Legislation

60396

Federal Register / Vol. 68, No. 204 / Wednesday, October 22, 2003 / Notices
clearance requests submitted to OMB for
review, call the HRSA Reports
Clearance Office on (301) 443–1129.
The following request has been
submitted to the Office of Management
and Budget for review under the
Paperwork Reduction Act of 1995:

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health Resources and Services
Administration
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
Periodically, the Health Resources
and Services Administration (HRSA)
publishes abstracts of information
collection requests under review by the
Office of Management and Budget, in
compliance with the Paperwork
Reduction Act of 1995 (44 U.S.C.
Chapter 35). To request a copy of the

Proposed Project: The Health Education
Assistance Loan (HEAL) Program:
Forms—(OMB No. 0915–0043)—
Revision
This clearance request is for a revision
of the approval for three HEAL forms:
the HEAL Repayment Schedule, Fixed
and Variable (provides the borrower
with cost of a HEAL loan, the number
Number of
respondents

Form and number

Responses
per
respondent

and amount of payments, and the Truthin-Lending disclosures); and the
Lender’s Report on HEAL Student Loans
Outstanding, Call Report (provides
information on the status of loans
outstanding by the number of borrowers
whose loan payments are in various
stages of the loan cycle, such as student
education and repayment, and the
corresponding dollar amounts). These
forms are needed to provide borrowers
with information on the cost of their
loan(s) and to determine which lenders
may have excessive delinquencies and
defaulted loans.
The estimate of burden for the forms
is as follows:
Total
responses

Hours per
responses

Total burden
hours

Disclosure: Repayment Schedule HRSA 502–1, 2 .............
Reporting: Call Report, HRSA 512 ......................................

15
20

666
4

9,990
80

.5
.75

4995
60

Total Reporting and Disclosure ....................................

20

........................

10,070

........................

5,055

Written comments and
recommendations concerning the
proposed information collection should
be sent within 30 days of this notice to:
John Morrall, Human Resources and
Housing Branch, Office of Management
and Budget, New Executive Office
Building, Room 10235, Washington, DC
20503.
Dated: October 15, 2003.
Jane M. Harrison,
Director, Division of Policy Review and
Coordination.
[FR Doc. 03–26573 Filed 10–21–03; 8:45 am]
BILLING CODE 4165–15–P

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health Resources and Services
Administration
Children’s Hospitals Graduate Medical
Education Payment Program: Final
Policies on Withholding and
Reconciliation Process and
Methodology for Calculating
Reconciliation Payments, Use of Wage
Index in Calculating Indirect Medical
Education Payments, Dissemination of
Program Data, and Audit; Updates on
Calculation of National Per Resident
Amount and Government Performance
and Results Act Measures
AGENCY: Health Resources and Services
Administration, HHS.
ACTION:

Final notice.

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SUMMARY: This notice adopts policies for
the Children’s Hospitals Graduate
Medical Education Payment Program
(CHGME PP) regarding the CHGME PP
withholding and reconciliation process
and calculation of reconciliation
payments, use of the wage index to
calculate CHGME PP indirect medical
education (IME) payments,
dissemination of CHGME PP data, and
audits. This notice also provides
updates and clarification on the CHGME
PP calculation of a national per resident
amount and CHGME PP compliance
with Government Perfornance and
Results Act (GPRA) measures.
DATES: This notice is effective
November 21, 2003. See discussion
under Supplemental Information.
FOR FURTHER INFORMATION CONTACT:
Ayah E. Johnson, Ph.D., Chief, Graduate
Medical Education Branch, Division of
Medicine and Dentistry, Bureau of
Health Professions, Health Resources
and Services Administration, Room 9A–
05, Parklawn Building, 5600 Fishers
Lane, Rockville, Maryland 20857;
telephone (301) 443–1058 or e-mail
address
[email protected].

The
CHGME PP, as authorized by section
340E of the Public Health Service Act
(42 U.S.C. 256e) (the Act), provides
funds to children’s hospitals that
operate graduate medical education
(GME) programs. Pub. L. 106–310
amended the CHGME PP statute to
continue the program through Federal
fiscal year (FFY) 2005.

