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Hide Section - GENERAL INFORMATION

GENERAL INFORMATION

Committee NameAdvisory Panel on Hospital Outpatient PaymentAgency NameDepartment of Health and Human Services
Fiscal Year2018Committee Number10710
Original Establishment Date11/29/1999Committee StatusChartered
Actual Termination Date Committee URLhttps://www.cms.gov/Regulations-and-Guidance/Gu...
New Committee This FYNoPresidential Appointments*No
Terminated This FYNoMax Number of Members*15
Current Charter Date11/21/2016Designated Fed Officer Position Title*Designated Federal Official, FACA; Health Insurance Specialist - Division of Outpatient Care, Center for Medicare Management, Centers for Medicare & Medicaid Servcies (CMS),
Date Of Renewal Charter11/21/2018Designated Federal Officer Prefix
Projected Termination Date Designated Federal Officer First Name*Chuck
Exempt From Renewal*NoDesignated Federal Officer Middle Name
Specific Termination AuthorityCharterDesignated Federal Officer Last Name*Braver
Establishment Authority*Statutory (Congress Created)Designated Federal Officer Suffix
Specific Establishment Authority*Section 1833(t)(9)(A) of the Social Security ActDesignated Federal Officer Phone*(410) 786-6719
Effective Date Of Authority*11/29/1999Designated Federal Officer Fax*(410) 786-6719
Committee Type*ContinuingDesignated Federal Officer Email*chuck.braver@cms.hhs.gov
Presidential*No
Committee Function*National Policy Issue Advisory Board
Hide Section - RECOMMENDATION/JUSTIFICATIONS

RECOMMENDATION/JUSTIFICATIONS

Agency Recommendation*Continue
Legislation to Terminate RequiredNo
Legislation StatusNot Applicable
How does cmte accomplish its purpose?*The Panel may advise the Secretary, Department of Health and Human Services (DHHS), and the Administrator, Centers for Medicare & Medicaid Services (CMS), on the following: 1)The clinical integrity of the Ambulatory Payment Classification (APC) groups and their associated weights, which are major elements of the Medicare Hospital Outpatient Prospective Payment System (OPPS); and2)The appropriate supervision level for hospital outpatient services. With respect to supervision, the Panel may recommend a supervision level to ensure an appropriate level of quality and safety for delivery of a given service, as described by a Healthcare Common Procedure Code System (HCPCS) code.
How is membership balanced?*The Panel shall consist of up to 15 total members who are representatives of providers. Members are selected by the Secretary or Administrator among the fields of hospital payment systems; hospital medical care delivery systems; provider billing and accounting systems; APC groups; CPT codes; HCPCS codes; the use of, and payment for, drugs, medical devices, and other services in the hospital outpatient setting; and other forms of relevant expertise. All members shall have a minimum of 5 years of experience in their area(s) of expertise, but it is not necessary that any member be an expert in all of the areas listed above. Panel members are full-time employees of hospitals, hospital systems, or other Medicare providers. The Panel also has an Acting Chair who is a Federal official and serves as a Medical Director at CMS. The Panel membership reflects a balance in terms of gender, race, and geographical location.
How frequent & relevant are cmte mtgs?*The Panel meets annually by the call of the Chair, or his/her appointee, and the decisionmaker at CMS. The meetings can be held up to three times per year, as stated in the Charter. The meetings are relevant since the Panel provides advice and consultation to the Secretary, Department of Health and Human Services (the Secretary) and to the Administrator, Centers for Medicare & Medicaid Services (CMS). The Panel is relevant for the following reasons:•Addressing whether procedures within an APC group are similar both clinically and in terms of resource use.•Reconfiguring APCs (for example, splitting of APCs, moving HCPCS codes from one APC to another, and moving HCPCS codes from new technology APCs to clinical APCs).•Evaluating APC group weights.•Reviewing packaging the cost of items and services, including drugs and devices, into procedures and services, including the methodology for packaging and the impact of packaging the cost of those items and services on APC group structure and payment. •Removing procedures from the inpatient list for payment under the OPPS.•Using claims and cost report data for CMS’ determination of APC group costs.•Addressing other technical issues concerning APC group structure.•Evaluating the required level of supervision for hospital outpatient services.
Why advice can't be obtained elsewhere?*The Secretary is mandated by section 1833(t) of the Social Security Act (the Act) as amended by section 201(h) of the Balanced Budget Refinement Act of 1999 (Pub. L. 106-113) to consult with an advisory panel on the APCs. Consequently, the Panel was created to advise the Secretary and the Administrator, CMS, concerning the clinical integrity of the APC groups and their weights, which are major elements of the hospital OPPS. The Panel may use data collected or developed by entities and organizations other than the Department and CMS in conducting its review. The Panel's recommendations have assisted in making the Outpatient Prospective Payment System a very responsive system to providers' needs.
Why close or partially close meetings?Meetings are not closed; in fact, they are open to the public. Notices of meetings are given to the public in the Federal Register, and there will be records of the meeting proceedings kept, as required by applicable laws and departmental regulations. In the event that a portion of a meeting is closed to the public, a report will be prepared that contains at a minimum a list of members and their business addresses, the Panel’s function, dates and places of meetings, and a summary of Panel activities and recommendations made during the fiscal year. A copy of the report will be provided to the Department Committee Management Officer.
Recommendation Remarks
Hide Section - PERFORMANCE MEASURES

