[Federal Register Volume 63, Number 223 (Thursday, November 19, 1998)]
[Rules and Regulations]
[Pages 64191-64195]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-30992]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Part 412
[HCFA-1049-FC]
RIN 0938-AJ26
Medicare Program; Limited Additional Opportunity to Request
Certain Hospital Wage Data Revisions for FY 1999
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final rule with comment period.
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SUMMARY: This final rule with comment period provides hospitals with a
limited additional opportunity to request certain revisions to their
wage data used to calculate the FY 1999 hospital wage index. In
addition, it explains the criteria that must be met to request a
revision, the types of revisions that will be considered, the
procedures for requesting a revision, the implementation of wage index
revisions, and other related issues. Requests for wage data revisions
must be received by the date and time specified in the ``DATES''
section of this preamble. We will implement revisions to the hospital
wage index in accordance with this final rule with comment period on a
prospective basis only.
DATES: Effective date: The provisions of this final rule with comment
period are effective on November 19, 1998.
Request date: Requests for wage data revisions will be considered
if we receive them at the appropriate address, as provided below, no
later than 5 p.m. eastern standard time on December 3, 1998.
Comment date: Comments will be considered if we receive them at the
appropriate address, as provided below, no later than 5 p.m. eastern
standard time on December 21, 1998.
ADDRESSES: Request for wage data revisions: Revision request must be
sent to the following address: Health Care Financing Administration,
Center for Health Plans and Providers, Division of Acute Care, Mail
Stop: C4-05-27, 7500 Security Boulevard, Baltimore, MD 21244-1850,
Attention: Stephen Phillips.
Comments: Mail an original and 3 copies of written comments to the
following address: Health Care Financing Administration, Department of
Health and Human Services, Attention: HCFA-1049-FC, P.O. Box 7517,
Baltimore, MD 21244-1850.
If you prefer, you may deliver an original and 3 copies of your
written comments to one of the following addresses: Room 443-G, Hubert
H. Humphrey Building, 200 Independence Avenue, SW., Washington, D.C.
20201, or Room C5-14-03, 7500 Security Boulevard, Baltimore, Maryland
21244-1850.
Information collection requirements: For comments that relate to
information collection requirements, mail a copy of comments to the
following: Health Care Financing Administration, Office of Information
Services, Information Technology Investment Management Group, Division
of HCFA Enterprise Standards, Room C2-26-17, 7500 Security Boulevard,
Baltimore, MD 21244-1850, Attn: John Burke HCFA-1049-NC, and the Office
of Management and Budget, Office of Information and Regulatory Affairs,
Room 10235, New Executive Office Building, Washington, DC 20503, Attn:
Allison Herron Eydt, HCFA Desk Officer.
FOR FURTHER INFORMATION CONTACT: Stephen Phillips, (410) 786-4531.
SUPPLEMENTARY INFORMATION:
Comments, Procedures, Availability of Copies, and Electronic Access
Because of staff and resource limitations, we cannot accept
comments by facsimile (FAX) transmission. In commenting, please refer
to file code HCFA-1049-FC. Comments received timely will be available
for public inspection as they are received, generally beginning
approximately 3 weeks after publication of a document, in Room 443-G of
the Department's office at 200 Independence Avenue, SW., Washington,
DC, on Monday through Friday of each week from 8:30 to 5 p.m. (phone:
(202) 690-7890).
Copies: To order copies of the Federal Register containing this
document, send your request to: New Orders, Superintendent of
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date
of the issue requested and enclose a check or money order payable to
the Superintendent of Documents, or enclose your Visa or Master Card
number and expiration date. Credit card orders can also be placed by
calling the order desk at (202) 512-1800 or by faxing to (202) 512-
2250. The cost for each copy is $8. As an alternative, you can view and
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is http://www.access.gpo.gov/nara____ docs/, by using local WAIS
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contact the GPO Access User Support Team by sending Internet e-mail to
help@eids05.eidsgpo.gov; by faxing to (202) 512-1262; or by calling
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through Friday, except for Federal holidays.
I. Introduction
Section 1886(d)(3)(E) of the Social Security Act (the Act) requires
that, as part of the methodology for determining prospective payments
to hospitals for inpatient operating costs, the Secretary must adjust
standardized amounts ``for area differences in hospital wage levels by
a factor (established by the Secretary) reflecting the relative
hospital wage level in the geographic area of the hospital compared to
the national average hospital wage level.'' In addition, section
1886(d)(3)(E) of the Act requires that the hospital wage index be
updated annually and that updates or adjustments to the hospital wage
index be budget neutral.
