Medicare and Medicaid programs; payment for the cost of malpractice insurance--HCFA. Confirmation of final rule

In this document, we are addressing public comments received in response to the interim final rule on payment for the cost of malpractice insurance, insurance, published on April 1, 1986. (51 FR 11142.) In that interim final rule, we established a specific methodology for apportionment of hospital malpractice insurance cost (that is, the cost of premiums or self-insurance) under Medicare that relied on, in part, a "scaling factor formula." We also provided for apportionment of skilled nursing facility malpractice insurance cost on the basis of Medicare patient utilization. With respect to the Medicaid program and the Maternal and Child Health program, we deferred to the States instead of establishing payment methodologies for these programs. As a result of our consideration of timely comments on the interim final rule and reevaluation of appropriate data, we plan to specify the values of the factors used in the scaling factor formula for the hospital methodology separately for short-term acute care hospitals and other hospitals. Accordingly, we have recomputed the values of the factors in the formula and, in this document, we are establishing values for short-term acute care hospitals. The values are the same as those announced in the interim final rule for all hospitals. We will issue another Federal Register document as soon as possible in which, as noted above, we intend to establish the values to be used in applying the formula to other hospitals. In the interim, for these other hospitals, we will continue to use the same formula values that were established in the interim final rule. We are not changing any of the other policies established in the interim final rule.