Federal Register / Vol. 62, No. 231 / Tuesday, December 2, 1997 / Rules and Regulations 63669

to the Chief Counsel for Advocacy of the

Small Business Administration.

VIII. Submission to Congress and the

General Accounting Office

Under 5 U.S.C. 801(a)(1)(A), as added

by the Small Business Regulatory

Enforcement Fairness Act of 1996, the

Agency has submitted a report

containing this rule and other required

information to the U.S. Senate, the U.S.

House of Representatives, and the

Comptroller General of the General

Accounting Office prior to publication

of this rule in today’s Federal Register.

This is not a ‘‘major rule’’ as defined by

5 U.S.C. 804(2).

List of Subjects in 40 CFR Parts 180

Environmental protection,

Administrative practice and procedure,

Agricultural commodities, Pesticides

and pest, Reporting and recordkeeping

requirements.

Dated: November 21, 1997.

Linda A. Travers,

Acting Director, Office of Pesticide Programs.

Therefore, 40 CFR chapter I is

amended as follows:

PART 180—[AMENDED]

a. The authority citation for part 180

continues to read as follows:

Authority: 21 U.S.C. 346a and 371

b. Section § 180.518 is added to read

as follows:

§ 180.518 Pyrimethanil; tolerances for

residues.

(a) General. [Reserved]

(b) Section 18 emergency exemptions.

[Reserved]

(c) Tolerances with regional

registrations. [Reserved]

(d) Indirect or inadvertent residues.

[Reserved]

(e) Import. Import tolerances are

established for residues of the fungicide

4,6-dimethyl-N-phenyl-2-

pyrimidinamine expressed as

pyrimethanil in or on the following raw

agricultural commodity:

Commodity Parts per million

Wine grapes .............. 5.0 ppm

[FR Doc. 97–31552 Filed 12-1-97; 8:45 am]

BILLING CODE 6560–50–F

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 417

[HCFA–1911–IFC]

RIN 0938–AI35

Medicare+Choice Program; Collection

of User Fees From Medicare+Choice

Plans and Risk-Sharing Contractors

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Interim final rule with request

for comments.

SUMMARY: This interim final rule with a

request for comments establishes the

methodology that will be employed to

assess fees applicable to Medicare risksharing contractors for fiscal year (FY)

1998. Under section 4002 of the

Balanced Budget Act of 1997, these

contractors must contribute their pro

rata share of costs relating to beneficiary

enrollment, dissemination of

information, and certain counseling and

assistance programs. The

Medicare+Choice regulation to be

published in June of 1998 will

implement this requirement for

Medicare+Choice plans.

DATES: Effective Date: These regulations

are effective on January 1, 1998.

Comment Date: Comments will be

considered if we receive them at the

appropriate address, as provided below,

no later than 5 p.m. on February 2,

1998.

ADDRESSES: Mail an original and 3

copies of written comments to the

following address: Health Care

Financing Administration, Department

of Health and Human Services,

Attention: HCFA–1911–IFC, P.O. Box

7517, Baltimore, MD 21207–5187.

If you prefer, you may deliver an

original and 3 copies of your written

comments to one of the following

addresses:

Room 309–G, Hubert H. Humphrey

Building, 200 Independence Avenue,

SW., Washington, D.C. 20201, or

Room C5–09–26, 7500 Security

Boulevard, Baltimore, Maryland

21244–1850.

Comments may also be submitted

electronically to the following e-mail

address: HCFA–1911–IFC@hcfa.gov. Email comments must include the full

name and address of the sender, and

must be submitted to the referenced

address in order to be considered. All

comments must be incorporated in the

e-mail message because we may not be

able to access attachments.

Electronically submitted comments will

be available for public inspection at the

Independence Avenue address, below.

Because of staffing and resource

limitations, we cannot accept comments

by facsimile (FAX) transmission. In

commenting, please refer to file code

HCFA–1911–IFC. Comments received

timely will be available for public

inspection as they are received,

generally beginning approximately 3

weeks after publication of a document,

in Room 309-G of the Department’s

offices at 200 Independence Avenue,

SW., Washington, D.C., on Monday

through Friday of each week from 8:30

a.m. to 5 p.m. (phone: (202) 690–7890).

FOR FURTHER INFORMATION CONTACT:

Randy Ricktor, (410) 786–4632, Marty

Abeln, (410) 786–1032.