In the July 31, 1998 Federal Register (63 FR 40966), we published
hospital inpatient prospective payment rates and policies for Federal
fiscal year (FY) 1999, including the hospital wage index. The FY 1999
wage index is based on data from Medicare cost reports for cost
reporting periods beginning in FY 1995. This cost report data is
submitted by hospitals and certified by hospitals. Before the
calculation of the FY 1999 hospital wage index was published on July
31, 1998, we provided opportunities to hospitals to request wage data
revisions and to verify wage data in HCFA's files. We established
[[Page 64192]]
deadlines for requesting wage data revisions.
Notwithstanding these deadlines, numerous hospitals have contacted
us to request revisions to the data reflected in the FY 1999 hospital
wage index. Many of these requests relate to issues arising from
hospitals failing to report costs in the first place and failing to
request revisions, or hospitals that failed to verify the final wage
data. However, it has come to our attention that certain aspects of the
development of the FY 1999 wage index may have led to some confusion
among the hospital community.
In light of the totality of the circumstances, as discussed below
in section III of this preamble, we are providing hospitals with an
additional opportunity to request limited types of revisions to the
wage data used to calculate the FY 1999 hospital wage index. This final
rule with comment period explains the types of revisions we will
consider, the procedures for requesting revisions, the implementation
of wage index revisions, and related issues.
II. Development of the FY 1999 Wage Index
As noted above, the FY 1999 hospital wage index is based on data
submitted by hospitals on Medicare cost reports for cost reporting
periods beginning in FY 1995. These cost reports reflected changes to
the manner in which we required hospitals to report certain types of
costs, in particular, certain ``wage-related costs.''
The development of the FY 1999 wage index also reflected changes to
the process for requesting wage data revisions. Under the timetable for
developing the wage index for FY 1998, we released a public use wage
data file in mid-August 1997, and hospitals could request corrections
for certain errors (data entry or tabulation errors) up until September
15, 1997 (after publication of the final rule on August 29, 1997, thus
necessitating publication of a subsequent correction notice). For the
development of the FY 1999 wage index, we revised the timetable for
making available public use wage data files and for requesting
revisions to wage data.
The new process was designed so that the wage index published in
the final rule would incorporate all revisions, including those to
correct data entry or tabulation errors by the intermediary or HCFA as
reflected in a ``final'' public use file released prior to publication
of the final rule. We gave hospitals opportunities to examine the wage
data used to construct the proposed and the final FY 1999 hospital wage
indices, by making available two public use data files containing the
FY 1995 hospital wage data. In memoranda dated February 2 and April 21,
1998, we instructed Medicare fiscal intermediaries to inform the
hospitals they serve of the availability of the wage data files and the
process and time frame for hospitals to request revisions. The proposed
and the final wage data files were made available February 6 and May
14, 1998, respectively, through the Internet on HCFA's home page
(http://www.hcfa.gov). We instructed fiscal intermediaries to advise
hospitals of the alternative availability of these data through their
representative hospital organizations or directly from HCFA.
Thus, under the timetable for developing the FY 1999 wage index, we
made available the final public use wage data file in May (rather than
August) and hospitals had to request corrections for data entry or
tabulation errors by the intermediary or HCFA by June 5, 1998 (rather
than mid-September as in past years).
After developing the final wage index, it came to our attention
that hospitals may have been confused by certain aspects of the
development of the FY 1999 wage index, as discussed below.
III. Provisions of the Final Rule With Comment Period
A. Limited Additional Opportunity to Request Certain Wage Data
Revisions for FY 1999
As explained further below, in this final rule with comment period,
we are providing hospitals a limited opportunity to request limited
types of revisions to the wage data used to calculate the FY 1999 wage
index. We are also addressing related issues. We are providing
hospitals with an additional opportunity to request certain limited
types of revisions because of the unique confluence of circumstances
relating to the development and application of the FY 1999 wage index
(as explained further below).
B. Criteria for Requesting Revisions and Explanation of the Types
of Revisions
We are providing a window of opportunity from the date of
publication of this final rule with comment period until the date and
time specified in the DATES section of this preamble for hospitals to
request revisions to their FY 1995 wage data, if they meet one of the
following criteria:
The hospital's data on the May 1998 public use file is
recorded as zero on Line 28 of Worksheet S-3, Part III (wage-related
costs).
