[Federal Register Volume 71, Number 28 (Friday, February 10, 2006)]
[Proposed Rules]
[Pages 6991-6992]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-1821]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 413

[CMS-1126-RCN]
RIN 0938-AK02


Medicare Program; Provider Bad Debt Payment; Extension of 
Timeline for Publication of Final Rule

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Extension of timeline.

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SUMMARY: Section 1871(a)(3)(A) of the Social Security Act (the Act) 
requires us to publish a Medicare final rule no later than 3 years 
after the publication date of the proposed rule. This notice announces 
an extension of the timeline for publication of a Medicare final rule 
in accordance with section 1871(a)(3)(B) of the Act, which allows us to 
extend the timeline for publication of the ``Medicare Program; Provider 
Bad Debt Payment'' final rule under exceptional circumstances.

Dates: Effective Date: This notice is effective on February 10, 2006.

FOR FURTHER INFORMATION CONTACT: Jill Keplinger, (410) 786-4550.

SUPPLEMENTARY INFORMATION: On February 10, 2003 (68 FR 6682), we 
published a proposed rule that would revise existing regulations 
governing reimbursement for bad debts for all providers or entities, 
other than hospitals, currently eligible for bad debt reimbursement 
under the Medicare program. These proposed revisions were intended to 
provide for a consistent bad debt reimbursement policy for all 
providers currently eligible to receive payments from Medicare for bad 
debt. The proposed revisions also would remove a cap on End Stage Renal 
Disease (ESRD) bad debt reimbursement, which limits payment of 
allowable bad debts to the facility's unrecovered costs. In addition, 
the

[[Page 6992]]

proposed rule would clarify that bad debts are not allowable for 
entities paid under a reasonable-charge or fee schedule methodology.
    This notice announces an extension of the timeline for publication 
of a final rule responding to comments on the above proposed rule. 
Section 1871(a)(3)(B) of the Social Security Act (the Act) requires us 
generally to publish a Medicare final rule no later than 3 years after 
the publication date of the proposed rule. To meet this 3-year 
timeframe, the final rule at issue here would have to be published by 
February 10, 2006.
    Section 1871(a)(3)(B) also provides, however, that under 
``exceptional circumstances'' the Secretary may extend the initial 
targeted publication date of a final regulation, if the Secretary 
provides public notice of this extension, including a brief explanation 
of the justification for the variation, no later than the regulation's 
previously established proposed publication date.
    This notice extends the timeline based on the following exceptional 
circumstances, which we believe justify such an extension in this case. 
On February 1, 2006, the Congress completed action on final legislation 
(S. 1932) that affects the provisions that would be modified under the 
proposed rule at issue here. Section 5004 of this bill, also known as 
the Deficit Reduction Act (DRA), generally provides for a 30 percent 
reduction in bad debt reimbursement to Skilled Nursing Facilities 
(SNFs), but only with respect to debt attributable to non-dual 
eligibles. Bad debt payment for dual eligibles would remain at 100 
percent. By contrast, the proposed rule applied the 30 percent 
reduction to all providers other than hospitals, and had no exception 
for debt attributable to dual-eligibles.
    If we were to finalize the SNF bad debt provisions of the proposed 
rule at issue here before the enactment of section 5004 of the DRA, 
these provisions could be superseded by contrary legislation very 
shortly after publication. This would require a new round of rulemaking 
to address the impact of the new legislation. By extending the deadline 
for publication of a final rule, we would hope to avoid needless and 
duplicative rulemaking, and confusion of the public, by responding to 
comments on this proposed rule, and addressing the effects of section 
5004 of the DRA on the proposed rule, in one rulemaking document.
    In order to allow time for the President to act on the DRA, and for 
us to fully assess the impact of this legislation on the provisions in 
the proposed rule, we are extending the timeline for this rulemaking 
for up to one year, and intend to publish the final rule no later than 
February 10, 2007. As required under section 1871(a)(3)(D), we will 
include a discussion of this extension in a report to Congress.

    Authority: Section 1871 of the Social Security Act (42 U.S.C. 
1395hh).

(Catalog of Federal Domestic Assistance Program No. 93.774, 
Medicare--Supplementary Medical Insurance Program)

    Dated: February 3, 2006.
Ann C. Agnew,
Executive Secretary to the Department.
 [FR Doc. E6-1821 Filed 2-9-06; 8:45 am]
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