227 will assist SSA's low-income disabled beneficiaries and beneficiaries age 65 and over who are or could be eligible for Medicaid benefits to help pay their Medicare costs. SSA intends to work with HCFA to identify and investigate barriers and to foster enrollment of those beneficiaries in the Medicare buy-in programs. SSA is requesting public comment about these plans and soliciting States to express their interest in participating in this demonstration.
The Second Joint Task Force of European Societies on Coronary Prevention (EAS-European Atherosclerosis Society, ESC-European Society of Cardiology, ESH-European Society of Hypertension) have established recommendations for the prevention of coronary heart disease in cooperation with the representatives of the International Society of Behavioral Medicine, the European Society of General Medicine/Family Medicine, and the European Heart-Network. These recommendations of the year 1998 are commented by Austrian cardiologists and lipidologists and supplemented with recent clinical findings.
In this Comment, Judge Rosenn discusses, from a judicial perspective, the development of manufacturer's liability for defective medical products, with particular attention to the evolution of the strict liability doctrine, the courts' willingness to apply that doctrine to medical manufacturers, and recent suggestions for seriated trials as a means of more effective resolution of the complex litigation that arises in cases of alleged faculty design of medical products.
BACKGROUND: The quality of peer reviewing in developing countries is thought to be poor. To examine whether this was so, we compared the performance of Indian and non-Indian reviewers who were sent original and review articles submitted to The National Medical Journal of India. We also tested whether informing reviewers that their comments would be exchanged improved the quality of their reviews. METHODS: In a prospective, randomized, blinded study, we sent 100 manuscripts to pairs of peer reviewers (Indian and non-Indian) of which 78 pairs of completed replies were available for analysis. Thirty-eight pairs of reviews were exchanged and 40 were not. The quality of the reviews was assessed by two editors who were unaware of the reviewers' nationality and whether they had been told that their reviews would be exchanged. The quality of the reviews was scored out of 100 (based on a predesigned evaluation proforma). We also measured the time taken to return a manuscript. RESULTS: Overall, non-Indian reviewers scored higher than Indians (mean scores non-Indians first, 56.7 v. 48.6, p < 0.001), especially those in the non-exchanged group (58.4 v. 47.3, p < 0.001) but not the exchanged group (54.8 v. 50.0, p < 0.06). Being informed that reviews would be exchanged did not affect the quality of reviews by non-Indians (54.8 exchanged v. 58.4 non-exchanged) or of reviews by Indians (50.0 exchanged v. 47.3 non-exchanged). The editors' assessment of the reviewers matched well (r = 0.59, p < 0.001). Non-Indians took the same amount of time as Indians to return their reviews, although the postage time was at least eight days longer. CONCLUSIONS: We found that non-Indian peer reviewers were better than Indians and informing them that their views would be exchanged did not seem to affect the quality of their reviews. We suggest that Indian editors should also use non-Indian reviewers and start training programmes to improve the quality of peer reviews in India.
BACKGROUND: Primary hyperoxaluria leads to oxalosis, a systemic illness with fatal prognosis in uremic youngsters because of systemic complications. CASE REPORT: A 14-year old boy with primary type 1 hyperoxaluria who had a long-lasting history of nephrolithiasis and passed from normal renal function to end-stage renal disease within 7 months. MEASUREMENT of alanine: glyoxylate aminotransferase (AGT) catalytic activity in the liver biopsy disclosed very low activity which was not. responsive to pyridoxin., thus the patient entered onto a priority national waiting list for liver-kidney transplantation and a week later received a combined transplant. In order to increase body clearance of oxalate, the patient underwent medical treatment to increase urine oxalate solubility (sodium and potassium citrate oral therapy, magnesium supplementation and increase of diuresis) and intensive dialysis both before and after transplantation. COMMENT: The medical approach to the treatment of this rare illness is discussed. Since the major risk for the grafted kidney is related to the oxalate burden, i.e. oxalate deposition from the body deposits to the kidney that becomes irreversibly damaged, treatment consists of increasing the body clearance of oxalate both by increasing oxalate solubility in the urine and with intensive dialysis performed both before and after combined transplantation. To the same extent (by limiting body oxalate deposits), a relatively early (native GFR 20-25 ml/minute) transplantation is advisable.
Summaries of the first draft Environmental Health Criteria (EHC) circulated for comments by IPCS during the period of 1998.4 1999.3 are presented. EHC drafts on 3 compounds were received during this 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.
This final rule with comment period revises and updates Medicare policy concerning ambulance services. It identifies destinations to which ambulance services are covered, establishes requirements for the vehicles and staff used to furnish ambulance services, and clarifies coverage of nonemergency ambulance services for Medicare beneficiaries. This rule also implements section 4531 (c) of the Balanced Budget Act of 1997 concerning Medicare coverage for paramedic intercept services in rural communities.
