Federal Register / Vol. 65, No. 203 / Thursday, October 19, 2000 / Notices 62725

and Supporting Regulations in 42 CFR

411.25, 489.2, and 489.20; Form

Number: HCFA–250 through HCFA–254

(OMB approval #: 0938–0214); Use:

Medicare Secondary Payer (MSP) refers

to those situations where Medicare does

not have primary responsibility for

paying the medical expenses of a

Medicare beneficiary. Medicare

intermediaries and carriers must collect

information to perform various tasks to

detect MSP cases, develop and

disseminate tools to enable them to

better perform their tasks, and monitor

their performance in achievement of

their assigned MSP functions. These

information collection requirements

describe the MSP requirements and

consist of the following:

1. Initial enrollment questionnaire

2. MSP claims investigation, which

consists of first claim development,

trauma code development, self-reporting

MSP liability development, notice to

responsible third party development

(411.25 notice), secondary claims

development, and ‘‘08’’ development

(involving claims where information

cannot be obtained from the beneficiary)

3. Provider MSP development, which

requires the provider to request

information from the beneficiary or

representative during admission and

other encounters; Frequency: On

occasion; Affected Public: Individuals or

households, Business or other for-profit,

and Not-for-profit institutions; Number

of Respondents: 14,204,000; Total

Annual Responses: 116,394,528; Total

Annual Hours Requested: 3,305,814.

To obtain copies of the supporting

statement and any related forms for the

proposed paperwork collections

referenced above, access HCFA’s Web

Site address at http://www.hcfa.gov/

regs/prdact95.htm, or E-mail your

request, including your address, phone

number, OMB number, and HCFA

document identifier, to

Paperwork@hcfa.gov, or call the Reports

Clearance Office on (410) 786–1326.

Public Meeting

HCFA will be holding a public

meeting to permit interested parties an

opportunity to give their views on how

the content and use of the MSP

collection requirements may need to be

revised. Representatives of the hospital

industry, health care consumer

advocacy groups, and provider groups

who wish to participate in the public

meeting are asked to notify the Agency

in advance of their interest in attending.

At this meeting, the Health Care

Financing Administration will solicit

comments on the topics listed in the

first paragraph of this notice and as

referenced in the supporting statement,

which may be obtained as described

above.

The public meeting will be held on

Friday, November 3, 2000, from 1:00–

4:00 p.m., in the Multipurpose Room

(Capacity: 100 persons) of the Health

Care Financing Administration, 7500

Security Boulevard, Baltimore,

Maryland 21244. Interested parties

should provide notification of their

planned attendance to Tom Bouchat or

Joan Fowler, either via telephone (410)

786–4621 or (410) 786–0922, fax (410)

786–9963, or e-mail: Tbouchat@hcfa.gov

or Jfowler@hcfa.gov by no later than 3

p.m., Monday, October 30, 2000.

Interested persons are invited to send

comments regarding the burden or any

other aspect of these collections of

information requirements. However, as

noted above, comments on these

information collection requirements

must be mailed and/or faxed to the

designees referenced below by

November 23, 2000:

Health Care Financing Administration,

Office of Information Services,

Division of HCFA Enterprise

Standards, Room N2–14–26, 7500

Security Boulevard, Baltimore, MD

21244–1850, Fax Number: (410) 786–

0262, Attn: Julie Brown HCFA–250

through HCFA–254 and,

Office of Information and Regulatory

Affairs, Office of Management and

Budget, Room 10235, New Executive

Office Building, Washington, DC

20503, Fax Number: (202) 395–6974

or (202) 395–5167, Attn: Wendy

Taylor, HCFA Desk Officer.

Dated: October 17, 2000.

John P. Burke, III,

HCFA Reports Clearance Officer, HCFA,

Office of Information Services, Information

Technology Investment Management Group,

Division of HCFA Enterprise Standards.

