11-26-12 Council Agenda & Packet

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§414.617 42 CFR Ch.IV(10-1-10 Edition) amounts that would have been deter- Time period Regional National mined had the inflation update factor percent percent for the entire CY 2001 been 3.7 percent. 7/1/04-12/31/04 80 20 Both portions of the transition pay- CY 2005 60 40 ment(that is the portion that is based Cr 2006 40 60 on reasonable charge or reasonable CY 2007 eV soon 20 80 cost and the portion that is based on CY 2010 and thereafter 0 100 the ambulance fee schedule) are up- dated annually for inflation by the in- [69 FR 40292,July 1,2004) flation factor described in§414.610(f). 4414.620 Publication of the ambulance (g) Exception. There will be no blend- fee schedule. ed payment allowance as described in paragraphs (a), (b), (c), and (d) of this Changes in payment rates resulting section for ground mileage in those from incorporation of the annual infla- States where the Medicare carrier paid tion factor described in §414.610(f) will separately for all out-of-county ground be announced by CMS by instruction ambulance mileage, but did not, before and on the CMS Web site CMS will fol- the implementation of the Medicare low applicable rulemaking procedures ambulance fee schedule, make a sepa- in publishing revisions to the fee sched- rate payment for any ground ambu- ule for ambulance services that result lance mileage within the county in from any factors other than the infla- which the beneficiary was transported. tion factor. Payment for ground ambulance mile- [67 FR 9132, Feb. 27, 2002, as amended at 72 age in that State will be made based on FR 66402,Nov.27,2007] the full ambulance fee schedule amount for ground mileage. This ex- 4414.625 Limitation on review. ception applies only to carrier-proc- There will be no administrative or ju- essed claims and only in those States dicial review under section 1869 of the in which the carrier paid separately for Act or otherwise of the amounts estab- out-of-county ambulance mileage, but lished under the fee schedule for ambu- did not make separate payment for any lance services, including the following: in-county mileage throughout the en- (a) Establishing mechanisms to con- tire State. trol increases in expenditures for am- bulance#414.617 Transition from regional to services. national ambulance fee schedule. (b)Establishing definitions for ambu- lance services that link payments to For services furnished during the pe- the type of services provided. riod July 1, 2004 through December 31, (c) Considering appropriate regional 2009, the amount for the ground ambu- and operational differences. lance base rate is subject to a floor (d) Considering adjustments to pay- amount determined by establishing ment rates to account for inflation and nine fee schedules based on each of the other relevant factors. nine census divisions using the same (e) Phasing in the application of the methodology as used to establish the payment rates under the fee schedule national fee schedule. If the regional in an efficient and fair manner. fee schedule methodology for a given census division results in an amount Subpart I—Payment for Drugs and that is less than or equal to the na- tional ground base rate, then it is not Biologicals used, and the national FS amount ap- plies. If the regional fee schedule meth- SotmcE:69 FR 1116,Jan.7,2004,unless oth- odology for a given census division re- erwise noted. sults in an amount that is greater than the national ground base rate, then the §414.701 Purpose. FS portion of the base rate for that This subpart implements section census division is equal to a blend of 1842(o) of the Social Security Act by the national rate and the regional rate specifying the methodology for deter- in accordance with the following sched- mining the payment allowance limit ule: for drugs and biologicals covered under 68