59366 Federal Register / Vol. 62, No. 212 / Monday, November 3, 1997 / Notices

mix of cases compared to that of other

hospitals. We then computed the

increase in average case mix for

hospitals paid under the Medicare

prospective payment system in fiscal

year 1997 compared to fiscal year 1996.

(Hospitals excluded from the

prospective payment system were

excluded from this calculation since

their payments are based on reasonable

costs and are affected only by real

increases in case mix.) We used bills

from prospective payment hospitals

received in HCFA as of July 1997. These

bills represent a total of about 8.3

million discharges for fiscal year 1997

and provide the most recent case mix

data available at this time. Based on

these bills, the increase in average case

mix in fiscal year 1997 is 0.12 percent.

Based on past experience, we expect

overall case mix to increase to 0.5

percent as the year progresses and more

fiscal year 1997 data become available.

Section 1813 of the Act requires that

the inpatient hospital deductible be

increased only by that portion of the

case mix increase that is determined to

be real. We estimate that the increase in

real case mix is about 0.5 percent. We

believe that any case mix increased up

to 1 percent is real case mix increase.

Therefore, for fiscal year 1997, all of the

case mix increase, 0.5 percent, is real

case mix increase.

Thus, the estimate of the paymentweighted average of the applicable

percentage increases used for updating

the payment rates is 0 percent, and the

real case mix adjustment factor for the

deductible is 0.5 percent. Therefore,

under the statutory formula, the

inpatient hospital deductible for

services furnished in calendar year 1998

is $764. This deductible amount is

determined by multiplying $760 (the

inpatient hospital deductible for 1997)

by the payment rate increase of 1.00

multiplied by the increase in real case

mix of 1.005 which equals $763.8 and

is rounded to $764.

III. Computing the Inpatient Hospital

and Extended Care Services

Coinsurance Amounts for 1998

The coinsurance amounts provided

for in section 1813 of the Act are

defined as fixed percentages of the

inpatient hospital deductible for

services furnished in the same calendar

year. Thus, the increase in the

deductible generates increases in the

coinsurance amounts. For inpatient

hospital and extended care services

furnished in 1998, in accordance with

the fixed percentages defined in the law,

the daily coinsurance for the 61st

through 90th days of hospitalization in

a benefit period will be $191 (1⁄4 of the

inpatient hospital deductible); the daily

coinsurance for lifetime reserve days

will be $382 (1⁄2 of the inpatient hospital

deductible); and the daily coinsurance

for the 21st through 100th days of

extended care services in a skilled

nursing facility in a benefit period will

be $95.50 (1⁄8 of the inpatient hospital

deductible).

IV. Cost to Beneficiaries

We estimate that in 1998 there will be

about 9.1 million deductibles paid at

$764 each, about 2.8 million days

subject to coinsurance at $191 per day

(for hospital days 61 through 90), about

1.3 million lifetime reserve days subject

to coinsurance at $382 per day, and

about 25.0 million extended care days

subject to coinsurance at $95.50 per day.

Similarly, we estimate that in 1997 there

will be about 8.9 deductibles paid at

$760 each, about 2.7 million days

subject to coinsurance at $190 per day

(for hospital days 61 through 90), about

1.3 million lifetime reserve days subject

to coinsurance at $380 per day, and

about 24.6 million extended care days

subject to coinsurance at $95.00 per day.

Therefore, the estimated total increase

in cost to beneficiaries is about $260

million (rounded to the nearest $10

million), due to (1) the increase in the

deductible and coinsurance amounts

and (2) the change in the number of

deductibles and daily coinsurance

amounts paid.

V. Waiver of Proposed Notice and

Comment Period

The Medicare statute, as discussed

previously, requires publication of the

Medicare Part A inpatient hospital

deductible and the hospital and

extended care services coinsurance

amounts for services for each calendar

year. The amounts are determined

according to the statute. As has been our

custom, we use general notices, rather

than formal notice and comment

rulemaking procedures, to make such

announcements. In doing so, we

acknowledge that, under the

Administrative Procedure Act,

interpretive rule, general statements of

policy, and rules of agency organization,

procedure, or practice are excepted from

the requirements of notice and comment

rulemaking.

We considered publishing a proposed

notice to provide a period for public

comment. However, we may waive that

procedure if we find good cause that

prior notice and comment are

impracticable, unnecessary, or contrary

to the public interest. We find that the

procedure for notice and comment is

unnecessary because the formula used

to calculate the inpatient hospital

deductible and hospital and extended

care services coinsurance amounts is

statutorily directed, and we can exercise

no discretion in following that formula.

Moreover, the statute establishes the

time period for which the deductible

and coinsurance amounts will apply

and delaying publication would be

contrary to the public interest.