[FR Doc. 00–27028 Filed 10–17–00; 3:06 pm]

BILLING CODE 4120–03–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

[HCFA–8007–N]

RIN 0938–AK27

Medicare Program; Inpatient Hospital

Deductible and Hospital and Extended

Care Services Coinsurance Amounts

for 2001

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 2001 under

Medicare’s hospital insurance program

(Medicare Part A). The Medicare statute

specifies the formulae used to determine

these amounts.

The inpatient hospital deductible will

be $792. The daily coinsurance amounts

will be: (a) $198 for the 61st through

90th day of hospitalization in a benefit

period; (b) $396 for lifetime reserve

days; and (c) $99 for the 21st through

100th day of extended care services in

a skilled nursing facility in a benefit

period.

EFFECTIVE DATE: This notice is effective

on January 1, 2001.

FOR FURTHER INFORMATION CONTACT:

Clare McFarland, (410) 786–6390. For

case-mix 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 2001

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) 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

62726 Federal Register / Vol. 65, No. 203 / Thursday, October 19, 2000 / Notices

(or, if midway between two multiples of

$4, to the next higher multiple of $4).

Under section 1886(b)(3)(B)(i) of the

Act, as amended by section 4401(a) of

the Balanced Budget Act of 1997 (BBA

‘97) (Public Law 105–33), the percentage

increase used to update the payment

rates for fiscal year 2001 for hospitals

paid under the prospective payment

system is the market basket percentage

increase minus 1.1 percentage points.

Under section 1886(b)(3)(B)(ii) of the

Act, as amended by section 4411(a) of

the BBA ‘97, the percentage increase

used to update the payment rates for

fiscal year 2001 for hospitals excluded

from the prospective payment system

depends on the hospital’s allowable

operating costs of inpatient hospital

services. If the hospital’s allowable

operating costs of inpatient hospital

services for the most recent cost

reporting period for which information

is available—

(1) Are equal to or exceed 110 percent

of the hospital’s target amount for that

cost reporting period, the applicable

percentage increase is the market basket

percentage;

(2) Exceed 100 percent but are less

than 110 percent of the hospital’s target

amount for that cost reporting period,

the applicable percentage increase is the

market basket percentage minus 0.25

percentage points for each percentage

point by which the hospital’s allowable

operating costs are less than 110 percent

of the target amount for that cost

reporting period (but not less than 0

percent);

(3) Are equal to or less than 100

percent of the hospital’s target amount

for that cost reporting period, but

exceed two-thirds of the target amount,

the applicable percentage increase is 0

percent or, if greater, the market basket

percentage minus 2.5 percentage points;

or

(4) Do not exceed two-thirds of the

hospital’s target amount for that cost

reporting period, the applicable

percentage increase is 0 percent.

The market basket percentage increase

for fiscal year 2001 is 3.4 percent, as

announced in the final rule titled

‘‘Medicare Program; Changes to the

Hospital Inpatient Prospective Payment

Systems and Fiscal Year 2001 Rates,’’

published in the Federal Register on

August 1, 2000 (65 FR 47054).

Therefore, the percentage increase for

hospitals paid under the prospective

payment system is 2.3 percent. The

average payment percentage increase for

hospitals excluded from the prospective

payment system is 1.4 percent.

Weighting these percentages in

accordance with payment volume, our

best estimate of the payment-weighted

average of the increases in the payment

rates for fiscal year 2001 is 2.21 percent.

To develop the adjustment for real

case mix, we first calculated for each

hospital an average case mix that

reflects the relative costliness of that

hospital’s mix of cases compared to

those of other hospitals. We then

computed the change in average case

mix for hospitals paid under the

Medicare prospective payment system

in fiscal year 2000 compared to fiscal

year 1999. (We excluded from this

calculation hospitals excluded from the

prospective payment system because

their payments are based on reasonable

costs and are affected only by real

changes in case mix.) We used bills

from prospective payment hospitals

received in HCFA as of June 2000.

