Federal Register / Vol. 70, No. 184 / Friday, September 23, 2005 / Notices 55885 

Medicare Provider #230019 

Saint Joseph Medical Center 

Creighton University Medical Center 

601 North 30th Street 

Omaha, NE 68131–2197 

Medicare Provider #280030 

Shasta Regional Medical Center 

1100 Butte Street 

Redding, CA 96001 

Medicare Provider #050733 

South Jersey Healthcare 

1505 West Sherman Avenue 

Vineland, NJ 08360 

Medicare Provider #310032 

St. Joseph’s Hospital 

69 West Exchange Street 

St. Paul, MN 55102 

Medicare Provider #240063 

St. Mary’s Hospital 

1601 West St. Mary’s Road 

Tucson, AZ 85745 

Medicare Provider #030010 

Trident Medical Center 

9330 Medical Plaza Drive 

Charleston, SC 29406 

Medicare Provider #420079 

University of Iowa Hospitals and Clinics 

Neurointerventional Radiology 

Department of Radiology 

200 Hawkins Drive 

Iowa City, IA 52242 

Medicare Provider #160058 

Venice Regional Medical Center 

540 The Rialto 

Venice, FL 34285 

Medicare Provider #100070 

Virginia Mason Medical Center 

1100 Ninth Avenue 

P.O. Box 98111 

Seattle, WA 98111 

Medicare Provider #500005 

WellStar Cobb Hospital 

805 Sandy Plains Road 

Marietta, GA 30060 

Medicare Provider #110143 

WellStar Kennestone Hospital 

805 Sandy Plains Road 

Marietta, GA 30060 

Medicare Provider #110035 

June 29, 2005 

Arkansas Heart Hospital 

1701 S. Shackleford Road 

Little Rock, AR 72211 

Medicare Provider #040134 

Baptist Healthcare of Oklahoma, Inc. 

d/b/a INTEGRIS Bass Baptist Health Center 

600 S. Monroe 

P.O. Box 3168 

Enid, OK 73702 

Medicare Provider #370016 

Boca Raton Community Hospital 

800 Meadows Road 

Boca Raton, FL 33486 

Medicare Provider #100168 

Carolinas Medical Center 

1000 Blythe Blvd 

Charlotte, NC 28203 

Medicare Provider #340113 

Decatur Memorial Hospital 

2300 North Edward Street 

Decatur, IL 62526 

Medicare Provider #140135 

Doctors Community Hospital 

8118 Good Luck Road 

Lanham, MD 20706–3586 

Medicare Provider #210051 

Duke University Medical Center 

Department of Radiology 

P.O. Box 3808 

Durham, NC 27710 

Medicare Provider #340030 

Heartland Health 

5325 Faraon Street 

St. Joseph, MO 64506–3398 

Medicare Provider #260006 

INTEGRIS Baptist Medical Center, Inc. 

