GAO reviewed the Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) new rule on ambulance temporary rate increase. GAO found that (1) the rule codifies the four payment provisions for Medicare covered ambulance services contained in section 414 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003; and (2) CMS complied with all applicable requirements in promulgating the rule.
Department of Health and Human Services, Centers for Medicare and Medicaid Services: Medicare Program; Medicare Ambulance MMA Temporary Rate Increases Beginning July 1, 2004, GAO-04-955R, July 14, 2004
The Honorable William M. Thomas
The Honorable Charles B. Rangel
Ranking Minority Member
Committee on Ways and Means
House of Representatives
Pursuant to section 801(a)(2)(A) of title 5, United States Code, this is our report on a major rule promulgated by the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), entitled "Medicare Program; Medicare Ambulance MMA Temporary Rate Increases Beginning July 1, 2004" (RIN: 0938-AN24). We received the rule on July 1, 2004. It was published in the Federal Register as an interim final rule with comment period on July 1, 2004. 69 Fed. Reg. 40288.
The interim final rule codifies the four payment provisions for Medicare covered ambulance services contained in section 414 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
Enclosed is our assessment of the CMS's compliance with the procedural steps required by section 801(a)(1)(B)(i) through (iv) of title 5 with respect to the rule. Our review indicates that the CMS complied with the applicable requirements.
In September 2003, GAO issued a report entitled Ambulance Services: Medicare Payments Can Be Better Targeted to Trips in Less Densely Populated Rural Areas (GAO-03-986). The data from this report was used by CMS to implement the statutory provisions.
If you have any questions about this report, please contact James W. Vickers, Assistant General Counsel, at (202) 512-8210. The official responsible for GAO evaluation work relating to the subject matter of the rule is Marjorie Kanof, Managing Director, Health Care Issues. Ms. Kanof can be reached at (202) 512-7101.
Kathleen E. Wannisky
Managing Associate General Counsel
ANALYSIS UNDER 5 U.S.C. 801(a)(1)(B)(i)-(iv) OF A MAJOR RULE
ISSUED BY THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES,
CENTERS FOR MEDICARE AND MEDICAID SERVICES
"MEDICARE PROGRAM; MEDICARE AMBULANCE MMA
TEMPORARY RATE INCREASES BEGINNING JULY 1, 2004"
(i) Cost-benefit analysis
CMS states that the cost to the Medicare program will be approximately840 million over the total 5-year period, during which the provisions of the interim final rule will be in effect.
(ii) Agency actions relevant to the Regulatory Flexibility Act, 5 U.S.C. 603-605, 607, and 609
CMS performed a Final Regulatory Flexibility Analysis for the interim final rule. It found that the rule will have a significant impact on all ambulance providers and suppliers to the extent that the rule authorizes higher payments to anyone furnishing Medicare-covered ambulance services to Medicare beneficiaries.
(iii) Agency actions relevant to sections 202-205 of the Unfunded Mandates Reform Act of 1995, 2 U.S.C. 1532-1535
The interim final rule does not contain either an intergovernmental or private sector mandate, as defined in title II, of more than100 million in any one year.
(iv) Other relevant information or requirements under acts and executive orders
Administrative Procedure Act, 5 U.S.C. 551 et seq .
CMS has found good cause to forgo notice and comment procedures because section 414(e) of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 specifies that the rule may be issued as an interim final rule in order to meet the statutorily required implementation date.
Paperwork Reduction Act, 44 U.S.C. 3501-3520
The interim final rule does not contain any information collections that are subject to review by the Office of Management and Budget (OMB) under the Paperwork Reduction Act.
Statutory authorization for the rule
The interim final rule is issued pursuant to section 414 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Pub. L. 108-173.
Executive Order No. 12866
The interim final rule was reviewed by OMB and found to be an economically significant regulatory action under the order.
Executive Order No. 13132 (Federalism)
CMS has determined that the interim final rule does not have federalism implications.