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CMS-1403-FC
metropolitan statistical area and has fewer than 100 beds.
We have determined that this final rule with comment period
will have minimal impact on small hospitals located in
rural areas. Of the 196 hospital-based ESRD facilities
located in rural areas, only 40 are affiliated with
hospitals with fewer than 100 beds.
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Section 202 of the Unfunded Mandates Reform Act of 1995
(UMRA) also requires that agencies assess anticipated costs
and benefits before issuing any rule whose mandates require
spending in any 1 year of $100 million in 1995 dollars,
updated annually for inflation. In 2008, that threshold is
approximately $130 million. This final rule with comment
period will not mandate any requirements for State, local,
or tribal governments. Medicare beneficiaries are
considered to be part of the private sector for this
purpose. A discussion concerning the impact of this rule on
beneficiaries is found later in this section.
Executive Order 13132 establishes certain requirements
that an agency must meet when it promulgates a proposed
rule (and subsequent final rule) that imposes substantial
direct requirement costs on State and local governments,
preempts State law, or otherwise has Federalism
implications. The e-prescribing portions of this rule
present a potential Federalism implication. No State
categorically bars e-prescribing, but the scope and