Federal Register / Vol. 70, No. 184 / Friday, September 23, 2005 / Notices 55903 

determined that this notice will not 

have a significant effect on a substantial 

number of small entities or on the 

operations of a substantial number of 

small rural hospitals. Therefore, we are 

not preparing analyses for either the 

RFA or 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 that may result in expenditure in 

any 1 year by State, local, or tribal 

governments, in the aggregate, or by the 

private sector, of $110 million. This 

notice has no consequential effect on 

State, local, or tribal governments. We 

believe the private sector costs of this 

notice fall below this threshold as well. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it publishes a proposed 

rule (and subsequent final rule) that 

imposes substantial direct compliance 

costs on State and local governments, 

preempts State law, or otherwise has 

Federalism implications. We have 

determined that this notice does not 

significantly affect the rights, roles, and 

responsibilities of States. 

This notice announces that the 

monthly actuarial rates applicable for 

2006 are $176.90 for enrollees age 65 

and over and $203.70 for disabled 

enrollees under age 65. It also 

announces that the monthly Part B 

premium rate for calendar year 2006 is 

$88.50 and that the Part B deductible for 

calendar year 2006 is $124.00. The Part 

B premium rate of $88.50 is 13.2 percent 

higher than the $78.20 premium rate for 

2005. We estimate that this increase will 

cost approximately 40 million Part B 

enrollees about $4.9 billion for 2006. In 

addition, we estimate that the increase 

in the annual deductible will cost 

approximately $0.4 billion in 2006. 

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. 

IV. Waiver of Proposed Notice 

The Medicare statute requires the 

publication of the monthly actuarial 

rates and the Part B premium amounts 

in September. We ordinarily use general 

notices, rather than notice and comment 

rulemaking procedures, to make such 

announcements. In doing so, we note 

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 

procedure if we find, for good cause, 

that prior notice and comment are 

impracticable, unnecessary, or contrary 

to the public interest. We find that the 

procedure for notice and comment is 

unnecessary because the formula used 

to calculate the Part B premium is 

statutorily directed, and we can exercise 

no discretion in applying that formula. 

Moreover, the statute establishes the 

time period for which the premium 

rates will apply, and delaying 

publication of the Part B premium rate 

such that it would not be published 

before that time would be contrary to 

the public interest. Therefore, we find 

good cause to waive publication of a 

proposed notice and solicitation of 

public comments. 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: September 12, 2005. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: September 15, 2005. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. 05–18837 Filed 9–16–05; 4 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1269–N5] 

Medicare Program; Emergency Medical 

Treatment and Labor Act (EMTALA) 

Technical Advisory Group (TAG) 

Meeting—October 26, 2005 Through 

October 28, 2005 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice of meeting. 

SUMMARY: In accordance with section 

10(a) of the Federal Advisory Committee 

Act (FACA) (5 U.S.C. Appendix 2), this 

notice announces the third meeting of 

the Emergency Medical Treatment and 

Labor Act (EMTALA) Technical 

Advisory Group (TAG). The purpose of 

the EMTALA TAG is to review 

regulations affecting hospital and 

physician responsibilities under 

EMTALA to individuals who come to a 

hospital seeking examination or 

treatment for medical conditions. The 

primary purpose of the third meeting is 

to enable the EMTALA TAG to hear 

additional testimony and further 

consider written responses from 

medical societies and other 

organizations on specific issues 

considered by the TAG at previous 

meetings. However, the public is 

permitted to attend this meeting and, to 

the extent that time permits and at the 

discretion of the Chairperson, the 

EMTALA TAG may hear comments 

from the floor. 

DATES: Meeting Date: The meetings of 

the EMTALA TAG announced in this 

notice are as follows: Wednesday, 

October 26, 2005, 9 a.m. to 5 p.m. e.s.t.; 

Thursday, October 27, 2005, 11 a.m. to 

5 p.m. e.s.t.; Friday, October 28, 2005, 

9 a.m. to 12 noon e.s.t. 

Registration Deadline: All individuals 

must register to attend this meeting. 

Individuals who wish to attend the 

meeting but do not wish to present 

testimony must register by October 19, 

2005. Individuals who wish both to 

attend the meeting and to present their 

testimony must register by October 5, 

2005, and must submit copies of their 

testimony in writing by October 12, 

2005. 

Comment Deadline: Written 

comments/statements to be presented to 

the EMTALA TAG must be received by 

October 12, 2005. 