The hospital's data on the May 1998 public use file is
recorded as zero in either column 3 or 4 (but not both), with nonzero
data in the other column, for Lines 2, 4, 6, or 33 of Worksheet S-3,
Part III.
The hospital properly requested a wage data revision by
March 9, 1998, the fiscal intermediary approved a revision (as
reflected in a revised Worksheet S-3), but the fiscal intermediary or
HCFA made a data entry or tabulation error.
We address each category in more detail below. We will not consider
requests for other types of revisions. Requests from hospitals meeting
these criteria must be limited to these specific criteria.
1. Zero Wage-related Costs on Line 28 of Worksheet S-3, Part III
The Medicare cost reports for cost reporting periods beginning in
FY 1995 reflected changes to the wage data portions (Parts II, III, and
IV) of Worksheet S-3. The FY 1999 wage index reflects, for the first
time, these changes to the cost report. We discussed these changes in
the rulemaking process for FY 1995, and we see no reason why hospitals
should not have properly reported these costs. Most hospitals did
report these costs, but it has come to our attention that a number of
hospitals incorrectly reported zero costs or otherwise did not include
costs on Line 28 of Worksheet S-3, Part III (wage-related costs).
If the May 1998 public use file reflects zero wage-related costs
for a hospital, the hospital may request a revision to Line 28 of
Worksheet S-3, Part III. The hospital must provide adequate verifiable
documentation to support the costs.
2. Zero Costs or Zero Hours (But Not Both) on Lines 2, 4, 6, or 33 of
Worksheet S-3, Part III
For certain categories of costs, hospitals are required to report
both hours and dollars. It has come to our attention that a number of
hospitals reported either (1) nonzero dollars but zero hours or (2)
nonzero hours but zero dollars, on Lines 2, 4, 6, or 33 of Worksheet S-
3. To calculate each hospital's average hourly wage, we summed the
dollars (Column 3) and hours (Column 4), respectively, for lines 2, 4,
6, 32, and 33. However, if a hospital reported zero dollars or zero
hours, but not both, for any of these lines (this situation did not
arise on line 32), we excluded the corresponding nonzero amount for
that line in
[[Page 64193]]
calculating the hospital's average hourly wage.
Under this final rule with comment period, we are permitting
hospitals to request revisions if the hospital improperly reported zero
dollars or zero hours, but not both, for Lines 2, 4, 6, or 33 of
Worksheet S-3. In order for a hospital's request for revision to be
granted, a hospital must satisfactorily justify that these costs and
hours should be included. For example, if a hospital reported $500,000
in physician Part A salaries but reported zero hours attributable to
physician Part A services, in order for a request to be granted, the
hospital must report accurate hours related to those costs or otherwise
explain why that $500,000 should be included in the calculation.
3. Data Entry or Tabulation Errors
On May 14, 1998, we made available a ``final'' public use wage data
file. In the May 8 proposed rule, we stated, ``If, after reviewing the
final file, a hospital believes that its wage data are incorrect due to
a fiscal intermediary or HCFA error in the entry or tabulation of the
final wage data,'' the hospital had to request a revision by June 5,
1998 in order for the data to be revised.
It has come to our attention that the revised timetable for
releasing the final wage file (May, rather than August) and the revised
deadline for requesting revisions for data entry or tabulation errors
(June 5, rather than mid-September) may have led to some confusion. If
a hospital properly requested a revision by March 9, 1998, and the
fiscal intermediary approved the revision (as reflected in a revised
Worksheet S-3), but there was an error in data entry or tabulation, we
will consider a hospital's request for revision to the wage data
notwithstanding the June 5, 1998 deadline. Thus, we are effectively
extending the June 5, 1998 deadline for correcting certain data entry
or tabulation errors.
C. Rationale for Accepting Limited Types of Revisions
We will consider requests only for the limited types of revisions
specified above. We will not consider requests for other types of
revisions.