PERFORMANCE MEASURES

Outcome Improvement To Health Or Safety*YesAction Reorganize Priorities*Yes
Outcome Trust In GovernmentYesAction Reallocate ResourcesYes
Outcome Major Policy ChangesYesAction Issued New RegulationsYes
Outcome Advance In Scientific ResearchYesAction Proposed LegislationYes
Outcome Effective Grant MakingNoAction Approved Grants Or Other PaymentsYes
Outcome Improved Service DeliveryYesAction OtherYes
Outcome Increased Customer SatisfactionYesAction CommentAt times, the Agency will approve other payments in new technology or in underpaid APCs as a result of the Panel's recommendations.
Outcome Implement Laws/Reg RequirementsYesGrants Review*No
Outcome OtherNoNumber Of Grants Reviewed0
Outcome CommentN/ANumber Of Grants Recommended0
Cost Savings*Unable to DetermineDollar Value Of Grants Recommended$0.00
Cost Savings CommentNAGrants Review CommentNA
Number Of Recommendations*513Access Contact Designated Fed. Officer*Yes
Number Of Recommendations CommentHistorically, about 25 - 35 recommendations from the APC Panel are generated at each of the two semiannual meetings for a total of 50 - 70 recommendations per year. In the past several years, this number has decreased to about 15-25 recommendations generated per year. This year, the panel generated 14 recommendations.Access Agency WebsiteYes
% of Recs Fully Implemented*85.00%Access Committee WebsiteYes
% of Recs Fully Implemented CommentApproximately 85 percent of the APC Panel recommendations are fully implemented by the Agency within the OPPS.Access GSA FACA WebsiteYes
% of Recs Partially Implemented*9.00%Access PublicationsYes
% of Recs Partially Implemented CommentOf the approximately 15 percent that are not fully implemented, approximately 9 percent are partially implemented. For the remaining 6 percent, CMS may not be able to address these issues due to statutory constraints, or they may be addressed in future years as we are able to do so.Access OtherYes
Agency Feedback*YesAccess CommentAccess is provided to the information for the Committee documentation by contacting the DFO; online Agency, Committee, and GSA FACA Web sites; publications; and regulations.
Agency Feedback CommentThe Panel is provided with copies of the recommendations at the end of each meeting. When the proposed or final rules are published, we provide the Panel with a list of the recommendations that have been addressed in these regulations.Narrative Description*The Advisory Panel on Hospital Outpatient Payment (the Panel). The Panel may advise the Secretary, Department of Health and Human Services (DHHS), and the Administrator, Centers for Medicare & Medicaid Services (CMS), on the following: 1) The clinical integrity of the Ambulatory Payment Classification (APC) groups and their associated weights, which are major elements of the Medicare Hospital Outpatient Prospective Payment System (OPPS); and2) The appropriate supervision level for hospital outpatient services. With respect to supervision, the Panel may recommend a supervision level to ensure an appropriate level of quality and safety for delivery of a given service, as described by a Healthcare Common Procedure Code System (HCPCS) code.DESCRIPTION OF DUTIESThe Panel is technical in nature, and it may advise on the following issues:• Addressing whether procedures within an APC group are similar both clinically and in terms of resource use.• Reconfiguring APCs (for example, splitting of APCs, moving HCPCS codes from one APC to another, and moving HCPCS codes from new technology APCs to clinical APCs).• Evaluating APC group weights.• Reviewing packaging the cost of items and services, including drugs and devices, into procedures and services, including the methodology for packaging and the impact of packaging the cost of those items and services on APC group structure and payment. • Removing procedures from the inpatient list for payment under the OPPS.• Using claims and cost report data for CMS’ determination of APC group costs.• Addressing other technical issues concerning APC group structure.• Evaluating the required level of supervision for hospital outpatient services.1The 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, charge compression, revisions to the cost report, pass-through payments, correct code usage, new technology applications (including supporting information/documentation), provider payment adjustments, and the types of practitioners that are permitted to supervise hospital outpatient services. The Panel may not recommend that services be designated as nonsurgical extended duration therapeutic services.
Hide Section - COSTS