SUPPLEMENTARY INFORMATION:

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On September 25, 2002, the Secretary
published a notice in the Federal
Register (67 FR 60241) clarifying
hospital eligibility criteria for the
CHGME PP. That notice also sought
public comments on proposals for (1)
establishing a methodology to determine
direct medical education (DME) and
IME payments during the withholding
and reconciliation processes stipulated
in the CHGME PP statute; (2) updating
the wage index used in the calculation
of IME payments; (3) disseminating
CHGME PP data; and (4) auditing.
During the comment period, the
Department received comments from six
interested parties, including hospitals
and professional associations. The
Secretary thanks the respondents for the
quality and thoroughness of their
comments. As a result of these
comments, the Department has made
revisions and clarifications in this final
notice. The comments and Department’s
responses to the comments, as well as
the final rules are set forth below.
Subsequent to the publication of this
notice, CHGME PP policies will be
codified.
As indicated in the September 25
Federal Register notice, an updated
listing of children’s hospitals potentially
eligible to participate in the CHGME PP
will be posted on the CHGME PP Web
site (http://bhpr.hrsa.gov/
childrenshospitalgme), during the third
quarter of each year.
Effective dates. To the extent this
notice reiterates or clarifies past
practices of the CHGME program, those
policies continue in effect. To the extent

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Federal Register / Vol. 68, No. 204 / Wednesday, October 22, 2003 / Notices
this notice creates new duties and
obligations which cannot be directly
drawn from the statute, the effective
date shall be November 21, 2003.
Final Provisions
The Department is finalizing the
following provisions: (1) Methodology
for withholding DME and IME payments
and determining reconciliation
payments as stipulated in the CHGME
PP statute; (2) updating of the wage
index used in calculating lIME
payments; (3) dissemination of CHGME
PP data; and (4) audit.
In its September 25, 2002 Federal
Register notice, the Department
proposed for public comment its
methodology for the withholding and
reconciliation of CHGME PP payments
as stipulated by statute. The Department
proposed to withhold up to 25% of both
DME and lIME payments to ensure that
hospitals did not receive overpayment.
It also proposed a methodology to
determine reconciliation payments
using changes in FTE resident counts
that occur during the Federal fiscal year
(FFY) for which payments are being
made.
In the same Federal Register notice,
the Department also proposed that the
most recently available wage index (WI)
be used in the determination of IME
payments. To date, the Department had
been using the FY 1999 WI published by
the Centers for Medicare and Medicaid
Services (CMS) to determine IME since
its use is statutorily mandated in the
determination of DME.
The Department also proposed that
each hospital could request its own
information (i.e., its application
information and information used to
determine payments) from the CHGME
PP but would need to request all other
information (e.g., information for other
hospitals or for all hospitals) through
the HRSA Freedom of Information Act
(FOIA).
Finally, the Department proposed that
the 0MB A–133 review requirements
originally imposed on hospitals
participating in the CHGME PP be
replaced with an assessment conducted
by an outside contractor familiar with
Medicare policies of the FTE resident
counts.
A description of the Department’s
final policies on these issues as well as
the public comments and the
Department’s response is included in
the following sections.
I. Withholding and Reconciliation
Processes and Methodology for
Calculating Reconciliation Payments
The Department is finalizing the
methodology for withholding children’s

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60397

hospitals DME and IME payments to
reduce the likelihood that a hospital is
overpaid on an interim basis,
determining revised full time equivalent
(FTE) resident counts, and calculating
reconciliation payments described in
the September 25, 2002 Federal Register
notice. The CHGME PP began
implementing this methodology
beginning with the payments it awarded
to children’s hospitals issued in Federal
Fiscal Year (FFY) 2002.

the terms and conditions of the CHGME
PP, the Department may suspend the
award, pending corrective action, or
may terminate the award for cause.
Hospitals that were not eligible to
participate or did not apply for funding
during the initial application cycle are
not eligible to apply for and receive
funding during the reconciliation
process. These hospitals must wait until
the next initial application cycle to
apply.

Withholding Process
The CHGME PP statute, as amended,
states that ‘‘the Secretary shall withhold
up to 25% from each interim (payment)
installment for direct and indirect
graduate medical education * * * as
necessary to ensure a hospital will not
be overpaid on an interim basis.’’ The
statute also indicates that, prior to the
end of each FFY, the Secretary must
determine any changes to the number of
FTE residents reported by a hospital in
its annual initial application for CHGME
PP funding. This determination by the
Secretary will be used to calculate the
final amount payable to that hospital for
the FFY. Funding withheld during the
interim period will be allocated to
children’s hospitals following the
determination by the Secretary of any
changes to the number of FTE residents
reported by participating hospitals. The
Secretary has statutory authority to
reconcile FTE resident counts only. It
should be noted, however, that the
Secretary does have the discretion to
audit any and all variables used to
determine CHGME PP payments to
children’s hospitals.