These bills represent a total of about 7.3

million discharges for fiscal year 2000

and provide the most recent case mix

data available at this time. Based on

these bills, the change in average case

mix in fiscal year 2000 is ¥0.95

percent. Based on past experience, we

expect the overall case mix change to be

¥0.5 percent as the year progresses and

more fiscal year 2000 data become

available.

Section 1813 of the Act requires that

the inpatient hospital deductible be

adjusted only by that portion of the case

mix change that is determined to be

real. There is a negligible change in

overall case mix for fiscal year 2000. We

estimate that there is no change in real

case mix; that is, we estimate that the

change in real case mix for fiscal year

2000 is 0.0 percent.

Thus, the estimate of the paymentweighted average of the applicable

percentage increases used for updating

the payment rates is 2.21 percent, and

the real case mix adjustment factor for

the deductible is 0.0 percent. Therefore,

under the statutory formula, the

inpatient hospital deductible for

services furnished in calendar year 2001

is $792. This deductible amount is

determined by multiplying $776 (the

inpatient hospital deductible for 2000)

by the payment-weighted average

increase in the payment rates of 1.0221

multiplied by the increase in real case

mix of 1.000, which equals $793.15 and

is rounded to $792.

III. Computing the Inpatient Hospital

and Extended Care Services

Coinsurance Amounts for 2001

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 2001, in accordance with

the fixed percentages defined in the law,

the daily coinsurance for the 61st

through 90th day of hospitalization in a

benefit period will be $198 (one-fourth

of the inpatient hospital deductible); the

daily coinsurance for lifetime reserve

days will be $396 (one-half of the

inpatient hospital deductible); and the

daily coinsurance for the 21st through

100th day of extended care services in

a skilled nursing facility in a benefit

period will be $99 (one-eighth of the

inpatient hospital deductible).

IV. Cost to Beneficiaries

We estimate that in 2001 there will be

about 8.56 million deductibles paid at

$792 each, about 2.10 million days

subject to coinsurance at $198 per day

(for hospital days 61 through 90), about

0.97 million lifetime reserve days

subject to coinsurance at $396 per day,

and about 30.08 million extended care

days subject to coinsurance at $99 per

day. Similarly, we estimate that in 2000

there will be about 8.42 million

deductibles paid at $776 each, about

2.06 million days subject to coinsurance

at $194 per day (for hospital days 61

through 90), about 0.95 million lifetime

reserve days subject to coinsurance at

$388 per day, and about 28.64 million

extended care days subject to

coinsurance at $97 per day. Therefore,

the estimated total increase in cost to

beneficiaries is about $480 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 notice and comment rulemaking

procedures, to make the

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

Federal Register / Vol. 65, No. 203 / Thursday, October 19, 2000 / Notices 62727

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 formulae used

to calculate the inpatient hospital

deductible and hospital and extended

care services coinsurance amounts are

statutorily directed, and we can exercise

no discretion in following these

formulae. 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. Regulatory Impact Statement

We have examined the impacts of this

notice 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 RFA requires agencies

to analyze options for regulatory relief

for small businesses. For purposes of the

RFA, States and individuals are not

considered small entities.

Also, section 1102(b) of the Act

requires the Secretary to prepare a

regulatory impact analysis for any

notice that may have a significant

impact on the operations of a substantial

number of small rural hospitals. Such

an analysis must conform to the

provisions of section 604 of the RFA.

For purposes of section 1102(b) of the

Act, we consider a small rural hospital

as a hospital that is located outside of

a Metropolitan Statistical Area and has

fewer than 50 beds. We have

determined that this notice will not

have a significant effect on the

operations of a substantial number of

small rural hospitals. Therefore, we are

not preparing an analysis for section

1102(b) of the Act.

As stated in section IV of this notice,

we estimate that the total increase in

costs to beneficiaries associated with

this notice is about $480 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. Therefore,

this notice is a major rule as defined in

Title 5, United States Code, section

804(2) and is an economically

significant rule under Executive Order

12866.

