Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for CY 2013, 69848-69850 [2012-28273]
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69848
Federal Register / Vol. 77, No. 225 / Wednesday, November 21, 2012 / Notices
regarding this collection contact Matt
Klischer at 410–786–7488. For all other
issues call 410–786–1326.)
2. Type of Information Collection
Request: New collection; Title of
Information Collection: Report of a
Hospital Death Associated with
Restraint or Seclusion; Use: Executive
Order 13563, Improving Regulation and
Regulatory Review, was signed on
January 18, 2011. The order recognized
the importance of a streamlined,
effective, and efficient regulatory
framework designed to promote
economic growth, innovation, job
creation, and competitiveness. Each
agency was directed to establish an
ongoing plan to reduce or eliminate
burdensome, obsolete, or unnecessary
regulations to create a more efficient
and flexible structure.
The regulation that was published on
May, 16, 2012 (77 FR 29034) included
a reduction in the reporting requirement
related to hospital deaths associated
with the use of restraint or seclusion,
§ 482.13(g). Hospitals are no longer
required to report to CMS those deaths
where there was no use of seclusion and
the only restraint was 2-point soft wrist
restraints. It is estimated that this will
reduce the volume of reports that must
be submitted by 90 percent for
hospitals. In addition, the final rule
replaced the previous requirement for
reporting via telephone to CMS, which
proved to be cumbersome for both CMS
and hospitals, with a requirement that
allows submission of reports via
telephone, facsimile or electronically, as
determined by CMS. Finally, the
amount of information that CMS needs
for each death report in order for CMS
to determine whether further on-site
investigation is needed has been
reduced.
The Child Health Act (CHA) of 2000
established in Title V, Part H, Section
591 of the Public Health Service Act
(PHSA) minimum requirements
concerning the use of restraints and
seclusion in facilities that receive
support with funds appropriated to any
Federal department or agency. In
addition, the CHA enacted Section 592
of the PHSA, which establishes
minimum mandatory reporting
requirements for deaths in such
facilities associated with use of restraint
or seclusion. Provisions implementing
this statutory reporting requirement for
hospitals participating in Medicare are
found at 42 CFR 482.13(g), as revised in
the final rule that published on May 16,
2012 (77 FR 29034). Form Number:
CMS–10455 (OCN: 0938–New);
Frequency: Occasionally; Affected
Public: Private Sector. Number of
Respondents: 4,900. Number of
VerDate Mar<15>2010
16:56 Nov 20, 2012
Jkt 229001
Responses: 24,500. Total Annual Hours:
8,085. (For policy questions regarding
this collection contact Danielle Miller at
410–786–8818. For all other issues call
410–786–1326.)
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS’ Web Site
address at https://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.
In commenting on the proposed
information collections please reference
the document identifier or OMB control
number. To be assured consideration,
comments and recommendations must
be submitted in one of the following
ways by January 22, 2013:
1. Electronically. You may submit
your comments electronically to https://
www.regulations.gov. Follow the
instructions for ‘‘Comment or
Submission’’ or ‘‘More Search Options’’
to find the information collection
document(s) accepting comments.
2. By regular mail. You may mail
written comments to the following
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Operations and Regulatory Affairs,
Division of Regulations Development,
Attention: Document Identifier/OMB
Control Number llll, Room C4–26–
05, 7500 Security Boulevard, Baltimore,
Maryland 21244–1850.
Dated: November 16, 2012.
Martique Jones,
Director, Regulations Development Group,
Division B, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2012–28381 Filed 11–20–12; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8046–N]
RIN 0938–AR14
Medicare Program; Inpatient Hospital
Deductible and Hospital and Extended
Care Services Coinsurance Amounts
for CY 2013
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This notice announces the
inpatient hospital deductible and the
SUMMARY:
PO 00000
Frm 00060
Fmt 4703
Sfmt 4703
hospital and extended care services
coinsurance amounts for services
furnished in calendar year (CY) 2013
under Medicare’s Hospital Insurance
Program (Medicare Part A). The
Medicare statute specifies the formulae
used to determine these amounts. For
CY 2013, the inpatient hospital
deductible will be $1,184. The daily
coinsurance amounts for CY 2013 will
be: $296 for the 61st through 90th day
of hospitalization in a benefit period;
$592 for lifetime reserve days; and $148
for the 21st through 100th day of
extended care services in a skilled
nursing facility in a benefit period.
DATES: This notice is effective on
January 1, 2013.
FOR FURTHER INFORMATION CONTACT:
Clare McFarland, (410) 786–6390 for
general information.