SUPPLEMENTARY INFORMATION:

I. Background

Section 4001 of the Balanced Budget

Act of 1997 (BBA) (Public Law 105–33),

added a new section 1857(e)(2) to the

Social Security Act (the Act), that

establishes a fee requirement that

Medicare+Choice plans must contribute

their pro rata share, as determined by

the Secretary, of costs relating to

enrollment and dissemination of

information and certain counseling and

assistance programs. Section 4002(b) of

the BBA makes this requirement

applicable to those managed care plans

with risk sharing contracts under

section 1876 of the Act. Any amounts

collected are authorized to be

appropriated only for the purpose of

carrying out section 1851 of the Act

(relating to enrollment and

dissemination of information) and

section 4360 of the Omnibus Budget

Reconciliation Act of 1990 (Public Law

103–66, OBRA 1990), relating to the

health insurance counseling and

assistance program.

For any Federal fiscal year (FY), the

fees authorized under section

1857(e)(2)(B) of the Act are contingent

upon enactment in an appropriations

act of a provision specifying the

aggregate amount of fees the Secretary is

directed to collect in that fiscal year.

The BBA fees collected during any FY

are to be credited as offsetting

collections. Under section 1857(e)(2)(D),

the fees authorized under section

1857(e)(2)(B) are not to be established at

any amount greater than the lesser of the

estimated costs to be incurred by the

Secretary in the FY in carrying out the

activities described in sections 1851 of

the Act and 4360 of the OBRA 1990; or

$200 million in Federal fiscal year 1998;

$150 million in fiscal year 1999; and

$100 million in fiscal year 2000 and
63670 Federal Register / Vol. 62, No. 231 / Tuesday, December 2, 1997 / Rules and Regulations

each subsequent fiscal year (or such

amounts as may be specified in

appropriations bills). The

appropriations bill for FY 1998, permits

the Secretary to collect no more than

$95 million in FY 1998. We estimate

that the costs to be incurred in carrying

out the activities described in sections

1851 and 4360 will exceed the full limit

of $95 million for FY 1998. Therefore,

we will collect the full $95 million

amount provided for in the FY 1998

appropriation bill.

II. Discussion of Possible Approaches to

Collecting Medicare+Choice Fees

Risk Contracting Plans

The BBA authorizes the collection of

fees from both Medicare+Choice plans

and existing managed care plans with

risk sharing contracts under section

1876 of the Act. Under section 4002 of

the BBA Medicare risk contracting plans

may continue to contract with HCFA

through December 31, 1998. Effective,

January 1, 1999, all risk contracting

plans are required to contract with

HCFA only as Medicare+Choice plans.

We do not expect final regulations for

the Medicare+Choice program to be

effective before June 1998. Until the

Medicare+Choice program regulations

are published the only organizations

subject to the BBA fees will be Medicare

risk contracting plans. Regulations

implementing the BBA fees for

Medicare+Choice plans will be included

as part of the larger Medicare+Choice

regulation to be published in June of

1998. In the June regulation we will

describe how we will continue to assess

the BBA fees from Medicare risk

contracting plans during FY 1998 and

how Medicare+Choice plans will be

included in the FY 1998 assessment of

$95 million. The June 1998 regulation

will also describe the BBA assessment

methodology for future fiscal years. It

should be noted that any new Medicare

risk contracts and Medicare+Choice

plans (during the FY 1998 assessment

period) will be subject to the FY 1998

BBA fee assessment. Since we anticipate

that Medicare risk contracting plans will

necessarily be responsible for a

substantial portion of the FY 1998 BBA

fees the following background is

provided regarding the size and scope of

the Medicare risk contracting program.

As of October 1, 1997, there were 279

active Medicare risk plans with each

having an average enrollment of 28,000

Medicare beneficiaries. There is great

range in the size of Medicare risk plans,

with the smallest risk plans having less

than 500 enrolled beneficiaries, up to

the largest risk plan having almost

300,000 enrolled beneficiaries.

Enrollment in risk contracting plans is

not evenly distributed, in fact, almost 50

percent of beneficiaries enrolled in

Medicare risk contracting plans are

concentrated in only 10 percent of the

risk plans. A Medicare risk contracting

plan is paid a capitation payment (that

varies depending on the geographic

location of the plan) for each enrolled

beneficiary in its plan, thus the range of

total Medicare payments received by

risk plans also varies greatly. The

typical risk contracting plan is paid

about $12 million each month.

Medicare’s monthly payments to all risk

contracting plans exceed $2 billion a

month, with payments to some of the

largest risk contracting plans averaging

over $100 million a month.

Approaches to Assessing Fees

A number of approaches were

considered in selecting a methodology

for assessing the BBA fees which would

be consistent with the goals of the

Medicare+Choice program and also

equitable in terms of financial impact on

current Medicare risk contracting plans

as well as new Medicare+choice plans.

In order to ensure that the selected fee

assessment methodology meets the

Medicare+Choice goals and is equitably

applied to all eligible plans, we

identified the specific criteria described

below.

