Medicare Program; Part A Premium for Calendar Year 2010 for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement, 54581-54583 [E9-25371]
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dcolon on DSK2BSOYB1PROD with NOTICES
Federal Register / Vol. 74, No. 203 / Thursday, October 22, 2009 / Notices
Congressional Review Act (5 U.S.C.
804(2)).
Executive Order 12866 directs
agencies to assess all costs and benefits
of available regulatory alternatives and,
if regulation is necessary, to select
regulatory approaches that maximize
net benefits (including potential
economic, environmental, public health
and safety effects, distributive impacts,
and equity). A regulatory impact
analysis (RIA) must be prepared for
major rules with economically
significant effects ($100 million or more
in any 1 year). As stated in section IV
of this notice, we estimate that the total
increase in costs to beneficiaries
associated with this notice is about $730
million due to—(1) The increase in the
deductible and coinsurance amounts;
and (2) the change in the number of
deductibles and daily coinsurance
amounts paid. Therefore, this notice is
a major rule as defined in Title 5,
United States Code, section 804(2), and
is an economically significant rule
under Executive Order 12866.
The RFA requires agencies to analyze
options for regulatory relief of small
businesses, if a rule has a significant
impact on a substantial number of small
entities. For purposes of the RFA, small
entities include small businesses,
nonprofit organizations, and
government agencies. Most hospitals
and most other providers and suppliers
are small entities, either by nonprofit
status or by having revenues of $7.0
million to $34.5 million in any 1 year.
Individuals and States are not included
in the definition of a small entity. We
have determined that this notice will
not have a significant economic impact
on a substantial number of small
entities. Therefore, we are not preparing
an analysis under the RFA.
In addition, section 1102(b) of the Act
requires us to prepare a regulatory
impact analysis if a rule may have a
significant impact on the operations of
a substantial number of small rural
hospitals. This analysis must conform to
the provisions of section 604 of the
RFA. For purposes of section 1102(b) of
the Act, we define a small rural hospital
as a hospital that is located outside of
a Metropolitan Statistical Area and has
fewer than 100 beds. The Secretary has
determined that this notice will not
have a significant impact on the
operations of a substantial number of
small rural hospitals. Therefore, we are
not preparing an analysis under section
1102(b) of the Act.
Section 202 of the Unfunded
Mandates Reform Act of 1995 (UMRA)
requires that agencies assess anticipated
costs and benefits before issuing any
rule whose mandates require spending
VerDate Nov<24>2008
15:13 Oct 21, 2009
Jkt 220001
in any 1 year of $100 million in 1995
dollars, updated annually for inflation.
In 2009, that threshold is approximately
$133 million. This notice has no
consequential effect on State, local, or
Tribal governments or on the private
sector. However, States may be required
to pay the deductibles and coinsurance
for dually-eligible beneficiaries.
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.
This notice will not have a substantial
effect on State or local governments.
In accordance with the provisions of
Executive Order 12866, this notice was
reviewed by the Office of Management
and Budget.
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance)
Dated: September 1, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare
& Medicaid Services.
Dated: September 17, 2009.
Kathleen Sebelius,
Secretary.
[FR Doc. E9–25372 Filed 10–16–09; 4:15 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8038–N]
RIN 0938–AP43
Medicare Program; Part A Premium for
Calendar Year 2010 for the Uninsured
Aged and for Certain Disabled
Individuals Who Have Exhausted Other
Entitlement
AGENCY: Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
SUMMARY: This annual notice announces
Medicare’s Hospital Insurance (Part A)
premium for uninsured enrollees in
calendar year (CY) 2010. This premium
is paid by enrollees age 65 and over who
are not otherwise eligible for benefits
under Medicare Part A (hereafter known
as the ‘‘uninsured aged’’) and by certain
disabled individuals who have
exhausted other entitlement. The
monthly Part A premium for the 12
months beginning January 1, 2010 for
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54581
these individuals will be $461. The
reduced premium for certain other
individuals as described in this notice
will be $254.
