Federal Register / Vol. 62, No. 212 / Monday, November 3, 1997 / Notices 59365

Addendum V—Categorization of Food

and Drug Administration-Approved

Investigational Device Exemptions

Under the Food, Drug, and Cosmetic

Act (21 U.S.C. 360c), devices fall into

one of three classes. Also, under the

new categorization process to assist

HCFA, the Food and Drug

Administration assigns each device with

a Food and Drug Administrationapproved investigational device

exemption to one of two categories. To

obtain more information about the

classes or categories, please refer to the

Federal Register notice published on

April 21, 1997 (62 FR 19328).

The following information presents

the device number, category (in this

case, A), and criterion code.

G960213 A2

G960218 A1

G960258 A1

G960266 A1

G970004 A1

G970007 A1

G970015 A2

G970016 A2

G970018 A2

G970022 A2

G970035 A2

G970051 A2

G970053 A2

The following information presents

the device number category (in this

case, B), and criterion code.

G950115 B1

G956391 B2

G960193 B4

G960199 B2

G960208 B1

G960229 B1

G960230 B2

G960231 B3

G960234 B4

G960235 B3

G960241 B2

G960243 B2

G960245 B2

G960246 B1

G960247 B1

G960248 B4

G960249 B4

G960250 B3

G960252 B2

G960253 B4

G960254 B2

G960255 B2

G960256 B1

G960257 B3

G960259 B4

G960262 B3

G960263 B3

G960264 B3

G960267 B1

G970001 B3

G970002 B4

G970003 B3

G970005 B4

G970011 B2

G970012 B4

G970019 B3

G970023 B4

G970025 B3

G970026 B3

G970028 B3

G970029 B3

G970030 B1

G970031 B3

G970032 B3

G970033 B4

G970034 B4

G970037 B4

G970038 B4

G970039 B4

G970040 B3

G970041 B4

G970046 B1

G970047 B3

G970052 B1

G970054 B4

G970059 B3

[FR Doc. 97–28972 Filed 10–31–97; 8:45 am]

BILLING CODE 4120–03–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

[OACT–057–N]

RIN 0938–AI12

Medicare Program; Inpatient Hospital

Deductible and Hospital and Extended

Care Services Coinsurance Amounts

for 1998

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Notice.

SUMMARY: This notice announces the

inpatient hospital deductible and the

hospital and extended care services

coinsurance amounts for services

furnished in calendar year 1998 under

Medicare’s hospital insurance program

(Medicare Part A). The Medicare statute

specifies the formulae to be used to

determine these amounts.

The inpatient hospital deductible will

be $764. The daily coinsurance amounts

will be: (a) $191 for the 61st through

90th days of hospitalization in a benefit

period; (b) $382 for lifetime reserve

days; and (c) $95.50 for the 21st through

100th days of extended care services in

a skilled nursing facility in a benefit

period.

EFFECTIVE DATE: This notice is effective

on January 1, 1998.

FOR FURTHER INFORMATION CONTACT: John

Wandishin, (410) 786–6389. For casemix analysis only: Gregory J. Savord,

(410) 786–1521.

SUPPLEMENTARY INFORMATION:

I. Background

Section 1813 of the Social Security

Act (the Act) provides for an inpatient

hospital deductible to be subtracted

from the amount payable by Medicare

for inpatient hospital services furnished

to a beneficiary. It also provides for

certain coinsurance amounts to be

subtracted from the amounts payable by

Medicare for inpatient hospital and

extended care services. Section

1813(b)(2) of the Act requires us to

determine and publish between

September 1 and September 15 of each

year the amount of the inpatient

hospital deductible and the hospital and

extended care services coinsurance

amounts applicable for services

furnished in the following calendar

year.

II. Computing the Inpatient Hospital

Deductible for 1998

Section 1813(b) of the Act prescribes

the method for computing the amount of

the inpatient hospital deductible. The

inpatient hospital deductible is an

amount equal to the inpatient hospital

deductible for the preceding calendar

year, changed by our best estimate of the

payment-weighted average of the

applicable percentage increases (as

defined in section 1886(b)(3)(B) of the

Act). This estimate is used for updating

the payment rates to hospitals for

discharges in the fiscal year that begins

on October 1 of the same preceding

calendar year and adjusted to reflect real

case mix. The adjustment to reflect real

case mix is determined on the basis of

the most recent case mix data available.

The amount determined under this

formula is rounded to the nearest

multiple of $4 (or, if midway between

two multiples of $4, to the next higher

multiple of $4).

Section 4401(a) of the Balanced

Budget Act of 1997 (Public Law 105–33,

enacted on August 5, 1997) amended

section 1886(b)(3)(B)(i) of the Act by

making the percentage increase for

hospitals paid under the prospective

payment system 0 percent for fiscal year

1998. Section 4411(a) of the Balanced

Budget Act of 1997 similarly amended

section 1886(b)(3)(B)(ii) of the Act by

making the percentage increase for

hospitals excluded from the prospective

payment system 0 percent for fiscal year

1998. Therefore, our best estimate of the

payment-weighted average of the

increase in the payment rates for fiscal

year 1998 is 0 percent.

To develop the adjustment for real

case mix, an average case mix was first

calculated for each hospital that reflects

the relative costliness of that hospital’s
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