Revisit User Fee Program for Medicare Survey and Certification Activities, 61540-61545 [07-5400]
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Federal Register / Vol. 72, No. 210 / Wednesday, October 31, 2007 / Rules and Regulations
Authority: 5 U.S.C. 5707; 31 U.S.C. 3726;
40 U.S.C. 121(c).
§ 301–72.203
(g) § 301–73.105, two times;
(h) § 301–73.106, section heading; and
(i) Note to § 301–73.106, three times.
[Amended]
I
45. Amend § 301–72.203 by adding a
comma after ‘‘e.g.’’, in two places.
PART 301–75—PRE-EMPLOYMENT
INTERVIEW TRAVEL
PART 301–73—TRAVEL PROGRAMS
I
46. The authority citation for 41 CFR
part 301–73 continues to read as
follows:
I
Authority: 5 U.S.C. 5707; 40 U.S.C. 121(c).
§ 301–73.1
[Amended]
[Amended]
48. Amend § 301–73.2(c), by removing
the words ‘‘eTravel Program
Management Office’’ and add ‘‘E-Gov
Travel Program Management Office’’, in
its place.
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[Amended]
49. Amend § 301–73.104(a)(1), by
removing the words ‘‘Travel
Management System’’ and add ‘‘Travel
Management Service’’, in its place.
I
§ 301–73.106
[Amended]
50. Amend § 301–73.106 by—
a. Removing in paragraph (a)(2), the
words ‘‘Federal Premier Lodging
Program’’ and add ‘‘FedRooms’’, in its
place.; and
I b. Removing in paragraph (a)(3), the
words ‘‘Military Traffic Management
Command (MTMC)’’ and adding
‘‘Surface Deployment and Distribution
Command (SDDC)’’ in its place.
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§§ 301–73.1 through 301–73.106
[Amended]
51. In addition to the amendments set
forth above, in 41 CFR part 301–73
remove the words ‘‘eTravel Service’’
and add, in their place, the words ‘‘EGov Travel Service’’ in the following
places:
(a) Note to § 301–73.1;
(b) § 301–73.100, section heading;
(c) § 301–73.103, section heading;
(d) § 301–73.104, section heading; and
(e) § 301–73.105, section heading.
I 52. In addition to the amendments set
forth above, in 41 CFR part 301–73
remove the word ‘‘eTS’’ and add, in
their place, the word ‘‘ETS’’ in the
following places:
(a) Note to § 301–73.1;
(b) § 301–73.2(a); (b), two times; (c);
(d); (e);
(c) § 301–73.100, five times;
(d) Note to § 301–73.100, five times;
(e) § 301–73.103;
(f) § 301–73.104(a); (a)(1), two times;
(a)(2); (a)(3); (a)(4);
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§ 301–75.4
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NARA: National Archives and Records
Administration
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NTE: Not to Exceed
OBE: Online Self-service Booking Tool
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[Amended]
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MARS: Military Affiliate Radio System
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54. Amend § 301–75.4, paragraph (f),
by removing ‘‘18 U.S.C. 287 and 1001.’’
and adding ‘‘(See 18 U.S.C. 287 and
1001).’’ in its place.
47. Amend § 301–73.1(d), by
removing the words ‘‘Federal Premier
Lodging Program (FPLP)’’ and add
‘‘FedRooms’’, in its place.
§ 301–73.104
*
Authority: 5 U.S.C. 5707.
PBP&E: Professional Books, Papers, and
Equipment
PART 301–76—COLLECTION OF
UNDISPUTED DELINQUENT AMOUNTS
OWED TO THE CONTRACTOR
ISSUING THE INDIVIDUALLY BILLED
TRAVEL CHARGE CARD
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55. The authority citation for 41 CFR
part 301–76 is revised to read as
follows:
*
Authority: 5 U.S.C. 5707; 40 U.S.C. 121(c);
Sec. 2, Pub. L. 105–264, 112 Stat. 2350 (5
U.S.C. 5701 note).
*
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§ 301–73.2
53. The authority citation for 41 CFR
part 301–75 continues to read as
follows:
ISSA: Inter-service Support Agreement(s)
ITRA: Income Tax Reimbursement
Allowance
I
56. Amend Appendix B to Chapter
301 by revising the introductory
paragraph to read as follows:
Appendix B to Chapter 301—
Allocation of M&IE Rates To Be Used in
Making Deductions From the M&IE
Allowance
I
Deductions to M&IE rates for localities in
both nonforeign areas and foreign areas shall
be allocated as shown in this table. For
information as to where to access per diem
rates for various types of Government travel,
please consult the table in § 301–11.6.
*
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I 57. Amend Appendix D to Chapter
301 by removing the acronym ‘‘GEBAT’’
and alphabetically adding or changing
the following acronyms to read as
follows:
Appendix D to Chapter 301—Glossary
of Acronyms
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CAS: Commercial Aviation Service(s)
CDW: Collision Damage Waiver
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CTO: Commercial Ticket Office
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ETS: E-Gov Travel Service(s)
FAA: Federal Aviation Administration
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FECA: Federal Employees’ Compensation
Act
Fedrooms: Enhanced Federal Premier
Lodging Program (formally known as FPLP)
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FICA: Federal Insurance Contribution Act
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HHG: Household Goods
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PMO: E-Gov Travel Program Management
Office
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SDDC: Surface Deployment and
Distribution Command
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SIT: Storage in Transit
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TMS: Travel Management Service
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U.S.: United States
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[FR Doc. E7–21254 Filed 10–30–07; 8:45 am]
BILLING CODE 6820–14–S
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 488
[CMS–2278–IFC]
RIN 0938–AP22
Revisit User Fee Program for Medicare
Survey and Certification Activities
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Interim final rule with comment
period.
AGENCY:
SUMMARY: This interim final rule with
comment period implements the
continuation of the revisit user fee
program for Medicare Survey and
Certification activities, in accordance
with the statutory authority in the
Continuing Appropriations Resolution
(‘‘Continuing Resolution’’) budget
legislation passed by the Congress and
signed by the President on September
29, 2007. On September 19, 2007, we
published a final rule that established a
system of revisit user fees applicable to
health care facilities that have been
cited for deficiencies during initial
certification, recertification or
substantiated complaint surveys and
require a revisit to confirm that
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Federal Register / Vol. 72, No. 210 / Wednesday, October 31, 2007 / Rules and Regulations
corrections to previously-identified
deficiencies have been corrected.
DATES: Effective date: These regulations
are effective October 1, 2007.
Comment date: To be assured
consideration, comments must be
received at one of the addresses
provided below, no later than 5 p.m. on
December 31, 2007.
ADDRESSES: In commenting, please refer
to file code CMS–2278–IFC. Because of
staff and resource limitations, we cannot
accept comments by facsimile (Fax)
transmission.