The following criteria were used in

selecting the BBA fee assessment

methodology:

• The fee assessment should serve to

support the goal of promoting

enrollment growth in Medicare+Choice

plans. In particular, the fee assessment

should not present a barrier to the entry

of new or small plans (e.g., low

enrollment plans in rural areas) into the

Medicare+Choice program.

• The fees should be equitably

applied to all eligible plans on a basis

which is balanced by their Medicare

revenue from the Federal government.

• The methodology for assessing the

fees should be as simple as possible,

and implemented in a manner that

minimizes the financial impact on plans

and the administrative costs to HCFA.

We considered four general

approaches which might be used in

assessing the BBA fees:

• The first and most direct approach

considered was to divide the total

annual BBA fee cost equally among all

the eligible plans. While this approach

would be simple to implement and

administer it was rejected because it

clearly imposes a disproportionate

financial burden on small plans, as they

would be paying the same amount of

BBA fees as the largest plans. In

addition, an equal fee assessment could

serve as a prohibitive financial barrier

restricting entry of new low enrollment

plans into the Medicare+Choice

program.

• As a second general approach, we

evaluated assessing the BBA fees based

on the number of beneficiaries enrolled

in a particular plan. Specifically, under

this approach a fixed per capita rate

would be assessed on a per member

month basis. Thus, a fixed dollar

amount would be deducted from the

capitation payment of each beneficiary

enrolled in the plan. For example, at a

total enrollment level of 5 million

beneficiaries, the assessment of a $95

million BBA fee (over a nine month

collection period) would result in a

deduction of approximately $2.09 from

the monthly capitation payment for

each beneficiary enrolled in an eligible

plan. Collecting fees under this

approach would mean that each plan’s

assessment is directly related to the

number of beneficiaries enrolled in the

plan. Thus, this method equitably links

the BBA fee assessment with the size of

the plan as determined by beneficiary

enrollment. However, this method does

not adjust for the geographic variation

in the monthly capitation payment paid

to plans, which range from

approximately $367 per member month

in the lowest payment areas (typically

rural) up to a maximum of $782 per

member month in the highest capitation

payment areas (typically urban).

• A third approach considered was to

assess the BBA fee as a fixed percentage

of the total monthly payment to each

plan. This approach is financially

equitable since any plan’s assessment is

based specifically on the total capitation

dollars an eligible plan receives from

the Federal government. Thus, the more

dollars a plan is paid the greater the

BBA fee assessment. Generally, this

approach would impose a slightly

higher cost on eligible plans located in

the higher capitation payment areas.

Alternatively, this approach would not

disproportionately effect those plans in

the lowest payment areas which tend to

be smaller plans in rural areas.

• A fourth approach considered was

establishing a flat base fee assessment (a

percentage of the overall fee) that each

eligible plan would pay, coupled with a

variable assessment that would be

determined by the size of the plan. We

evaluated such an approach because of

concern that assessing fees based solely

on size (determined either by

beneficiary enrollment or dollars paid to

the plan), would mean that smaller and

new plans with limited enrollment

might not be contributing their fair

share toward the annual BBA fee

assessment. However, upon evaluating
Federal Register / Vol. 62, No. 231 / Tuesday, December 2, 1997 / Rules and Regulations 63671

various fixed dollar amounts as a base

fee assessment we recognized that any

fixed amount would have to be very

small in order to not present an

excessive financial burden for small

plans or create an entry barrier for new

low enrollment plans. For example, at

the $95 million national fee level, if all

plans were assessed an annual fee of

$15,000 combined with a variable cost,

we estimated that for small plans (500

or fewer members) the $15,000 annual

fee amount (combined with the variable

assessment) would result in these plans

being assessed from 1 to 5 percent of the

total capitation payments small plans

receive from the Medicare program.

This result is in contrast to the other

assessment approaches discussed above

under which all plans would be

assessed less than 1 percent of the

payments they receive from the

Medicare Program.

Conclusion

Based on the selection criteria, we

have chosen the third methodology

(described above) which calls for the

BBA fees to be assessed as a fixed

percentage of the total monthly

calculated Medicare payments eligible

plans receive from Medicare. Assessing

fees on this basis in FY 1998 will

require the deduction of only a very

small percentage of any plan’s total

annual Medicare payments (less than

one-half of one percent). Accordingly,

we believe this approach best meets the

goals of supporting the

Medicare+Choice program as well as

being equitable to current Medicare risk

contracting plans and future

Medicare+Choice plans.

III. Provisions of the Interim Final Rule

In summary the provisions of this

interim final rule are as follows:

• Section 1857(e)(2) of the Act

provides for the collection of fees from

each eligible organization with a risksharing contract its share of the fees for

administering section 1851 of the Act

relating to enrollment and

dissemination of information and

section 4360 of the OBRA 1990 relating

to the health insurance counseling and

assistance program in accordance with

the specified requirements.

