69848 Federal Register / Vol. 77, No. 225 / Wednesday, November 21, 2012 / Notices 

regarding this collection contact Matt 

Klischer at 410–786–7488. For all other 

issues call 410–786–1326.) 

2. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Report of a 

Hospital Death Associated with 

Restraint or Seclusion; Use: Executive 

Order 13563, Improving Regulation and 

Regulatory Review, was signed on 

January 18, 2011. The order recognized 

the importance of a streamlined, 

effective, and efficient regulatory 

framework designed to promote 

economic growth, innovation, job 

creation, and competitiveness. Each 

agency was directed to establish an 

ongoing plan to reduce or eliminate 

burdensome, obsolete, or unnecessary 

regulations to create a more efficient 

and flexible structure. 

The regulation that was published on 

May, 16, 2012 (77 FR 29034) included 

a reduction in the reporting requirement 

related to hospital deaths associated 

with the use of restraint or seclusion, 

§ 482.13(g). Hospitals are no longer 

required to report to CMS those deaths 

where there was no use of seclusion and 

the only restraint was 2-point soft wrist 

restraints. It is estimated that this will 

reduce the volume of reports that must 

be submitted by 90 percent for 

hospitals. In addition, the final rule 

replaced the previous requirement for 

reporting via telephone to CMS, which 

proved to be cumbersome for both CMS 

and hospitals, with a requirement that 

allows submission of reports via 

telephone, facsimile or electronically, as 

determined by CMS. Finally, the 

amount of information that CMS needs 

for each death report in order for CMS 

to determine whether further on-site 

investigation is needed has been 

reduced. 

The Child Health Act (CHA) of 2000 

established in Title V, Part H, Section 

591 of the Public Health Service Act 

(PHSA) minimum requirements 

concerning the use of restraints and 

seclusion in facilities that receive 

support with funds appropriated to any 

Federal department or agency. In 

addition, the CHA enacted Section 592 

of the PHSA, which establishes 

minimum mandatory reporting 

requirements for deaths in such 

facilities associated with use of restraint 

or seclusion. Provisions implementing 

this statutory reporting requirement for 

hospitals participating in Medicare are 

found at 42 CFR 482.13(g), as revised in 

the final rule that published on May 16, 

2012 (77 FR 29034). Form Number: 

CMS–10455 (OCN: 0938–New); 

Frequency: Occasionally; Affected 

Public: Private Sector. Number of 

Respondents: 4,900. Number of 

Responses: 24,500. Total Annual Hours: 

8,085. (For policy questions regarding 

this collection contact Danielle Miller at 

410–786–8818. For all other issues call 

410–786–1326.) 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS’ Web Site 

address at http://www.cms.hhs.gov/

PaperworkReductionActof1995, or 

Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office on (410) 786– 

1326. 

In commenting on the proposed 

information collections please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways by January 22, 2013: 

1. Electronically. You may submit 

your comments electronically to http:// 

www.regulations.gov. Follow the 

instructions for ‘‘Comment or 

Submission’’ or ‘‘More Search Options’’ 

to find the information collection 

document(s) accepting comments. 

2. By regular mail. You may mail 

written comments to the following 

address: CMS, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attention: Document Identifier/OMB 

Control Number llll, Room C4–26– 

05, 7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: November 16, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–28381 Filed 11–20–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8046–N] 

RIN 0938–AR14 

Medicare Program; Inpatient Hospital 

Deductible and Hospital and Extended 

Care Services Coinsurance Amounts 

for CY 2013 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), 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 (CY) 2013 

under Medicare’s Hospital Insurance 

Program (Medicare Part A). The 

Medicare statute specifies the formulae 

used to determine these amounts. For 

CY 2013, the inpatient hospital 

deductible will be $1,184. The daily 

coinsurance amounts for CY 2013 will 

be: $296 for the 61st through 90th day 

of hospitalization in a benefit period; 

$592 for lifetime reserve days; and $148 

for the 21st through 100th day of 

extended care services in a skilled 

nursing facility in a benefit period. 

DATES: This notice is effective on 

January 1, 2013. 

FOR FURTHER INFORMATION CONTACT: 

Clare McFarland, (410) 786–6390 for 

general information. 

Gregory J. Savord, (410) 786–1521 for 

case-mix analysis. 

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 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 

(CY). 

