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Medicare Program: Meeting of the Advisory Panel on Ambulatory Payment Classification (APC) Groups-March 1, 2, and 3, 2006

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Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (DHHS).




In accordance with section 10(a) of the Federal Advisory Committee Act (FACA) (5 U.S.C. Appendix 2), this notice announces the first biannual meeting of the Ambulatory Payment Classification (APC) Panel (the Panel) for 2006.

The purpose of the Panel is to review the APC groups and their associated weights and to advise the Secretary of the Department of Health and Human Services (HHS) and the Administrator of the Centers for Medicare & Medicaid Services (CMS) concerning the clinical integrity of the APC groups and their associated weights. The advice provided by the Panel will be considered as CMS prepares its annual updates of the hospital Outpatient Prospective Payment System (OPPS) through rulemaking.


Meeting Dates: The first biannual meeting for 2006 is scheduled for the following dates and times:

  • Wednesday, March 1, 2006, 1 p.m. to 5 p.m. (e.s.t.).
  • Thursday, March 2, 2006, 8 a.m. to 5 p.m. (e.s.t.).
  • Friday, March 3, 2006, 8 a.m. to 12 noon (e.s.t.).


Deadline for Hardcopy Comments/Suggested Agenda Topics

5 p.m. (e.s.t.), Wednesday, February 1, 2006.

Deadline for Hardcopy Presentations

5 p.m. (e.s.t.), Wednesday, February 1, 2006.

Deadline for Attendance Registration

5 p.m. (e.s.t.), Wednesday, February 8, 2006.

Deadline for Special Accommodations

5 p.m. (e.s.t.), Wednesday, February 8, 2006.

Submittal of Materials to the Designated Federal Officer (DFO):

Because of staffing and resource limitations, we cannot accept written comments and presentations by FAX, nor can we print written comments and presentations received electronically for dissemination at the meeting.

Only hardcopy comments and presentations will be accepted for placement in the meeting booklets. All hardcopy presentations must be accompanied by Form CMS-20017. The form is now available through the CMS Forms Web site. The URL for linking to this form is (​forms/​cms20017.pdf.)

We are also requiring electronic versions of the written comments and presentations (in addition to the hardcopies), so we can send them electronically to the Panel members for their review before the meeting.

Consequently, you must send BOTH electronic and hardcopy versions of your presentations and written comments by the prescribed deadlines. (Electronic transmission must be sent to the e-mail address below, and hardcopies—accompanied by Form CMS-20017—must be mailed to the Designated Federal Officer [DFO], as specified in the FOR FURTHER INFORMATION CONTACT: section of this notice.)


The meeting will be held in the Multipurpose Room, 1st Floor, CMS Central Office, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

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For inquiries regarding the meeting; meeting registration; and hardcopy submissions of oral presentations, agenda items, and comments, please contact the DFO: Shirl Ackerman-Ross, DFO, CMS, CMM, HAPG, DOC, 7500 Security Boulevard, Mail Stop C4-05-17, Baltimore, MD 21244-1850. Phone: (410) 786-4474.

  • E-mail Address for comments, presentations, and registration requests is
  • News media representatives must contact our Public Affairs Office at (202) 690-6145.

Advisory Committees' Information Lines:

The CMS Advisory Committees' Information Line is 1-877-449-5659 (toll free) and (410) 786-9379 (local).

Web Sites:

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I. Background

The Secretary is required by section 1833(t)(9)(A) of the Act, as amended and redesignated by sections 201(h) and 202(a)(2) of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106-113), respectively, to establish and consult with an expert, outside advisory panel on Ambulatory Payment Classification (APC) groups. The APC Panel (the Panel), which was re-chartered by the Secretary on November 1, 2004, meets up to three times annually to review the APC groups and to provide technical advice to the Secretary and the Administrator concerning the clinical integrity of the groups and their associated weights. All members must have technical expertise that shall enable them to participate fully in the Start Printed Page 76314work of the Panel. Such expertise encompasses hospital payment systems, hospital medical-care delivery systems, outpatient payment requirements, APCs, Current Procedural Terminology (CPT) codes, and the use and payment of drugs and medical devices in the outpatient setting, as well as other forms of relevant expertise. However, it is not necessary that any one member be an expert in all of the areas listed above. All members shall have a minimum of 5 years experience in their areas of expertise, and they must be currently employed full-time in their areas of expertise. For purposes of this Panel, consultants or independent contractors are not considered to be full-time employees.

We will consider the technical advice provided by the Panel as we prepare the proposed changes to the OPPS for the next calendar year.

The Panel may consist of a Chair and up to 15 representatives who are full-time employees (not consultants) of Medicare providers, which are subject to the OPPS.

The Administrator selects the Panel membership based upon either self-nominations or nominations submitted by providers or interested organizations. The Panel presently consists of the following members and a Chair:

  • Edith Hambrick, M.D., J.D., Chair.
  • Marilyn Bedell, M.S., R.N., O.C.N.
  • Gloryanne Bryant, B.S., R.H.I.A., R.H.I.T., C.C.S.
  • Albert Brooks Einstein, Jr., M.D.
  • Hazel Kimmel, R.N., C.C.S., C.P.C.
  • Sandra J. Metzler, M.B.A., R.H.I.A., C.P.H.Q.
  • Thomas M. Munger, M.D., F.A.C.C.
  • Frank G. Opelka, M.D., F.A.C.S.
  • Louis Potters, M.D., F.A.C.R.
  • James V. Rawson, M.D.
  • Lou Ann Schraffenberger, M.B.A., R.H.I.A., C.C.S.-P.
  • Judie S. Snipes, R.N., M.B.A., F.A.C.H.E.
  • Lynn R. Tomascik, R.N., M.S.N., C.N.A.A.
  • Timothy Gene Tyler, Pharm.D.
  • Kim Allan Williams, M.D., F.A.C.C., F.A.B.C.
  • Robert Matthew Zwolak, M.D., Ph.D., F.A.C.S.