(§ 417.472(h))

• The aggregate amount of fees for a

fiscal year are the lesser of the estimated

costs to be incurred by HCFA in that

fiscal year to carry out the activities

described in section 1851 of the Act and

section 4360 of the OBRA 1990, or, if

less, the amount set forth in the DHHS

appropriation for the fiscal year.

(§ 417.472(h)(1)).

• We establish a fee percentage rate

and collect the fees over nine

consecutive months beginning with

January of the fiscal year or until the

$95 million assessment limit has been

reached. The aggregate amount of fees

we are authorized to collect in FY 1998

is $95 million. We will begin collecting

the BBA fees for fiscal year 1998 from

eligible plans starting January 1, 1998.

The three months from October thru

December will be used by HCFA to

make any necessary adjustments

regarding the fees collected from plans

in the previous assessment period.

The percentage BBA fee assessment

for FY 1998 is .428 percent. This

percentage rate is based on the total

estimated Medicare payment amount to

all eligible plans on January 1, 1998.

The percentage amount is calculated by

multiplying the projected total January

payment amount by nine (months in the

assessment period) and then dividing

this figure into the total FY 1997 BBA

fee assessment of $95 million. We

estimate that we will pay all risk

contracting plans $2,464,524,000 in

January of 1998. We then multiplied

$2,464,524,000 times nine (the projected

assessment period) which equals

$22,180,716,000. A $95 million total

BBA fee represents .428 percent of the

$22,180,716,000 figure. Accordingly,

during the nine month assessment

period we will deduct .428 percent of

each eligible plan’s total calculated

monthly payment as its portion of the

BBA fee. Adjustments for retroactive

enrollments and disenrollments to our

enrollment system subsequent to

November are not considered or

factored into the calculation for the fee

determination. (§ 417.472(h)(2))

• An eligible organization with a risk

contract’s pro rata share of the annual

fee is determined based upon the

organization’s monthly calculated

Medicare payment amount during the

preceding nine consecutive months

beginning with January. We will

calculate each monthly pro rata share

for an eligible plan by multiplying the

established BBA fee percentage by the

total monthly calculated Medicare

payment amount to plans as recorded in

our payment system on the first day of

the month. We recognize that retroactive

changes to enrollment and

disenrollment dates are normal business

transactions and occur on a routine

basis. However, we have determined

that the overall dollar impact on plans

of these enrollment and disenrollment

changes do not represent a material

amount to warrant an adjustment to the

organization’s pro rata share of the BBA

fee assessment. (§ 417.472(h)(3))

• We will collect the fees by offset

against the organization’s monthly

Medicare payment. Beginning with the

January payment, we will withhold the

organization’s share of fees and deduct

the amount from the total payment

made to the organization for that month.

(§ 417.472(h)(4))

• We will stop collecting the BBA fee

from plans when the $95 million has

been assessed. We will not collect more

than the $95 million FY 1998

assessment from eligible plans.

• Should delays occur in determining

the aggregate amount of fees for a fiscal

year we may adjust the assessment time

period and fee percentage amount if: (1)

it becomes evident that the full

aggregate amount of fees cannot be

collected within the allotted assessment

time period; or (2) for any other reason

the assessment cannot be started in

January. In addition, if the annual fee

limit is reached in any month prior to

the end of the assessment period, we

will cease collecting fees.

(§ 417.472(h)(5))

Medicare demonstrations with a

section 1876 risk sharing contract will

also be subject to the annual fee

assessment.

IV. Regulatory Impact Statement

A. Background

We have examined the impact of this

interim final rule as required by

Executive Order 12866 and the

Regulatory Flexibility Act (RFA) (Public

Law 96–354). Executive Order 12866

directs agencies to assess all costs and

benefits of available regulatory

alternatives and, when regulation is

necessary, to select regulatory

approaches that maximize net benefits

(including potential economic,

environmental, public health and safety

effects; distributive impacts; and

equity). The Regulatory Flexibility Act

(RFA) requires agencies to analyze

options for regulatory relief for small

businesses, unless we certify that the

regulation would not have a significant

economic impact on a substantial

number of small entities. Most Medicare

risk contracting plans are not

considered to be small entities within

the meaning of the RFA.