You may submit comments in one of
four ways (no duplicates, please):
1. Electronically. You may submit
electronic comments on specific issues
in this regulation to https://
www.cms.hhs.gov/eRulemaking. Click
on the link ‘‘Submit electronic
comments on CMS regulations with an
open comment period.’’ (Attachments
should be in Microsoft Word,
WordPerfect, or Excel; however, we
prefer Microsoft Word.)
2. By regular mail. You may mail
written comments (one original and two
copies) to the following address only:
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, Attention: CMS–2278–
IFC, P.O. Box 8010, Baltimore, MD
21244–8016.
Please allow sufficient time for mailed
comments to be received before the
close of the comment period.
3. By express or overnight mail. You
may send written comments (one
original and two copies) to the following
address only: Centers for Medicare &
Medicaid Services, Department of
Health and Human Services, Attention:
CMS–2278–IFC, Mail Stop C4–26–05,
7500 Security Boulevard, Baltimore, MD
21244–1850.
4. By hand or courier. If you prefer,
you may deliver (by hand or courier)
your written comments (one original
and two copies) before the close of the
comment period to one of the following
addresses. If you intend to deliver your
comments to the Baltimore address,
please call telephone number (410) 786–
7195 in advance to schedule your
arrival with one of our staff members.
Room 445–G, Hubert H. Humphrey
Building, 200 Independence Avenue,
SW., Washington, DC 20201; or 7500
Security Boulevard, Baltimore, MD
21244–1850.
(Because access to the interior of the
HHH Building is not readily available to
persons without Federal Government
identification, commenters are
encouraged to leave their comments in
the CMS drop slots located in the main
lobby of the building. A stamp-in clock
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is available for persons wishing to retain
a proof of filing by stamping in and
retaining an extra copy of the comments
being filed.)
Comments mailed to the addresses
indicated as appropriate for hand or
courier delivery may be delayed and
received after the comment period.
For information on viewing public
comments, see the beginning of the
SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Kathryn Linstromberg, (410) 786–8279.
SUPPLEMENTARY INFORMATION:
Submitting Comments: As the public
was provided an opportunity to
comment on the substance of the rule
during the comment period prior to the
publication of the September 19, 2007
final rule, and as the substance of the
rule is not changed by this interim final
rule with comment period, we are
accepting comments only to the extent
that they pertain to the applicability of
the new authority for the rule. You can
assist us by referencing the file code
CMS–2278–IFC.
Inspection of Public Comments: All
comments received before the close of
the comment period are available for
viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. We post all comments
received before the close of the
comment period on the following Web
site as soon as possible after they have
been received: https://www.cms.hhs.gov/
eRulemaking. Click on the link
‘‘Electronic Comments on CMS
Regulations’’ on that Web site to view
public comments.
Comments received timely will be
also available for public inspection as
they are received, generally beginning
approximately three weeks after
publication of a document, at the
headquarters of the Centers for Medicare
& Medicaid Services, 7500 Security
Boulevard, Baltimore, Maryland 21244,
Monday through Friday of each week
from 8:30 a.m. to 4 p.m. To schedule an
appointment to view public comments,
phone 1–800–743–3951.
SUPPLEMENTARY INFORMATION:
I. Background
In the June 29, 2007 Federal Register
(72 FR 35673), we published the
proposed rule entitled, ‘‘Establishment
of Revisit User Fee Program for
Medicare Survey and Certification
Activities’’ and provided for a 60-day
comment period. In the September 19,
2007 Federal Register (72 FR 53628) we
published the Revisit User Fee Program
final rule. That final rule set forth final
requirements and a final fee schedule
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61541
for providers and suppliers who require
a revisit survey as a result of
deficiencies cited during an initial
certification, recertification, or
substantiated complaint survey.
The Centers for Medicare & Medicaid
Services (CMS) has in place an
outcome-oriented survey process that is
designed to determine whether existing
Medicare-certified providers and
suppliers or providers and suppliers
seeking initial Medicare certification are
actually meeting statutory and
regulatory requirements, conditions of
participation, or conditions for
coverage. These health and safety
requirements apply to the environments
of care and the delivery of services to
residents or patients served by these
facilities and agencies. The Secretary of
the Department of Health and Human
Services (HHS) has designated CMS to
enforce the conditions of participation/
coverage and other requirements of the
Medicare program. The revisit user fee
will be assessed for revisits conducted
in order to determine whether
deficiencies cited as a result of failing to
satisfy federal quality of care
requirements have been corrected.
Pursuant to the requirements of the
Continuing Appropriations Resolution
budget bill for fiscal year (FY) 2007,
which was passed by the Congress and
signed by the President, we were
directed by the Secretary to implement
the revisit user fees for FY 2007 for
certain providers and suppliers for
which a revisit was required to confirm
that previously-identified failures to
meet federal quality of care
requirements had been remedied. The
fees recover the costs associated with
the Medicare Survey and Certification
program’s revisit surveys. The primary
purpose for implementing the revisit
user fees is to ensure the continuance of
CMS Survey and Certification quality
assurance functions that improve
patient care and safety. The fees became
effective upon publication September
19, 2007, when the final rule was
published.
II. Provisions of the Interim Final Rule
The current Continuing Resolution
(Pub. L. 110–92, H. J. Res. 52 §§ 101 &
106(2007)) authorizes HHS to continue
the revisit user fees until November 16,
2007, as follows:
* * *
Sec. 101. Such amounts as may be
necessary, at a rate for operations as provided
in the applicable appropriations Acts for
fiscal year 2007 and under the authority and
conditions provided in such Acts, for
continuing projects or activities (including
the costs of direct loans and loan guarantees)
that are not otherwise specifically provided
for in this joint resolution, that were
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conducted in fiscal year 2007, and for which
appropriations, funds, or other authority
were made available in the following
appropriations Acts:
* * *
(3) The Continuing Appropriations
Resolution, 2007 (division B of Public Law
109–289, as amended by Pub. L. 110–5). (H.J.
Res. 20, § 101(2007)).
Sec. 106. Unless otherwise provided for in
this joint resolution or in the applicable
appropriations Act for fiscal year 2008,
appropriations and funds made available and
authority granted pursuant to this joint
resolution shall be available until whichever
of the following first occurs:
* * *
(3) November 16, 2007.
As directed by the Secretary, in the
September 19, 2007 Federal Register (72
FR 53628), we established revisit user
fees for revisit surveys and put forth in
regulation the definitions, criteria for
determining the fee, the fee schedule,
collection of fees, reconsideration
process for revisit user fees,
enforcement and regulatory language
addressing enrollment and billing
privileges, and provider agreements. In
the September 19, 2007 final rule, cost
projections were based on FY 2006
actual data and were expected to
amount to $37.3 million on an annual
basis for FY 2007. These calculations
were included in section IV of the final
rule (72 FR 53642).