Determining Changes in FTE Resident
Counts
Hospitals will report revised FTE
resident counts to the CHGME PP by
submitting a complete reconciliation
application. Any changes to resident
FTE counts reported on the
reconciliation application must be for
the same Medicare cost report (MCR)
period(s) identified in the hospital’s
initial application for the FFY. Hospitals
whose resident counts have not changed
are not exempt from completing and
submitting a CHGME PP reconciliation
application. For purposes of
clarification, an FTE resident is
measured in terms of time worked
during a residency training year. It is
not a measure of individual residents
who are working.
Prior to FFY 2003, assessment of FTE
resident counts was done by the
Medicare fiscal intermediaries (FIs) for
the subset of children’s hospitals that
filed full MCRs. The Secretary has
established an assessment process that
will ensure this determination is made
for FTE resident counts submitted by all
children’s hospitals. Beginning in FFY
2003, the CHGME PP is contracting with
FIs to assess the FTE resident counts
submitted by participating hospitals in
their FFY 2003 initial CHGME PP
application. This assessment of FTE
resident counts will be performed for all
hospitals regardless of the type of MCR
they file (e.g., full, low or no
utilization). This process is designed to
assess FTE resident counts for all
children’s hospitals within the CHGME
PP time constraints in an equitable
fashion. The resident FTE counts
reported by the hospitals in their
reconciliation application must be
consistent with those reported by the
hospital’s CHGME FI to be accepted by
the Department. The Department will
provide final review and determination
of the hospitals’ FTE counts. The
reconciliation process requires that
participating hospitals comply with
requests from the CHGME PP FI. The
CHGME PP has placed a guidance
document providing further information
about the FTE resident count
assessment on the program’s Web site

Reporting Revised Resident Counts
To assess the impact of payment
resulting from the FTE assessment
process, during the third quarter (March
1–June 30) of each FFY for which
payments are being made, the CHGME
PP will release a reconciliation
application for use by participating
hospitals to report changes in the FTE
resident counts reported in their initial
applications. The reconciliation
application will include forms HRSA–
99 (Hospital Demographics), HRSA–99–
1 (Reconciliation of FTE resident
counts), HRSA 99–2 (Determination of
Indirect Medical Education Data),
HRSA–99–3 (Certification), and HRSA–
99–4 (Required Data Reporting for
Government Performance and Results
Act). This collection of information has
been approved under 0MB Information
Collection No. 09 5–0247. Hospitals will
have 30 days to complete and return the
reconciliation application. If a hospital
fails to complete and return the
reconciliation application according to

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Federal Register / Vol. 68, No. 204 / Wednesday, October 22, 2003 / Notices

(http://bhpr.hrsa.gov/
childrenshospitalgme).
Comment: One respondent noted that
the Department should seek FI review of
hospitals’ resident counts and reporting
of those counts consistent with the
review for a given point in time and that
the FIs should not be required to attest
to hospitals’ resident counts. The
respondent noted that such an
attestation suggests that the FI could be
held legally liable for a hospital’s error
in resident counts even though the FI is
not responsible for the maintenance and
accuracy of the hospital’s records. In
addition, the review of resident counts
reflects those counts at a point in time:
The counts may be subject to change
over time due to a variety of factors such
as a cost report re-opening.
Response: The Department will not
require the CHGME FIs to attest to a
hospital’s FTE resident count but
instead will require a review of the FTE
resident counts. This review will be
based on the FTE resident counts
submitted by the hospitals with their
initial application for funding in a
particular FFY. It will reflect the
hospitals’ FTE resident counts at a point
in time just prior to the submission of
the hospitals’ reconciliation application.
The hospital’s reconciliation application
must be consistent with the results of
this CHGME PP FI FTE resident count
assessment. The Department also
recognizes that these FTE resident
counts may change over time.
Comment: One respondent
commented that although the
Department should contract with FIs to
provide independent review of resident
counts for the CHGME PP, the hospitals
should be able to have the same FI
providing both the review and
processing of their MCR and the
assessment of resident FTE counts for
their CHGME PP application.
Response: In developing a contract
with the FIs to assess the FTE resident
counts training in children’s hospitals,
the Department made every effort to
ensure that the same FI would work
with the hospital on both their MCR and
their CHGME PP application. However,
not all FIs chose to participate in the
CHGME PP FTE resident assessment
contract and, as a result, some hospitals
will have different FIs reviewing their
MCR and their CHGME PP application.
It is important to note that the prime
contractor for Medicare and the CHGME
PP is the same. As a result,
communications are facilitated between
the Medicare and CHGME PP FIs in
instances where the two are different
entities. In those instances where a
children’s hospital has one FI for
Medicare and one for CHGME PP,

