Department of Health and Human Services, Centers for Medicare and Medicaid Services: Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for Calendar Year 2010

GAO-10-207R, Nov 6, 2009

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This format should be used: GAO reviewed Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) "Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for Calendar Year 2010" on inpatient hospital deductible and hospital and extended care services coinsurance amounts for calendar year 2010. GAO found that (1) notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year 2010 under Medicare's Hospital Insurance Program; and the (2) CMS complied with applicable requirements in promulgating the rule.

Department of Health and Human Services, Centers for Medicare and Medicaid Services: Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for Calendar Year 2010, GAO-10-207R, November 6, 2009

B-318865

November 6, 2009

The Honorable MaxBaucus
Chairman
The Honorable Charles E. Grassley
Ranking Minority Member
Committee on Finance
United States Senate

The Honorable Charles B.Rangel
Chairman
The Honorable Dave Camp
Ranking Minority Member
Committee on Ways and Means
House of Representatives

Subject: Department of Health and Human Services, Centers for Medicare andMedicaid Services: Medicare Program; Inpatient Hospital Deductible and Hospitaland Extended Care Services Coinsurance Amounts for Calendar Year 2010

Pursuant to section801(a)(2)(A) of title 5, United States Code, this is our report on a major rulepromulgated by the Department of Health and Human Services, Centers forMedicare and Medicaid Services (CMS), entitled "Medicare Program; Inpatient Hospital Deductible andHospital and Extended Care Services Coinsurance Amounts for Calendar Year 2010"(RIN: 0938-AP42). We received the ruleon October 19, 2009. It was published inthe Federal Register as a notice on October22, 2009. 74 Fed. Reg. 54,579.

The notice announces the inpatient hospital deductible andthe hospital and extended care services coinsurance amounts for servicesfurnished in calendar year (CY) 2010 under Medicare's Hospital InsuranceProgram (Medicare Part A). For CY 2010,the inpatient hospital deductible will be $1,100. The daily coinsurance amounts for CY 2010will be: (a) $275 for the 61st through 90th day of hospitalization in a benefitperiod; (b) $550 for lifetime reserve days; and (c) $137.50 for the 21stthrough 100th day of extended care services in a skilled nursing facility in abenefit period.

Enclosed is our assessment of the CMS's compliance withthe procedural steps required by section 801(a)(1)(B)(i) through (iv) of title5 with respect to the rule. Our reviewof the procedural steps taken indicates that CMS complied with the applicablerequirements.

If you have any questions about this report or wish tocontact GAO officials responsible for the evaluation work relating to thesubject matter of the rule, please contact Shirley A. Jones, Assistant GeneralCounsel, at (202) 512-8156.

signed

Robert J. Cramer
Managing Associate General Counsel

Enclosure

cc: VivianStallion
Office Manager, Department of
Health and Human Services


ENCLOSURE

REPORT UNDER 5 U.S.C. sect.801(a)(2)(A) ON A MAJORRULE
ISSUED BY THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES,
CENTERS FOR MEDICARE AND MEDICAID SERVICES
ENTITLED
"MEDICARE PROGRAM; INPATIENT HOSPITAL DEDUCTIBLE
AND HOSPITAL AND EXTENDED CARE SERVICES
COINSURANCE AMOUNTS FOR CALENDAR YEAR 2010"
(RIN: 0938-AP42)

(i) Cost-benefit analysis

CMS determined that the total increase in costs tobeneficiaries will be about $730 million, due to the increase in the deductibleand coinsurance amounts and the change in the number of deductibles and dailycoinsurance amounts paid.

(ii) Agency actions relevant to the RegulatoryFlexibility Act, 5 U.S.C. sections603-605, 607, and 609

CMS determined that the notice will not have a significanteconomic impact on a substantial number of small entities, and therefore CMSdid not prepare an analysis under the Regulatory Flexibility Act. Additionally, CMS determined that the noticewill not have a significant impact on the operations of a substantial number ofsmall rural hospitals. Therefore, CMSdid not prepare an analysis under section 1102(b) of the Regulatory FlexibilityAct.

(iii) Agency actions relevant to sections 202-205 ofthe Unfunded Mandates Reform Act of 1995, 2 U.S.C. sections1532-1535

CMS determined that the notice will not have a substantialeffect on state or local governments.However, states may be required to pay the deductibles and coinsurancefor dually-eligible beneficiaries.

(iv) Other relevant information or requirements underacts and executive orders

Administrative Procedure Act, 5 U.S.C. sections551 etseq.

In accordance with CMS's pastpractice regarding publication of deductible and coinsurance amounts underMedicare where such amounts are determined according to statute, a generalnotice is used rather than notice and comment rulemaking procedures containedin section 553 of the Administrative Procedure Act. In addition, CMS noted good cause to waive thepublication of a proposed notice and solicitation of public comments becausedelaying publication of rates would be contrary to the public interest.

Paperwork Reduction Act, 44 U.S.C. sections3501-3520

The notice does not impose information collection andrecordkeeping requirements. Therefore,it need not be reviewed by the Office of Management and Budget under thePaperwork Reduction Act.

Statutory authorization for the rule

The notice was issued under the authority contained insection 1813(b)(2) of the Social Security Act (42 U.S.C. 1395e-2(b)(2)).

Executive Order No. 12,866 (Regulatory Planning and Review)

CMS determined that the notice is an economicallysignificant rule under the Order because the total increase in costs tobeneficiaries associated with the notice will be about $730 million. The notice was reviewed by the Office ofManagement and Budget.

Executive Order No. 13,132 (Federalism)

CMS determined that the notice does not have federalismimplications.