We stated in the final rule that, ‘‘if
authority for the revisit user fee is
continued, we will use the current fee
schedule in [the final rule] for the
assessment of such fees until such time
as a new fee schedule notice is proposed
and published in final form.’’ (72 FR
53628). The current Continuing
Resolution continues the authority of
the FY 2007 Continuing Resolution from
October 1, 2007 through November 16,
2007. Accordingly, the revisit fees will
continue to be assessed for the entire
time period authorized by the current
Continuing Resolution.
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III. Response to Comments
Because of the large number of public
comments we normally receive on
Federal Register documents, 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 preamble, and, when we proceed
with a subsequent document, we will
respond to the comments in the
preamble to that document.
IV. Waiver of Proposed Rulemaking
and Delay in Effective Date
We ordinarily publish a notice of
proposed rulemaking in the Federal
Register and invite public comment on
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the proposed rule in accordance with 5
U.S.C. section 553(b) of the
Administrative Procedure Act (APA).
The notice of proposed rulemaking
includes a reference to the legal
authority under which the rule is
proposed, and the terms and substances
of the proposed rule or a description of
the subjects and issues involved. This
procedure can be waived, however, if an
agency finds good cause that a noticeand-comment procedure is
impracticable, unnecessary, or contrary
to the public interest and incorporates a
statement of the finding and its reasons
in the rule issued. We find that the
notice-and-comment procedure is
unnecessary in this circumstance
because providers and suppliers have
already been provided notice and an
opportunity to comment on the
substance of this rule. This interim final
rule with comment merely updates the
Congressional authority under which
the rule operates.
Therefore, we find good cause to
waive the notice of proposed
rulemaking and to issue this final rule
on an interim basis. We are providing a
60-day public comment period.
We ordinarily provide a 30-day delay
in the effective date of the provisions of
a rule in accordance with the
Administrative Procedure Act (APA) 5
U.S.C. 553(d). However, the delay in the
effective date may be waived as, in
pertinent part, ‘‘provided by the agency
for good cause found and published
with the rule’’ 5 U.S.C. 553(d)(3). The
Secretary finds that good cause exists to
waive the 30-day effective date delay.
The good cause exception to the 30
day effective date delay provision of
section 553(d) of the APA is read to be
broader than the good cause exception
to the notice and comment provision of
section 553(b)of the APA.
The legislative history of the APA
indicates that the purpose for deferring
the effectiveness of a rule under section
553(d) was to ‘‘afford persons affected a
reasonable time to prepare for the
effective date of a rule or rules or to take
other action which the issuance may
prompt.’’ S. Rep. No. 752, 79th Cong.,
1st Sess. 15 (1946); H.R. Rep. No. 1980,
79th Cong. 2d Sess. 25 (1946). In this
case, affected parties do not need time
to adjust their behavior before this rule
takes effect. This rule merely updates
the authority under which the revisit fee
is assessed and does not provide any
additional requirements for the affected
parties. Moreover, with or without a
revisit fee, a provider or supplier must
be found to have corrected significant
deficiencies in order to avoid
termination. Additionally, the
application of a fee for the revisit does
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not place appreciable administrative
burdens on the affected providers or
suppliers. We do not expect appreciable
cost to State survey agencies because we
are undertaking the billing and
collection of the revisit user fee.
We identified in the proposed rule the
immediacy of this revisit user fee
program and the limited nature of FY
2007, Continuing Resolution
Appropriation (Pub. L. 110–5).
Specifically, the Continuing Resolution
required us to implement the revisit fee
program in FY 2007. Accordingly,
providers and suppliers have been on
notice for some time that these fees will
be imposed, and do not need additional
time to be prepared to comply with the
requirements of this regulation. We
believe that given the short timeframe
that we have to collect fees before the
statutory authority of the current
Continuing Resolution expires, there is
good cause to waive the 30-day effective
date.
V. 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.
VI. Regulatory Impact Analysis
A. Overall Impact
We have examined the impacts of this
rule 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 Social Security Act, the Unfunded
Mandates Reform Act of 1995 (Pub. L.
104–4), and Executive Order 13132.
Executive Order 12866 (as amended
by Executive Order 13258, 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). A regulatory impact analysis
(RIA) must be prepared for major rules
with economically significant effects
($100 million or more in any one year).
This rule is not a major rule. The
aggregate costs will total approximately
$37.3 million in any one year.
The RFA requires agencies to analyze
options for regulatory relief of small
businesses. For purposes of the RFA,
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small entities include small businesses,
nonprofit organizations, and small
governmental jurisdictions. Individuals
and States are not included in the
definition of a small entity. Small
businesses are small entities, either by
nonprofit status or by having revenues
of $6.5 million to $31.9 million or less
in any one year for purposes of the RFA.
The September 19, 2007 final rule
provided an analysis on the impact of
small entities (72 FR 53642–3). The
analysis published in the final rule
remains valid. Since this interim final
rule with comment merely updates the
Congressional authority under which
the rule operates, we have determined,
and the Secretary certifies, that this rule
will not have a significant impact on
small entities based on the overall effect
on revenues.
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 (superseded by Core
Based Statistical Areas) and has fewer
than 100 beds. This rule affects those
small rural hospitals that have been
cited for a deficiency based on
noncompliance with required
conditions of participation and for
which a revisit is needed to make sure
that the deficiency has been corrected.
We identified in the September 19, 2007
final rule that for the effective period of
that rule that less than 3 percent of all
hospitals may be assessed a revisit user
fee and that less than 1 percent of those
hospitals would be rural hospitals (72
FR 53643). The analysis published in
the final rule remains valid. Since this
interim final rule with comment merely
updates the Congressional authority
under which the rule operates, we
maintain that given the effective period
of this rule, we have determined, and
the Secretary certifies, that this rule will
not have a significant impact on small
rural hospitals.
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 one year of $100 million in 1995
dollars, updated annually for inflation.
That threshold level is currently
approximately $120 million. This
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interim final rule with comment will
have no mandated effect on State, local,
or tribal governments and the impact on
the private sector is estimated to be less
than $120 million and will only affect
those Medicare providers or suppliers
for which a revisit user fee is assessed
based on the need to conduct a revisit
survey to ensure deficient practices that
were cited have been corrected.
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 interim final rule with comment
will not substantially affect State or
local governments. This rule establishes
user fees for providers and suppliers for
which CMS has identified deficient
practices and requires a revisit to assure
that corrections have been made.
Therefore, we have determined that this
interim final rule with comment will
not have a significant effect on the
rights, roles, and responsibilities of
State or local governments.
61543
TABLE A.—FINAL FEE SCHEDULE—
Continued
Facility
HHA ..................
Hospice .............
ASC ..................
RHC ..................
ESRD ................
