[Federal Register: February 6, 2008 (Volume 73, Number 25)]
[Notices]
[Page 6971-6973]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr06fe08-63]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-5014-N]
Medicare Program; Rural Community Hospital Demonstration Program;
Solicitation of Additional Participants
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces a solicitation for up to six additional
hospitals to participate in the Rural Community Hospital Demonstration
Program for the remainder of the 5-year time period allowed by section
410A of
[[Page 6972]]
the MMA that is currently scheduled to end in 2010.
DATES: Application Submission Deadline: Applications must be received
by 5 p.m., e.s.t. on or before March 24, 2008. Only applications that
are considered ``timely'' will be reviewed and considered by the
technical panel.
ADDRESSES: The applications should be MAILED or sent by an overnight
delivery service to the following address: Centers for Medicare &
Medicaid Services, ATTN: Sid Mazumdar, Rural Community Hospital
Demonstration, Medicare Demonstrations Program Group, Mail Stop C4-17-
27, 7500 Security Boulevard, Baltimore, MD 21244.
Please allow sufficient time for mailed information to be received
in a timely manner in the event of delivery delays. Because of staffing
and resources limitations, and because we require an application
containing an original signature, we cannot accept applications by
facsimile (Fax) transmission.
FOR FURTHER INFORMATION CONTACT: Sid Mazumdar at (410) 786-6673 or by
e-mail at: Siddhartha.mazumdar@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
I. Background
Section 410A(a) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Pub. L. 108-173) (MMA) requires the
Secretary to establish a demonstration to test the feasibility and
advisability of establishing ``rural community hospitals'' for Medicare
payment purposes for covered hospital inpatient services furnished to
Medicare beneficiaries. A rural community hospital, as defined in
section 410A(f)(1) of the MMA, is a hospital that--
Is located in a rural area (as defined in section
1886(d)(2)(D) of the Social Security Act (the Act) (42 U.S.C.
1395ww(d)(2)(D))) or treated as being so located pursuant to section
1886(d)(8)(E) of the Act (42 U.S.C. 1395ww(d)(8)(E));
Has fewer than 51 acute care inpatient beds, as reported
in its most recent cost report;
Makes available 24-hour emergency care services; and
Is not eligible for critical access hospital (CAH)
designation, or has not been designated a CAH under section 1820 of the
Act.
Section 410A(a)(4) of the MMA specifies that the Secretary is to
select for participation no more than 15 rural community hospitals in
rural areas of States that the Secretary identifies as having low
population densities. Using 2002 data from the U.S. Census Bureau, we
identified the 10 States with the lowest population densities in which
rural community hospitals must be located to participate in the
demonstration: Alaska, Idaho, Montana, Nebraska, Nevada, New Mexico,
North Dakota, South Dakota, Utah, and Wyoming. (Source: U.S. Census
Bureau, Statistical Abstract of the United States: 2003).
The demonstration is designed to test the feasibility and
advisability of reasonable cost reimbursement for inpatient services to
small rural hospitals. The demonstration is aimed at increasing the
capability of the selected rural hospitals to meet the needs of their
service areas.
Section 410A(a)(5) of the MMA states the Secretary shall conduct
the demonstration program for a 5-year period. We originally solicited
applicants for the demonstration in May 2004; 13 hospitals began
participation with cost report years beginning on or after October 1,
2004. Four of these 13 hospitals have withdrawn from the program and
have become CAHs. For the remaining 9 participating hospitals, the
demonstration will end in 2010 when each hospital has completed its
fifth cost report year.
II. Provisions of the Notice
This notice announces the solicitation for up to six additional
hospitals to participate in the Rural Community Hospital Demonstration
Program. Hospitals that enter the demonstration under this solicitation
will be able to participate for no more than 2 years. We will adhere to
the requirement under section 410A of the MMA to limit the
demonstration to 5 years, that is, the program will end in 2010.
A. Demonstration Payment Methodology
Section 410A of the MMA requires that ``in conducting the
demonstration program under this section, the Secretary shall ensure
that the aggregate payments made by the Secretary do not exceed the
amount which the Secretary would have paid if the demonstration program
under this section was not implemented.'' In order to achieve budget
neutrality for this demonstration program for FYs 2005, 2006, 2007, and
2008, we adjusted the national hospital inpatient prospective payment
system (IPPS) rates by an amount sufficient to offset the added costs
of this demonstration program. We will present an estimate of the
amount needed to offset the additional costs incurred under the
demonstration in FY 2009, including the cost of newly selected rural
community hospitals, in the FY 2009 IPPS proposed rule.
Hospitals selected for participation in the demonstration will
receive payment for covered inpatient services, with the exclusion of
services furnished in a psychiatric or rehabilitation unit that is a
distinct part of the hospital, using the following rules. For
discharges occurring--
In the first cost reporting period on or after the
implementation of the program, their reasonable costs for covered
inpatient services; or
During the second or subsequent cost reporting period, the
lesser of their reasonable costs or a target amount. The target amount
in the second cost reporting period is defined as the reasonable costs
of providing covered inpatient hospital services in the first cost
reporting period, increased by the IPPS update factor (as defined in
section 1886(b)(3)(B) of the Act) for that particular cost reporting
period. The target amount in subsequent cost reporting periods is
defined as the preceding cost reporting period's target amount
increased by the IPPS update factor for that particular cost reporting
period.
Covered inpatient hospital services means inpatient hospital
services (defined in section 1861(b) of the Act) and including extended
care services furnished under an agreement under section 1883 of the
Act.
B. Participation in the Demonstration
To participate in this demonstration, a hospital must be located in
one of the identified States and meet the criteria for a rural
community hospital. Eligible hospitals that desire to participate in
the demonstration must submit an application to CMS. Information about
the demonstration and details on how to apply can be found on the CMS
Web site at http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/2004_Rural_Community_Hospital_Dem-
onstration_Program.pdf.
III. Collection of Information Requirements
The information collection requirements contained in this notice
are subject to the Paperwork Reduction Act of 1995 (PRA). As discussed
in section II.B. of this notice, a hospital must submit the required
information on the cover sheet of the CMS Medicare Waiver Demonstration
Application to receive consideration by the technical review panel. The
burden associated with voluntary requirement is the time and effort
necessary to complete the Medicare Waiver Demonstration Application and
submit the information
[[Page 6973]]
to CMS. The burden associated with this requirement is currently
approved under OMB control number 0938-0880 with an expiration date of
November 20, 2010.
Authority: Section 410A of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003, Pub. L. No. 108-173.
(Catalog of Federal Domestic Assistance Program No. 93.773
Medicare--Hospital Insurance Program; and No. 93.774, Medicare--
Supplementary Medical Insurance Program).
Dated: January 11, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 08-511 Filed 2-1-08; 10:00 am]
BILLING CODE 4120-01-P