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information and FTE assessment results
will be shared between both FIs.
Determining Revised Resident Counts
for ‘‘New Children’s Teaching
Hospitals’’
New children’s teaching hospitals’’, as
defined by the CHGME PP in its July 20,
2001 Federal Register notice, do not
include those hospitals with a newly
approved residency training program as
described in 42 CFR 413.86(g)(6)(i).
These ‘‘new children’s teaching
hospitals’’ will calculate FTE resident
counts for the reconciliation application
process using the methodology
proposed in the September 25 Federal
Register notice. This proposed
methodology provides that the hospital
would calculate its FTE resident counts
in one of two ways:
1. If a hospital has filed a Medicare
cost report (MCR) by the CHGME PP
reconciliation application deadline, the
hospital would report the actual number
of resident FTEs trained during that cost
reporting period;
2. If a hospital has not filed an MCR
by the CHGME PP reconciliation
application deadline, the hospital
would determine the FTE residents
training at the hospital from the
beginning of the FFY for which
payments are being made up to the
reconciliation application deadline. The
revised FTE resident count will equal
the average number of FTE residents
trained per day during this period
multiplied by the total number of days
the hospital will be training residents
during the FFY for which payments are
being made. In the event that a ‘‘new
children’s teaching hospital’’ counts
residents in excess of its FTE resident
cap as a result of an affiliation
agreement with one or more other
hospitals, it is important to note that the
total number of FTE residents counted
by members of the affiliated group
cannot exceed the aggregate FTE cap for
member hospitals. ‘‘New children’s
teaching hospitals’’ will report these
updated FTE resident counts on form
HRSA 99–1 of the reconciliation
application.
Determining IME Payments for ‘‘New
Children’s Teaching Hospitals’’
All hospitals, including ‘‘new
children’s teaching hospitals,’’ must
submit a complete reconciliation
application. In completing form HRSA
99–2 (Indirect Medical Education) in the
reconciliation application, ‘‘new
children’s teaching hospitals’’ will use
the methodology described in the
September 25 Federal Register notice.
Those hospitals that have not filed an
MCR or completed a full Medicare cost

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reporting period will use the timeframe
from the beginning of the FFY for which
payments are being made up to the
reconciliation application deadline date
to determine the estimates needed to
complete the form.
Reconciliation Payment Process
The Secretary will determine any
balance due or any overpayment made
to individual hospitals following the
determination of changes, if any, to the
number of residents reported by
hospitals in their reconciliation
applications. Hospitals will be notified,
in writing, of the Secretary’s final
reconciliation payment determination
during the fourth quarter (July 1–
September 30) of the FFY in which
payments are being made.
Hospitals that have been notified of
an overpayment will have 30 days to
return the overpayment to the
Department without accrual of interest.
Hospitals that fail to return
overpayments within the specified
timeframe will accrue and be
responsible for any interest.
Reconciliation payments will be made
to individual hospitals on or before the
end of the FFY (September 30) in which
payments are being made. The Secretary
will include in the reconciliation
payments all funding initially withheld
from the hospital as a result of
withholding required by statute. At the
end of the FFY, the CHGME PP may
make a final payment to distribute any
remaining funds, including those funds
that have been returned to the
Department during the course of the
FFY as a result of overpayment or
hospitals’ loss of eligibility.
All hospitals, whether or not they
report changes to their resident FTE
resident counts during the
reconciliation process, can expect
changes to their final payment
determination as a result of FTE
resident count changes reported by
other participating hospitals. This is due
to the methodology used to determine
CHGME PP payments. Payments to
individual hospitals are based upon the
hospital’s share of the total amount of
DME and IME funding available for a
given FFY. A hospital’s portion of the
total DME and IME funding available is
calculated based on payment variables
in the CHGME PP statute and
regulations. This individual hospital
portion (the numerator) is then divided
by the sum of all hospitals’ portions (the
denominator) to determine the share of
the total available funding to be
distributed to the hospital. Hence,
although an individual hospital’s FTE
resident count and subsequent portion
(numerator) may not change at the time