Section 1102(b) of the Act requires us

to prepare a regulatory impact analysis

if a final rule may have a significant

impact on the operations of a substantial

number of small rural hospitals. This

analysis must conform to the provisions

of section 604 of the RFA. For purposes

of section 1102(b) of the Act, we define

a small rural hospital as a hospital that

is located outside a Metropolitan

Statistical Area and has fewer than 50
63672 Federal Register / Vol. 62, No. 231 / Tuesday, December 2, 1997 / Rules and Regulations

beds. We are not preparing an analysis

for section 1102(b) of the Act because

we have determined, and we certify,

that this final rule will not have a

significant impact on the operations of

a substantial number of small rural

hospitals.

The Balanced Budget Act of 1997

directs HCFA to collect the BBA fees

from Medicare risk contracting plans,

and from Medicare+Choice plans, in

order to finance an annual informational

campaign for Medicare beneficiaries.

These collections begin in fiscal year

1998, and are limited, in the aggregate,

to amounts stipulated in the BBA and

determined by the Congress in

appropriations legislation. This interim

final rule discusses the regulatory

alternatives that HCFA considered in

establishing user fee charges to these

organizations.

Although we view the anticipated

results of this interim final regulation as

beneficial to the Medicare program as

well as to Medicare beneficiaries, we

recognize that some of the provisions

could be controversial and may be

responded to unfavorably by some

affected entities. We also recognize that

not all of the potential effects of these

provisions can be anticipated, and that

it may be impossible to quantify

meaningfully some of the potential

effects, particularly the economic

impact of the informational campaign

on individual Medicare+Choice plans. It

is clear that all existing Medicare risk

contracting plans and future

Medicare+Choice plans will be affected

by these provisions to varying degrees.

In selecting our regulatory options, we

have attempted to identify a

methodology that is consistent with the

legislative intent of the BBA while being

equitable to current Medicare risk

contracting plans and new

Medicare+Choice plans. For the

aforementioned reasons, we have

prepared the following voluntary

analysis. This analysis, in combination

with the rest of the preamble, is

consistent with the standards of analysis

set forth by the RFA.

B. Anticipated Effects

1. Effects on the Medicare Trust Funds

The user fees outlined in this

regulation to be collected by HCFA are

established as a result of enactment of

the BBA. We have determined that the

estimated costs to be incurred in

carrying out the activities described in

section 1851 of the Act and section 4360

of the OBRA 1990 will exceed the limit

contained in the FY 1998 appropriations

bill. Therefore, the maximum amount to

be collected by HCFA will be the

amount authorized in the appropriation

bill.

Under any regulatory approach to

collect these user fees, we would collect

the same aggregate amount of BBA fees.

This is because we collect the lesser of

the amount of estimated costs or the

amount specified in appropriations

legislation.

2. Effects on Risk-sharing Plans

Assessing BBA fees based on the

payment plans receive from the

Medicare program distributes the

impact of these fees in direct proportion

to the amount of money the plan is

receiving from the Federal government.

It should also be noted that Medicare

risk contracting plans and

Medicare+Choice plans will benefit

from the Secretary’s enrollment and

information activities, which will be

financed through the BBA fee

assessment. Accordingly, we believe

that assessing the BBA fees as a fixed

percentage of total Medicare payments

to plans is the most equitable approach.

3. Effects on Medicare Beneficiaries

Medicare beneficiaries are certain to

benefit from the informational campaign

financed by these user fee collections.

They are not, however, directly affected

by the regulatory approach to

establishing BBA fee charges to risk

contracting plans and are therefore not

directly impacted by the provisions of

this interim final rule.

C. Alternatives Considered

We considered several alternatives in

assessing BBA fees on Medicare risk

contracting plans and discussed them

elsewhere in this preamble.

The first alternative was to simply

equally divide the total annual user fee

cost among all the eligible plans. With

approximately 280 plans currently

subject to the fees, this approach would

mean for example, that in FY 1998, with

a total assessment of $95 million, each

of the eligible plans would be assessed

more than $339,000. The regulatory

impact of this alternative, which we

rejected, results in a disproportionate

financial burden on smaller plans.

As a second general approach, we

evaluated assessing the BBA fees based

on the number of beneficiaries enrolled

in a particular plan. Specifically, under

this approach a fixed per capita rate

would be assessed on a per member

month basis. Thus, a fixed dollar

amount would be deducted from the

capitation payment of each beneficiary

enrolled in the plan. For example, given

a constant enrollment level of 5 million

beneficiaries, the assessment of a $95

million dollar BBA fee would result in

a deduction of approximately $2.09

from the monthly capitation payment

for each beneficiary enrolled in a risk

contracting plan over a nine month

assessment time frame. Collecting fees

under this approach means that each

plan’s assessment is directly related to

the number of beneficiaries enrolled in

the plan. Thus, this approach can be

considered equitable since it directly

links the BBA fee assessment with the

size of the plan. However, the method

does not adjust for the wide geographic

variation in the monthly capitation

payment paid to plans, which ranges

from approximately $367 per member

month in the lowest payment areas up

to a maximum of $782 per member

month in the highest capitation

payment area.