Special Accommodations: Individuals 

requiring sign-language interpretation or 

other special accommodations should 

send a request to these services to 

Beverly J. Parker by 5 p.m., October 12, 

2005 at address listed below. 

ADDRESSES: Meeting Address: The 

EMTALA TAG meeting will be held in 

the Multipurpose Room at the CMS 

Headquarters (Central Bldg), 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

Mailing and E-mail Addresses for 

Inquiries or Comments: Inquiries or 

comments regarding this meeting may 

be sent to—Beverly J. Parker, Division of 

Acute Care, Centers for Medicare & 

Medicaid Services, Mail Stop C4–08–06, 

7500 Security Boulevard, Baltimore, MD 

21244–1850. Inquiries or comments may 

also be e-mailed to 

Beverly.Parker@cms.hhs.gov or 

EMTALATAG@cms.hhs.gov. 

Web Site Address for Additional 

Information: For additional information 

on the EMTALA TAG meeting agenda 

topics, updated activities, and to obtain 

Charter copies, please search our 

Internet Web site at: http:// 

55904 Federal Register / Vol. 70, No. 184 / Friday, September 23, 2005 / Notices 

www.cms.hhs.gov/faca/emtalatag/ 

emtalatagpage.asp. 

FOR FURTHER INFORMATION CONTACT: 

Beverly J. Parker, (410) 786–5320; 

George Morey, (410) 786–4653. 

Press inquiries are handled through 

the CMS Press Office at (202) 690–6145. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Sections 1866(a)(1)(I), 1866(a)(1)(N), 

and 1867 of the Social Security Act (the 

Act) impose specific obligations on 

Medicare-participating hospitals that 

offer emergency services. These 

obligations concern individuals who 

come to a hospital emergency 

department and request or have a 

request made on their behalf for 

examination or treatment for a medical 

condition. EMTALA applies to all these 

individuals, regardless of whether or not 

they are beneficiaries of any program 

under the Act. Section 1867 of the Act 

sets forth requirements for medical 

screening examinations for emergency 

medical conditions, as well as necessary 

stabilizing treatment or appropriate 

transfer. 

Regulations implementing the 

EMTALA legislation are set forth at 42 

CFR 489.20(l), (m), (q) and (r)(1), (r)(2), 

(r)(3), and 489.24. Section 945 of the 

Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA) (Pub. L. 108–173), requires 

that the Secretary establish a Technical 

Advisory Group (TAG) for advice 

concerning issues related to EMTALA 

regulations and implementation. 

Section 945 of the MMA specifies that 

the EMTALA TAG—

• Shall review the EMTALA 

regulations; 

• May provide advice and 

recommendations to the Secretary 

concerning these regulations and their 

application to hospitals and physicians; 

• Shall solicit comments and 

recommendations from hospitals, 

physicians, and the public regarding 

implementation of such regulations; and 

• May disseminate information 

concerning the application of these 

regulations to hospitals, physicians, and 

the public. 

The EMTALA TAG, as chartered 

under the legal authority of section 945 

of the MMA, is also governed by the 

provisions of the Federal Advisory 

Committee Act (FACA) (5 U.S.C. 

Appendix 2) for the selection of 

members and the conduct of all 

meetings. 

In the May 28, 2004 Federal Register 

(69 FR 30654), we specified the 

statutory requirements regarding the 

charter, general responsibilities, and 

structure of the EMTALA TAG. That 

notice also solicited nominations for 

members based on the statutory 

requirements for the EMTALA TAG. In 

the August 27, 2004 Federal Register 

(69 FR 52699), we solicited nominations 

again for members in two categories 

(patient representatives and a State 

survey agency representative) for which 

no nominations were received in 

response to the May 28, 2004 Federal 

Register notice. In the March 15, 2005 

Federal Register (70 FR 12691), we 

announced the inaugural meeting of the 

EMTALA TAG and the membership 

selection. In the May 18, 2005 Federal 

Register (70 FR 28541) we announced 

the second meeting of the EMTALA 

TAG with a purpose to hear public 

testimony and consider written 

responses from medical societies and 

other organizations on specific issues 

considered by the EMTALA TAG at its 

inaugural meeting. The EMTALA TAG 

has established the following three 

subcommittees: 

• On-Call Subcommittee 

(Chairperson, John Kusske, M.D.) 

charged to review the testimony 

provided and other materials to identify 

some specific issues relating to on-call 

requirements. 

