Federal Register / Vol. 72, No. 193 / Friday, October 5, 2007 / Notices 57035 

burden; (3) ways to enhance the quality, 

utility, and clarity of the information to 

be collected; and (4) the use of 

automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 

1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Recognition of 

pass-through payment for additional 

(new) categories of devices under the 

Outpatient Prospective Payment System 

and Supporting Regulations in 42 CFR, 

Part 4 19; Use: Section 20 1 (b) of the 

Balanced Budget Act of 1999 amended 

section 1833(t) of the Social Security 

Act (the Act) by adding new section 

1833(t)(6). This provision requires the 

Secretary to make additional payments 

to hospitals for a period of 2 to 3 years 

for certain drugs, radiopharmaceuticals, 

biological agents, medical devices and 

brachytherapy devices. Section 

1833(t)(6)(A)(iv) establishes the criteria 

for determining the application of this 

provision to new items. Section 

1833(t)(6)(C)(ii) provides that the 

additional payment for medical devices 

be the amount by which the hospital’s 

charges for the device, adjusted to cost, 

exceed the portion of the otherwise 

applicable hospital outpatient 

department fee schedule amount 

determined by the Secretary to be 

associated with the device. Section 402 

of the Benefits Improvement and 

Protection Act of 2000 made changes to 

the transitional pass-through provision 

for medical devices. The most 

significant change is the required use of 

categories as the basis for determining 

transitional pass-through eligibility for 

medical devices, through the addition of 

section 1833(t)(6)(B) of the Act. 

Interested parties such as hospitals, 

device manufacturers, pharmaceutical 

companies, and physicians apply for 

transitional pass-through payment for 

certain items used with services covered 

in the outpatient prospective payment 

system. After CMS receives all 

requested information, CMS will 

evaluate the information to determine if 

the creation of an additional category of 

medical devices for transitional passthrough payments is justified. Form 

Number: CMS–10052 (OMB#: 0938–

0857); Frequency: Reporting: Yearly; 

Affected Public: Business or other forprofit; Number of Respondents: 10; 

Total Annual Responses: 10; Total 

Annual Hours: 160. 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Hospice Cost 

and Data Report and supporting 

regulations 42 CFR 413.20 and 42 CFR 

413.24; Use: In accordance with sections 

1815(a), 1833(e), 1861(v)(A)(ii) and 1881 

(b)(2)(B) of the Social Security Act, 

providers of services in the Medicare 

program are required to submit annual 

information to receive reimbursement 

for health care services provided to 

Medicare beneficiaries. In addition, 42 

CFR 413.20(b) requires that cost reports 

be filed with the provider’s fiscal 

intermediary/Medicare Administrative 

Contractor (FI/MAC). The functions of 

the FI/MAC are described in section 

1816 of the Social Security Act. The 

Center for Medicare and Medicaid 

Services will use the information from 

providers for rate evaluations for the 

Prospective Payment System. Form 

Number: CMS–R–249 (OMB#: 0938–

0758); Frequency: Reporting: Yearly; 

Affected Public: Business or other forprofit; Number of Respondents: 1938; 

Total Annual Responses: 1938; Total 

Annual Hours: 341,088. 

3. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Physicians’

Referrals to Health Care Entities With 

Which They Have Financial 

Relationships and Supporting 

Regulations in 42 CFR, Sections 411.352 

through 411.361; Use: The collection of 

information contained in 42 CFR 

sections 411.352(d), 411.354(d), 

411.355(e), 411.357(a), (b), (d), (e), (h), 

(l), (p), and (s), and 411.361 is necessary 

to allow CMS to implement section 

1877 of the Social Security Act. This 

collection has been revised to eliminate 

the requirement in section 411.357(s) to 

notify insurance companies that an 

entity has a professional courtesy 

policy. CMS issued these regulations to 

comply with the provisions of section 

1877 of the Social Security Act that 

prohibit a physician from referring a 

patient to an entity for a designated 

health service for which Medicare might 

otherwise pay, if the physician or an 

immediate family member has a 

financial relationship with the entity, 

unless an exception applies. Form 

Number: CMS–10047 (OMB#: 0938–

0846); Frequency: Yearly; Affected 

Public: Business or other for-profit and 

Not-for-profit institutions; Number of 

Respondents: 154,404 Total Annual 

Responses: 154,404; Total Annual 

Hours: 116,035. 

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. 

To be assured consideration, 

comments and recommendations for the 

proposed information collections must 

be received by the OMB desk officer at 

the address below, no later than 5 p.m. 

on November 5, 2007. 

OMB Human Resources and Housing 

Branch, Attention: Carolyn Lovett, 

New Executive Office Building, Room 

10235, Washington, DC 20503, Fax 

Number: (202) 395–6974. 

Dated: September 27, 2007. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E7–19506 Filed 10–4–07; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8032–N] 

RIN 0938–AO61 

Medicare Program; Inpatient Hospital 

Deductible and Hospital and Extended 

Care Services Coinsurance Amounts 

for Calendar Year 2008 

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) 2008 

under Medicare’s Hospital Insurance 

program (Medicare Part A). The 

Medicare statute specifies the formulae 

used to determine these amounts. 

