30817

Proposed Rule

that relate to physician services include: resource-based practice expense relative, value units, medical direction rules for

anesthesia services, and payment for abnormal Pap smears. Also, we would rebase the Medicare Economic Index

from a 1989 base year to a 1996 base year. Under the law, we are required to develop a resource-based system for

determining practice expense relative value units. The Balanced Budget Act of

1997 (BBA 1997) delayed, for 1 year, implementation of the resource-based practice expense relative value units

until January 1, 1999. Also, BBA 1997 revised our payment policy for nonphysician practitioners, for outpatient rehabilitation services, and for drugs and biologicals not paid on a cost or prospective payment basis. In addition, BBA 1997 permits certain physicians and practitioners to opt out of Medicare and furnish covered services to Medicare beneficiaries through private contracts. In addition, since we established the physician fee schedule on January 1, 1992, our, experience indicates that some of our Part B payment policies need to be reconsidered. This proposed rule is intended to correct inequities inphysician payment and solicits public comments on specific proposed policy changes.

the appropriate address, as providedbelow, no later than 5 p.m. on September 3, 1998. Comments on all

other issues will be considered if wereceive them at the appropriate address, as provided below, no later than 5 p.m.