We are providing for these limited revisions because of the
totality of the circumstances, including--
The number of hospitals contacting us about the same types
of problems;
The hardship that might result for a number of hospitals
if we did not revise the wage data;
The changes to the Medicare cost report, reflected for the
first time in the FY 1999 wage index;
The revised statutory timetable for publishing the
proposed and final hospital inpatient prospective payment system rules,
effective for the first time for FY 1999 (see section 4644 of the
Balanced Budget Act of 1997); and
The revised timetable for finalizing wage data (including
the revised timetable for releasing the final public use wage data file
and the revised timetable for requesting corrections of data entry and
tabulation errors), applied for the first time in developing the FY
1999 wage index.
None of these factors, by itself, would be sufficient grounds for
making a mid-year revision. For example, we believe we should not make
a wage index revision merely because a single individual hospital might
receive significantly lower payments as a result of its failure to
properly report costs or its failure to properly request revisions and
verify data. In deciding which types of revisions we would make, we
considered the factors above not only in combination with each other,
but also in light of the previous opportunities we provided to
hospitals to verify data and request revisions.
We evaluated the totality of the circumstances and decided it was
appropriate to make limited types of revisions. As indicated earlier,
we believe most problems with wage data arise because hospitals fail to
properly report costs on the cost report, fail to properly request
revisions, or fail to verify the data that the intermediary and HCFA
are using to calculate the wage index. We believe it would not be
necessary or appropriate to consider, at this time, requests for any
and all types of revisions to the FY 1995 wage data. We note that, if
we permitted hospitals to request any and all revisions, it would
presumably take longer for hospitals to receive revised wage indexes
for FY 1999.
Also, we emphasize that this final rule with comment period should
not be construed as an acknowledgment that the development of the FY
1999 wage index, as reflected in the July 31 Federal Register, was in
any way unfair or unreasonable. Moreover, it should not be construed as
an acknowledgment that mid-year corrections may be appropriate in other
contexts or in other years. Many of our policies reflect balancing the
competing considerations of finality, accuracy, and certainty, and many
aspects of developing payment rates and policies require the use of the
best data available at the time. As stated above, we are providing for
limited wage data revisions for FY 1999 because of the totality of the
circumstances in this context.
D. Procedures for Submission of Requests and Evaluation of Requests
A hospital seeking a revision to its FY 1995 wage data under the
applicable criteria must submit a written request to both its fiscal
intermediary and HCFA, clearly explaining the basis for the request.
Each request must include all information and supporting documentation
needed for HCFA and the fiscal intermediary to determine whether the
request meets the applicable criteria, and to verify the accuracy of
the requested revision.
A hospital seeking a revision must submit its request to the HCFA
official whose name appears in the ADDRESSES section of the preamble.
The request must be received by date and time specified in the DATES
section of this preamble.
Upon receipt of a request for revision, HCFA will confer with the
hospital's fiscal intermediary as necessary and appropriate. We will
review each request and the supporting documentation and make a
decision as to whether to grant the request in full, reject it in full,
or grant it in part and reject it in part.
E. Implementation of Wage Index Revisions
We will implement the wage index revisions we make in accordance
with the process described in this final rule with comment period on a
prospective basis only. We note that the timing of wage index
revisions, as well as other adjustments described below, will depend in
part on the number of the requests that we receive. Also, we note that
this process might result in wage index revisions for hospitals that do
not request revisions, not only hospitals in the same labor market area
as hospitals that request revisions, but also all other hospitals. This
is because the hospital wage index measures relative wage levels across
geographic areas, and reflects the average hourly wage in each labor
market area as well as the national average hourly wage.
IV. Other Related Issues
A. Budget Neutrality and Adjustment to Standardized Amounts
Under section 1886(d)(3)(E) of the Act, ``adjustments or updates''
to the hospital wage index for a fiscal year ``shall be made in a
manner that assures that aggregate payments . . . in the fiscal year
are not greater than or less than those that would have been made in
the year without such adjustment.'' Accordingly, to the extent that
mid-year revisions to the hospital wage index would affect aggregate
payments, we
[[Page 64194]]
will apply a budget neutrality adjustment to the standardized amounts
so that aggregate payments ``are not greater than or less than those
that would have been made in the year without [mid-year wage index]
adjustment.'' With respect to individual hospitals who do not request
revisions, we anticipate that the combined impact of wage index
revisions and the budget neutrality adjustment will be minimal, because
the ``cost'' of permitting wage index revisions to some hospitals will
be spread out over all prospective payment hospitals.