A third alternative which we

considered and accepted was to assess

the BBA fee through a fixed percentage

deduction from the plan’s aggregate

monthly capitation payments.

A fourth alternative reviewed in

assessing user fees is a combination of

a flat annual fee with a variable

component. That is, there would be a

base fee assessment that each eligible

plan would pay, plus an additional

assessment based on a variable element

such as plan enrollment or total plan

payment. We rejected the regulatory

approach of a base assessment with

additional variable assessments as we

have determined that a flat fee of more

than a nominal amount (e.g., $15,000 in

FY 1998) will result in a

disproportionate impact on smaller

plans.

As noted above we decided to impose

fees based on a percentage of the total

dollar amount of capitation payments a

plan is receiving from the Medicare

program. Collecting the BBA fees under

this approach means that each plan’s

assessment will be directly related to

the total dollars the plan is receiving

from the Federal government. Thus,

eligible plans which are receiving the

largest payments (based on number of

enrollees and monthly payment levels)

from the Federal government will pay

the largest share of the fees. Conversely,

smaller plans will have an assessment

directly related to their smaller size. We

also found this approach met the criteria

we had established for the selection of

the BBA Fee assessment methodology.

Specifically, we determined that an

assessment based on percentage of plan

payment is: consistent with the intent of

the Medicare+Choice program in that it

does not pose barriers to the

participation of new plans and those

with small enrollment levels; the

approach is equitable for current

Medicare risk contracting plans (large
Federal Register / Vol. 62, No. 231 / Tuesday, December 2, 1997 / Rules and Regulations 63673

and small) and finally; the approach is

simple for eligible plans and for HCFA

to administer.

D. Conclusion

Since the number of plans over which

the BBA fee collections will be spread

is likely to continue to rise with

increased participation in the

Medicare+Choice program in future

years, we believe the regulatory impact

of any reasonable selected option for

imposition of fees on Medicare risk

contracting plans and ultimately

Medicare+Choice plans will not be

significant. In accordance with our

stated objective of choosing the

assessment methodology which best

supports the goals of the

Medicare+Choice program and is

equitable to current risk contracting

plans we have selected the option to

impose fees based on total plan payment

assessed on a monthly basis. Assessing

fees based on the total Medicare dollars

paid to plans over a nine month time

frame will represent only a small

percentage of any plan’s total payment

from the government. In subsequent

fiscal years, BBA fees as a percentage of

Medicare payments will likely represent

an even smaller percentage of the

Medicare payments as the number of

eligible plans increase and the existing

plans experience enrollment growth. In

addition, it should also be noted that the

information campaign (financed by the

BBA fees) will be designed to reach all

Medicare beneficiaries and it is likely

that, to the extent that this encourages

growth in the Medicare+Choice

program, larger more experienced plans

will be well positioned to take

advantage of an expanding market. The

economic impact of this regulatory

option measured in terms of the BBA

fees as a percentage of overall plan

revenues from the Federal government

is very small. The consequence of a fee

assessment based on a percentage of

total payment is a distribution of the

BBA fee burden proportional to the size

of the plan. We have concluded this is

the most equitable approach for all

eligible plans in assessing the BBA fees.

In accordance with the provisions of

Executive Order 12866, this final

regulation was reviewed by the Office of

Management and Budget.

V. Waiver of Notice of Proposed

Rulemaking

We ordinarily publish a notice of

proposed rulemaking in the Federal

Register and invite prior public

comment on proposed rules. The notice

of proposed rulemaking can be waived,

however, if an agency finds good cause

that a notice-and-comment procedure is

impracticable, unnecessary, or contrary

to the public interest and it incorporates

a statement of the finding and its

reasons in the rule issued. We find good

cause to waive the notice-and-comment

procedure with respect to this rule

because it is impracticable to employ

such a procedure in this instance,

because it is unnecessary, and because

the delay in promulgating this rule

would be contrary to the public interest.

Even if we did not find good cause for

a waiver of prior notice and comment,

section 1856(b)(1) of the Act expressly

authorizes the Secretary to publish final

rules without prior notice and comment

implementing provisions in the new

Part C of Title XVIII including the fees

provided for in section 1857(e)(2) of the

BBA.

Issuing a proposed rule with a

comment period before issuing a final

rule would be impracticable because it

would allow for less time for HCFA to

collect the full $95 million amount

allowed by Congress in the

appropriations bill for FY 1998. An

abbreviated assessment period would

increase the financial impact on those

plans subject to the BBA fees in FY

1998.