II. Computing the Inpatient Hospital 

Deductible for CY 2013 

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 CY, 

adjusted 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 (FY) that begins on October 

1 of the same preceding CY, and 

adjusted to reflect changes in real casemix. The adjustment to reflect real casemix 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 


srobinson on DSK4SPTVN1PROD with 
Federal Register / Vol. 77, No. 225 / Wednesday, November 21, 2012 / Notices 69849 

(or, if midway between two multiples of 

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

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

the Act, the percentage increase used to 

update the payment rates for FY 2013 

for hospitals paid under the inpatient 

prospective payment system is the 

market basket percentage increase, 

otherwise known as the market basket 

update, reduced by 0.1 percentage 

points (see section 1886(b)(3)(B)(xii)(II) 

of the Act), and an adjustment based on 

changes in the economy-wide 

productivity (the multifactor 

productivity (MFP) adjustment (see 

section 1886(b)(3)(B)(xi)(II) of the Act). 

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

Act, hospitals will receive this update 

only if they submit quality data as 

specified by the Secretary. The update 

for hospitals that do not submit this data 

is reduced by 2.0 percentage points. We 

are estimating that after accounting for 

those hospitals receiving the lower 

market basket update in the paymentweighted average update, the calculated 

deductible will remain the same, as the 

majority of hospitals submit quality data 

and receive the full market basket 

update. 

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

the Act, the percentage increase used to 

update the payment rates for FY 2013 

for hospitals excluded from the 

inpatient prospective payment system is 

as follows: 

• For FY 2013, the percentage 

increase for long term care hospitals is 

the market basket percentage increase 

reduced by 0.1 percentage points and 

the MFP adjustment (see sections 

1886(m)(3)(A) and 1886(m)(4)(C) of the 

Act). 

• For FY 2013, the percentage 

increase for inpatient rehabilitation 

facilities is the market basket percentage 

increase reduced by 0.1 percentage 

points and the MFP adjustment (see 

sections 1886(j)(3)(C) and 

1886(j)(3)(D)(ii) of the Act). 

• For FY 2013, the percentage 

increase used to update the payment 

rate for psychiatric hospitals is the 

market basket percentage increase 

reduced by 0.1 percentage points and 

the MFP adjustment (see sections 

1886(s)(2)(A)(ii) and 1886(s)(3)(B) of the 

Act). 

The market basket percentage increase 

for 2013 is 2.6 percent and the MFP 

adjustment is 0.7 percent, as announced 

in the final rule with comment period 

published in the Federal Register on 

August 31, 2012 entitled, ‘‘Changes to 

the Hospital Inpatient Prospective 

Payment Systems for Acute Care 

Hospitals and FY 2013 Rates and to the 

Long Term Care Hospital PPS and FY 

2013 Rates’’ (77 FR 53257). Therefore, 

the percentage increase for hospitals 

paid under the inpatient prospective 

payment system is 1.8 percent. The 

average payment percentage increase for 

hospitals excluded from the inpatient 

prospective payment system is 2.05 

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 FY 2013 is 1.84 percent. 

To develop the adjustment to reflect 

changes in real case-mix, we first 

calculated an average case-mix for each 

hospital 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 FY 2012 compared 

to FY 2011. (We excluded from this 

calculation hospitals whose payments 

are not based on the inpatient 

prospective payment system because 

their payments are based on alternate 

prospective payment systems or 

reasonable costs.) We used Medicare 

bills from prospective payment 

hospitals that we received as of July 

2012. These bills represent a total of 

about 8.2 million Medicare discharges 

for FY 2012 and provide the most recent 

case-mix data available at this time. 

Based on these bills, the change in 

average case-mix in FY 2012 is 0.33 

percent. Based on these bills and past 

experience, we expect the overall case 

mix change to be 0.7 percent as the year 

progresses and more FY 2012 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. We estimate that the change in 

real case mix will be 0.7 percent. 

Thus, the estimate of the paymentweighted average of the applicable 

percentage increases used for updating 

the payment rates is 1.84 percent, and 

the real case-mix adjustment factor for 

the deductible is 0.7 percent. Therefore, 

under the statutory formula, the 

inpatient hospital deductible for 

services furnished in CY 2013 is $1,184. 

This deductible amount is determined 

by multiplying $1,156 (the inpatient 

hospital deductible for CY 2012) by the 

payment-weighted average increase in 

the payment rates of 1.0184 multiplied 

by the increase in real case-mix of 1.007, 

which equals $1,185.51 and is rounded 

to $1,184. 

III. Computing the Inpatient Hospital 

and Extended Care Services 

Coinsurance Amounts for CY 2013 

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 CY. The 

increase in the deductible generates 

increases in the coinsurance amounts. 