Fee
assessed
per offsite
revisit
survey
168
168
168
168
168
Fee
assessed
per onsite
revisit
survey
1,613
1,736
1,669
851
1,490
Costs for All Revisit User Fees Assessed
We anticipated that the combined
costs for all providers and suppliers for
all revisit surveys in FY 2007 would
total approximately $37.3 million on an
annual basis, with onsite revisit surveys
amounting to approximately $34.6
million and offsite revisit surveys
totaling approximately $2.7 million (72
FR 53645). However, actual fees
assessed in FY 2007 were much less
than this annual amount, since CMS did
not charge for revisits that occurred
prior to publication of the final
regulation. Since we continue to operate
under these same annual estimates, we
provide here estimates of the impact for
B. Impact on Providers/Suppliers
the period of the current continuing
There is no change on the impact on
resolution as listed below in monthly
providers and suppliers with the
estimates in Tables B and C. For the
publication of this interim final rule
period of the current continuing
with comment. The impact remains as
resolution, we will use the FY 2007 fee
discussed in the final rule (72 FR
schedule established in the final rule for
53643).
the assessment of fees until a new fee
schedule notice is proposed and
Final Fee Schedule for Onsite and
published as final.
Offsite Revisit Surveys
In Table B below, we provide the
The FY 2007 fee schedule published
on September 19, 2007 (72 FR 53647) in projected costs for the period of this
continuing resolution based on the fee
the final rule will be retained. As noted
schedule of the final rule. We expect the
in the final rule, the published fee
schedule will be utilized by CMS for the combined costs for all providers and
suppliers for all onsite revisit surveys
assessment of such fees until such time
as a new fee schedule notice is proposed for the period of this continuing
resolution to total approximately $4.3
and published in final form. The
million. We first multiplied the total
calculations utilized to determine the
fee as identified in the final rule will be number of onsite revisit surveys in one
year by the expected revisit user fees
the same (72 FR 53645–6). We will
assessed per revisits as finalized in
continue to assess a flat fee based on
Table A above, estimated by provider or
provider or supplier type and type of
revisit survey conducted. Table A below supplier, to obtain the annual cost of
revisit surveys. We then divided this
identifies the final fee schedule.
number by 12 to obtain the monthly cost
of onsite revisit surveys and multiplied
TABLE A.—FINAL FEE SCHEDULE
by the effective period of the continuing
resolution (roughly 1.5 months) to
Fee
Fee
obtain the total costs for onsite revisit
assessed
assessed
Facility
per offsite
per onsite
surveys for the period of the continuing
revisit
revisit
resolution. We then totaled all providers
survey
survey
and suppliers to achieve the total costs
SNF & NF .........
$168
$2,072 for all onsite revisit surveys for the
Hospitals ...........
168
2,554 period of this continuing resolution.
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61544
Federal Register / Vol. 72, No. 210 / Wednesday, October 31, 2007 / Rules and Regulations
TABLE B.—ONSITE REVISIT SURVEYS—ESTIMATED MONTHLY COSTS
Monthly number of onsite
revisit surveys
Fee assessed
per onsite revisit surveys
(hrs × $112)
Monthly costs
for onsite revisit surveys*
Total costs for
onsite revisit
surveys for period of CR **
SNF & NF ........................................................................................................
Hospitals ..........................................................................................................
HHA .................................................................................................................
Hospice ............................................................................................................
ASC ..................................................................................................................
RHC .................................................................................................................
ESRD ...............................................................................................................
1,191
48
89
21
8
12
58
$2,072
2,554
1,613
1,736
1,669
851
1,490
$2,467,061
122,379
143,557
37,035
13,213
10,567
86,668
$3,700,592
183,569
215,336
55,552
19,819
15,850
130,003
Total ..........................................................................................................
1,427
........................
2,880,480
4,320,721
Facility
* Monthly costs may differ from the multiple of monthly revisits and fee per revisit due to rounding.
** Monthly costs were multiplied by the effective period of the CR (roughly 1.5 months) Total numbers of onsite revisit surveys were rounded
up based on FY 2006 actual data presented in the final rule.
We expect the combined costs for all
providers and suppliers for all offsite
revisit surveys to total $343,875 for the
period of the current continuing
resolution. In Table C below, we first
estimated by provider or supplier the
number of offsite revisit surveys
expected for an entire fiscal year, and
multiplied this number by the expected
revisit user fee of $168 per offsite revisit
survey to obtain the annual cost of
surveys. We then divided this number
by 12 to obtain the monthly cost of
offsite revisit surveys and multiplied
this number by the effective period of
the continuing resolution (roughly 1.5
months) to obtain the total costs for
offsite revisit surveys for the period of
the continuing resolution.
TABLE C.—OFFSITE REVISIT SURVEYS—ESTIMATED MONTHLY COSTS
Monthly number of offsite
revisit surveys
Fee assessed
per offsite revisit survey
($112 × 1.5
hrs)
Monthly costs
for offsite revisit surveys*
Total costs for
offsite revisit
surveys for period of CR **
SNF & NF ........................................................................................................
Hospitals ..........................................................................................................
HHA .................................................................................................................
Hospice ............................................................................................................
ASC ..................................................................................................................
RHC .................................................................................................................
ESRD ...............................................................................................................
1,262
23
43
4
8
6
19
$168
168
168
168
168
168
168
$211,932
3,892
7,238
714
1,302
938
3,234
$317,898
5,838
10,857
1,071
1,953
1,407
4,851
Total ..........................................................................................................
1,365
........................
229,250
343,875
Facility
* Monthly costs may differ from the multiple of monthly revisits and fee per revisit due to rounding.
** Monthly costs were multiplied by the effective period of the CR (roughly 1.5 months).
As shown in Table D below, we
provide the aggregate costs expected as
projected for the entire FY 2007, as well
as the costs we would expect to offset
for the period of the current continuing
resolution.
TABLE D.—TOTAL COSTS COMBINED FOR ALL REVISITS SURVEYS PER FISCAL YEAR & PERIOD OF CR
FY 2007
Period of CR *
Onsite Revisit Surveys ............................................................................................................................................
Offsite Revisit Surveys ............................................................................................................................................
$34,565,760
2,751,000
$4,320,512
343,980
Total Costs All Revisits ....................................................................................................................................
37,316,760
4,664,492
* CR period’s costs are based on CR period revisit surveys rounded up to the nearest whole number as shown in Table B & C.
mstockstill on PROD1PC66 with RULES
C. Alternatives Considered
CMS considered a number of
alternatives to the Revisit User Fee.
Such alternatives were discussed in the
final rule published on September 19,
2007 (72 FR 53647). We affirm the
continuing validity of that analysis. The
current continuing resolution provides
VerDate Aug<31>2005
16:50 Oct 30, 2007
Jkt 214001
CMS with the authority to continue
projects or activities as was otherwise
provided for in FY 2007, and as such
CMS is required to publish an interim
final rule with comment. This interim
final rule with comment merely updates
the Congressional authority under
which the rule operates.