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Federal Register / Vol. 68, No. 204 / Wednesday, October 22, 2003 / Notices
of the reconciliation application
process, the denominator of the
payment calculation may change as a
result of changes in FTE resident counts
reported by other hospitals. More
detailed information is available on the
CHGME PP payment formulas in the
June 19, 2000 Federal Register notice
(DME payment formula) and the July 20,
2001 Federal Register notice (IME
payment formula). Information on the
payment formulas is also available on
the CHGME PP Web site http://
bhpr.hrsa.gov/childrenshospitalgme/.
As provided by statute, for disputes
greater than $10,000, a hospital may
request a hearing on the Secretary’s
payment determination by the Provider
Reimbursement Review Board under
section 1878 of the Social Security Act
(42 U.S.C. 1395oo), implemented by
regulations at 42 CFR part 405, subpart
R.
It should also be noted that the
reconciliation process does not take the
place of a separate audit process to
which the hospitals may be subject.
Participating children’s hospitals are
subject to audit (other than OMB
Circular A–133 as described in section
IV below) to determine whether the
applicant hospital has complied with
applicable laws, regulations, and its
application for funding.
Comment: One respondent requested
that the interest rate charged by the
Government be published.
Response: Interest will be accrued at
a rate set on a quarterly basis by the
Secretary of the Treasury pursuant to 45
CFR 30.13.
II. Updating the Wage Index in
Calculation of Indirect Medical
Education Payment
The Department has determined that
it will continue to use the wage index
(WI) determined by the Centers for
Medicare and Medicaid Services (CMS)
for fiscal year (FY) 1999 to calculate the
indirect medical education (IME)
payment for children’s hospitals. In its
September 25, 2002 Federal Register
notice, the CHGME PP proposed that the
wage index (WI) from the most recent
fiscal year available be used to calculate
IME payments. Although the CHGME
PP statute states that the factor applied
under section 1886(d)(3)(E) of the Social
Security Act (i.e., the wage index
calculated by the Centers for Medicare
and Medicaid Services) for discharges
occurring during fiscal year 1999 for the
hospital’s area be used in the
calculation of direct medical education
(DME) payments, the Secretary has
discretion to choose the WI used in the
calculation of IME payments. Since the
statute specifies the use of the FY 1999

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WI to determine DME, however, the use
of the WI from the most recent fiscal
year available to calculate IME
payments would result in two different
WI being used to determine the CHGME
PP payments to children’s hospitals.
After consideration of the public
comments on this topic, the Department
has determined that it will continue to
use the wage index (WI) determined by
the Centers for Medicare and Medicaid
Services (CMS) for fiscal year (FY) 1999
to calculate the indirect medical
education (IME) payment for children’s
hospitals. In using the WI to determine
CHGME PP payments for both DME and
IME, the Secretary will use the most
recently available Medicare PPS laborrelated (and non-labor-related) share;
currently, the PPS labor-related share is
71.1%.
Comment: Several respondents
expressed concern regarding use of the
updated CMS WI because of current
Congressional efforts to make
substantive changes in the
determination of the CMS WI. As the
outcome of these efforts (i.e., if and
when a bill is passed) and the resulting
implications for recalculation of the WI
by CMS are not clear, the respondents
encouraged the CHGME PP to postpone
implementation of this policy.
Response: Since its inception,
determination of the WI has been
subject to change both at the
Congressional and Department level.
Given this ongoing iterative process and
the lack of statutory directive regarding
the use of WI in the calculation of IME,
the Department has determined that it
will continue to use the WI from FY
1999 to calculate the IME payment.
Comment: One respondent was
concerned about the potential confusion
that could result from using two
different WI values, one for DME and
one for lIME, to determine payments for
the participating hospitals.
Response: The Department recognizes
the potential confusion that using two
different WI values could create among
hospitals participating in the CHGME
PP. In order to prevent such confusion,
the WI from FY 1999 will continue to
be used to calculate IME.
Comment: One respondent
commented that it may be more
appropriate to postpone the
implementation of the proposed WI
policy until it could be assessed in light
of the findings of the ongoing analytic
activities related to the CHGME PP IME
payment formula.
Response: The Department agrees that
it may be best to introduce any changes
to the IME payment formula
simultaneously and not in an
incremental fashion. It should be noted,