Gregory J. Savord, (410) 786–1521 for
case-mix analysis.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1813 of the Social Security
Act (the Act) provides for an inpatient
hospital deductible to be subtracted
from the amount payable by Medicare
for inpatient hospital services furnished
to a beneficiary. It also provides for
certain coinsurance amounts to be
subtracted from the amounts payable by
Medicare for inpatient hospital and
extended care services. Section
1813(b)(2) of the Act requires us to
determine and publish 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 calendar year
(CY).
II. Computing the Inpatient Hospital
Deductible for CY 2013
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,
adjusted 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 changes in real casemix. The adjustment to reflect real casemix 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
E:\FR\FM\21NON1.SGM
21NON1
Federal Register / Vol. 77, No. 225 / Wednesday, November 21, 2012 / Notices
(or, if midway between two multiples of
$4, to the next higher multiple of $4).
Under section 1886(b)(3)(B)(i)(XX) of
the Act, the percentage increase used to
update the payment rates for FY 2013
for hospitals paid under the inpatient
prospective payment system is the
market basket percentage increase,
otherwise known as the market basket
update, reduced by 0.1 percentage
points (see section 1886(b)(3)(B)(xii)(II)
of the Act), and an adjustment based on
changes in the economy-wide
productivity (the multifactor
productivity (MFP) adjustment (see
section 1886(b)(3)(B)(xi)(II) of the Act).
Under section 1886(b)(3)(B)(viii) of the
Act, hospitals will receive this update
only if they submit quality data as
specified by the Secretary. The update
for hospitals that do not submit this data
is reduced by 2.0 percentage points. We
are estimating that after accounting for
those hospitals receiving the lower
market basket update in the paymentweighted average update, the calculated
deductible will remain the same, as the
majority of hospitals submit quality data
and receive the full market basket
update.
Under section 1886(b)(3)(B)(ii)(VIII) of
the Act, the percentage increase used to
update the payment rates for FY 2013
for hospitals excluded from the
inpatient prospective payment system is
as follows:
• For FY 2013, the percentage
increase for long term care hospitals is
the market basket percentage increase
reduced by 0.1 percentage points and
the MFP adjustment (see sections
1886(m)(3)(A) and 1886(m)(4)(C) of the
Act).
• For FY 2013, the percentage
increase for inpatient rehabilitation
facilities is the market basket percentage
increase reduced by 0.1 percentage
points and the MFP adjustment (see
sections 1886(j)(3)(C) and
1886(j)(3)(D)(ii) of the Act).
• For FY 2013, the percentage
increase used to update the payment
rate for psychiatric hospitals is the
market basket percentage increase
reduced by 0.1 percentage points and
the MFP adjustment (see sections
1886(s)(2)(A)(ii) and 1886(s)(3)(B) of the
Act).
The market basket percentage increase
for 2013 is 2.6 percent and the MFP
adjustment is 0.7 percent, as announced
in the final rule with comment period
published in the Federal Register on
August 31, 2012 entitled, ‘‘Changes to
the Hospital Inpatient Prospective
Payment Systems for Acute Care
Hospitals and FY 2013 Rates and to the
Long Term Care Hospital PPS and FY
2013 Rates’’ (77 FR 53257). Therefore,
the percentage increase for hospitals
paid under the inpatient prospective
payment system is 1.8 percent. The
average payment percentage increase for
hospitals excluded from the inpatient
prospective payment system is 2.05
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 2013 is 1.84 percent.
To develop the adjustment to reflect
changes in real case-mix, we first
calculated an average case-mix for each
hospital 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 case-mix for hospitals paid
under the Medicare prospective
payment system in FY 2012 compared
to FY 2011. (We excluded from this
calculation hospitals whose payments
are not based on the inpatient
prospective payment system because
their payments are based on alternate
prospective payment systems or
reasonable costs.) We used Medicare
bills from prospective payment
hospitals that we received as of July
2012. These bills represent a total of
about 8.2 million Medicare discharges
for FY 2012 and provide the most recent
case-mix data available at this time.
Based on these bills, the change in
average case-mix in FY 2012 is 0.33
percent. Based on these bills and past
experience, we expect the overall case
mix change to be 0.7 percent as the year
progresses and more FY 2012 data
become available.
Section 1813 of the Act requires that
the inpatient hospital deductible be
69849
adjusted only by that portion of the
case-mix change that is determined to
be real. We estimate that the change in
real case mix will be 0.7 percent.
Thus, the estimate of the paymentweighted average of the applicable
percentage increases used for updating
the payment rates is 1.84 percent, and
the real case-mix adjustment factor for
the deductible is 0.7 percent. Therefore,
under the statutory formula, the
inpatient hospital deductible for
services furnished in CY 2013 is $1,184.