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In accordance with Executive Order
12866, this rule has been reviewed by
the Office of Management and Budget.
List of Subjects in 42 CFR Part 488
Administrative practice and
procedure, Health facilities, Medicare,
Reporting and recording requirements.
E:\FR\FM\31OCR1.SGM
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Federal Register / Vol. 72, No. 210 / Wednesday, October 31, 2007 / Rules and Regulations
For the reasons set forth in the
preamble, the Centers for Medicare &
Medicaid Services amends 42 CFR
chapter IV, part 488 as set forth below:
I
PART 488—SURVEY, CERTIFICATION,
AND ENFORCEMENT PROCEDURES
1. The authority citation for part 488
is revised to read as follows:
I
Authority: Secs. 1102 and 1871 of the
Social Security Act, unless otherwise noted
(42 U.S.C. 1302 and 1395(hh)); Pub. L. 110–
92, H. J. Res. 52 §§ 101 & 106 (2007).
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program)
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance; and Program No. 93.774,
Medicare—Supplementary Medical
Insurance Program)
Dated: October 11, 2007.
Kerry Weems,
Acting Administrator, Centers for Medicare
& Medicaid Services.
Approved: October 25, 2007.
Michael O. Leavitt,
Secretary.
[FR Doc. 07–5400 Filed 10–26–07; 12:02 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF HOMELAND
SECURITY
Federal Emergency Management
Agency
44 CFR Part 78
[Docket ID FEMA–2007–0003]
RIN 1660–AA00
Flood Mitigation Assistance
Federal Emergency
Management Agency, DHS.
ACTION: Final rule.
mstockstill on PROD1PC66 with RULES
AGENCY:
SUMMARY: The Federal Emergency
Management Agency (FEMA) is
adopting as final, without substantive
change, an interim rule that implements
sections 553 and 554 of the National
Flood Insurance Reform Act of 1994.
Section 553 authorizes a flood
mitigation assistance program through
which FEMA is authorized to provide
grants to States and communities for
planning assistance and for mitigation
projects that reduce the risk of flood
damage to structures covered under
contracts for flood insurance. Section
554 establishes the National Flood
Mitigation Fund to fund assistance
provided under section 553.
DATES: Effective Date: November 30,
2007.
VerDate Aug<31>2005
16:50 Oct 30, 2007
Jkt 214001
FOR FURTHER INFORMATION CONTACT:
Cecelia Rosenberg, Mitigation
Directorate, Federal Emergency
Management Agency, 500 C Street, SW.,
Washington, DC 20472, (phone) 202–
646–3321, (facsimile) 202–646–2719, or
(e-mail) cecelia.rosenberg@dhs.gov.
SUPPLEMENTARY INFORMATION:
I. Background
Sections 553 and 554 of the National
Flood Insurance Reform Act of 1994
(NFIRA) (Pub. L. 103–325, enacted
September 23, 1994) (also known as
Title V of the Riegle Community
Development and Regulatory
Improvement Act of 1994) amended the
National Flood Insurance Act of 1968
(42 U.S.C. 4101 et seq.). Specifically,
section 553 authorized the Director
(now Administrator) of the Federal
Emergency Management Agency
(FEMA) to carry out a flood mitigation
assistance program, known as the Flood
Mitigation Assistance Program (FMA).
Through the FMA Program, FEMA is
authorized to provide grants to States
and communities for planning
assistance and mitigation projects that
reduce the risk of flood damage to
structures covered under contracts for
flood insurance. Section 554 required
FEMA to establish the National Flood
Mitigation Fund (NFMF) to provide
funds for flood mitigation program
assistance described in section 553. On
March 20, 1997 (62 FR 13346), FEMA
published an interim rule implementing
section 553 and 554 of the National
Flood Insurance Reform Act.
This final rule adopts, without
substantive change, the regulations
established by the March 20, 1997
interim rule. It addresses the comments
received from the public in response to
the interim rule, and finalizes the
regulations contained in 44 CFR part 78.
Records Management
The Regulation Identifier Number
(RIN) listed in the March 20, 1997
interim final rule was 3067–AC45. Since
FEMA became a component of the
Department of Homeland Security
(DHS), FEMA’s RINs were renumbered
and 3067–AC45 became 1660–AA00.
II. Discussion of Public Comments
FEMA received seven public
comments on the interim rule. The
seven commenters included five States,
one local government, and one
association. The comments received,
together with FEMA’s responses, are set
forth below.
The Community Rating System. One
commenter wrote that while it is good
that the Community Rating System
(CRS) criterion may be a basis for a
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61545
floodplain management plan, CRS
communities with repetitive loss or
floodplain management plans
developed prior to the publishing of 44
CFR part 78 in March 1997 may not
realize that their plans will require
modification to meet the new criteria of
44 CFR 78.5, and States and regions
should be counseled to closely review
these older plans. The commenter wrote
that the CRS plan reviewer for the
Insurance Services Organization (ISO)
should be consulted before any FEMA
region approves any CRS plans
developed prior to 1997 for the purpose
of receiving FMA project funds unless
the region or State carefully reviews
them to see that they meet FMA criteria.
The commenter wrote that the States
and regions should accept nothing less
than plan adoption by resolution of the
community’s governing board. The
commenter also wanted FEMA not to
accept as evidence of adoption a letter
from the Mayor stating that the
community will follow the plan since
the CRS criterion requires full adoption
by the governing board. The commenter
thought that FMA should be consistent
with the CRS plan adoption process and
require that all local elected officials see
the proposed plan and ratify it.
FEMA’s Response: The CRS program
is a voluntary program that predates
these regulations and creates an
incentive for communities that
participate in the National Flood
Insurance Program (NFIP) to implement
floodplain management practices that
exceed NFIP minimum requirements.
The CRS program, which was
established in 1993, provides credit for
communities in the form of lower flood
insurance premium rates for property
owners. The CRS has been and is
currently operated by FEMA through an
agreement with ISO. The schedule of
creditable activities is described in its
reference guide, the CRS Coordinator’s
Manual available through https://
www.fema.gov/business/nfip/
intnfip.shtm. One of the approved CRS
activities that communities may receive
credit for is to develop a flood
mitigation or repetitive flood loss plan.
FEMA has addressed CRS plans
developed prior to 1997 by coordinating
with CRS staff to ensure that all review
criteria are consistent with FMA and
CRS plans. As a result, FEMA has
accepted CRS plans based on guidance
provided in FEMA Publication No. 299:
The FMA Program Guidance (August
1997), as meeting the requirements of
§ 78.5 as approvable local Flood
Mitigation Plans. Further, ISO continues
to review CRS plans submitted by local
communities against the requirements
of § 78.5 if requested by a local
E:\FR\FM\31OCR1.SGM
31OCR1
]]>Agencies
[Federal Register Volume 72, Number 210 (Wednesday, October 31, 2007)]
[Rules and Regulations]
[Pages 61540-61545]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 07-5400]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 488
[CMS-2278-IFC]
RIN 0938-AP22
Revisit User Fee Program for Medicare Survey and Certification
Activities
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Interim final rule with comment period.