For these reasons, we find good cause

to waive publishing a proposed rule and

to issue this final rule with comment

period. We invite written comments on

this final rule and will consider

comments we receive by the date and

time specified in the DATES section of

this preamble. Although we cannot

respond to comments individually, if

we change this rule as a result of our

consideration of timely comments, we

will respond to such comments in the

preamble of the amended rule.

VI. Response to Comments

Because of the large number of items

of correspondence we normally receive

on Federal Register documents

published for comment, we are not able

to acknowledge or respond to them

individually. We will consider all

comments we receive by the date and

time specified in the DATES section of

this preamble, and, when we proceed

with a subsequent document, we will

respond to the comments in the

preamble to that document.

List of Subjects in 42 CFR Part 417

Administrative practice and

procedure, Grant programs-health,

Health care, Health facilities, Health

insurance, Health maintenance

organizations (HMO), Loan programshealth, Medicare, Reporting and record

keeping requirements.

42 CFR Part 417 is amended as set

forth below:

PART 417—HEALTH MAINTENANCE

ORGANIZATIONS, COMPETITIVE

MEDICAL PLANS, AND HEALTH CARE

PREPAYMENT PLANS

1. The authority citation for Part 417

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

Social Security Act (42 U.S.C. 1302 and

1395hh), secs. 1301, 1306, and 1310 of the

Public Health Service Act (42 U.S.C. 300e,

300e–5, and 300e–9); and 31 U.S.C. 9701.

2. In § 417.470, paragraph (a) is

revised to read as follows:

§ 417.470 Basis and Scope.

(a) Basis. This subpart implements

those portions of section 1857(e)(2) of

the Act pertaining to cost sharing in

enrollment-related costs and section

1876(c), (g), (h), and (i) of the Act that

pertain to the contract between HCFA

and an HMO or CMP for participation

in the Medicare program.

* * * * *

3. Section 417.472 is amended by

adding a new paragraph (h) to read as

follows:

§ 417.472 Basic contract requirements.

* * * * *

(h) Collection of fees from risk

contracting plans. HCFA is authorized

to charge and directed to collect from

each eligible organization with a risksharing contract its share of fees for

administering section 1851 of the Act

relating to enrollment and

dissemination of information and

section 4360 of the Omnibus Budget

Reconciliation Act of 1990 relating to

the health insurance counseling and

assistance program in accordance with

the requirements of paragraphs (h)(1)

through (5) of this section.

(1) The aggregate amount of fees for a

fiscal year are the lesser of the estimated

costs to be incurred by HCFA in that

fiscal year to carry out the activities

described in section 1851 of the Act and

section 4360 of the Omnibus Budget

Reconciliation Act of 1990, or, if less,

the amount set forth in the DHHS

appropriation for the fiscal year.

(2) HCFA establishes a fee percentage

rate and collects the fees over nine

consecutive months beginning with

January of the fiscal year. The

percentage rate is determined by

multiplying the total of the estimated

January 1998 payments to all eligible

plans by nine (months in the assessment

period) and dividing this figure into the

total fee assessment as determined in

paragraph (h)(1) of this section.

Adjustments for retroactive enrollments

and disenrollments to HCFA’s

enrollment system subsequent to

November are not considered or
63674 Federal Register / Vol. 62, No. 231 / Tuesday, December 2, 1997 / Rules and Regulations

factored into the calculation for the fee

determination.

(3) An eligible organization with a

risk contract’s pro rata share of the

annual fee is determined based upon the

organization’s monthly calculated

Medicare payment amount during the

preceding nine consecutive months

beginning with January. HCFA

calculates each monthly pro rata share

for an organization by multiplying the

established BBA fee percentage by the

total monthly calculated Medicare

payment amount to plans as recorded in

HCFA’s payment system on the first day

of the month.

(4) HCFA offsets the fees against the

organization’s monthly Medicare

payment. Beginning with the January

payment, HCFA withholds the

organization’s share of fees and deducts

the amount from the total payment

made by HCFA to the organization for

that month. HCFA will stop collecting

the FY 1998 BBA fee from eligible plans

when $95 million has been assessed.

(5) Should delays occur in

determining the amount of fees

specified in paragraph (h)(1) of this

section or the fee percentage rate

specified in paragraph (h)(2) HCFA may

adjust the assessment time period and

fee percentage amount.

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance; and Program No. 93.774,

Medicare—Supplementary Medical

Insurance Program)

Dated: November 26, 1997.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing

Administration.

Approved: November 26, 1997.

Donna E. Shalala,

Secretary.

[FR Doc. 97–31710 Filed 12–1–97; 8:45 am]

BILLING CODE 4120–01–P

FEDERAL COMMUNICATIONS

COMMISSION

47 CFR Part 73

[MM Docket No. 96–195; RM–8867]

Radio Broadcasting Services;

Geneseo, IL and DeWitt, IA

AGENCY: Federal Communications

Commission.

