{"abstract":"This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. In addition, the final rule with comment period describes changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. This final rule with comment period also changes the requirement for physician oversight of mid-level practitioners in critical access hospitals (CAHs). In this final rule with comment period, we also are responding to public comments received on the November 15, 2004, final rule with comment period pertaining to the ambulatory payment classification (APC) group assignment of Healthcare Common Procedure Coding System (HCPCS) codes identified in Addendum B of that rule with the new interim (NI) comment indicator. These changes are applicable to services furnished on or after January 1, 2006.","action":"Final rule with comment period.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2005/11/10/05-22136.html","cfr_references":[{"chapter":null,"citation_url":null,"part":419,"title":42},{"chapter":null,"citation_url":null,"part":485,"title":42}],"citation":"70 FR 68516","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"Effective Date: This final rule with comment period is effective on January 1, 2006.","disposition_notes":null,"docket_ids":["CMS-1501-FC"],"dockets":[],"document_number":"05-22136","effective_on":null,"end_page":68980,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2005/11/10/05-22136.xml","html_url":"https://www.federalregister.gov/documents/2005/11/10/05-22136/medicare-program-changes-to-the-hospital-outpatient-prospective-payment-system-and-calendar-year","images":{"ER10NO05.025":{"original_size":"https://img.federalregister.gov/ER10NO05.025/ER10NO05.025_original_size.gif"},"ER10NO05.146":{"original_size":"https://img.federalregister.gov/ER10NO05.146/ER10NO05.146_original_size.gif"},"ER10NO05.267":{"original_size":"https://img.federalregister.gov/ER10NO05.267/ER10NO05.267_original_size.gif"},"ER10NO05.024":{"original_size":"https://img.federalregister.gov/ER10NO05.024/ER10NO05.024_original_size.gif"},"ER10NO05.145":{"original_size":"https://img.federalregister.gov/ER10NO05.145/ER10NO05.145_original_size.gif"},"ER10NO05.266":{"original_size":"https://img.federalregister.gov/ER10NO05.266/ER10NO05.266_original_size.gif"},"ER10NO05.023":{"original_size":"https://img.federalregister.gov/ER10NO05.023/ER10NO05.023_original_size.gif"},"ER10NO05.144":{"original_size":"https://img.federalregister.gov/ER10NO05.144/ER10NO05.144_original_size.gif"},"ER10NO05.265":{"original_size":"https://img.federalregister.gov/ER10NO05.265/ER10NO05.265_original_size.gif"},"ER10NO05.022":{"original_size":"https://img.federalregister.gov/ER10NO05.022/ER10NO05.022_original_size.gif"},"ER10NO05.143":{"original_size":"https://img.federalregister.gov/ER10NO05.143/ER10NO05.143_original_size.gif"},"ER10NO05.264":{"original_size":"https://img.federalregister.gov/ER10NO05.264/ER10NO05.264_original_size.gif"},"ER10NO05.021":{"original_size":"https://img.federalregister.gov/ER10NO05.021/ER10NO05.021_original_size.gif"},"ER10NO05.142":{"original_size":"https://img.federalregister.gov/ER10NO05.142/ER10NO05.142_original_size.gif"},"ER10NO05.263":{"original_size":"https://img.federalregister.gov/ER10NO05.263/ER10NO05.263_original_size.gif"},"ER10NO05.020":{"original_size":"https://img.federalregister.gov/ER10NO05.020/ER10NO05.020_original_size.gif"},"ER10NO05.141":{"original_size":"https://img.federalregister.gov/ER10NO05.141/ER10NO05.141_original_size.gif"},"ER10NO05.262":{"original_size":"https://img.federalregister.gov/ER10NO05.262/ER10NO05.262_original_size.gif"},"ER10NO05.140":{"original_size":"https://img.federalregister.gov/ER10NO05.140/ER10NO05.140_original_size.gif"},"ER10NO05.261":{"original_size":"https://img.federalregister.gov/ER10NO05.261/ER10NO05.261_original_size.gif"},"ER10NO05.260":{"original_size":"https://img.federalregister.gov/ER10NO05.260/ER10NO05.260_original_size.gif"},"ER10NO05.029":{"original_size":"https://img.federalregister.gov/ER10NO05.029/ER10NO05.029_original_size.gif"},"ER10NO05.028":{"original_size":"https://img.federalregister.gov/ER10NO05.028/ER10NO05.028_original_size.gif"},"ER10NO05.149":{"original_size":"https://img.federalregister.gov/ER10NO05.149/ER10NO05.149_original_size.gif"},"ER10NO05.027":{"original_size":"https://img.federalregister.gov/ER10NO05.027/ER10NO05.027_original_size.gif"},"ER10NO05.148":{"original_size":"https://img.federalregister.gov/ER10NO05.148/ER10NO05.148_original_size.gif"},"ER10NO05.269":{"original_size":"https://img.federalregister.gov/ER10NO05.269/ER10NO05.269_original_size.gif"},"ER10NO05.026":{"original_size":"https://img.federalregister.gov/ER10NO05.026/ER10NO05.026_original_size.gif"},"ER10NO05.147":{"original_size":"https://img.federalregister.gov/ER10NO05.147/ER10NO05.147_original_size.gif"},"ER10NO05.268":{"original_size":"https://img.federalregister.gov/ER10NO05.268/ER10NO05.268_original_size.gif"},"ER10NO05.036":{"original_size":"https://img.federalregister.gov/ER10NO05.036/ER10NO05.036_original_size.gif"},"ER10NO05.157":{"original_size":"https://img.federalregister.gov/ER10NO05.157/ER10NO05.157_original_size.gif"},"ER10NO05.278":{"original_size":"https://img.federalregister.gov/ER10NO05.278/ER10NO05.278_original_size.gif"},"ER10NO05.035":{"original_size":"https://img.federalregister.gov/ER10NO05.035/ER10NO05.035_original_size.gif"},"ER10NO05.156":{"original_size":"https://img.federalregister.gov/ER10NO05.156/ER10NO05.156_original_size.gif"},"ER10NO05.277":{"original_size":"https://img.federalregister.gov/ER10NO05.277/ER10NO05.277_original_size.gif"},"ER10NO05.034":{"original_size":"https://img.federalregister.gov/ER10NO05.034/ER10NO05.034_original_size.gif"},"ER10NO05.155":{"original_size":"https://img.federalregister.gov/ER10NO05.155/ER10NO05.155_original_size.gif"},"ER10NO05.276":{"original_size":"https://img.federalregister.gov/ER10NO05.276/ER10NO05.276_original_size.gif"},"ER10NO05.033":{"original_size":"https://img.federalregister.gov/ER10NO05.033/ER10NO05.033_original_size.gif"},"ER10NO05.154":{"original_size":"https://img.federalregister.gov/ER10NO05.154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