Rule2024-31146
Medicare Program: Appeal Rights for Certain Changes in Patient Status and Changes to the Medicare Claims and Medicare Prescription Drug Coverage Determination Appeals Procedures; Correcting Amendment
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
December 30, 2024
Effective
December 30, 2024
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This document corrects technical errors in the final rule that appeared in the October 15, 2024, Federal Register titled "Medicare Program: Appeal Rights for Certain Changes in Patient Status." It also corrects technical errors in the final rule that appeared in the May 7, 2019, Federal Register titled "Medicare Program; Changes to the Medicare Claims and Medicare Prescription Drug Coverage Determination Appeals Procedures."
Full Text
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<title>Federal Register, Volume 89 Issue 249 (Monday, December 30, 2024)</title>
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[Federal Register Volume 89, Number 249 (Monday, December 30, 2024)]
[Rules and Regulations]
[Pages 106362-106364]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-31146]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 405
[CMS-4204-F2 & CMS-4174-F2]
RINs 0938-AV16 and 0938-AT27
Medicare Program: Appeal Rights for Certain Changes in Patient
Status and Changes to the Medicare Claims and Medicare Prescription
Drug Coverage Determination Appeals Procedures; Correcting Amendment
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Final rules; correcting amendment.
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SUMMARY: This document corrects technical errors in the final rule that
appeared in the October 15, 2024, Federal Register titled ``Medicare
Program: Appeal Rights for Certain Changes in Patient Status.'' It also
corrects technical errors in the final rule that appeared in the May 7,
2019, Federal Register titled ``Medicare Program; Changes to the
Medicare Claims and Medicare Prescription Drug Coverage Determination
Appeals Procedures.''
DATES: This correcting amendment is effective December 30, 2024.
FOR FURTHER INFORMATION CONTACT: Kristy Nishimoto, (206) 615-2367.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2024-23195 of October 15, 2024 (89 FR 83240), the final
rule titled ``Medicare Program: Appeal Rights for Certain Changes in
Patient Status,'' there were technical errors associated with the
regulations text that are identified and corrected in this correcting
amendment.
In FR Doc. 2019-09114 of May 7, 2019 (84 FR 19855), the final rule
titled ``Medicare Program; Changes to the Medicare Claims and Medicare
Prescription Drug Coverage Determination Appeals Procedures,'' there
was a technical error associated with the regulation text that is
identified and corrected in this correcting amendment.
II. Summary of Errors
For the October 15, 2024, final rule, we are making the following
corrections:
<bullet> In Sec. Sec. 405.932(i)(1), 405.936(d)(1), and
405.1210(b)(3), we are correcting errors in paragraph numbering.
<bullet> In Sec. 405.934(c)(4)(viii), we are correcting a
grammatical error in the use of the word ``party.''
For the May 7, 2019, final rule, in Sec. 405.1014(a)(1)(i), we are
removing the term ``health'' in the phrase ``Medicare health number''
because the word ``health'' is not necessary to describe an
individual's Medicare number. ``Health'' was inadvertently included in
the regulation text and we are deleting the unnecessary term to avoid
confusion.
III. Waiver of Proposed Rulemaking and Delay in Effective Date
Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA),
the agency is usually required to publish a notice of the proposed rule
in the Federal Register before the provisions of a rule take effect.
Specifically, 5 U.S.C. 553 requires the agency to publish a notice of
the proposed rule in the Federal Register that includes a reference to
the legal authority under which the rule is proposed, and the terms and
substance of the proposed rule or a description of the subjects and
issues involved. Further, 5 U.S.C. 553 generally requires the agency to
give interested parties the opportunity to participate in the
rulemaking through public comment before a final rule is issued.
Section 1871(b)(1) of the Social Security Act (the Act) also generally
requires the Secretary to provide for notice of the proposed rule in
the Federal Register and provide a period of not less than 60 days for
public comment for rules to
[[Page 106363]]
carry out the administration of the Medicare program under title XVIII
of the Act. In addition, section 553(d) of the APA and section
1871(e)(1)(B)(i) of the Act usually require a 30-day delay in effective
date after issuance or publication of a rule. Sections 553(b)(B) and
553(d)(3) of the APA, however, provide for exceptions from the notice
and comment and delay in effective date APA requirements in some
limited situations. In cases in which these exceptions apply, sections
1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act also provide exceptions
from the advanced public notice and 60-day comment period and delay in
effective date requirements of the Act. Section 553(b)(B) of the APA
and section 1871(b)(2)(C) of the Act authorize an agency to dispense
with certain rulemaking requirements for good cause if the agency makes
a finding that the notice and comment process is impracticable,
unnecessary, or contrary to the public interest. In addition, both
section 553(d)(3) of the APA and section 1871(e)(1)(B)(ii) of the Act
allow the agency to waive the normal 30-day delay in effective date
where there is good cause or the delay in the effective date would be
contrary to the public interest and the agency includes an appropriate
finding to support the rule becoming effective sooner.
We find there is good cause to issue this technical correction
final rule without seeking advanced public comments based on the
``unnecessary'' prong of the good cause exception allowed under section
553(b)(B) of the APA and which is also expressly incorporated by cross-
reference in section 1871(b)(2)(C) of the Act. The corrections in this
document are insignificant or technical in nature and impact and will
largely be inconsequential to the public. CMS periodically issues
correction notices to implement non-substantive edits to previously
finalized rules. The non-substantive corrections described herein do
not require regulated parties to adjust their behavior, and therefore
are of little impact or consequence for the public. This correcting
amendment simply corrects paragraph numbering and technical errors in
the regulatory text of the aforementioned final rules but does not make
substantive changes to the policies that were adopted in those final
rules. As a result, this correcting amendment is intended to ensure
that the regulations at Sec. Sec. 405.932, 405.934, 405.936, 405.1014,
and 405.1210 accurately reflect the policies adopted in the final
rules.