As discussed in numerous Federal Register documents, we calculate a
budget neutrality adjustment by simulating payments with and without
the adjustment to the wage indexes. We would implement the budget
neutrality adjustment (on a prospective basis) at the same time we
implement the revised wage indexes.
Also, we note that the capital prospective payment system
incorporates the hospital wage index for operating costs. Accordingly,
we will incorporate the wage index revisions made in accordance with
this final rule with comment period into capital prospective payments,
including the geographic adjustment factor (GAF).
B. The Relationship Between Wage Revisions and the MGCRB Process
Under section 1886(d)(10) of the Act, the Medicare Geographic
Classification Review Board (MGCRB) considers applications by hospitals
to be reclassified to another geographic area for purposes of the wage
index. For purposes of evaluating a hospital's application for
reclassification for FY 2000, the MGCRB will use hospitals' average
hourly wages incorporating all of the revisions made in accordance with
this final rule with comment period at the time the MGCRB rules on the
hospital's application.
V. Response to Comments
Because of the large number of items of correspondence we normally
receive on Federal Register documents published for comment, we are not
able to acknowledge or respond to them individually. We will consider
all comments we receive by the date and time specified in the DATES
section of this preamble, and, when we proceed with a subsequent
document, we will respond to the comments in the preamble to that
document.
VI. Waiver of Notice of Proposed Rulemaking and 30-Day Delay in the
Effective Date
We ordinarily publish a notice of proposed rulemaking to provide a
period of public comment on a rule. However, we may waive that
procedure if we find good cause that prior notice and comment would be
impracticable, unnecessary, or contrary to public interest.
We find that it would be impracticable to undertake prior notice
and comment procedures before implementing this final rule with comment
period. This final rule with comment period provides hospitals with a
limited opportunity to request very limited types of revisions to the
wage data used to calculate the FY 1999 hospital wage index. As
discussed earlier, we are providing this process for mid-year revisions
because of the totality of the circumstances arising this year. These
circumstances include the number of hospitals contacting us about the
same types of wage data problems (reflecting apparent confusion about
certain aspects of the development of the FY 1999 wage index) and the
hardship that might result if we did not revise the wage data for these
hospitals. If we delayed the wage data revision process in order to
complete notice and comment procedures, we would delay the
implementation of revised wage indexes and thus diminish the extent to
which we address the potential hardship that might result for certain
hospitals. Also, it is essential to finalize the FY 1999 wage index
process expeditiously because the MGCRB will soon be evaluating and
making decisions on applications for hospital geographic
reclassification for FY 2000. The MGCRB's decision-making process for
these applications requires analysis of the wage data used to calculate
the FY 1999 wage index, and delaying the wage data revision process
might result in problems in the MGCRB process.
For these reasons, we find that it would be impracticable to
complete notice and comment procedures before providing hospitals with
the opportunity to request revisions to the wage data used to calculate
the FY 1999 wage index. Therefore, we find good cause to waive the
notice of proposed rulemaking and to issue this document as a final
rule with comment period. We are providing a 30-day period for public
comment.
Also, we normally provide a delay of 30 days in the effective date
of a regulation. However, if adherence to this procedure would be
impracticable, unnecessary, or contrary to the public interest, we may
waive the delay in the effective date. For the reasons discussed above,
it is important that the provisions of this final rule with comment
period have immediate effect so that we can finalize the FY 1999 wage
index. Therefore, we find good cause to waive the usual 30-day delay in
the effective date.
VII. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995 (PRA), agencies are
required to provide a 60-day notice in the Federal Register and solicit
public comment before a collection of information requirement is
submitted to the Office of Management and Budget (OMB) for review and
approval. In order to fairly evaluate whether an information collection
should be approved by OMB, section 3506(c)(2)(A) of the PRA requires
that we solicit comment on the following issues:
Whether the information collection is necessary and useful
to carry out the proper functions of the agency;
The accuracy of the agency's estimate of the information
collection burden;
The quality, utility, and clarity of the information to be
collected; and
Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
While a hospital seeking a revision to its FY 1995 cost report wage
data must submit a request, including all information and supporting
documentation needed to determine whether the request meets the
applicable criteria and to verify the accuracy of the requested
revision, HCFA believes this request for information meets one of the
exceptions to the definition of information under the PRA and is
therefore not subject to the PRA. In summary, 5 CFR 1320.3(h)(9) states
that information does not include, ``facts or opinions solicited
through nonstandardized follow-up questions designed to clarify
responses to approved collections of information''. Since we believe
this voluntary request is not standardized and is designed only to
provide hospitals with an additional opportunity to clarify information
previously provided to HCFA in their 1995 cost report (HCFA-2552, OMB
approval #0938-0050, current expiration date of 8/31/2000), HCFA
believes that this exception to the PRA applies.