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60399

however, that the payment formulas
used by the program may be subject to
statutory amendment.
III. Dissemination of CHGME PP Data
The Department considers all CHGME
PP information obtained by the program
in hospital applications and generated
by the program to determine payments
to be fully disclosable; that is, its release
to the public poses no potential harm to
the hospital(s) that originally submitted
the Program application. The
Department is finalizing the following
procedure for the dissemination of
information related to the CHGME PP.
Each hospital participating in the
CHGME PP may request its own
hospital-specific data related to the
CHGME PP through a written request to
the CHGME PP. Contact information is
provided earlier in this notice.
All other requests for information
(e.g., information requested about
another participating hospital or all
participating hospitals) must be
submitted to the Freedom of
Information Act (FOIA) Officer for the
Health Resources and Services
Administration (HRSA). The HRSA
FOIA Office address is 5600 Fishers
Lane, Room 14–45, Rockville Maryland
20857.
In addition, the CHGME PP will
follow the policies regarding fees and
charges associated with release of
information as stated in 45 CFR part 5,
subpart D.
IV. Audit
In the March 1, 2001 Federal Register
notice, the Department announced that
awards under the CHGME PP must be
audited under Office of Management
and Budget (OMB) Circular A–133. The
Department has reconsidered its
position with respect to this
requirement, and is making final the
policy proposed in the September 25
Federal Register notice that CHGME PP
awards are not subject to review/audit
under OMB Circular A–133. This policy
will be in effect beginning with the FFY
2003 CHGME PP application.
The relevant compliance
requirements that the Department needs
for the CHGME PP are the FTE resident
counts reported on the initial and
reconciliation applications for the
Program. Since the Secretary must
account for change in the number of
FTE residents prior to the close of each
FFY, the Department is required to
assess FTE resident counts per the
applications prior to the end of each
FFY for all CHGME PP participating
hospitals. The Department has
established a process to assess the FTE
resident counts submitted by children’s

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Federal Register / Vol. 68, No. 204 / Wednesday, October 22, 2003 / Notices

hospitals in their applications for funds
from the CHGME PP. The process is
based on the assessment process
utilized by CMS in their review of FTE
resident counts submitted on MCR. The
process will be implemented by
Department contractors familiar with
both CMS procedures and CHGME PP
requirements.
The Department believes this
approach is more effective than an
audit/review under OMB Circular A–
133, as it provides the Department upfront assurance on the reconciliation of
FTE resident counts as mandated in
statute. Excluding the CHGME PP from
the definition of Federal awards
expended under OMB Circular A–133
removes a potential duplication of effort
that would result from an auditor testing
FTE counts that the Department has
already verified, and may allow these
audit resources to be used to test other
Federal programs of higher risk.
Comment: Several respondents
commented that the elimination of the
requirement for compliance with OMB
Circular A–133 should be made
retroactive.
Response: The compliance reviews
under OMB Circular A–133 will have
been initiated and/or completed for
FFYs 2000–2002 prior to the finalization
of the Department’s policy on this issue.
As a result, the Department is not in a
position to make the elimination of this
compliance requirement retroactive.
The Department policy will become
effective with the FFY 2003 funding
cycle. Furthermore, the comprehensive
FTE resident count assessment process
undertaken by the Department was not
in place prior to FFY 2003.
Clarification of Provisions
The Department wishes to clarify its
current rules related to the calculation
of a national per resident amount for
determining CHGME PP payments and
the measures used by the CHGME PP to
be in compliance with the Government
Performance and Results Act (GPRA).
V. Calculation of National Per Resident
Amount
The CHGME PP statute specifies the
calculation of a baseline national per
resident amount (NPRA) using FFY
1997 data. As amended, the statute also
specifies that this baseline amount
should be updated annually using the
estimated percentage increase in the
consumer price index (CPI) for all urban
consumers during the period beginning
October 1997 and ending with the
midpoint of the federal fiscal year for
which payments are made. The NPRA is
used in the calculation of DME
payments.