Undertaking further notice and comment procedures to incorporate
the regulatory text corrections in this document into the final rules
or delaying the effective date would be unnecessary, as we are not
altering our policies or regulatory changes, but rather, we are simply
correcting paragraph numbering and technical errors that do not affect
the requirements that we previously proposed, requested comment on, and
subsequently finalized. This final rule correcting amendment is
intended solely to ensure that the final rules and the Code of Federal
Regulations (CFR) accurately reflect policies and regulatory changes
that have been adopted through rulemaking.
Additionally, we find there is good cause to waive the normal 30-
day delay in effective date for this technical correction final rule
under section 553(d)(3) of the APA. The purpose of the 30-day delay in
effective date under section 553(d) of the APA is to ``give affected
parties a reasonable time to adjust their behavior before the final
rule takes effect.'' Omnipoint Corp. v. FCC, 78 F.3d 620, 630 (D.C.
Cir. 1996). These non-substantive, technical corrections do not make
changes that would require the public to adjust their behavior in any
manner, rendering a delayed effective date unnecessary. We also note
that the requirement for a 30-day delay in effective date under section
1871(e)(1)(B)(i) of the Act applies only to substantive changes;
because the corrections described herein are non-substantive, the
requirements of section 1871(e)(1)(B)(i) of the Act are inapplicable.
Even if the changes could be construed as substantive, we find that
additional delay would be contrary to the public interest under section
1871(e)(1)(B)(ii) of the Act. We believe there is no need for the
public to prepare for the nonsubstantive, technical corrections in this
rule as they are merely correcting errors in form and designation in
the regulation text specified in the previous final rules. Moreover,
since we have announced that we are targeting January 1, 2025 for
implementation of the retrospective appeals procedures in Sec. Sec.
405.931 through 405.938, a 30-day delay in the effective date for these
non-substantive, technical corrections could cause undue hardship for
eligible parties who are preparing to exercise their right immediately
once the appeal process is implemented and who may be entitled to
financial relief following a favorable appeal.
Therefore, for the reasons state previously, we find good cause to
waive the notice and comment and effective date requirements.
List of Subjects in 42 CFR Part 405
Administrative practice and procedure, Diseases, Health facilities,
Health professions, Medical devices, Medicare, Reporting and
recordkeeping requirements, Rural areas, X-rays.
For the reasons set forth in the preamble, the Centers for Medicare
& Medicaid Services corrects 42 CFR part 405 by making the following
correcting amendments:
PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
0
1. The authority citation for part 405 continues to read as follows:
Authority: 42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x,
1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).
Sec. 405.932 [Amended]
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2. Section 405.932 is amended by redesignating paragraphs (i)(1)(A) and
(B) as paragraphs (i)(1)(i) and (ii).
Sec. 405.934 [Amended]
0
3. Section 405.934 is amended in paragraph (c)(4)(viii) by removing the
phrase ``an eligible parties' right'' and adding in its place the
phrase ``an eligible party's right''.
0
4. Section 405.936 is amended by revising paragraph (d)(1) to read as
follows:
Sec. 405.936 Hearings before an ALJ and decisions by an ALJ or
Attorney Adjudicator.
* * * * *
(d) * * *
(1)(i) If the ALJ or attorney adjudicator determines that the
inpatient admission, and as applicable, eligible SNF services,
satisfied the relevant criteria for Part A coverage at the time the
services were furnished, then the ALJ or attorney adjudicator issues
notice of the favorable decision to the eligible party (or the party's
representative).
(ii) The ALJ or attorney adjudicator also notifies the hospital and
SNF, as applicable, in the case of a favorable determination for Part A
coverage.
* * * * *
0
5. Section 405.1014 is amended by revising paragraph (a)(1)(i) to read
as follows:
Sec. 405.1014 Request for an ALJ hearing or a review of a QIC
dismissal.
(a) * * *
(1) * * *
(i) The name, address, and Medicare number of the beneficiary whose
claim is being appealed, and the beneficiary's
[[Page 106364]]
telephone number if the beneficiary is the appealing party and not
represented.
* * * * *
0
6. Section 405.1210 is amended by adding paragraph (b)(3) to read as
follows:
Sec. 405.1210 Notifying eligible beneficiaries of appeal rights when
a beneficiary is reclassified from an inpatient to an outpatient
receiving observation services.
* * * * *
(b) * * *
(3) When delivery of the notice is valid. Delivery of the written
notice of appeal rights described in this section is valid if--
(i) The eligible beneficiary (or the eligible beneficiary's
representative) has signed and dated the notice to indicate that he or
she has received the notice and can comprehend its contents, except as
provided in paragraph (b)(4) of this section; and
(ii) The notice is delivered in accordance with paragraph (b)(1) of
this section and contains all the elements described in paragraph
(b)(2) of this section.
* * * * *
Elizabeth J. Gramling,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2024-31146 Filed 12-27-24; 8:45 am]
BILLING CODE 4120-01-P
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</html>Indexed from Federal Register on December 30, 2024.
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