Therefore, we find good cause to waive

publication of a proposed notice and

solicitation of public comments.

VI. Impact Statement

This notice merely announces

amounts required by legislation. This

notice is not a proposed rule or a final

rule issued after a proposal and does not

alter any regulation or policy. Therefore,

we have determined, and certify, that no

analyses are required under Executive

Order 12866, the Regulatory Flexibility

Act (5 U.S.C. 601 through 612), or

section 1102(b) of the Act.

In accordance with the provisions of

Executive Order 12866, this notice was

reviewed by the Office of Management

and Budget.

Authority: Section 1813(b)(2) of the Social

Security Act (42 U.S.C. 1395e(b)(2)).

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance)

Dated: September 19, 1997.

Nancy-Ann Min DeParle,

Deputy Administrator, Health Care Financing

Administration.

Dated: October 7, 1997.

Donna E. Shalala,

Secretary.

[FR Doc. 97–29032 Filed 10–31–97; 8:45 am]

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

[OACT–056–N]

RIN 0938–AI10

Medicare Program; Part A Premium for

1998 for the Uninsured Aged and for

Certain Disabled Individuals Who Have

Exhausted Other Entitlement

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Notice.

SUMMARY: This notice announces the

hospital insurance premium for

calendar year 1998 under Medicare’s

hospital insurance program (Part A) for

the uninsured aged and for certain

disabled individuals who have

exhausted other entitlement. The

monthly Medicare Part A premium for
Federal Register / Vol. 62, No. 212 / Monday, November 3, 1997 / Notices 59367

the 12 months beginning January 1,

1998 for these individuals is $309. The

reduced premium for certain other

individuals as described in this notice is

$170. Section 1818(d) of the Social

Security Act specifies the method to be

used to determine these amounts.

EFFECTIVE DATE: This notice is effective

on January 1, 1998.

FOR FURTHER INFORMATION CONTACT: John

Wandishin, (410) 786–6389.

SUPPLEMENTARY INFORMATION:

I. Background

Section 1818 of the Social Security

Act (the Act) provides for voluntary

enrollment in the Medicare hospital

insurance program (Medicare Part A),

subject to payment of a monthly

premium, of certain persons who are age

65 and older, uninsured for social

security or railroad retirement benefits

and do not otherwise meet the

requirements for entitlement to

Medicare Part A. (Persons insured under

the Social Security or Railroad

Retirement Acts need not pay premiums

for hospital insurance.)

Section 1818(d) of the Act requires us

to estimate, on an average per capita

basis, the amount to be paid from the

Federal Hospital Insurance Trust Fund

for services performed and for related

administrative costs incurred in the

following year with respect to

individuals age 65 and over who will be

entitled to benefits under Medicare Part

A. We must then, during September of

each year, determine the monthly

actuarial rate (the per capita amount

estimated above divided by 12) and

publish the dollar amount to be

applicable for the monthly premium in

the succeeding year. If the premium is

not a multiple of $1, the premium is

rounded to the nearest multiple of $1

(or, if it is a multiple of 50 cents but not

of $1, it is rounded to the next highest

$1). The 1997 premium under this

method was $311 and was effective

January 1, 1997. (See 61 FR 56691,

November 4, 1996.)

Section 1818(d)(2) of the Act requires

us to determine and publish, during

September of each calendar year, the

amount of the monthly premium for the

following calendar year for persons who

voluntarily enroll in Medicare Part A.

Section 1818A of the Act provides for

voluntary enrollment in Medicare Part

A, subject to payment of a monthly

premium, of certain disabled

individuals who have exhausted other

entitlement. These individuals are those

not now entitled but who have been

entitled under section 226(b) of the Act,

who continue to have the disabling

impairment upon which their

entitlement was based, and whose

entitlement ended solely because they

had earnings that exceeded the

substantial gainful activity amount (as

defined in section 223(d)(4) of the Act).

Section 1818A(d)(2) of the Act

specifies that the premium determined

under section 1818(d)(2) of the Act for

the aged will also apply to certain

disabled individuals as described above.

Section 13508 of the Omnibus Budget

Reconciliation Act of 1993 (Public Law

103–66, enacted on August 10, 1993)

amended section 1818(d) of the Act to

provide for a reduction in the monthly

premium amount for certain voluntary

enrollees. The reduction applies for

individuals who are not eligible for

social security or railroad retirement

benefits but who:

• Had at least 30 quarters of coverage

under title II of the Act;

• Were married and had been married

for the previous 1-year period to an

individual who had at least 30 quarters

of coverage;

• Had been married to an individual

for at least 1 year at the time of the

individual’s death and the individual

had at least 30 quarters of coverage; or

• Are divorced from an individual

who at the time of divorce had at least

30 quarters of coverage and the marriage

lasted at least 10 years.