-----------------------------------------------------------------------
SUMMARY: This interim final rule with comment period implements the
continuation of the revisit user fee program for Medicare Survey and
Certification activities, in accordance with the statutory authority in
the Continuing Appropriations Resolution (``Continuing Resolution'')
budget legislation passed by the Congress and signed by the President
on September 29, 2007. On September 19, 2007, we published a final rule
that established a system of revisit user fees applicable to health
care facilities that have been cited for deficiencies during initial
certification, recertification or substantiated complaint surveys and
require a revisit to confirm that
[[Page 61541]]
corrections to previously-identified deficiencies have been corrected.
DATES: Effective date: These regulations are effective October 1, 2007.
Comment date: To be assured consideration, comments must be
received at one of the addresses provided below, no later than 5 p.m.
on December 31, 2007.
ADDRESSES: In commenting, please refer to file code CMS-2278-IFC.
Because of staff and resource limitations, we cannot accept comments by
facsimile (Fax) transmission.
You may submit comments in one of four ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to https://www.cms.hhs.gov/eRulemaking. Click
on the link ``Submit electronic comments on CMS regulations with an
open comment period.'' (Attachments should be in Microsoft Word,
WordPerfect, or Excel; however, we prefer Microsoft Word.)
2. By regular mail. You may mail written comments (one original and
two copies) to the following address only: Centers for Medicare &
Medicaid Services, Department of Health and Human Services, Attention:
CMS-2278-IFC, P.O. Box 8010, Baltimore, MD 21244-8016.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments (one
original and two copies) to the following address only: Centers for
Medicare & Medicaid Services, Department of Health and Human Services,
Attention: CMS-2278-IFC, Mail Stop C4-26-05, 7500 Security Boulevard,
Baltimore, MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to one of the following addresses. If you
intend to deliver your comments to the Baltimore address, please call
telephone number (410) 786-7195 in advance to schedule your arrival
with one of our staff members. Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security
Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Kathryn Linstromberg, (410) 786-8279.
SUPPLEMENTARY INFORMATION:
Submitting Comments: As the public was provided an opportunity to
comment on the substance of the rule during the comment period prior to
the publication of the September 19, 2007 final rule, and as the
substance of the rule is not changed by this interim final rule with
comment period, we are accepting comments only to the extent that they
pertain to the applicability of the new authority for the rule. You can
assist us by referencing the file code CMS-2278-IFC.
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all comments
received before the close of the comment period on the following Web
site as soon as possible after they have been received: https://
www.cms.hhs.gov/eRulemaking. Click on the link ``Electronic Comments on
CMS Regulations'' on that Web site to view public comments.
Comments received timely will be also available for public
inspection as they are received, generally beginning approximately
three weeks after publication of a document, at the headquarters of the
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an appointment to view public comments,
phone 1-800-743-3951.
SUPPLEMENTARY INFORMATION:
I. Background
In the June 29, 2007 Federal Register (72 FR 35673), we published
the proposed rule entitled, ``Establishment of Revisit User Fee Program
for Medicare Survey and Certification Activities'' and provided for a
60-day comment period. In the September 19, 2007 Federal Register (72
FR 53628) we published the Revisit User Fee Program final rule. That
final rule set forth final requirements and a final fee schedule for
providers and suppliers who require a revisit survey as a result of
deficiencies cited during an initial certification, recertification, or
substantiated complaint survey.
The Centers for Medicare & Medicaid Services (CMS) has in place an
outcome-oriented survey process that is designed to determine whether
existing Medicare-certified providers and suppliers or providers and
suppliers seeking initial Medicare certification are actually meeting
statutory and regulatory requirements, conditions of participation, or
conditions for coverage. These health and safety requirements apply to
the environments of care and the delivery of services to residents or
patients served by these facilities and agencies. The Secretary of the
Department of Health and Human Services (HHS) has designated CMS to
enforce the conditions of participation/coverage and other requirements
of the Medicare program. The revisit user fee will be assessed for
revisits conducted in order to determine whether deficiencies cited as
a result of failing to satisfy federal quality of care requirements
have been corrected.
Pursuant to the requirements of the Continuing Appropriations
Resolution budget bill for fiscal year (FY) 2007, which was passed by
the Congress and signed by the President, we were directed by the
Secretary to implement the revisit user fees for FY 2007 for certain
providers and suppliers for which a revisit was required to confirm
that previously-identified failures to meet federal quality of care
requirements had been remedied. The fees recover the costs associated
with the Medicare Survey and Certification program's revisit surveys.
The primary purpose for implementing the revisit user fees is to ensure
the continuance of CMS Survey and Certification quality assurance
functions that improve patient care and safety. The fees became
effective upon publication September 19, 2007, when the final rule was
published.
II. Provisions of the Interim Final Rule
The current Continuing Resolution (Pub. L. 110-92, H. J. Res. 52
Sec. Sec. 101 & 106(2007)) authorizes HHS to continue the revisit user
fees until November 16, 2007, as follows:
* * *
Sec. 101. Such amounts as may be necessary, at a rate for
operations as provided in the applicable appropriations Acts for
fiscal year 2007 and under the authority and conditions provided in
such Acts, for continuing projects or activities (including the
costs of direct loans and loan guarantees) that are not otherwise
specifically provided for in this joint resolution, that were
[[Page 61542]]
conducted in fiscal year 2007, and for which appropriations, funds,
or other authority were made available in the following
appropriations Acts:
* * *
(3) The Continuing Appropriations Resolution, 2007 (division B
of Public Law 109-289, as amended by Pub. L. 110-5). (H.J. Res. 20,
Sec. 101(2007)).
Sec. 106. Unless otherwise provided for in this joint resolution
or in the applicable appropriations Act for fiscal year 2008,
appropriations and funds made available and authority granted
pursuant to this joint resolution shall be available until whichever
of the following first occurs:
* * *
(3) November 16, 2007.
As directed by the Secretary, in the September 19, 2007 Federal
Register (72 FR 53628), we established revisit user fees for revisit
surveys and put forth in regulation the definitions, criteria for
determining the fee, the fee schedule, collection of fees,
reconsideration process for revisit user fees, enforcement and
regulatory language addressing enrollment and billing privileges, and
provider agreements. In the September 19, 2007 final rule, cost
projections were based on FY 2006 actual data and were expected to
amount to $37.3 million on an annual basis for FY 2007. These
calculations were included in section IV of the final rule (72 FR
53642).