If you want to comment on this issue, please mail copies directly
to the HCFA and OMB officials whose names appear
[[Page 64195]]
in the ADDRESSES section of this preamble.
VIII. Regulatory Impact Statement
We have examined the impacts of this final rule with comment period
as required by Executive Order 12866 and the Regulatory Flexibility Act
(RFA) (Public Law 96-354). Executive Order 12866 directs agencies to
assess all costs and benefits of available regulatory alternatives and,
when regulation is necessary, to select regulatory approaches that
maximize net benefits (including potential economic, environmental,
public health and safety effects, distributive impacts, and equity).
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 $5 million or less
annually. For purposes of the RFA, all hospitals are considered to be
small entities.
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. Such an
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 (MSA) and has fewer than 50 beds.
The implementation of this final rule with comment period will have
isolated positive payment impacts in areas whose wage indexes include
hospitals receiving wage data revisions as described above. We believe
approximately 163 hospitals had zero on Line 28 of Worksheet S-3, Part
III, on the May 1998 public use file. In addition, we believe
approximately 127 hospitals had zero in either column 3 or 4 (but not
both), with nonzero data in the other column, for Lines 2, 4, 6, or 33
of Worksheet S-3, Part III, on the May 1998 public use file. We do not
know how many, if any, hospitals may be eligible under the third
criterion: the hospital properly requested a wage data revision by
March 9, 1998, the fiscal intermediary approved a revision, but the
fiscal intermediary or HCFA made a data entry or tabulation error on
the May 1998 public use file.
Of the approximately 163 hospitals potentially eligible under the
first criterion, there are 59 rural hospitals (located in 15 different
States) and 104 urban hospitals (located in 63 different MSAs). Of the
approximately 127 hospitals potentially eligible under the second
criterion, there are 40 rural hospitals and 87 urban hospitals.
All other hospitals' wage index values are likely to decrease
slightly as a result of any revisions under this process. This is
because the revisions will likely have the effect of slightly
increasing the national average hourly wage ($20.7325 in the July 31,
1998 final rule (63 FR 40973)). Therefore, hospitals in areas without
any revisions may experience a slight decrease in their wage index
values when their area's unchanged average hourly wage is compared to
the higher national average hourly wage.
In addition, as described above in section IV.A., we intend to
implement any necessary budget neutrality adjustment at the same time
we implement revised wage indexes. The impact of this adjustment will
depend on the changes to the hospital wage index. With respect to
hospitals in labor market areas whose average hourly wage is not
affected, we believe the combined effect of the higher national average
hourly wage and budget neutrality will be minimal. We will estimate and
publish the entire impacts of payment changes associated with any
revisions to hospitals' wage indexes in the subsequent document to this
final rule with comment period.
IX. Contract With America Advancement Act (Public Law 104-121)
This rule has been determined to be a major rule as defined in
Title 5, United States Code, section 804(2). Although the actual impact
of this final rule with comment period cannot be determined prior to
reviewing the revision requests, we believe it could range from $0 to
$500 million. Ordinarily, under 5 U.S.C. 801, as added by section 251
of Pub. L. 104-121, a major rule shall take effect 60 days after the
later of (1) the date a report on the rule is submitted to the Congress
or (2) the date the rule is published in the Federal Register. However,
section 808(2) of Title 5, United States Code, provides that,
notwithstanding 5 U.S.C. 801, a major rule shall take effect at such
time as the Federal agency promulgating the rule determines, if for
good cause the agency finds that notice and public procedure are
impracticable, unnecessary, or contrary to the public interest. As
indicated above, for good cause we find that it was impracticable to
complete notice and comment procedures before publication of this rule.
Accordingly, pursuant to 5 U.S.C. 808(2), this final rule with comment
period is effective on November 19, 1998.
.(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: October 30, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
Approved: November 3, 1998.
Donna E. Shalala,
Secretary.
[FR Doc. 98-30992 Filed 11-17-98; 10:27 am]
BILLING CODE 4120-01-P