For calendar year 1998, section

1818(d)(4)(A) of the Act specifies that

the monthly premium that these

individuals will pay for calendar year

1998 will be equal to the monthly

premium for aged voluntary enrollees

reduced by 45 percent.

II. Premium Amount for 1998

Under the authority of sections

1818(d)(2) and 1818A(d)(2) of the Act,

the Secretary has determined that the

monthly Medicare Part A hospital

insurance premium for the uninsured

aged and for certain disabled

individuals who have exhausted other

entitlement for the 12 months beginning

January 1, 1998, is $309.

The monthly premium for those

individuals entitled to a 45-percent

reduction in the monthly premium for

the 12-month period beginning January

1, 1998 is $170.

III. Statement of Actuarial Assumptions

and Bases Employed in Determining the

Monthly Premium Rate

As discussed in section I of this

notice, the monthly Medicare Part A

premium for 1998 is equal to the

estimated monthly actuarial rate for

1998 rounded to the nearest multiple of

$1. The monthly actuarial rate is

defined to be one-twelfth of the average

per capita amount that the Secretary

estimates will be paid from the Federal

Hospital Insurance Trust Fund for

services performed and related

administrative costs incurred in 1998

for individuals age 65 and over who will

be entitled to benefits under the hospital

insurance program. Thus, the number of

individuals age 65 and over who will be

entitled to hospital insurance benefits

and the costs incurred on behalf of these

beneficiaries must be projected to

determine the premium rate.

The principal steps involved in

projecting the future costs of the

hospital insurance program are (a)

establishing the present cost of services

furnished to beneficiaries, by type of

service, to serve as a projection base; (b)

projecting increases in payment

amounts for each of the various service

types; and (c) projecting increases in

administrative costs. Establishing

historical Medicare Part A enrollment

and projecting future enrollment, by

type of beneficiary, is part of this

process.

We have completed all of the above

steps, basing our projections for 1998 on

(a) current historical data and (b)

projection assumptions under current

law from the Midsession Review of the

President’s Fiscal Year 1998 Budget,

incorporating the provisions of Public

Law 103–66. It is estimated that in

calendar year 1998, 33.032 million

people age 65 and over will be entitled

to Medicare Part A benefits (without

premium payment), and that these

individuals will, in 1998, incur

$122.357 billion of benefits for services

performed and related administrative

costs. Thus, the estimated monthly

average per capita amount is $308.68

and the monthly premium is $309. The

monthly premium for those individuals

eligible to pay this premium reduced by

45 percent is $170.

IV. Costs to Beneficiaries

The 1998 Medicare Part A premium is

less than 1 percent lower than the $311

monthly premium amount for the 12-

month period beginning January 1,

1997.

We estimate that there will be, in

calendar year 1998, approximately

344,000 enrollees who will voluntarily

enroll in Medicare Part A by paying the

full premium and who do not otherwise

meet the requirements for entitlement.

An additional 9,000 enrollees will be

paying the reduced premium. The

estimated overall effect of the changes

in the premium will be a savings to

these voluntary enrollees of about $10

million.
59368 Federal Register / Vol. 62, No. 212 / Monday, November 3, 1997 / Notices

V. Waiver of Notice of Proposed

Rulemaking

The Medicare statute, as discussed

previously, requires publication of the

Medicare Part A hospital insurance

premium for the upcoming calendar

year during September of each year. The

amounts are determined according to

the statute. As has been our custom, we

use general notices, rather than formal

notice and comment rulemaking

procedures, to make such

announcements. In doing so, we

acknowledge that, under the

Administrative Procedure Act,

interpretive rules, general statements of

policy, and rules of agency organization,

procedure, or practice are excepted from

the requirements of notice and comment

rulemaking.

We considered publishing a proposed

notice to provide a period for public

comment. However, we may waive that

procedure if we find good cause that

prior notice and comment are

impracticable, unnecessary, or contrary

to the public interest. We find that the

procedure for notice and comment is

unnecessary because the formula used

to calculate the Part A hospital

insurance premium is statutorily

directed, and we can exercise no

discretion in following that formula.

Moreover, the statute established the

time period for which the premium will

apply and delaying publication of the

premium amount would be contrary to

the public interest. Therefore, we find

good cause to waive publication of a

proposed notice and solicitation of

public comments.

VI. Impact Statement

This notice merely announces

amounts required by legislation. This

notice is not a proposed rule or a final

rule issued after a proposal, and it does

not alter any regulation or policy.