3300 Northwest Expressway 

Oklahoma City, OK 73112 

Medicare Provider #370028 

Lehigh Valley Hospital 

Muhlenberg Campus 

2545 Schoenersville Road 

Bethlehem, PA 18017 

Medicare Provider #390263 

McLaren Regional Medical Center 

401 South Ballenger Highway 

Flint, MI 48532–3685 

Medicare Provider #230141 

Mountain States Health Alliance 

400 North State of Franklin Road 

Johnson City, TN 37604–6094 

Medicare Provider #440063 

New York University Medical Center 

550 First Avenue, HCC–15 

New York, NY 10016–6481 

Medicare Provider #330214 

Overlook Hospital 

99 Beauvoir Avenue 

P.O. Box 220 

Summit, NJ 07802–0220 

Medicare Provider #310051 

Saint Marys Hospital 

1216 Second Street S.W. 

Rochester, MN 55902 

Medicare Provider #240010 

Sarasota Memorial Hospital 

1700 S. Tamiami Trail 

Sarasota, FL 34239 

Medicare Provider #100087 

Shands Hospital at the University of Florida 

P.O. Box 100326 

Gainesville, FL 32610–0326 

Medicare Provider #100113 

Sisters of Charity Hospital 

2157 Main Street 

Buffalo, NY 14214 

Medicare Provider #330078 

St. Luke’s Hospital 

4202 Belfort Road 

Jacksonville, FL 32216–5898 

Medicare Provider #100151 

University Medical Center 

602 Indiana Avenue 

Lubbock, TX 79415 

Medicare Provider #450686 

Vanderbilt University Medical Center 

D–3300 Medical Center North 

Nashville, TN 37232–2104 

Medicare Provider #440039 

West Virginia University Hospitals, Inc. 

Medical Center Drive 

P.O. Box 8059 

Morgantown, WV 36506 

Medicare Provider #510001 

[FR Doc. 05–18926 Filed 9–22–05; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8026–N] 

RIN 0938–AO00 

Medicare Program; Inpatient Hospital 

Deductible and Hospital and Extended 

Care Services Coinsurance Amounts 

for Calendar Year 2006 

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) 2006 

under Medicare’s Hospital Insurance 

program (Medicare Part A). The 

Medicare statute specifies the formulae 

used to determine these amounts. 

For CY 2006, the inpatient hospital 

deductible will be $952. The daily 

coinsurance amounts for CY 2006 will 

be: (a) $238 for the 61st through 90th 

day of hospitalization in a benefit 

period; (b) $476 for lifetime reserve 

days; and (c) $119.00 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, 2006. 

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 

55886 Federal Register / Vol. 70, No. 184 / Friday, September 23, 2005 / Notices 

furnished in the following calendar 

year. 

II. Computing the Inpatient Hospital 

Deductible for CY 2006 

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 (FY) 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 

(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, the percentage increase used to 

update the payment rates for FY 2006 

for inpatient hospitals paid under the 

prospective payment system is the 

market basket percentage increase. 

Under section 501 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003, hospitals 

will receive the full market basket 

update only if they submit quality data 

as specified by the Secretary. Those 

hospitals that do not submit data will 

receive an update of market basket 

minus .4 percentage points. In 

determining the payment-weighted 

average of the updates to payment rates 

to hospitals in FY 2006, we are 

estimating that the payment to hospitals 

not submitting quality data will be 

insignificant. 

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

Act, the percentage increase used to 

update the payment rates for FY 2006 

for hospitals excluded from the 

prospective payment system is the 

market basket percentage increase, 

defined according to section 

1886(b)(3)(B)(iii) of the Act. 

The market basket percentage increase 

for 2006 is 3.7 percent, as announced in 

the final rule published in the Federal 

Register entitled ‘‘Medicare Program; 

Changes to the Hospital Inpatient 

Prospective Payment Systems and Fiscal 

Year 2006 Rates’’ (70 FR 47278). 

Therefore, the percentage increase for 

hospitals paid under the prospective 

payment system is 3.7 percent. The 

average payment percentage increase for 

hospitals excluded from the prospective 

payment system is 3.8 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 2006 is 3.7 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 casemix for hospitals paid under the 

Medicare prospective payment system 

in FY 2005 compared to FY 2004. (We 

excluded from this calculation hospitals 

excluded from the prospective payment 

system because their payments are 

based on reasonable costs.) We used 

Medicare bills from prospective 

payment hospitals that we received as of 

July 2005. These bills represent a total 

of about 9.5 million Medicare 

discharges for FY 2005 and provide the 

most recent case-mix data available at 

this time. Based on these bills, the 

change in average case-mix in FY 2005 

is 0.15 percent. Based on past 

experience, we expect the overall casemix change to be 0.45 percent as the 

year progresses and more FY 2005 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 for FY 2005 is .45 percent. 

Thus, the estimate of the paymentweighted average of the applicable 

percentage increases used for updating 

the payment rates is 3.7 percent, and the 

real case-mix adjustment factor for the 

deductible is .45 percent. Therefore, 

under the statutory formula, the 

inpatient hospital deductible for 

services furnished in CY 2006 is $952. 