DATES: Effective Date: This notice is
effective on January 1, 2010.
FOR FURTHER INFORMATION CONTACT:
Clare McFarland, (410) 786–6390.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1818 of the Social Security
Act (the Act) provides for voluntary
enrollment in the Medicare Hospital
Insurance Program (Medicare Part A),
subject to payment of a monthly
premium, of certain persons aged 65
and older who are uninsured under the
Old-Age, Survivors, and Disability
Insurance (OASDI) program or the
Railroad Retirement Act and do not
otherwise meet the requirements for
entitlement to Medicare Part A. (Persons
insured under the OASDI program or
the Railroad Retirement Act and certain
others do not have to pay premiums for
Medicare Part A.)
Section 1818A of the Act provides for
voluntary enrollment in Medicare Part
A, subject to payment of a monthly
premium of certain disabled individuals
who have exhausted other entitlement.
These are individuals who were entitled
to coverage due to a disabling
impairment under section 226(b) of the
Act, but are no longer entitled to
disability benefits and free Medicare
Part A coverage because they have gone
back to work and their earnings exceed
the statutorily defined ‘‘substantial
gainful activity’’ amount (section
223(d)(4) of the Act).
Section 1818A(d)(2) of the Act
specifies that the provisions relating to
premiums under section 1818(d)
through section 1818(f) of the Act for
the aged will also apply to certain
disabled individuals as described above.
Section 1818(d) of the Act requires us
to estimate, on an average per capita
basis, the amount to be paid from the
Federal Hospital Insurance Trust Fund
for services incurred in the following
calendar year (CY) (including the
associated administrative costs) on
behalf of individuals aged 65 and over
who will be entitled to benefits under
Medicare Part A. We must then
determine, during September of each
year, the monthly actuarial rate for the
following year (the per capita amount
estimated above divided by 12) and
publish the dollar amount for the
monthly premium in the succeeding CY.
If the premium is not a multiple of $1,
the premium is rounded to the nearest
multiple of $1 (or, if it is a multiple of
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54582
Federal Register / Vol. 74, No. 203 / Thursday, October 22, 2009 / Notices
50 cents but not of $1, it is rounded to
the next highest $1).
Section 13508 of the Omnibus Budget
Reconciliation Act of 1993 (Pub. L. 103–
66) amended section 1818(d) of the Act
to provide for a reduction in the
premium amount for certain voluntary
enrollees (section 1818 and section
1818A of the Act). The reduction
applies to an individual who is eligible
to buy into the Medicare Part A program
and who, as of the last day of the
previous month—
• Had at least 30 quarters of coverage
under Title II of the Act;
• Was married, and had been married
for the previous 1-year period, to a
person who had at least 30 quarters of
coverage;
• Had been married to a person for at
least 1 year at the time of the person’s
death if, at the time of death, the person
had at least 30 quarters of coverage; or
• Is divorced from a person and had
been married to the person for at least
10 years at the time of the divorce if, at
the time of the divorce, the person had
at least 30 quarters of coverage.
Section 1818(d)(4)(A) of the Act
specifies that the premium that these
individuals will pay for CY 2010 will be
equal to the premium for uninsured
aged enrollees reduced by 45 percent.
dcolon on DSK2BSOYB1PROD with NOTICES
II. Monthly Premium Amount for CY
2010
The monthly premium for the
uninsured aged and certain disabled
individuals who have exhausted other
entitlement for the 12 months beginning
January 1, 2010, is $461.
The monthly premium for those
individuals subject to the 45 percent
reduction in the monthly premium is
$254.
III. Monthly Premium Rate Calculation
As discussed in section I of this
notice, the monthly Medicare Part A
premium is equal to the estimated
monthly actuarial rate for CY 2010
rounded to the nearest multiple of $1
and equals one-twelfth of the average
per capita amount, which is determined
by projecting the number of Part A
enrollees aged 65 years and over as well
as the benefits and administrative costs
that will be incurred on their behalf.