This deductible amount is determined
by multiplying $1,156 (the inpatient
hospital deductible for CY 2012) by the
payment-weighted average increase in
the payment rates of 1.0184 multiplied
by the increase in real case-mix of 1.007,
which equals $1,185.51 and is rounded
to $1,184.
III. Computing the Inpatient Hospital
and Extended Care Services
Coinsurance Amounts for CY 2013
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. The
increase in the deductible generates
increases in the coinsurance amounts.
For inpatient hospital and extended care
services furnished in CY 2013, 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 $296 (one-fourth of the
inpatient hospital deductible); the daily
coinsurance for lifetime reserve days
will be $592 (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 $148 (one-eighth of the
inpatient hospital deductible).
IV. Cost to Medicare Beneficiaries
Table 1 below summarizes the
deductible and coinsurance amounts for
CYs 2012 and 2013, as well as the
number of each that is estimated to be
paid.
TABLE 1—PART A DEDUCTIBLE AND COINSURANCE AMOUNTS FOR CALENDAR YEARS 2012 AND 2013
Value
Number paid (in millions)
Type of cost sharing
srobinson on DSK4SPTVN1PROD with
2012
Inpatient hospital deductible ..........................................................................
Daily coinsurance for 61st–90th Day .............................................................
Daily coinsurance for lifetime reserve days ...................................................
SNF coinsurance ...........................................................................................
VerDate Mar<15>2010
16:56 Nov 20, 2012
Jkt 229001
PO 00000
Frm 00061
Fmt 4703
Sfmt 4703
$1,156
289
578
144.50
2013
2012
$1,184
296
592
148
E:\FR\FM\21NON1.SGM
21NON1
8.19
2.11
1.04
43.82
2013
8.44
2.17
1.08
45.72
69850
Federal Register / Vol. 77, No. 225 / Wednesday, November 21, 2012 / Notices
The estimated total increase in costs
to beneficiaries is about $1,030 million
(rounded to the nearest $10 million) due
to—(1) the increase in the deductible
and coinsurance amounts; and (2) the
increase 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.
srobinson on DSK4SPTVN1PROD with
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 impact of this
notice as required by Executive Order
12866 on Regulatory Planning and
Review (September 30, 1993), Executive
Order 13563 on Improving Regulation
and Regulatory Review (January 18,
VerDate Mar<15>2010
16:56 Nov 20, 2012
Jkt 229001
2011), the Regulatory Flexibility Act
(RFA) (September 19, 1980, Pub. L. 96–
354), section 1102(b) of the Social
Security Act, section 202 of the
Unfunded Mandates Reform Act of 1995
(March 22, 1995; Pub. L. 104–4),
Executive Order 13132 on Federalism
(August 4, 1999) and the Congressional
Review Act (5 U.S.C., Part I, Ch. 8).
Executive Orders 12866 and 13563
direct 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 $1,030 million due to—
(1) the increase in the deductible and
coinsurance amounts; and (2) the
increase in the number of deductibles
and daily coinsurance amounts paid.
Therefore, this notice is a major action
as defined in Title 5, United States
Code, Part I, Ch. 8), and is an
economically significant action 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 small
governmental jurisdictions. Most
hospitals and most other providers and
suppliers are small entities, either by
nonprofit status or by having revenues
of $7.0 million to $34.5 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 under the
RFA.
In addition, section 1102(b) of the
Social Security 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 for Medicare payment
regulations and has fewer than 100
beds. The Secretary has determined that
this notice will not have a significant
impact on the operations of a substantial
PO 00000
Frm 00062
Fmt 4703
Sfmt 4703
number of small rural hospitals.
Therefore, we are not preparing an
analysis under 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 whose mandates require spending
in any 1 year of $100 million in 1995
dollars, updated annually for inflation.
In 2012, that threshold is approximately
$139 million. This notice will have no
consequential effect on State, local, or
tribal governments or on the private
sector. However, States may be required
to pay the deductibles and coinsurance
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.
This notice will not have a substantial
effect on State or local governments.
In accordance with the provisions of
Executive Order 12866, this notice was
reviewed by the Office of Management
and Budget.
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance)
Dated: November 6, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare
& Medicaid Services.
Dated: November 15, 2012.
Kathleen Sebelius,
Secretary.