II. Agenda

The agenda for the March 2006 meeting will provide for discussion and comment on the following topics as designated in the Panel's Charter:

  • Reconfiguration of APCs (for example, splitting of APCs, moving Healthcare Common Procedure Coding System (HCPCS) codes from one APC to another and moving HCPCS codes from new technology APCs to clinical APCs).
  • Evaluation of APC weights.
  • Packaging devices and drug costs into APCs: methodology, effect on APCs, and need for reconfiguring APCs based upon device and drug packaging.
  • Removal of procedures from the inpatient list for payment under the OPPS.
  • Use of single and multiple procedure claims data.
  • Packaging of HCPCS codes.
  • Other technical issues concerning APC structure.

The subject matter before the Panel shall be limited to these and related topics. Unrelated topics are not subjects for discussion. Unrelated topics include, but are not limited to, the conversion factor, cost compression, pass-through payments for medical devices and drugs, and wage adjustments. These subjects will not be addressed by the Panel.

The Panel may use data collected or developed by entities and organizations, other than DHHS and CMS, in conducting its review.

III. Written Comments and Suggested Agenda Topics

Hardcopy written comments and suggested agenda topics should be sent to the DFO. Such items must be received by the date and time specified in the DATES section of this notice.

Additionally, the written comments and suggested agenda topics must fall within the subject categories outlined in the Panel's Charter listed in the Agenda section of this notice.

IV. Oral Presentations

Individuals or organizations wishing to make 5-minute oral presentations must contact the DFO. The DFO must receive hardcopy presentations by the date and time specified in the DATES section of this notice in order to be scheduled.

The number of oral presentations may be limited by the time available. Oral presentations should not exceed 5 minutes in length.

The Chair may further limit time allowed for presentations due to the number of oral presentations, if necessary.

V. Presenter and Presentation Criteria

The additional criteria below must be supplied to the DFO by the date specified in the DATES section of this notice (along with hardcopies of presentations).

  • Required personal information regarding presenter(s):

+ Name of presenter(s);

+ Title(s);

+ Organizational affiliation;

+ Address;

+ E-mail address, and

+ Telephone number(s).

  • All presentations must contain, at a minimum, the following supporting information and data:

+ Financial relationship(s) of presenter(s), if any, with any company whose products, services, or procedures that are under consideration;

+ Physicians' CPTs involved;

+ APC(s) affected;

+ Description of the issue(s);

+ Clinical description of the service under discussion (with comparison to other services within the APC);

+ Recommendations and rationale for change;

+ Expected outcome of change; and

+ Potential consequences of not making the change(s).


All presenters must also submit Form CMS-20017.

VI. Oral Comments

In addition to formal oral presentations, there will be opportunity during the meeting for public oral comments, which will be limited to 1 minute for each individual and a total of 5 minutes per organization.

VII. Meeting Attendance

The meeting is open to the public; however, attendance is limited to space available. Attendance will be determined on a first-come, first-served basis.

Persons wishing to attend this meeting, which is located on Federal property, must e-mail the Panel DFO to register by the date and time specified in the DATES section of this notice. A confirmation will be sent to the requester(s) via return e-mail.

The following information must be e-mailed or telephoned to the DFO by the date and time above:

  • Name(s) of attendee(s),
  • Title(s),
  • Organization,
  • E-mail address(es), and
  • Telephone number(s).

VIII. Security, Building, and Parking Guidelines

Persons attending the meeting must present photographic identification to the Federal Protective Service or Guard Service personnel before they will be allowed to enter the building.

Security measures will include inspection of vehicles, inside and out, at the entrance to the grounds. In addition, all persons entering the building must pass through a metal detector. All items brought to CMS, including personal items such as desktops, cell phones, Start Printed Page 76315palm pilots, etc., are subject to physical inspection.

Individuals who are not registered in advance will not be permitted to enter the building and will be unable to attend the meeting. (Note: Presenters must also be registered for attendance at the meeting.) The public may enter the building 30-45 minutes before when the meeting convenes each day. (The meeting convenes at the date and time specified in the DATES section of this notice.)

All visitors must be escorted in areas other than the lower and first-floor levels in the Central Building.

Parking permits and instructions are issued upon arrival by the guards at the main entrance.

IX. Special Accommodations

Individuals requiring sign-language interpretation or other special accommodations must send a request for these services to the DFO by the date and time specified in the DATES section of this notice.

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Authority: Section 1833(t)(9) of the Act (42 U.S.C. 13951(t)). The Panel is governed by the provisions of Pub. L. 92-463, as amended (5 U.S.C. Appendix 2).

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(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare-Hospital Insurance; and Program No. 93.774, Medicare-Supplementary Medical Insurance Program)

Dated: November 10, 2005.

Mark B. McClellan,

Administrator, Centers for Medicare & Medicaid Services.

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[FR Doc. 05-24290 Filed 12-22-05; 8:45 am]