The steps involved in projecting these
future costs to the Federal Hospital
Insurance Trust Fund are:
• Establishing the present cost of
services furnished to beneficiaries, by
type of service, to serve as a projection
base;
• Projecting increases in payment
amounts for each of the service types;
and
• Projecting increases in
administrative costs.
VerDate Nov<24>2008
15:13 Oct 21, 2009
Jkt 220001
We base our projections for CY 2010
on—(1) current historical data; and (2)
projection assumptions derived from
current law and the Mid-Session Review
of the President’s Fiscal Year 2010
Budget.
We estimate that in CY 2010,
38,086,139 people aged 65 years and
over will be entitled to benefits (without
premium payment) and that they will
incur about $210.795 billion in benefits
and related administrative costs. Thus,
the estimated monthly average per
capita amount is $461.22 and the
monthly premium is $461. The full
monthly premium reduced by 45
percent is $254.
IV. Costs to Beneficiaries
The CY 2010 premium of $461 is
approximately 4 percent higher than the
CY 2009 premium of $443.
We estimate that approximately
558,000 enrollees will voluntarily enroll
in Medicare Part A by paying the full
premium. We estimate an additional
40,000 enrollees will pay the reduced
premium. We estimate that the aggregate
cost to enrollees paying these premiums
will be about $125 million in CY 2010
more than the amount that they paid in
CY 2009.
V. Waiver of Proposed Notice and
Comment Period
We are not using notice and comment
rulemaking in this notification of
Medicare Part A premiums for CY 2010,
as that procedure is unnecessary
because of the lack of discretion in the
statutory formula that is used to
calculate the premium and the solely
ministerial function that this notice
serves. The Administrative Procedure
Act (APA) permits agencies to waive
notice and comment rulemaking when
notice and public comment thereon are
unnecessary. On this basis, we waive
publication of a proposed notice and a
solicitation of public comments.
VI. Regulatory Impact Statement
We have examined the impacts of this
final rule as required by Executive
Order 12866 on Regulatory Planning
and Review (September 30, 1993), the
Regulatory Flexibility Act (RFA)
(September 19, 1980, Pub. L. 96–354),
section 1102(b) of the Social Security
Act, section 202 of the Unfunded
Mandates Reform Act of 1995 (Pub. L.
104–4), Executive Order 13132 on
Federalism (August 4, 1999), and the
Congressional Review Act (5 U.S.C.
804(2)).
Executive Order 12866 directs
agencies to assess all costs and benefits
of available regulatory alternatives and,
if regulation is necessary, to select
PO 00000
Frm 00048
Fmt 4703
Sfmt 4703
regulatory approaches that maximize
net benefits (including potential
economic, environmental, public health
and safety effects, distributive impacts,
and equity). A regulatory impact
analysis (RIA) must be prepared for
major rules with economically
significant effects ($100 million or more
in any 1 year). As stated in section IV
of this notice, we estimate that the
overall effect of these changes in the
Part A premium will be an increased
cost to voluntary enrollees (section 1818
and section 1818A of the Act) of about
$125 million. Therefore, this notice is a
major rule as defined in Title 5, United
States Code, section 804(2) and is an
economically significant rule under
Executive Order 12866.
The RFA requires agencies to analyze
options for regulatory relief of small
businesses, if a rule has a significant
impact on a substantial number of small
entities. For purposes of the RFA, small
entities include small businesses,
nonprofit organizations, and
government agencies. Most hospitals
and most other providers and suppliers
are small entities, either by nonprofit
status or by having revenues of $7
million to $34.5 million in any 1 year.
Individuals and States are not included
in the definition of a small entity. We
have determined that this notice will
not have a significant economic impact
on a substantial number of small
entities. Therefore, we are not preparing
an analysis under the RFA.