This deductible amount is determined 

by multiplying $912 (the inpatient 

hospital deductible for CY 2005 by the 

payment-weighted average increase in 

the payment rates of 1.037 multiplied by 

the increase in real case-mix of 1.0045, 

which equals $950 and is rounded to 

$952. 

III. Computing the Inpatient Hospital 

and Extended Care Services 

Coinsurance Amounts for 2006 

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 CY 2006, 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 $238 (onefourth of the inpatient hospital 

deductible); the daily coinsurance for 

lifetime reserve days will be $476 (onehalf 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 $119.00 (one-eighth of the inpatient 

hospital deductible). 

IV. Cost to Medicare Beneficiaries 

Table 1 summarizes the deductible 

and coinsurance amounts for CYs 2005 

and 2006, as well as the number of each 

that is estimated to be paid. 

TABLE 1.—PART A DEDUCTIBLE AND COINSURANCE AMOUNTS FOR CALENDAR YEARS 2005 AND 2006 

Type of cost sharing 

Value Number paid 

(in millions) 

2005 2006 2005 2006 

Inpatient hospital deductible ............................................................................................ $912 $952 8.91 8.70 

Daily coinsurance for 61st-90th Day ............................................................................... 228 238 2.28 2.23 

Daily coinsurance for lifetime reserve days .................................................................... 456 476 1.06 1.04 

SNF coinsurance ............................................................................................................. 114.00 119.00 32.84 31.92 

The estimated total increase in costs 

to beneficiaries is about $230 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 

Federal Register / Vol. 70, No. 184 / Friday, September 23, 2005 / Notices 55887 

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 (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 those 

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 (September 1993, Regulatory 

Planning and Review), the Regulatory 

Flexibility Act (RFA) (September 19, 

1980, Pub. L. 96–354), section 1102(b) of 

the Act, the Unfunded Mandates Reform 

Act of 1995 (Pub. L. 104–4), and 

Executive Order 13132. 

Executive Order 12866, which merely 

reassigns responsibility of duties) 

directs 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). As stated in Section IV of this 

notice, we estimate that the total 

increase in costs to beneficiaries 

associated with this notice is about $230 

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. 

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 

government agencies. Most hospitals 

and most other providers and suppliers 

are small entities, either by nonprofit 

status or by having revenues of $6 

million to $29 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 for the RFA. 

In addition, section 1102(b) of the 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 and has 

fewer than 100 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. 

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 or on 

the private sector. 

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 has no consequential effect 

on State or local governments. 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was reviewed by the Office of 

Management and Budget. 

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 12, 2005. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Dated: September 15, 2005. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. 05–18838 Filed 9–16–05; 4:00 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1307–GNC] 

RIN 0938–ZA74 

Medicare Program; Criteria and 

Standards for Evaluating Intermediary, 

Carrier, and Durable Medical 

Equipment, Prosthetics, Orthotics, and 

Supplies (DMEPOS) Regional Carrier 

Performance During Fiscal Year 2006 

AGENCY: Centers for Medicare and 

Medicaid Services (CMS), Health and 

Human Services (HHS). 

ACTION: General notice with comment 

period. 

SUMMARY: This notice describes the 

criteria and standards to be used for 

evaluating the performance of fiscal 

intermediaries (FIs), carriers, and 

Durable Medical Equipment, 

Prosthetics, Orthotics, and Supplies 

(DMEPOS) regional carriers in the 

administration of the Medicare program 

beginning on the first day of the first 

month following publication of this 

notice in the Federal Register. The 

results of these evaluations are 

considered whenever we enter into, 

renew, or terminate an intermediary 

agreement, carrier contract, or DMEPOS 

regional carrier contract or take other 

contract actions, for example, assigning 

or reassigning providers or services to 

an intermediary or designating regional 

or national intermediaries. We are 

requesting public comment on these 

criteria and standards. 

DATES: Effective Date: The criteria and 

standards are effective on October 24, 

2005. 

Comment Date: To be assured 

consideration, comments must be 

received at one of the addresses