Therefore, we have determined and

certify that no analyses are required

under Executive Order 12866, the

Regulatory Flexibility Act (5 U.S.C. 601

through 612), or section 1102(b) of the

Act.

In accordance with the provisions of

Executive Order 12866, this notice was

reviewed by the Office of Management

and Budget.

Authority: Sections 1818(d)(2) and

1818A(d)(2) of the Social Security Act (42

U.S.C. 1395i–2(d)(2) and 1395i–2a(d)(2)).

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance)

Dated: September 19, 1997.

Nancy-Ann Min DeParle,

Deputy Administrator, Health Care Financing

Administration.

Dated: October 7, 1997.

Donna E. Shalala,

Secretary.

[FR Doc. 97–29030 Filed 10–31–97; 8:45 am]

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Substance Abuse and Mental Health

Services Administration (SAMHSA)

Notice of Meeting

Pursuant to Public Law 92–463,

notice is hereby given of the meeting of

the Substance Abuse and Mental Health

Services Administration (SAMHSA)

National Advisory Council in November

1997.

The meeting will include the review,

discussion and evaluation of individual

contract proposals, as well as a

presentation and discussion of

information about the Agency’s

procurement plans. Therefore, a portion

of the meeting will be closed to the

public as determined by the

Administrator, SAMHSA, in accordance

with Title 5 U.S.C. 552b(c) (3), (4), and

(6) and 5 U.S.C. App. 2, Section 10(d).

In addition, a portion of the SAMHSA

National Advisory Council meeting will

be open and include a presentation of

certificates of appreciation to those

members whose terms will end on

November 30. Attendance by the public

will be limited to space available. Public

comments are welcome during the open

session. Please communicate with the

individual listed as contact below to

make arrangements to comment or to

request special accommodations for

persons with disabilities.

Substantive program information,

summary of the meeting and a roster of

Council members may also be obtained

from the contact whose name and

telephone number is listed below.

Committee Name: SAMHSA National

Advisory Council.

Meeting Date: November 13, 1997.

Place: Phoenix Park Hotel, 520 North

Capitol Street, N.W., Washington, D.C.

20001.

Closed: November 13, 1997, 1:00 p.m. to

4:20 p.m.

Open: November 13, 1997, 4:30 p.m. to

5:30 p.m.

Contact: Toian Vaughn, Executive

Secretary, Room 12C–15, Parklawn Building,

Telephone: (301) 443–4640 and FAX: (301)

443–1450.

Dated: October 28, 1997.

Jeri Lipov,

Committee Management Officer, Substance

Abuse and Mental Health Services

Administration.

[FR Doc. 97–28991 Filed 10–31–97; 8:45 am]

BILLING CODE 4162–20–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Substance Abuse and Mental Health

Services Administration (SAMHSA)

Notice of Meeting

Pursuant to Pub. L. 92–463, notice is

hereby given of the following meeting of

the SAMHSA Special Emphasis Panel II

in November, 1997.

A summary of the meeting may be

obtained from: Ms. Dee Herman,

Committee Management Liaison,

SAMHSA, Office of Program Planning

and Coordination (OPPC), Division of

Extramural Activities Policy and

Review, 5600 Fishers Lane, Room 17–

89, Rockville, Maryland 20857.

Telephone: (301) 443–7390.

Substantive program information may

be obtained from the individual named

as Contact for the meeting listed below.

The meeting will include the review,

discussion and evaluation of individual

contract proposals. These discussions

could reveal personal information

concerning individuals associated with

the proposals and confidential and

financial information about an

individual’s proposal. The discussion

may also reveal information about

procurement activities exempt from

disclosure by statute and trade secrets

and commercial or financial information

obtained from a person and privileged

and confidential. Accordingly, the

meeting is concerned with matters

exempt from mandatory disclosure in

Title 5 U.S.C. 552b(c) (3), (4), and (6)

and 5 U.S.C. App. 2, § 10(d).

Committee Name: SAMHSA Special

Emphasis Panel II.

Meeting Date: November 13, 1997.

Place: Residence Inn, Gate House Board

Room, 335 Wisconsin Avenue, Bethesda, MD

20814.

Closed: November 13, 1997, 9:00 a.m.—

Adjournment.

Contact: Ferdinand W. Hui, Ph.D., Room

17–89, Parklawn Building, Telephone: (301)

443–2437 and FAX: (301) 443–3437.

Dated: October 28, 1997.

Jeri Lipov,

Committee Management Officer, Substance

Abuse and Mental Health Services

Administration.

[FR Doc. 97–28994 Filed 10–31–97; 8:45 am]

BILLING CODE 4162–20–P