• Action Subcommittee (Chairperson, 

Julie Nelson, J.D.) charged to identify 

issues other than on-call issues. 

• Framework Subcommittee 

(Chairperson, Charlotte Yeh, M.D.) 

charged to clarify the historical context 

and conceptual basis for the TAG’s 

recommendations and develop a 

document for review and approval by 

the TAG. 

II. Meeting Format, Agenda, and 

Presentation Topics 

A. Meeting Format 

The initial portion of the meeting 

(convening at 9 a.m. on October 26) will 

involve opening remarks, followed by a 

limited period of public testimony on 

emergency medical services and 

specialty hospital issues. Participants 

wishing to present testimony on the 

EMTALA impact of specialty hospitals 

are requested to address their comments 

to the following issues: 

• Whether there should be a Federal 

requirement for specialty hospitals to 

maintain emergency departments and, if 

so, whether this is best achieved by 

amending EMTALA or through some 

other means. 

• Whether specialty hospitals, 

irrespective of whether they have 

emergency departments, are subject to 

the EMTALA requirement under which 

a Medicare participating hospitals with 

specialized capabilities or facilities may 

not refuse to accept an appropriate 

transfer of an individual who requires 

such specialized capabilities or facilities 

if the hospital has the capacity to treat 

the individual. 

• Whether additional or different, oncall requirements should be established 

for specialty hospitals (for example, 

whether specialty hospitals should be 

required to participate in community 

protocols). 

The public testimony will be followed 

by discussion of emergency medical 

services (EMS), specialty hospitals, and 

other issues under consideration by the 

On-Call, Action, and Framework 

Subcommittees. TAG members will be 

afforded the opportunity to ask 

questions, prioritize the topics 

presented, and to conduct other 

necessary business. At the conclusion of 

each day’s meeting, to the extent that 

time is available and at the discretion of 

the Chair, the public will be permitted 

a reasonable time to comment on issues 

being considered by the TAG. 

B. Tentative Meeting Agenda 

The tentative agenda for the EMTALA 

TAG meetings is as follows: 

Day 1 

Convenes at 9 a.m. 

• Welcome, Call to Order, and 

Opening Remarks. 

• Administrative and Housekeeping 

Issues. 

• Public Testimony on Emergency 

Medical Services and Specialty Hospital 

Issues. 

• Report of On-Call Subcommittee. 

• Discussion of On-Call Issues. 

• Report of Action Subcommittee. 

• Discussion of Action Subcommittee 

Issues (for example, psychiatric 

emergency medical conditions and 

stabilizing treatment; hospitals with 

specialized capabilities; follow-up on 

other issues discussed at the last TAG 

meeting). 

• Public Comment. 

Day 2 

Convenes at 11 a.m. 

• Report of Framework 

Subcommittee. 

• Discussion of Framework Issues. 

• Discussion of Specialty Hospital 

Issues. 

• Continuation of discussion of OnCall issues. 

• Continuation of discussion of 

Action Subcommittee Issues. 

• Discussion of Current Business. 

• Public Comment. 

Federal Register / Vol. 70, No. 184 / Friday, September 23, 2005 / Notices 55905 

Day 3 

Convening at 9 a.m. 

• Discussion of Current Business 

(continued). 

C. Public Presentations 

Only individuals who register and 

submit written testimony as specified in 

section IV. of this notice will be 

considered registered presenters. The 

time allotted for each presentation will 

be approximately 5 minutes but will be 

based on the number of registered 

presenters. Presenters will speak in their 

assigned order. If registered presenters 

are not given an opportunity to speak 

because of time restrictions, we will 

accept and present their testimony to 

the TAG members. Comments from 

other participants (individuals who are 

not registered presenters) may be heard 

after the scheduled testimonies, if time 

permits. 

If there are individuals who cannot 

attend the meeting but wish to submit 

comments/statements regarding 

emergency medical services or specialty 

hospitals, we will accept and present 

their written comments/statements at 

the meeting if their comments/ 

statements are received via postal mail 

or email at the address listed in the 

ADDRESSES section of this notice by 

October 12, 2005. 

III. Registration Instructions 

The Center for Medicare Management 

is coordinating meeting registration. 

While there is no registration fee, all 

individuals must register to attend due 

to limited seating. As specified in the 

DATES section of this notice, individuals 

who wish to attend the meeting but do 

not plan to present testimony must 

register by October 19, 2005. Individuals 

who would like both to attend and to 

present testimony on the topics of 

emergency medical services or specialty 

hospitals must register by October 5, 

2005 and must state specifically in their 

registration request that they wish to 

present testimony for EMTALA TAG 

consideration. A copy of the presenter’s 

written testimony must be received by 

CMS at the address specified in the 

ADDRESSES section of this notice by 

October 12, 2005. 