For CY 2008, the inpatient hospital 

deductible will be $1024. The daily 

coinsurance amounts for CY 2008 will 

be: (a) $256 for the 61st through 90th 

day of hospitalization in a benefit 

period; (b) $512 for lifetime reserve 

days; and (c) $128 for the 21st through 

100th day of extended care services in 

a skilled nursing facility in a benefit 

period. 

DATES: Effective Date: This notice is 

effective on January 1, 2008. 

FOR FURTHER INFORMATION CONTACT: 

Clare McFarland, (410) 786–6390. For 

case-mix analysis: Gregory J. Savord, 

(410) 786–1521. 

SUPPLEMENTARY INFORMATION: 


yshivers on PROD1PC62 with NOTICES
57036 Federal Register / Vol. 72, No. 193 / Friday, October 5, 2007 / Notices 

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 CY. 

II. Computing the Inpatient Hospital 

Deductible for CY 2008 

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, 

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 CY, 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 2008 

for inpatient hospitals paid under the 

prospective payment system is the 

market basket percentage increase. 

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

Act, 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 2.0 percentage 

points. We are estimating that after 

including the impact of those hospitals 

receiving the lower update in the 

payment-weighted average update, the 

calculated deductible will remain the 

same. 

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

Act, the percentage increase used to 

update the payment rates for FY 2008 

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 2008 is 3.3 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 2008 Rates’’ 72 FR 47130. 

Therefore, the percentage increase for 

hospitals paid under the prospective 

payment system is 3.3 percent. The 

average payment percentage increase for 

hospitals excluded from the prospective 

payment system is 3.3 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 2008 is 3.3 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 2007 compared to FY 2006. (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 2007. These bills represent a total 

of about 8.9 million Medicare 

discharges for FY 2007 and provide the 

most recent case-mix data available at 

this time. Based on these bills, the 

change in average case-mix in FY 2007 

is ¥0.48 percent. Based on these bills 

and past experience, we estimate that 

the change in real case-mix for FY 2007 

will be 0 percent. 

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. 

Thus, the estimate of the paymentweighted average of the applicable 

percentage increases used for updating 

the payment rates is 3.3 percent, and the 

real case-mix adjustment factor for the 

deductible is 0 percent. Therefore, 

under the statutory formula, the 

inpatient hospital deductible for 

services furnished in CY 2008 is $1024. 

This deductible amount is determined 

by multiplying $992 (the inpatient 

hospital deductible for CY 2007) by the 

payment-weighted average increase in 

the payment rates of 1.033 multiplied by 

the increase in real case-mix of 1.00, 

which equals $1024.74 and is rounded 

to $1024. 

III. Computing the Inpatient Hospital 

and Extended Care Services 

Coinsurance Amounts for CY 2008 

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. 

Thus, the increase in the deductible 

generates increases in the coinsurance 

amounts. For inpatient hospital and 

extended care services furnished in CY 

2008, 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 $256 (one-fourth of the 

inpatient hospital deductible); the daily 

coinsurance for lifetime reserve days 

will be $512 (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 $128 (one-eighth of the 

inpatient hospital deductible). 

IV. Cost to Medicare Beneficiaries 

Table 1 summarizes the deductible 

and coinsurance amounts for CYs 2007 

and 2008, as well as the number of each 

that is estimated to be paid. 

TABLE 1.—PART A DEDUCTIBLE AND COINSURANCE AMOUNTS FOR CALENDAR YEARS 2007 AND 2008 

Type of cost sharing 

Value Number paid 

(in millions) 

2007 2008 2007 2008 

Inpatient hospital deductible ............................................................................ $992 $1,024 8.57 8.81 

Daily coinsurance for 61st–90th Day ............................................................... 248 256 2.23 2.30 

Daily coinsurance for lifetime reserve days ..................................................... 496 512 1.01 1.04 

SNF coinsurance ............................................................................................. 124 128 39.42 40.40


yshivers on PROD1PC62 with NOTICES
Federal Register / Vol. 72, No. 193 / Friday, October 5, 2007 / Notices 57037 

The estimated total increase in costs 

to beneficiaries is about $870 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 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 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 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). 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 $870 

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 $6.5 

million to $31.5 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 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 expenditures in 

any 1 year by State, local, or tribal 

governments, in the aggregate, or by the 

private sector, of $120 million. This 

notice has no consequential effect on 

State, local, or tribal governments or on 

the private sector. However, States are 

required to pay the premiums 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. 

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 26, 2007. 

Kerry Weems, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: September 26 2007. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. 07–4911 Filed 10–1–07; 11:18 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8031–N] 

RIN 0938–AO62 

Medicare Program; Part A Premium for 

Calendar Year 2008 for the Uninsured 

Aged and for Certain Disabled 

Individuals Who Have Exhausted Other 

Entitlement 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This annual notice announces 

Medicare’s Hospital Insurance (Part A) 

premium for uninsured enrollees in 

calendar year (CY) 2008. This premium 

is to be paid by enrollees age 65 and 

over who are not otherwise eligible for 

benefits under Medicare Part A 

(hereafter known as the ‘‘uninsured 

aged’’) and by certain disabled 

individuals who have exhausted other 

entitlement. The monthly Part A 

premium for the 12 months beginning 

January 1, 2008 for these individuals 

will be $423. The reduced premium for 


yshivers on PROD1PC62 with NOTICES