ACTION: Final rule.

SUMMARY: The Commission, at the

request of Connoisseur Communications

of Quad Cities, L.P., substitutes Channel

285C3 for Channel 285A at Geneseo,

Illinois, reallots Channel 285C3 from

Geneseo to DeWitt, Iowa, and modifies

Station WGEN–FM’s license

accordingly. See 61 FR 51075,

September 30, 1996. Channel 285C3 can

be reallotted to DeWitt in compliance

with the Commission’s minimum

distance separation requirements with a

site restriction of 14.0 kilometers (8.7

miles) southeast to avoid short-spacings

to the licensed sites of Station

WXRX(FM), Channel 285A, Belvidere,

Illinois, and Station WXCL(FM),

Channel 285A, Pekin, Illinois, at

petitioner’s requested site. The

coordinates for Channel 285C3 at

DeWitt are North Latitude 41–42–50 and

West Longitude 90–27–20. With this

action, the proceeding is terminated.

EFFECTIVE DATE: January 5, 1998.

FOR FURTHER INFORMATION CONTACT:

Sharon P. McDonald, Mass Media

Bureau, (202) 418–2180.

SUPPLEMENTARY INFORMATION: This is a

synopsis of the Commission’s Report

and Order, MM Docket No. 96–195,

adopted November 12, 1997, and

released November 21, 1997. The full

text of this Commission decision is

available for inspection and copying

during normal business hours in the

FCC Reference Center (Room 239), 1919

M Street, NW., Washington, DC.

The complete text of this decision

may also be purchased from the

Commission’s copy contractors,

International Transcription Service,

Inc., (202) 857–3800, 1231 20th Street,

NW., Washington, DC 20036.

List of Subjects in 47 CFR Part 73

Radio broadcasting.

Part 73 of Title 47 of the Code of

Federal Regulations is amended as

follows:

PART 73—[AMENDED]

1. The authority citation for Part 73

continues to read as follows:

Authority: 47 U.S.C. 154, 303, 334, 336.

§ 73.202 [Amended]

2. Section 73.202(b), the Table of FM

Allotments under Illinois, is amended

by removing Channel 285A at Geneseo.

3. Section 73.202(b), the Table of FM

Allotments under Iowa, is amended by

adding DeWitt, Channel 285C3.

Federal Communications Commission.

John A. Karousos,

Chief, Allocations Branch, Policy and Rules

Division, Mass Media Bureau.

[FR Doc. 97–31512 Filed 12–1–97; 8:45 am]

BILLING CODE 6712–01–P

FEDERAL COMMUNICATIONS

COMMISSION

47 CFR Part 73

[MM Docket No. 96–243; RM–8925]

Radio Broadcasting Services;

Chugwater, WY

AGENCY: Federal Communications

Commission.

ACTION: Final rule.

SUMMARY: The Commission, at the

request of Mountain Tower

Broadcasting, allots Channel 258A at

Chugwater, Wyoming, as the

community’s first local aural

transmission service. See 61 FR 65509,

December 13, 1996. Channel 258A can

be allotted to Chugwater in compliance

with the Commission’s minimum

distance separation requirements at city

reference coordinates. The coordinates

for Channel 258A at Chugwater are

North Latitude 41–45–36 and West

Longitude 104–49–30. With this action,

this proceeding is terminated.

EFFECTIVE DATE: January 5, 1998. A filing

window for Channel 258A at

Chugwater, Wyoming, will not be

opened at this time. Instead, the issue of

opening a filing window for this

channel will be addressed by the

Commission in a subsequent order.

FOR FURTHER INFORMATION CONTACT:

Sharon P. McDonald, Mass Media

Bureau, (202) 418–2180.

SUPPLEMENTARY INFORMATION: This is a

synopsis of the Commission’s Report

and Order, MM Docket No. 96–243,

adopted November 5, 1997, and released

November 21, 1997. The full text of this

Commission decision is available for

inspection and copying during normal

business hours in the FCC Reference

Center (Room 239), 1919 M Street, NW.,

Washington, DC. The complete text of

this decision may also be purchased

from the Commission’s copy

contractors, International Transcription

Service, Inc., (202) 857–3800, 1231 20th

Street, NW., Washington, DC 20036.

List of Subjects in 47 CFR Part 73

Radio broadcasting.

Part 73 of Title 47 of the Code of

Federal Regulations is amended as

follows:

PART 73—[AMENDED]

1. The authority citation for Part 73

continues to read as follows:

Authority: 47 U.S.C. 154, 303, 334, 336.