We stated in the final rule that, ``if authority for the revisit
user fee is continued, we will use the current fee schedule in [the
final rule] for the assessment of such fees until such time as a new
fee schedule notice is proposed and published in final form.'' (72 FR
53628). The current Continuing Resolution continues the authority of
the FY 2007 Continuing Resolution from October 1, 2007 through November
16, 2007. Accordingly, the revisit fees will continue to be assessed
for the entire time period authorized by the current Continuing
Resolution.
III. Response to Comments
Because of the large number of public comments we normally receive
on Federal Register documents, 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 preamble,
and, when we proceed with a subsequent document, we will respond to the
comments in the preamble to that document.
IV. Waiver of Proposed Rulemaking and Delay in Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register and invite public comment on the proposed rule in
accordance with 5 U.S.C. section 553(b) of the Administrative Procedure
Act (APA). The notice of proposed rulemaking includes a reference to
the legal authority under which the rule is proposed, and the terms and
substances of the proposed rule or a description of the subjects and
issues involved. This procedure can be waived, however, if an agency
finds good cause that a notice-and-comment procedure is impracticable,
unnecessary, or contrary to the public interest and incorporates a
statement of the finding and its reasons in the rule issued. We find
that the notice-and-comment procedure is unnecessary in this
circumstance because providers and suppliers have already been provided
notice and an opportunity to comment on the substance of this rule.
This interim final rule with comment merely updates the Congressional
authority under which the rule operates.
Therefore, we find good cause to waive the notice of proposed
rulemaking and to issue this final rule on an interim basis. We are
providing a 60-day public comment period.
We ordinarily provide a 30-day delay in the effective date of the
provisions of a rule in accordance with the Administrative Procedure
Act (APA) 5 U.S.C. 553(d). However, the delay in the effective date may
be waived as, in pertinent part, ``provided by the agency for good
cause found and published with the rule'' 5 U.S.C. 553(d)(3). The
Secretary finds that good cause exists to waive the 30-day effective
date delay.
The good cause exception to the 30 day effective date delay
provision of section 553(d) of the APA is read to be broader than the
good cause exception to the notice and comment provision of section
553(b)of the APA.
The legislative history of the APA indicates that the purpose for
deferring the effectiveness of a rule under section 553(d) was to
``afford persons affected a reasonable time to prepare for the
effective date of a rule or rules or to take other action which the
issuance may prompt.'' S. Rep. No. 752, 79th Cong., 1st Sess. 15
(1946); H.R. Rep. No. 1980, 79th Cong. 2d Sess. 25 (1946). In this
case, affected parties do not need time to adjust their behavior before
this rule takes effect. This rule merely updates the authority under
which the revisit fee is assessed and does not provide any additional
requirements for the affected parties. Moreover, with or without a
revisit fee, a provider or supplier must be found to have corrected
significant deficiencies in order to avoid termination. Additionally,
the application of a fee for the revisit does not place appreciable
administrative burdens on the affected providers or suppliers. We do
not expect appreciable cost to State survey agencies because we are
undertaking the billing and collection of the revisit user fee.
We identified in the proposed rule the immediacy of this revisit
user fee program and the limited nature of FY 2007, Continuing
Resolution Appropriation (Pub. L. 110-5). Specifically, the Continuing
Resolution required us to implement the revisit fee program in FY 2007.
Accordingly, providers and suppliers have been on notice for some time
that these fees will be imposed, and do not need additional time to be
prepared to comply with the requirements of this regulation. We believe
that given the short timeframe that we have to collect fees before the
statutory authority of the current Continuing Resolution expires, there
is good cause to waive the 30-day effective date.
V. 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.
VI. Regulatory Impact Analysis
A. Overall Impact
We have examined the impacts of this rule 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 Social Security Act, the Unfunded Mandates
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 (as amended by Executive Order 13258, 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). A
regulatory impact analysis (RIA) must be prepared for major rules with
economically significant effects ($100 million or more in any one
year). This rule is not a major rule. The aggregate costs will total
approximately $37.3 million in any one year.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA,
[[Page 61543]]
small entities include small businesses, nonprofit organizations, and
small governmental jurisdictions. Individuals and States are not
included in the definition of a small entity. Small businesses are
small entities, either by nonprofit status or by having revenues of
$6.5 million to $31.9 million or less in any one year for purposes of
the RFA. The September 19, 2007 final rule provided an analysis on the
impact of small entities (72 FR 53642-3). The analysis published in the
final rule remains valid. Since this interim final rule with comment
merely updates the Congressional authority under which the rule
operates, we have determined, and the Secretary certifies, that this
rule will not have a significant impact on small entities based on the
overall effect on revenues.
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 (superseded by Core Based Statistical Areas) and has
fewer than 100 beds. This rule affects those small rural hospitals that
have been cited for a deficiency based on noncompliance with required
conditions of participation and for which a revisit is needed to make
sure that the deficiency has been corrected. We identified in the
September 19, 2007 final rule that for the effective period of that
rule that less than 3 percent of all hospitals may be assessed a
revisit user fee and that less than 1 percent of those hospitals would
be rural hospitals (72 FR 53643). The analysis published in the final
rule remains valid. Since this interim final rule with comment merely
updates the Congressional authority under which the rule operates, we
maintain that given the effective period of this rule, we have
determined, and the Secretary certifies, that this rule will not have a
significant impact on small rural hospitals.
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 one year of
$100 million in 1995 dollars, updated annually for inflation. That
threshold level is currently approximately $120 million. This interim
final rule with comment will have no mandated effect on State, local,
or tribal governments and the impact on the private sector is estimated
to be less than $120 million and will only affect those Medicare
providers or suppliers for which a revisit user fee is assessed based
on the need to conduct a revisit survey to ensure deficient practices
that were cited have been corrected.
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 interim final rule with comment will not
substantially affect State or local governments. This rule establishes
user fees for providers and suppliers for which CMS has identified
deficient practices and requires a revisit to assure that corrections
have been made. Therefore, we have determined that this interim final
rule with comment will not have a significant effect on the rights,
roles, and responsibilities of State or local governments.
B. Impact on Providers/Suppliers
There is no change on the impact on providers and suppliers with
the publication of this interim final rule with comment. The impact
remains as discussed in the final rule (72 FR 53643).
Final Fee Schedule for Onsite and Offsite Revisit Surveys
The FY 2007 fee schedule published on September 19, 2007 (72 FR
53647) in the final rule will be retained. As noted in the final rule,
the published fee schedule will be utilized by CMS for the assessment
of such fees until such time as a new fee schedule notice is proposed
and published in final form. The calculations utilized to determine the
fee as identified in the final rule will be the same (72 FR 53645-6).
We will continue to assess a flat fee based on provider or supplier
type and type of revisit survey conducted. Table A below identifies the
final fee schedule.