[FR Doc. 2012–28273 Filed 11–16–12; 11:15 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8048–N]
RIN 0938–AR16
Medicare Program; Medicare Part B
Monthly Actuarial Rates, Premium
Rate, and Annual Deductible
Beginning January 1, 2013
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This notice announces the
monthly actuarial rates for aged (age 65
and over) and disabled (under age 65)
beneficiaries enrolled in Part B of the
Medicare Supplementary Medical
SUMMARY:
E:\FR\FM\21NON1.SGM
21NON1
]]>Agencies
[Federal Register Volume 77, Number 225 (Wednesday, November 21, 2012)]
[Notices]
[Pages 69848-69850]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-28273]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-8046-N]
RIN 0938-AR14
Medicare Program; Inpatient Hospital Deductible and Hospital and
Extended Care Services Coinsurance Amounts for CY 2013
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) 2013 under Medicare's Hospital
Insurance Program (Medicare Part A). The Medicare statute specifies the
formulae used to determine these amounts. For CY 2013, the inpatient
hospital deductible will be $1,184. The daily coinsurance amounts for
CY 2013 will be: $296 for the 61st through 90th day of hospitalization
in a benefit period; $592 for lifetime reserve days; and $148 for the
21st through 100th day of extended care services in a skilled nursing
facility in a benefit period.
DATES: This notice is effective on January 1, 2013.
FOR FURTHER INFORMATION CONTACT:
Clare McFarland, (410) 786-6390 for general information.
Gregory J. Savord, (410) 786-1521 for case-mix analysis.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1813 of the Social Security Act (the Act) provides for an
inpatient hospital deductible to be subtracted from the amount payable
by Medicare for inpatient hospital services furnished to a beneficiary.
It also provides for certain coinsurance amounts to be subtracted from
the amounts payable by Medicare for inpatient hospital and extended
care services. Section 1813(b)(2) of the Act requires us to determine
and publish 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 calendar year (CY).
II. Computing the Inpatient Hospital Deductible for CY 2013
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, adjusted 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 changes in 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
[[Page 69849]]
(or, if midway between two multiples of $4, to the next higher multiple
of $4).
Under section 1886(b)(3)(B)(i)(XX) of the Act, the percentage
increase used to update the payment rates for FY 2013 for hospitals
paid under the inpatient prospective payment system is the market
basket percentage increase, otherwise known as the market basket
update, reduced by 0.1 percentage points (see section
1886(b)(3)(B)(xii)(II) of the Act), and an adjustment based on changes
in the economy-wide productivity (the multifactor productivity (MFP)
adjustment (see section 1886(b)(3)(B)(xi)(II) of the Act). Under
section 1886(b)(3)(B)(viii) of the Act, hospitals will receive this
update only if they submit quality data as specified by the Secretary.
The update for hospitals that do not submit this data is reduced by 2.0
percentage points. We are estimating that after accounting for those
hospitals receiving the lower market basket update in the payment-
weighted average update, the calculated deductible will remain the
same, as the majority of hospitals submit quality data and receive the
full market basket update.
Under section 1886(b)(3)(B)(ii)(VIII) of the Act, the percentage
increase used to update the payment rates for FY 2013 for hospitals
excluded from the inpatient prospective payment system is as follows:
For FY 2013, the percentage increase for long term care
hospitals is the market basket percentage increase reduced by 0.1
percentage points and the MFP adjustment (see sections 1886(m)(3)(A)
and 1886(m)(4)(C) of the Act).
For FY 2013, the percentage increase for inpatient
rehabilitation facilities is the market basket percentage increase
reduced by 0.1 percentage points and the MFP adjustment (see sections
1886(j)(3)(C) and 1886(j)(3)(D)(ii) of the Act).
For FY 2013, the percentage increase used to update the
payment rate for psychiatric hospitals is the market basket percentage
increase reduced by 0.1 percentage points and the MFP adjustment (see
sections 1886(s)(2)(A)(ii) and 1886(s)(3)(B) of the Act).
The market basket percentage increase for 2013 is 2.6 percent and
the MFP adjustment is 0.7 percent, as announced in the final rule with
comment period published in the Federal Register on August 31, 2012
entitled, ``Changes to the Hospital Inpatient Prospective Payment
Systems for Acute Care Hospitals and FY 2013 Rates and to the Long Term
Care Hospital PPS and FY 2013 Rates'' (77 FR 53257). Therefore, the
percentage increase for hospitals paid under the inpatient prospective
payment system is 1.8 percent. The average payment percentage increase
for hospitals excluded from the inpatient prospective payment system is
2.05 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 2013 is 1.84 percent.
