[Federal Register Volume 67, Number 226 (Friday, November 22, 2002)]
[Notices]
[Pages 70442-70443]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-29850]


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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.

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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