In addition, section 1102(b) of the Act
requires us to prepare a regulatory
impact analysis if a rule may have a
significant impact on the operations of
a substantial number of small rural
hospitals. This analysis must conform to
the provisions of section 604 of the
RFA. For purposes of section 1102(b) of
the Act, we define a small rural hospital
as a hospital that is located outside of
a Metropolitan Statistical Area and has
fewer than 100 beds. The Secretary has
determined that this notice will not
have a significant impact on the
operations of a substantial number of
small rural hospitals. Therefore, we are
not preparing an analysis under section
1102(b) of the Act.
Section 202 of the Unfunded
Mandates Reform Act of 1995 (UMRA)
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 2009, that threshold is approximately
$133 million. This notice has no
consequential effect on State, local, or
tribal governments or on the private
sector. However, States are required to
E:\FR\FM\22OCN1.SGM
22OCN1
Federal Register / Vol. 74, No. 203 / Thursday, October 22, 2009 / Notices
pay the premiums for dually-eligible
beneficiaries.
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.
This notice will not have a substantial
effect on State or local governments.
In accordance with the provisions of
Executive Order 12866, this notice was
reviewed by the Office of Management
and Budget.
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance)
Dated: September 1, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare
& Medicaid Services.
Dated: September 17, 2009.
Kathleen Sebelius,
Secretary.
[FR Doc. E9–25371 Filed 10–16–09; 4:15 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA–2009–N–0664]
Radiological Devices Panel of the
Medical Devices Advisory Committee;
Notice of Meeting
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice.
dcolon on DSK2BSOYB1PROD with NOTICES
This notice announces a forthcoming
meeting of a public advisory committee
of the Food and Drug Administration
(FDA). The meeting will be open to the
public.
Name of Committee: Radiological Devices
Panel of the Medical Devices Advisory
Committee.
General Function of the Committee: To
provide advice and recommendations to the
agency on FDA’s regulatory issues.
Date and Time: The meeting will be held
on November 17 and 18, 2009, from 8 a.m.
to 5:30 p.m.
Location: Holiday Inn, Ballroom, Two
Montgomery Village Ave., Gaithersburg, MD.
Contact Person: Toby Lowe, Center for
Devices and Radiological Health, Food and
Drug Administration, 10903 New Hampshire
Ave., Silver Spring, MD 20993, 301–796–
6512, or FDA Advisory Committee
Information Line, 1–800–741–8138 (301–
443–0572 in the Washington, DC area), code
3014512526. Please call the Information Line
for up-to-date information on this meeting. A
notice in the Federal Register about last
VerDate Nov<24>2008
15:13 Oct 21, 2009
Jkt 220001
minute modifications that impact a
previously announced advisory committee
meeting cannot always be published quickly
enough to provide timely notice. Therefore,
you should always check the agency’s Web
site and call the appropriate advisory
committee hot line/phone line to learn about
possible modifications before coming to the
meeting.
Agenda: On November 17, 2009, the
committee will discuss and make
recommendations regarding the agency’s
regulatory strategy for Full Field Digital
Mammography (FFDM) Devices. The
committee will discuss the public comments
received in response to the publication of the
draft guidance document entitled ‘‘Class II
Special Controls Guidance Document: Full
Field Digital Mammography System.’’ This
guidance document can be found on the FDA
Web site at https://www.fda.gov/
MedicalDevices/DeviceRegulation
andGuidance/GuidanceDocuments/
ucm107552.htm.
On November 18, 2009, the committee will
discuss and make recommendations
regarding the agency’s regulatory strategy for
computer-assisted detection (CADe) devices
for radiological devices. CADe devices are
devices intended to identify, mark, highlight
or in any other manner direct attention to
potential abnormalities revealed in
radiological data of the human body or
imaging device data during interpretation of
patient images or patient imaging data by a
physician or other health care professional.
The committee will discuss two draft
guidance documents entitled ‘‘ComputerAssisted Detection Devices Applied to
Radiology Images and Radiology Device
Data—Premarket Notification [510(k)]
Submissions’’ and ‘‘Clinical Performance
Assessment: Considerations for ComputerAssisted Detection Devices Applied to
Radiology Images and Radiology Device
Data—Premarket Approval (PMA) and
Premarket Notification [510(k)]
Submissions.’’ These guidance documents
can be found on the FDA Web site at https://
www.fda.gov/MedicalDevices/
DeviceRegulationandGuidance/Guidance
Documents. Type in the title of the guidance
document included in this notice. The
guidance documents will also be available as
background materials.