For inpatient hospital and extended care 

services furnished in CY 2013, 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 $296 (one-fourth of the 

inpatient hospital deductible); the daily 

coinsurance for lifetime reserve days 

will be $592 (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 $148 (one-eighth of the 

inpatient hospital deductible). 

IV. Cost to Medicare Beneficiaries 

Table 1 below summarizes the 

deductible and coinsurance amounts for 

CYs 2012 and 2013, as well as the 

number of each that is estimated to be 

paid. 

TABLE 1—PART A DEDUCTIBLE AND COINSURANCE AMOUNTS FOR CALENDAR YEARS 2012 AND 2013 

Type of cost sharing 

Value Number paid (in millions) 

2012 2013 2012 2013 

Inpatient hospital deductible .......................................................................... $1,156 $1,184 8.19 8.44 

Daily coinsurance for 61st–90th Day ............................................................. 289 296 2.11 2.17 

Daily coinsurance for lifetime reserve days ................................................... 578 592 1.04 1.08 

SNF coinsurance ........................................................................................... 144 .50 148 43.82 45.72 


srobinson on DSK4SPTVN1PROD with 
69850 Federal Register / Vol. 77, No. 225 / Wednesday, November 21, 2012 / Notices 

The estimated total increase in costs 

to beneficiaries is about $1,030 million 

(rounded to the nearest $10 million) due 

to—(1) the increase in the deductible 

and coinsurance amounts; and (2) the 

increase 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 CY. 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 (APA), 

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 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 the 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. Collection of Information 

Requirements 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

VII. Regulatory Impact Statement 

We have examined the impact of this 

notice as required by Executive Order 

12866 on Regulatory Planning and 

Review (September 30, 1993), Executive 

Order 13563 on Improving Regulation 

and Regulatory Review (January 18, 

2011), the Regulatory Flexibility Act 

(RFA) (September 19, 1980, Pub. L. 96– 

354), section 1102(b) of the Social 

Security Act, section 202 of the 

Unfunded Mandates Reform Act of 1995 

(March 22, 1995; Pub. L. 104–4), 

Executive Order 13132 on Federalism 

(August 4, 1999) and the Congressional 

Review Act (5 U.S.C., Part I, Ch. 8). 

Executive Orders 12866 and 13563 

direct agencies to assess all costs and 

benefits of available regulatory 

alternatives and, if regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). A regulatory impact analysis 

(RIA) must be prepared for major rules 

with economically significant effects 

($100 million or more in any 1 year). As 

stated in section IV of this notice, we 

estimate that the total increase in costs 

to beneficiaries associated with this 

notice is about $1,030 million due to— 

(1) the increase in the deductible and 

coinsurance amounts; and (2) the 

increase in the number of deductibles 

and daily coinsurance amounts paid. 

Therefore, this notice is a major action 

as defined in Title 5, United States 

Code, Part I, Ch. 8), and is an 

economically significant action under 

Executive Order 12866. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of $7.0 million to $34.5 million in any 

1 year. Individuals and States are not 

included in the definition of a small 

entity. We have determined that this 

notice will not have a significant 

economic impact on a substantial 

number of small entities. Therefore, we 

are not preparing an analysis under the 

RFA. 

In addition, section 1102(b) of the 

Social Security Act requires us to 

prepare a regulatory impact analysis if 

a 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 of a Metropolitan 

Statistical Area for Medicare payment 

regulations and has fewer than 100 

beds. The Secretary has determined that 

this notice will not have a significant 

impact on the operations of a substantial 

number of small rural hospitals. 

Therefore, we are not preparing an 

analysis under section 1102(b) of the 

Act. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule whose mandates require spending 

in any 1 year of $100 million in 1995 

dollars, updated annually for inflation. 

In 2012, that threshold is approximately 

$139 million. This notice will have no 

consequential effect on State, local, or 

tribal governments or on the private 

sector. However, States may be required 

to pay the deductibles and coinsurance 

for dually-eligible beneficiaries. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

This notice will not have a substantial 

effect on State or local governments. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance) 

Dated: November 6, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: November 15, 2012. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2012–28273 Filed 11–16–12; 11:15 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8048–N] 

RIN 0938–AR16 

Medicare Program; Medicare Part B 

Monthly Actuarial Rates, Premium 

Rate, and Annual Deductible 

Beginning January 1, 2013 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

monthly actuarial rates for aged (age 65 

and over) and disabled (under age 65) 

beneficiaries enrolled in Part B of the 

Medicare Supplementary Medical 


srobinson on DSK4SPTVN1PROD with