Several adjustments were made to the SIC code data to more accurately determine the cost to small and non-profit businesses. For health plans (SIC code 6320), we adjusted the SIC data to include self-insured, self-administered health plans because these health plans are not included in any SIC code, though they are covered entities under the rule. Similarly, we have added third-party administrators (TPAs) into this SIC. Although they are not covered entities, TPAs are likely to be business associates of covered entities. For purposes of the regulatory analyses, we have assumed that TPAs would bear many of the same costs of the health plans to assure compliance for the covered entity. To make this adjustment, we assumed the self-insured/self administered health plans and TPAs have the average revenue of the health plans contained in the SIC code, and then added those assumed revenues to the SIC code and to the total of all health care expenditures. Moreover, we needed to account for the cost to non-profit institutions that might receive more than $5 million in revenue, because all non-profit institutions are small businesses regardless of revenue. To make this adjustment for hospitals, nursing homes, and home health agencies, we used data on the number of non-profit institutions from industry sources and from data reported to HCFA. With this data, we assumed the current count of establishments in the SIC codes includes these non-profit entities and that non-profits have the same distribution of revenues as all establishments reported in the applicable SIC codes. The proportions discussed below, which determine the cost for small business, therefore include these non-profit establishments in SIC codes 8030, 8060, and 8080.
The SIC code tables provided in this RFA do not include several categories of businesses that are included in the total cost to small businesses. Claims clearinghouses are not included in the table because claims clearinghouses report their revenues under the SIC 7374 "Computer Processing and Data Preparation," and the vast majority of businesses in this SIC code are involved in non-medical claims data processing. In addition, claims processing is often just one business-line of companies that may be involved in multiple forms of data processing, and therefore, even if the claims processing line of the business generates less than $5 million in revenue, the company in total may exceed the SBA definition for a small business (the total firm revenue, not each line of business, is the standard for inclusion). Similarly, fully-insured ERISA health plans sponsored by employers are not identified as a separate category in the SIC code tables because employers in virtually all SIC codes may sponsor fully-insured health plans. We have identified the cost for small fully-insured ERISA health plans by using the Department of Labor definition of a small ERISA plan, which is a plan with fewer than 100 insured participants. Using this definition, the initial cost for small fully-insured ERISA health plans is $7.1 million. Finally, Institutional Review Boards (IRBs) will not appear in a separate SIC code because IRBs are not "businesses"; rather, they are committees of researchers who work for institutions where medical research is conducted, such as universities or teaching hospitals. IRB members usually serve as a professional courtesy or as part of their employment duties and are not paid separately for their IRB duties. Although IRBs are not "businesses" that generate revenues, we have treated them as small business for illustrative purposes in this RFA to demonstrate the additional opportunity costs that will be faced by those researchers who sit on IRBs. Therefore, assuming IRBs are small businesses, the initial costs are $.089 million and ongoing costs are approximately $84.2 million over 9 years.