8406 Federal Register / Vol. 60, No. 30 / Tuesday, February 14, 1995 / Notices

TABLE 3.—AGENCIES EXCEEDING THE

COST LIMITS 1—Continued

HHAs in

Model

Exceeding the

limits as

of 7/1/93

Exceeding the

limits as

of 7/1/95

Rural .. 606 235 473

1All figures are based on revised cost limits

as published in this notice for cost reporting

periods beginning on or before July 1, 1993

and before July 1, 1994.

Again, we are unable to identify the

effects of these provisions on individual

HHAs. However, we anticipate that

overall HHA payments for FY 1995

through FY 1997 will be approximately

0.9 percent, 2.0 percent, and 0.5 percent

less, respectively, than they would have

been in those years if the OBRA ’93

provisions were not in effect. The effects

of this reduction on the total revenues

of individual HHAs will depend on the

HHA’s ability to operate within the cost

limits and on the proportion of the

HHA’s revenues that come from the

Medicare program. We estimate that the

delay in updating the limits will not

result in a significant number of

facilities’ total revenues being increased

or reduced by 3 percent or more from

the revised limits effective for cost

reporting periods beginning on July 1,

1993, as set forth in this notice, adjusted

for inflation.

Section 1102(b) of the Act requires the

Secretary to prepare a regulatory impact

analysis if a notice such as this 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 define a

small rural hospital as a hospital with

fewer than 100 beds located outside of

a Metropolitan Statistical Area.

We have not prepared a rural impact

statement since we have determined

and the Secretary certifies that this final

notice will not have a significant

economic impact on the operations of a

substantial number of small rural

hospitals.

In accordance with the provisions of

Executive Order 12866, this notice was

reviewed by the Office of Management

and Budget.

VI. Other Required Information

A. Waiver of Proposed Notice and 30-

Day Delay in the Effective Date

In adopting notices such as this, we

ordinarily publish a proposed notice in

the Federal Register with a 60-day

period for public comment as required

under section 1871(b)(1) of the Act. We

also normally provide a delay of 30 days

in the effective date for documents such

as this. However, we may waive these

procedures if we find good cause that

prior notice and comment or a delay in

the effective date are impracticable,

unnecessary, or contrary to the public

interest.

This notice revises the per-visit limits

effective for cost reporting periods

beginning on or after July 1, 1993. We

believe the revised limits will be

beneficial to HHAs. Moreover, we have

revised the limits based on public

comments on our July 8, 1993 notice

with comment period.

In addition, as discussed above,

before the enactment of OBRA ’93,

section 1861(v)(1)(L)(iii) of the Act

required that the HHA per-discipline

cost limits be updated annually no later

than July 1 of each year. However,

section 13564(a)(1) of OBRA ’93

specifies that there be no changes in the

HHA cost limits (except as may be

necessary to take into account the

elimination of the A&G add-on for

hospital-based HHAs) for cost reporting

periods beginning on or after July 1,

1994, and before July 1, 1996. Section

13564(a)(2) of OBRA ’93 amended

section 1861(v)(1)(L)(iii) of the Act to

delay the next required update of the

HHA limits until July 1, 1996.

Thus, in conformance with the clear

direction of section 13564(a) of OBRA

’93, this notice announces the new HHA

provisions and explains the effects of

these provisions on the methodology

used in calculating the HHA cost limits.

We have made no changes in this

methodology beyond those directly

required by OBRA ’93. Moreover,

section 13564(a) of OBRA ’93 mandates

that these provisions are effective

beginning with cost reporting periods

beginning on or after July 1, 1994.

Because many of the provisions in this

notice announce, and explain the

impact of, changes made by statute that

are already effective, we believe it is

unnecessary to publish a proposed

notice or delay the effective date.

In summary, the only discretionary

aspect of this notice is the revision of

the schedule of HHA cost limits

effective for cost reporting periods

beginning on or after July 1, 1993. As

noted above, this change is being made

in response to public comment and is

clearly beneficial to HHAs. Publishing a

proposed rule or delaying the effective

date would postpone the correction of

errors in the database used to compute

the HHA cost limits. Thus, we have

concluded that in this instance, it would

be impracticable, unnecessary, and

contrary to the public interest to publish

a proposed notice or to provide for a 30-

day delay in the effective date of this

notice. Therefore, we find good cause to

waive publication of a proposed notice

and the 30-day delay in effective date.

However, we are providing a 60-day

period for public comment, as indicated

at the beginning of this notice.

B. Paperwork Reduction Act

This notice with comment period

does not impose information collection

requirements. Consequently, it need not

be reviewed by the Office of

Management and Budget under the

authority of the Paperwork Reduction

Act of 1980 (44 U.S.C. 3501 et seq.).

C. Requests for Data From the Public

In order to respond promptly to

public requests for data used in

calculating the HHA cost limits, we

have set up a process under which

commenters can gain access to the raw

data on an expedited basis. The HHA

database is available on computer tape

format or diskette for $680. Anyone

wishing to purchase data tapes or

diskettes should submit a written

request along with a company check or

money order (payable to HCFA-PUF) to

cover the cost, to the following address:

Health Care Financing Administration,

Public Use Files, Accounting Division,

P.O. Box 7520, Baltimore, Maryland

21207–0520, (410) 597–5151.

D. Public 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 notice, and, if we proceed with a

subsequent document, we will respond

to the comments in that document.

Authority: (Sections 1102, 1814(b),

1861(v)(1)(A) and (v)(1)(L), 1866(a), and 1871

of the Social Security Act (42 U.S.C. 1302,

1395f(b), 1395x(v)(1)(A) and (v)(1)(L),

1395cc(a), and 1395hh); section 13564(a) of

Public Law 103–66 (42 U.S.C. 1395x(note))

and 42 CFR 413.30.)

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance)

Dated: October 11, 1994.

Bruce C. Vladeck,

Administrator, Health Care Financing

Administration.

Dated: November 4, 1994.

Donna E. Shalala,

Secretary.

[FR Doc. 95–3526 Filed 2–13–95; 8:45 am]

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