In accordance with the provisions of

Executive Order 12866, this notice was

reviewed by the Office of Management

and Budget.

We have reviewed this notice under

the threshold criteria of Executive Order

13132, Federalism. We have determined

that it does not significantly affect the

rights, roles, and responsibilities of

States.

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

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

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance)

Dated: September 5, 2000.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing

Administration.

Dated: September 26, 2000.

Donna E. Shalala,

Secretary.

[FR Doc. 00–26846 Filed 10–18–00; 8:45 am]

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

[HCFA–8009–N]

Medicare Program; Monthly Actuarial

Rates and Monthly Supplementary

Medical Insurance Premium Rate

Beginning January 1, 2001

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Notice.

SUMMARY: In accordance with section

1839 of the Social Security Act, this

notice announces the monthly actuarial

rates for aged (aged 65 and over) and

disabled (under age 65) enrollees in the

Medicare Supplementary Medical

Insurance (SMI) program for 2001. It

also announces the monthly SMI

premium to be paid by all enrollees

during 2001. The monthly actuarial

rates for 2001 are $101.00 for aged

enrollees and $132.00 for disabled

enrolless. The monthly SMI premium

rate for 2001 is $50.00. This compares

to projections of the 2001 SMI premium

of $49.90 in the 2000 Trustees Report

and $57.00 in the 1998 Trustees Report.

The 2000 premium rate was $45.50 and

a good portion of the increase for 2001

is due to additional amounts of home

health being transferred into Part B (the

2001 monthly premium includes $3.09

for home health services being

transferred into Part B). The 2001 Part

B premium is not equal to 50 percent of

the monthly actuarial rate because of the

differential between the amount of

home health that is transferred into Part

B in 2001 (four-sixths) and the amount

in Part B that is included in the

premium calculation (four-sevenths).

EFFECTIVE DATE: January 1, 2001.

FOR FURTHER INFORMATION CONTACT:

Carter S. Warfield, (410) 786–6396.

SUPPLEMENTARY INFORMATION:

I. Background

The Medicare Supplementary Medical

Insurance (SMI) program is the

voluntary Medicare Part B program that

pays all or part of the costs for

physicians’ services, outpatient hospital

services, home health services, services

furnished by rural health clinics,

ambulatory surgical centers,

comprehensive outpatient rehabilitation

facilities, and certain other medical and

health services not covered by hospital

insurance (HI) (Medicare Part A). The

SMI program is available to individuals

who are entitled to HI and to U.S.

residents who have attained age 65 and

are citizens, or aliens who were lawfully

admitted for permanent residence and

have resided in the United States for 5

consecutive years. This program

requires enrollment and payment of

monthly premiums, as provided in 42

CFR part 407, subpart B, and part 408,

respectively. The difference between the

premiums paid by all enrollees and total

incurred costs is met from the general

revenues of the Federal government.

The Secretary of Health and Human

Services is required by section 1839 of

the Social Security Act (the Act) to issue

two annual notices relating to the SMI

program.

One notice announces two amounts

that, according to actuarial estimates,

will equal respectively, one-half the

expected average monthly cost of SMI

for each aged enrollee (age 65 or over)

and one-half the expected average

monthly cost of SMI for each disabled

enrollee (under age 65) during the year

beginning the following January. These

amounts are called ‘‘monthly actuarial

rates.’’

The second notice announces the

monthly SMI premium rate to be paid

by aged and disabled enrollees for the

year beginning the following January.

(Although the costs to the program per

disabled enrollee are different than for

the aged, the law provides that they pay

the same premium amount.) Beginning

with the passage of section 203 of the

Social Security Amendments of 1972

(Public Law 92–603), the premium rate,

which was determined on a fiscal year

basis, was limited to the lesser of the

actuarial rate for aged enrollees, or the