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The March 1, 2001 Federal Register
notice indicated that the NPRA for cost
reporting periods ending in FFY 1997,
using the methodology prescribed by
the CHGME PP statute, is $67,688. This
amount has only been updated by the
program once to date. As published in
the March 1, 2001 Federal Register
notice, the updated amount for FFY
2000 was estimated at $71,709. Since
the NPRA appears as the same number
in both the individual hospital portion
(numerator) and the sum of all
hospitals’ portions (denominator) used
to determine DME payments, it doesn’t
affect the calculation of payments; as a
result, the update has not been
performed annually.
Beginning with FFY 2002, the NPRA
will be updated annually using the
methodology included in the statute.
The updated amount will be posted on
the CHGME PP Web site (http://
bhpr.hrsa.gov/childrenshospitalgme) in
the third quarter of each year. For FFY
2002, the updated NPRA is estimated at
$74,890—determined by applying the
percent increase in CPI from October
1997 to April 2002 to the baseline NPRA
from FFY 1997.
VI. Government Performance and
Results Act (GPRA) Measures
In order to be in compliance with the
GPRA, the CHGME PP collects
information on a series of measures
determined by the Department in its
annual performance plan. These
performance measures are
developmental and are subject to
periodic modification. In the future, the
CHGME PP will post annual updates of
its GPRA performance measures on the
CHGME PP Web site (http://
bhpr.hrsa.gov/childrenshospitalgme).
The following measures are being
used by the Department to evaluate the
performance of the CHGME PP for FFY
2003: (1) Maintain the number of FTE
residents in training in eligible
children’s teaching hospitals; (2) Report
the percentage of hospitals funded by
the program with negative total margins;
and (3) Report the proportion of
hospitals’ gross revenue from patient
care attributed to public insurance
(Medicaid, Medicare, SCHIP) and
uninsured patients.
Other Applicable Laws, Executive
Orders, and Policies
Economic and Regulatory Impact:
Executive Order 12866 directs agencies
to assess all costs and benefits of
available regulatory alternatives, and
when rulemaking is necessary, to select
regulatory approaches that provide the
greatest net benefits (including potential
economic, environmental, public health,

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safety, distributive, and equity effects).
In addition, under the Regulatory
Flexibility Act (RFA) of 1980, if a rule
has a significant economic effect on a
substantial number of small entities, the
Secretary must specifically consider the
economic effect of the rule on small
entities and analyze regulatory options
that could lessen the impact of the rule.
Executive Order 12866 requires that
all regulations reflect consideration of
alternatives of costs, benefits,
incentives, equity, and available
information. Regulations must meet
certain standards, such as avoiding an
unnecessary burden. Regulations which
are ‘‘significant’’ because of cost,
adverse effects on the economy,
inconsistency with other agency actions,
effects on the budget, or novel legal or
policy issues, require special analysis.
In accordance with the RFA and the
Small Business Regulatory Enforcement
Act of 1996, which amended the RFA,
the Secretary certifies that this action
will have a significant effect on a
substantial number of small entities, in
that this action will provide significant
funding to eligible children’s hospitals.
The Department has determined that the
only burden this action will impose on
children’s hospitals is the allocation of
resources required to submit an
application to the CHGME PP. Since
this action will not impose a significant
burden on a substantial number of small
entities, the Department has not
examined any alternatives for reducing
the burden on children’s hospitals. The
Secretary has also determined that this
action does not meet criteria for a major
rule as defined by Executive Order
12866 and would have no major effect
on the economy or Federal
expenditures.
The Department has determined that
the proposed rule is not a major rule
within the meaning of the statute
providing for Congressional Review of
Agency Rulemaking, 5 U.S.C. 801.
Similarly, the proposed rule will not
have effects on State, local and tribal
governments and on the private sector
such as to require consultation under
the Unfunded Mandates Reform Act of
1995.
Further, Executive Order 13132
establishes certain requirements that an
agency must meet when it promulgates
a rule that imposes substantial direct
compliance costs on State and local
governments, preempts State law, or
otherwise has Federalism implications.
The Department has reviewed this
action under the threshold criteria of
Executive Order 13132, Federalism, and
has determined that this action would
not have substantial direct effects on the

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60401

Federal Register / Vol. 68, No. 204 / Wednesday, October 22, 2003 / Notices
rights, roles, and responsibilities of
States.
Paperwork Reduction Act of 1995
In accordance with section 3507(a) of
the Paperwork Reduction Act (PRA) of
1995, the Department is required to
solicit public comments and receive
final 0MB approval on collections of
information. In order to implement the
CHGME PP, certain information is
required, as set forth in this notice, in
order to determine eligibility for
payment and amount of payment. In
accordance with the PRA, we have
received final 0MB approval on the
collection of information for the
reconciliation procedures beginning in