Table A.--Final Fee Schedule
------------------------------------------------------------------------
Fee Fee
assessed assessed
Facility per offsite per onsite
revisit revisit
survey survey
------------------------------------------------------------------------
SNF & NF...................................... $168 $2,072
Hospitals..................................... 168 2,554
HHA........................................... 168 1,613
Hospice....................................... 168 1,736
ASC........................................... 168 1,669
RHC........................................... 168 851
ESRD.......................................... 168 1,490
------------------------------------------------------------------------
Costs for All Revisit User Fees Assessed
We anticipated that the combined costs for all providers and
suppliers for all revisit surveys in FY 2007 would total approximately
$37.3 million on an annual basis, with onsite revisit surveys amounting
to approximately $34.6 million and offsite revisit surveys totaling
approximately $2.7 million (72 FR 53645). However, actual fees assessed
in FY 2007 were much less than this annual amount, since CMS did not
charge for revisits that occurred prior to publication of the final
regulation. Since we continue to operate under these same annual
estimates, we provide here estimates of the impact for the period of
the current continuing resolution as listed below in monthly estimates
in Tables B and C. For the period of the current continuing resolution,
we will use the FY 2007 fee schedule established in the final rule for
the assessment of fees until a new fee schedule notice is proposed and
published as final.
In Table B below, we provide the projected costs for the period of
this continuing resolution based on the fee schedule of the final rule.
We expect the combined costs for all providers and suppliers for all
onsite revisit surveys for the period of this continuing resolution to
total approximately $4.3 million. We first multiplied the total number
of onsite revisit surveys in one year by the expected revisit user fees
assessed per revisits as finalized in Table A above, estimated by
provider or supplier, to obtain the annual cost of revisit surveys. We
then divided this number by 12 to obtain the monthly cost of onsite
revisit surveys and multiplied by the effective period of the
continuing resolution (roughly 1.5 months) to obtain the total costs
for onsite revisit surveys for the period of the continuing resolution.
We then totaled all providers and suppliers to achieve the total costs
for all onsite revisit surveys for the period of this continuing
resolution.
[[Page 61544]]
Table B.--Onsite Revisit Surveys--Estimated Monthly Costs
----------------------------------------------------------------------------------------------------------------
Total costs
Monthly number Fee assessed Monthly costs for onsite
of onsite per onsite for onsite revisit
Facility revisit revisit revisit surveys for
surveys surveys (hrs x surveys* period of CR
$112) **
----------------------------------------------------------------------------------------------------------------
SNF & NF........................................ 1,191 $2,072 $2,467,061 $3,700,592
Hospitals....................................... 48 2,554 122,379 183,569
HHA............................................. 89 1,613 143,557 215,336
Hospice......................................... 21 1,736 37,035 55,552
ASC............................................. 8 1,669 13,213 19,819
RHC............................................. 12 851 10,567 15,850
ESRD............................................ 58 1,490 86,668 130,003
---------------------------------------------------------------
Total....................................... 1,427 .............. 2,880,480 4,320,721
----------------------------------------------------------------------------------------------------------------
* Monthly costs may differ from the multiple of monthly revisits and fee per revisit due to rounding.
** Monthly costs were multiplied by the effective period of the CR (roughly 1.5 months) Total numbers of onsite
revisit surveys were rounded up based on FY 2006 actual data presented in the final rule.
We expect the combined costs for all providers and suppliers for
all offsite revisit surveys to total $343,875 for the period of the
current continuing resolution. In Table C below, we first estimated by
provider or supplier the number of offsite revisit surveys expected for
an entire fiscal year, and multiplied this number by the expected
revisit user fee of $168 per offsite revisit survey to obtain the
annual cost of surveys. We then divided this number by 12 to obtain the
monthly cost of offsite revisit surveys and multiplied this number by
the effective period of the continuing resolution (roughly 1.5 months)
to obtain the total costs for offsite revisit surveys for the period of
the continuing resolution.
Table C.--Offsite Revisit Surveys--Estimated Monthly Costs
----------------------------------------------------------------------------------------------------------------
Total costs
Monthly number Fee assessed Monthly costs for offsite
of offsite per offsite for offsite revisit
Facility revisit revisit survey revisit surveys for
surveys ($112 x 1.5 surveys* period of CR
hrs) **
----------------------------------------------------------------------------------------------------------------
SNF & NF........................................ 1,262 $168 $211,932 $317,898
Hospitals....................................... 23 168 3,892 5,838
HHA............................................. 43 168 7,238 10,857
Hospice......................................... 4 168 714 1,071
ASC............................................. 8 168 1,302 1,953
RHC............................................. 6 168 938 1,407
ESRD............................................ 19 168 3,234 4,851
Total....................................... 1,365 .............. 229,250 343,875
----------------------------------------------------------------------------------------------------------------
* Monthly costs may differ from the multiple of monthly revisits and fee per revisit due to rounding.
** Monthly costs were multiplied by the effective period of the CR (roughly 1.5 months).
As shown in Table D below, we provide the aggregate costs expected
as projected for the entire FY 2007, as well as the costs we would
expect to offset for the period of the current continuing resolution.
Table D.--Total Costs Combined for All Revisits Surveys per Fiscal Year
& Period of CR
------------------------------------------------------------------------
FY 2007 Period of CR *
------------------------------------------------------------------------
Onsite Revisit Surveys.................. $34,565,760 $4,320,512
Offsite Revisit Surveys................. 2,751,000 343,980
-------------------------------
Total Costs All Revisits............ 37,316,760 4,664,492
------------------------------------------------------------------------
* CR period's costs are based on CR period revisit surveys rounded up to
the nearest whole number as shown in Table B & C.
C. Alternatives Considered
CMS considered a number of alternatives to the Revisit User Fee.
Such alternatives were discussed in the final rule published on
September 19, 2007 (72 FR 53647). We affirm the continuing validity of
that analysis. The current continuing resolution provides CMS with the
authority to continue projects or activities as was otherwise provided
for in FY 2007, and as such CMS is required to publish an interim final
rule with comment. This interim final rule with comment merely updates
the Congressional authority under which the rule operates.
In accordance with Executive Order 12866, this rule has been
reviewed by the Office of Management and Budget.
List of Subjects in 42 CFR Part 488
Administrative practice and procedure, Health facilities, Medicare,
Reporting and recording requirements.
[[Page 61545]]
0
For the reasons set forth in the preamble, the Centers for Medicare &
Medicaid Services amends 42 CFR chapter IV, part 488 as set forth
below:
PART 488--SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES
0
1. The authority citation for part 488 is revised to read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act,
unless otherwise noted (42 U.S.C. 1302 and 1395(hh)); Pub. L. 110-
92, H. J. Res. 52 Sec. Sec. 101 & 106 (2007).
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: October 11, 2007.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
Approved: October 25, 2007.
Michael O. Leavitt,
Secretary.
[FR Doc. 07-5400 Filed 10-26-07; 12:02 pm]
BILLING CODE 4120-01-P