To develop the adjustment to reflect changes in real case-mix, we
first calculated an average case-mix for each hospital 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 case-
mix for hospitals paid under the Medicare prospective payment system in
FY 2012 compared to FY 2011. (We excluded from this calculation
hospitals whose payments are not based on the inpatient prospective
payment system because their payments are based on alternate
prospective payment systems or reasonable costs.) We used Medicare
bills from prospective payment hospitals that we received as of July
2012. These bills represent a total of about 8.2 million Medicare
discharges for FY 2012 and provide the most recent case-mix data
available at this time. Based on these bills, the change in average
case-mix in FY 2012 is 0.33 percent. Based on these bills and past
experience, we expect the overall case mix change to be 0.7 percent as
the year progresses and more FY 2012 data become available.
Section 1813 of the Act requires that the inpatient hospital
deductible be adjusted only by that portion of the case-mix change that
is determined to be real. We estimate that the change in real case mix
will be 0.7 percent.
Thus, the estimate of the payment-weighted average of the
applicable percentage increases used for updating the payment rates is
1.84 percent, and the real case-mix adjustment factor for the
deductible is 0.7 percent. Therefore, under the statutory formula, the
inpatient hospital deductible for services furnished in CY 2013 is
$1,184. This deductible amount is determined by multiplying $1,156 (the
inpatient hospital deductible for CY 2012) by the payment-weighted
average increase in the payment rates of 1.0184 multiplied by the
increase in real case-mix of 1.007, which equals $1,185.51 and is
rounded to $1,184.
III. Computing the Inpatient Hospital and Extended Care Services
Coinsurance Amounts for CY 2013
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. The increase in the deductible
generates increases in the coinsurance amounts. For inpatient hospital
and extended care services furnished in CY 2013, 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
$296 (one-fourth of the inpatient hospital deductible); the daily
coinsurance for lifetime reserve days will be $592 (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 $148 (one-eighth of the inpatient
hospital deductible).
IV. Cost to Medicare Beneficiaries
Table 1 below summarizes the deductible and coinsurance amounts for
CYs 2012 and 2013, as well as the number of each that is estimated to
be paid.
Table 1--Part A Deductible and Coinsurance Amounts for Calendar Years 2012 and 2013
----------------------------------------------------------------------------------------------------------------
Value Number paid (in millions)
Type of cost sharing ---------------------------------------------------------------
2012 2013 2012 2013
----------------------------------------------------------------------------------------------------------------
Inpatient hospital deductible................... $1,156 $1,184 8.19 8.44
Daily coinsurance for 61st-90th Day............. 289 296 2.11 2.17
Daily coinsurance for lifetime reserve days..... 578 592 1.04 1.08
SNF coinsurance................................. 144.50 148 43.82 45.72
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[[Page 69850]]
The estimated total increase in costs to beneficiaries is about
$1,030 million (rounded to the nearest $10 million) due to--(1) the
increase in the deductible and coinsurance amounts; and (2) the
increase 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 impact of this notice as required by Executive
Order 12866 on Regulatory Planning and Review (September 30, 1993),
Executive Order 13563 on Improving Regulation and Regulatory Review
(January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19,
1980, Pub. L. 96-354), section 1102(b) of the Social Security Act,
section 202 of the Unfunded Mandates Reform Act of 1995 (March 22,
1995; Pub. L. 104-4), Executive Order 13132 on Federalism (August 4,
1999) and the Congressional Review Act (5 U.S.C., Part I, Ch. 8).
Executive Orders 12866 and 13563 direct 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
$1,030 million due to-- (1) the increase in the deductible and
coinsurance amounts; and (2) the increase in the number of deductibles
and daily coinsurance amounts paid. Therefore, this notice is a major
action as defined in Title 5, United States Code, Part I, Ch. 8), and
is an economically significant action 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 small governmental
jurisdictions. Most hospitals and most other providers and suppliers
are small entities, either by nonprofit status or by having revenues of
$7.0 million to $34.5 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 under the RFA.
In addition, section 1102(b) of the Social Security 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 for Medicare payment regulations and
has fewer than 100 beds. The Secretary has determined that this notice
will not have a significant impact on the operations of a substantial
number of small rural hospitals. Therefore, we are not preparing an
analysis under 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 whose mandates require spending in any 1 year of $100
million in 1995 dollars, updated annually for inflation. In 2012, that
threshold is approximately $139 million. This notice will have no
consequential effect on State, local, or tribal governments or on the
private sector. However, States may be required to pay the deductibles
and coinsurance 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. This notice will not have a substantial effect on State
or local governments.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance)
Dated: November 6, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
Dated: November 15, 2012.
Kathleen Sebelius,
Secretary.
[FR Doc. 2012-28273 Filed 11-16-12; 11:15 am]
BILLING CODE 4120-01-P