Hospitals will be requested to submit
such information in an annual
application. Hospitals will also be
requested to submit data on the number
of full-time equivalent residents a
second time during the Federal fiscal
year to participate in the reconciliation
payment process.
Description of Respondents:
Children’s hospitals operating approved
graduate medical residency training
programs.
Estimated Annual Reporting: The
estimated average annual reporting for
this data collection is approximately
150 hours per hospital. The estimated
annual burden is as follows:

the FFY 2002 cycle (0MB No. 0915–
0247).
Collection of Information: The
Children’s Hospitals Graduate Medical
Education Payment Program.
Description: Data is collected on the
number of full-time equivalent residents
in applicant children’s hospitals’
training programs to determine the
amount of direct and indirect medical
education payments to be distributed to
participating children’s hospitals.
Indirect medical education payments
will also be derived from a formula that
requires the reporting of discharges,
beds, and case mix index information
from participating children’s hospitals.

Responses
per
respondent

Number of
respondents

Form

Hours per
response

Total
burden hours

HRSA–99–1 .....................................................................................................
HRSA99–1 (Reconciliation of FTE counts) .....................................................
HRSA99–2 .......................................................................................................
HRSA–99–4 .....................................................................................................

54
54
54
54

1
1
1
1

99.9
8
14
28

5,395
432
756
1,512

Total ..........................................................................................................

54

........................

........................

8,095

Education and Service Linkage: As
part of its long-range planning, HRSA
will be targeting its efforts to strengthen
linkages between Department education
programs and programs that provide
comprehensive primary care services to
the underserved.
Smoke-Free Workplace: The
Department strongly encourages all
award recipients to provide a smokefree workplace and promote abstinence
from all tobacco products, and Pub. L.
103–227, the ProChildren Act of 1994,
prohibits smoking in certain facilities
that receive Federal funds in which
education, library, day care, health care,
and early childhood development
services are provided to children.
This program is not subject to the
Public Health Systems Reporting
Requirements.
Dated: September 2, 2003.
Elizabeth M. Duke,
Administrator, Health Resources and Services
Administration.
Dated: October 16, 2003.
Tommy G. Thompson,
Secretary.
[FR Doc. 03–26626 Filed 10–21–03; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health Resources and Services
Administration
Advisory Committee on Infant
Mortality; Notice of Meeting
In accordance with section 10(a)(2) of
the Federal Advisory Committee Act
(Pub. L. 92–463), notice is hereby given
of the following meeting:
Name: Advisory Committee on Infant
Mortality (ACIM).
Dates and Times: November 12, 2003, 9
a.m.—5 p.m.; November 13, 2003, 8:30 a.m.—
3 p.m.
Place: The Washington Marriott Hotel,
1221 22nd Street, NW., Washington, DC
20037, (202) 872–1500.
Status: The meeting is open to the public.
Purpose: The Committee provides advice
and recommendations to the Secretary of
Health and Human Services on the following:
Department programs that are directed at
reducing infant mortality and improving the
health status of pregnant women and infants;
factors affecting the continuum of care with
respect to maternal and child health care,
including outcomes following childbirth;
strategies to coordinate the variety of Federal,
State, local and private programs and efforts
that are designed to deal with the health and
social problems impacting on infant
mortality; and the implementation of the
Healthy Start initiative and infant mortality
objectives from Healthy People 2010.
Agenda: Topics that will be discussed
include the following: Low-Birth Weight and
Preterm Birth, Racial Disparities, Border
Health, and the Healthy Start Program.

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Agenda items are subject to change as
priorities are further determined.
For Further Information Contact: Anyone
requiring information regarding the
Committee should contact Peter C. van Dyck,
M.D., M.P.H., Executive Secretary, ACIM,
Health Resources and Services
Administration (HRSA), Room 18–05,
Parklawn Building, 5600 Fishers Lane,
Rockville, MD 20857, telephone (301) 443–
2170.
Individuals who are interested in attending
any portion of the meeting or who have
questions regarding the meeting should
contact Ann M. Koontz, C.N.M., Dr.P.H.,
HRSA, Maternal and Child Health Bureau,
telephone (301) 443–6327.
Dated: October 15, 2003.
Jane M. Harrison,
Director, Division of Policy Review and
Coordination.
[FR Doc. 03–26572 Filed 10–21–03; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health Resources and Services
Administration National Advisory
Council on Nurse Education and
Practice; Notice of Meeting
In accordance with section 10(a)(2) of
the Federal Advisory Committee Act
(Pub. L. 92–463), notice is hereby given
of the following meeting:
Name: National Advisory Council on
Nurse Education and Practice (NACNEP).

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