COSTS

Payments to Non-Federal Members*$0.00Est Payments to Non-Fed Members Next FY*$0.00
Payments to Federal Members* Est. Payments to Fed Members Next FY* 
Payments to Federal Staff*$195,711.00Estimated Payments to Federal Staff*$199,430.00
Payments to Consultants*$0.00Est. Payments to Consultants Next FY*$0.00
Travel Reimb. For Non-Federal Members*$5,139.00Est Travel Reimb Non-Fed Members nextFY*$11,500.00
Travel Reimb. For Federal Members*$0.00Est Travel Reimb For Fed Members*$0.00
Travel Reimb. For Federal Staff*$0.00Est. Travel Reimb to Fed Staff Next FY*$0.00
Travel Reimb. For Consultants*$0.00Est Travel Reimb to Consultants Next FY*$0.00
Other Costs$12,114.00Est. Other Costs Next FY*$16,600.00
Total Costs$212,964.00Est. Total Next FY*$227,530.00
Federal Staff Support (FTE)*1.50Est. Fed Staff Support Next FY*1.50
Hide Section - MEMBERS,MEETINGS AND ADVISORY REPORTS

MEMBERS,MEETINGS AND ADVISORY REPORTS

To View all the members, meetings and advisory reports for this committee please click here
Hide Section - SUBCOMMITTEES

SUBCOMMITTEES

Committee

Subcommittees

 
ActionCommittee System IDSubcommittee NameFiscal Year
 COM-031365Data Subcommittee2018
 COM-032319Packaging Subcommittee2018
 COM-032379Visits and Observation Subcommittee2018
Hide Section - CHARTERS AND RELATED DOCS

CHARTERS AND RELATED DOCS

No Documents Found
Hide Section - DATA FROM PREVIOUS YEARS

DATA FROM PREVIOUS YEARS

Committee

Data from Previous Years

  
ActionCommittee System IDCommittee NameFiscal Year
 COM-002059Advisory Panel on Hospital Outpatient Payment2017
 COM-002282Advisory Panel on Hospital Outpatient Payment2016
 COM-004001Advisory Panel on Hospital Outpatient Payment2015
 COM-004385Advisory Panel on Hospital Outpatient Payment2014
 COM-006209Advisory Panel on Hospital Outpatient Payment2013
 COM-006598Advisory Panel on Hospital Outpatient Payment2012
 COM-008313Advisory Panel on Hospital Outpatient Payment2011
 COM-008805Advisory Panel on Ambulatory Payment Classification Groups2010
 COM-010331Advisory Panel on Ambulatory Payment Classification Groups2009
 COM-010744Advisory Panel on Ambulatory Payment Classification Groups2008
 COM-012107Advisory Panel on Ambulatory Payment Classification Groups2007
 COM-012848Advisory Panel on Ambulatory Payment Classification Groups2006
 COM-014074Advisory Panel on Ambulatory Payment Classification Groups2005
 COM-014760Advisory Panel on Ambulatory Payment Classification Groups2004
 COM-015963Advisory Panel on Ambulatory Payment Classification Groups2003
 COM-016597Advisory Panel on Ambulatory Payment Classification Groups2002
 COM-017979Advisory Panel on Ambulatory Payment Classification Groups2001