You may register with Marianne 

Myers at Marianne.Myers@cms.hhs.gov 

or by, fax to the attention of Marianne 

Myers at (410) 786–0681, or by 

telephone at (410) 786–5962. All 

registration requests must include your 

name, name of the organization (if 

applicable), address, telephone and fax 

numbers, e-mail address (if available). 

You will receive a registration 

confirmation with instructions for your 

arrival at the CMS Headquarters. If 

seating has been reached, you will be 

notified that the meeting has reached 

capacity. All registrants are asked to 

arrive at the CMS (Central Building) no 

later than 20 minutes before the 

scheduled starting time of each meeting 

session they wish to attend. 

IV. Security Information 

Since this meeting will be held in a 

Federal government building, Federal 

security measures are applicable. As 

noted above, in planning your arrival 

time, we recommend allowing 

additional time to clear security. All 

vehicles will be inspected inside and 

out at the entrance to the grounds. In 

order to gain access to the building, 

participants must bring a governmentissued photo identification (driver’s 

license, passport, etc.) and a copy of 

your registration information for the 

meeting. Access may be denied to 

persons without proper identification. 

All persons entering the building 

must pass through a metal detector. In 

addition, all items brought to CMS, 

whether personal or for the purpose of 

demonstration or to support a 

presentation, are subject to inspection. 

We cannot assume responsibility for 

coordinating the receipt, transfer, 

transport, storage, set-up, safety, or 

timely arrival of any personal 

belongings or items used for 

demonstration or to support a 

presentation. 

Authority: Section 945 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA). 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: September 13, 2005. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 05–18925 Filed 9–22–05; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3159–N] 

Medicare Program; Meeting of the 

Medicare Coverage Advisory 

Committee—November 29, 2005 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces a 

public meeting of the Medicare 

Coverage Advisory Committee (MCAC). 

The Committee provides advice and 

recommendations about whether 

scientific evidence is adequate to 

determine whether certain medical 

items and services are reasonable and 

necessary under the Medicare statute. 

This meeting concerns the treatments 

for age-related macular degeneration. 

Notice of this meeting is given under the 

Federal Advisory Committee Act (5 

U.S.C. App. 2, section 10(a)). 

DATES: The public meeting will be held 

on Tuesday, November 29, 2005 from 

7:30 a.m. until 4:30 p.m. e.s.t. 

Deadlines: Deadline for Presentations 

and Comments: Written comments and 

presentations must be received by 

October 31, 2005, 5 p.m., e.s.t. 

Deadline for Registration to Attend 

Meeting: For security reasons, 

individuals wishing to attend this 

meeting must register by close of 

business on November 22, 2005. 

Special Accommodations: Persons 

attending the meeting who are hearing 

or visually impaired, or have a 

condition that requires special 

assistance or accommodations, are 

asked to notify the Executive Secretary 

by November 22, 2005 (see FOR FURTHER

INFORMATION CONTACT). 

ADDRESSES: The meeting will be held in 

the main auditorium of the Centers for 

Medicare & Medicaid Services, 7500 

Security Blvd., Baltimore, MD 21244. 

FOR FURTHER INFORMATION CONTACT: 

Michelle Atkinson, Executive Secretary, 

by telephone at 410–786–2881 or by 

e-mail at 

Michelle.Atkinson@cms.hhs.gov. 

Web Site: You may access up-to-date 

information on this meeting at http:// 

www.cms.hhs.gov/mcac/ 

default.asp#meetings. 

Presentations And Comments: 

Interested persons can present data, 

information, or views orally or in 

writing on issues pending before the 

Committee. Please submit written 

comments to Michelle Atkinson, by 

e-mail at 

Michelle.Atkinson@cms.hhs.gov, or by 

mail to the Executive Secretary for 

MCAC, Coverage and Analysis Group, 

Office of Clinical Standards and 

Quality, Centers for Medicare & 

Medicaid Services, 7500 Security 

Boulevard, Mail Stop C1–09–06, 

Baltimore, MD 21244. 

SUPPLEMENTARY INFORMATION: 

I. Background 

On December 14, 1998, we published 

a notice in the Federal Register (63 FR 

68780) to describe the Medicare