[Federal Register: November 22, 2002 (Volume 67, Number 226)]
[Notices]
[Page 70442-70443]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr22no02-85]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-1220-N]
RIN 0938-AL97
Medicare Program; Fee Schedule for Payment of Ambulance
Services--Update for CY 2003
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice updates the Ambulance Inflation Factor (AIF) for
ambulance services for calendar year (CY) 2003. The AIF is used in
determining the payment limit for ambulance services required by
section 1834(l) of the Social Security Act (the Act).
DATES: The AIF for 2003 is effective for ambulance services furnished
during the period January 1, 2003, through December 31, 2003.
FOR FURTHER INFORMATION CONTACT: Anne E. Tayloe, (410) 786-4546.
SUPPLEMENTARY INFORMATION:
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I. Background
Requirements of the Statute for Updating the Ambulance Inflation Factor
(AIF) for Ambulance Services for CY 2003
On February 27, 2002, we published a final rule entitled ``Medicare
Program; Fee Schedule for Payment of Ambulance Services and Revisions
to the Physician Certification Requirements for Coverage of
Nonemergency Ambulance Services; Final Rule'' (HCFA-1002-FC) in the
Federal Register (67 FR 9100), that established a fee schedule for
ambulance services required by section 1834(l) of the Social Security
Act (the Act). This final rule provided that the ambulance fee schedule
would be updated by the AIF annually, based on the percentage increase
in the consumer price index (CPI) for all urban consumers (U.S. city
average) for the 12-month period ending with June of the previous year
(Sec. 414.610(f)). It also provided that notice of the AIF would be
published in the Federal Register without opportunity for prior comment
(Sec. 414.620). We will follow applicable rulemaking procedures in
publishing revisions to the fee schedule for ambulance services that
result from any factors other than the inflation factor. In this
notice, we set forth the ambulance inflation factor for CY 2003.
II. Provisions of the Notice
Section 1834(l)(3)(B) of the Act provides the basis for updating
payment amounts for ambulance services. Specifically, this section
provides for an update in payments for CY 2003 that is equal to the
percentage increase in the CPI for all urban consumers (CPI-U), for the
12-month period ending with June of the previous year (that is, June
2002). For CY 2003 that percentage is 1.1 percent.
During the transition period, the AIF is applied to both the fee
schedule portion of the blended payment amount and to the reasonable
charge/cost portion of the blended payment amount separately for each
ambulance provider/supplier. Then, these two amounts are added together
to determine the total payment amount for each provider/supplier.
III. Waiver of Proposed Rulemaking
We ordinarily publish a proposed notice in the Federal Register and
provide a period for public comment before we make final the provisions
of the notice. We can waive this procedure, however, if we find good
cause that notice-and-comment procedure is impracticable, unnecessary,
or contrary to the public interest and we incorporate a statement of
finding and its reasons in the notice issued. We find it unnecessary to
undertake notice and comment rulemaking in this instance because the
law specifies the method of computation of annual updates, and we have
no discretion in this matter. Further, this notice does not change
substantive policy, but merely applies the statutorily-specified update
method. Therefore, under 5 U.S.C. 553(b)(B), for good cause, we waive
notice and comment procedures.
IV. Regulatory Impact Statement
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 16, 1980, Pub. L. 96-354),
section 1102(b) of
[[Page 70443]]
the Social Security Act, the Unfunded Mandates Reform Act of 1995 (Pub.
L. 104-4), and Executive Order 13132.
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, if regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity). A regulatory impact
analysis (RIA) must be prepared for major rules with economically
significant effects ($100 million or more in any 1 year). This is not
considered a major rule because it has an effect on the Medicare
program of less than $100 million in 1 year.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and government agencies.
Most hospitals and most other providers and suppliers are small
entities, either by nonprofit status or by having revenues of $6
million to $29 million in any 1 year. For purposes of the RFA, all
ambulance providers/suppliers are considered to be small entities.
Individuals and States are not included in the definition of a small
entity.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 604 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a Metropolitan
Statistical Area and has fewer than 100 beds. This notice does not
apply to 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 that may result in expenditure in any 1 year by State,
local, or tribal governments, in the aggregate, or by the private
sector, of $110 million. This notice does not result in an expenditure
in any 1 year by State, local, or tribal governments of $110 million.
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 rule will not have a substantial effect on State or
local governments.
This notice provides an update for inflation as mandated by
statute. We estimate that the total expenditure for CY 2003 for
ambulance services covered by the Medicare program is approximately $3
billion. Inflation of 1.1 percent will result in an additional total
expenditure of approximately $30 million.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
Authority: Section 1834(l) of the Social Security Act (42 U.S.C.
1395m(l)).
(Catalog of Federal Domestic Assistance Program No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: October 4, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
Approved: November 1, 2002.
Tommy G. Thompson,
Secretary.
[FR Doc. 02-29850 Filed 11-20-02; 10:28 am]
BILLING CODE 4120-01-P