This final rule with comment period establishes a program to encourage individuals to submit suggestions that could improve the efficiency of the Medicare program. The rule implements section 203(c) of the Health Insurance Portability and Accountability Act of 1996. The intent of this rule is to encourage suggestions and to award, if we deem appropriate, monetary payments to individuals for suggestions that improve efficiency and produce monetary savings to the Medicare program.
This interim final rule with comment period implements, or conforms the regulations to, certain statutory provisions relating to Medicare payments to hospitals for inpatient services that are contained in the Medicare, Medicaid, and State Children's Health Insurance Program Balanced Budget Refinement Act of 1999 (Public Law 106-113). These provisions relate to reclassification of hospitals from urban to rural status, reclassification of certain hospitals for purposes of payment during Federal fiscal year 2000, critical access hospitals, payments to hospitals excluded from the hospital inpatient prospective payment system, and payments for indirect and direct graduate medical education costs. Many of the provisions of Public Law 106-113 modify changes to the Social Security Act made by the Balanced Budget Act of 1997 (P.L. 105-33). These provisions are already in effect in accordance with Public Law 106-113.
This interim final rule implements section 704 of the National Defense Authorization Act for Fiscal Year 2000, to allow additional benefits under the retiree dental insurance plan for Uniformed Services retirees and their family members that may be comparable to those under the Dependents Dental Program. The Department is publishing this rule as an interim final rule in order to comply timely with the desire of Congress to meet the needs of retirees for additional dental coverage. Public comments are invited and will be considered for possible revisions to this rule at the time of publication of the final rule.
In this review article, a brief history and main results of the studies on the nuclear transplantation (cloning) in fish was introduced. Late Professor T. C. Tung (TONG Di-Zhou), a noted Chinese Experimental Embryologist and his research group at the Institute of Zoology, the Chinese Academy of Sciences (CAS) in Beijing, China initiated and established successful technology of nuclear transplantation in fish in 1963. During the past 36 years, most of the studies on fish cloning were performed mainly by Chinese groups except only one article was published by authors in former USSR (Gasaryan et al. 1979), and the other one was published by Japanese authors in Japan (Niwa et al. 1999). The primary goals of the studies of Tung's group were: (1) to study the inter-relationship between the nucleus and the cytoplasm in terms of the controlling effects determined by nucleus or cytoplasm or both during the ontogenesis, cell differentiation and phenotypic expression in a developing animal; and (2) to produce fish clones of commercial importance for agricultural purposes. The most successful results that have been obtained by Tung's group in collaboration with the investigators at various fisheries institutions in China were the production of nucleocytoplasmic adult hybrid fish between different varieties, species, genera and subfamilies that produced viable offspring. Furthermore, these nucleocytoplasmic fish hybrid revealed that while most phenotypic characteristics are controlled by the nucleus, a few are controlled by the cytoplasm or by both. In addition, the resulting nucleocytoplasmic fish hybrids also showed some better characteristics of economic importance such as faster growth rate, increasing of protein content and reducing of fat content in muscle, etc. So far, no such kinds of evidences are available either in amphibian or in mammals. Another most important result obtained by other Chinese groups showed that the uncultured or cultured adult somatic cell in fish which can support the nuclear transplanted eggs developing into adults. They were: (1) a 17 month old gold-fish obtained by transplanting an adult erythrocytes into an enucleated egg (WU et al. 1982); (2) a subcultured kidney cell nucleus of Crucian carp (Carassius auratus) can support the transplanted enucleated egg of same species developing into a three years old adult with female sexual characteristics (CHEN et al. 1986) and (3) a cultured liver cell nucleus from grass carp (Ctenopharyngoden idellus) can support a nuclear transplanted unfertilized egg of the same species developing into an adult fish at least of one year old when that paper was published. Some discussions and comments for evaluating the results obtained from previous studies and suggestions for further investigations in this research field are also provided. More detailed information could be found in the book--"Cloning in Fish-nucleocytoplasmic Hybrids" which was written by Shaoyi Yan in English and published by International Union of Biological Sciences and Educational and Cultural Press Ltd. Hong Kong in 1998.
This final rule with comment period expands State flexibility in providing prevocational, educational, and supported employment services under the Medicaid home and community-based services waiver provisions currently found in section 1915(c) of the Social Security Act (the Act); and incorporates the self-implementing provisions of section 4743 of the Balanced Budget Act of 1997 that amends section 1915(c)(5) of the Act to delete the requirements that an individual have prior institutionalization in a nursing facility or intermediate care facility for the mentally retarded before becoming eligible for the expanded habilitation services. In addition, we are making a number of technical changes to update or correct the regulations.