FDA intends to make background material
available to the public no later than 2
business days before the meeting. If FDA is
unable to post the background material on its
Web site prior to the meeting, the background
material will be made publicly available at
the location of the advisory committee
meeting, and the background material will be
posted on FDA’s Web site after the meeting.
Background material is available at https://
www.fda.gov/AdvisoryCommittees/Calendar/
default.htm. Scroll down to the appropriate
advisory committee link.
Procedure: Interested persons may present
data, information, or views, orally or in
writing, on issues pending before the
committee. Written submissions may be
made to the contact person on or before
November 12, 2009. Oral presentations from
the public will be scheduled between
approximately 1 p.m. and 2 p.m. on both
PO 00000
Frm 00049
Fmt 4703
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54583
days. Those desiring to make formal oral
presentations should notify the contact
person and submit a brief statement of the
general nature of the evidence or arguments
they wish to present, the names and
addresses of proposed participants, and an
indication of the approximate time requested
to make their presentation on or before
November 6, 2009. Time allotted for each
presentation may be limited. If the number of
registrants requesting to speak is greater than
can be reasonably accommodated during the
scheduled open public hearing session, FDA
may conduct a lottery to determine the
speakers for the scheduled open public
hearing session. The contact person will
notify interested persons regarding their
request to speak by November 9, 2009.
Persons attending FDA’s advisory
committee meetings are advised that the
agency is not responsible for providing
access to electrical outlets.
FDA welcomes the attendance of the
public at its advisory committee meetings
and will make every effort to accommodate
persons with physical disabilities or special
needs. If you require special accommodations
due to a disability, please contact AnnMarie
Williams, Conference Management Staff,
301–796–5966, at least 7 days in advance of
the meeting.
FDA is committed to the orderly conduct
of its advisory committee meetings. Please
visit our Web site at https://www.fda.gov/
AdvisoryCommittees/AboutAdvisory
Committees/ucm111462.htm for procedures
on public conduct during advisory
committee meetings.
Notice of this meeting is given under the
Federal Advisory Committee Act (5 U.S.C.
app. 2).
Dated: October 16, 2009.
David Horowitz,
Assistant Commissioner for Policy.
[FR Doc. E9–25406 Filed 10–21–09; 8:45 am]
BILLING CODE 4160–01–S
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
National Institutes of Health
Office of the Director, National
Institutes of Health; Notice of Meeting
Pursuant to section 10(a) of the
Federal Advisory Committee Act, as
amended (5 U.S.C. App.), notice is
hereby given of a meeting of the
Scientific Management Review Board.
The NIH Reform Act of 2006 (Pub.
L.109–482) provides organizational
authorities to HHS and NIH officials to:
(1) Establish or abolish national research
institutes; (2) reorganize the offices
within the Office of the Director, NIH
including adding, removing, or
transferring the functions of such offices
or establishing or terminating such
offices; and (3) reorganize, divisions,
centers, or other administrative units
within an NIH national research
E:\FR\FM\22OCN1.SGM
22OCN1
]]>Agencies
[Federal Register Volume 74, Number 203 (Thursday, October 22, 2009)]
[Notices]
[Pages 54581-54583]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-25371]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-8038-N]
RIN 0938-AP43
Medicare Program; Part A Premium for Calendar Year 2010 for the
Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted
Other Entitlement
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This annual notice announces Medicare's Hospital Insurance
(Part A) premium for uninsured enrollees in calendar year (CY) 2010.
This premium is paid by enrollees age 65 and over who are not otherwise
eligible for benefits under Medicare Part A (hereafter known as the
``uninsured aged'') and by certain disabled individuals who have
exhausted other entitlement. The monthly Part A premium for the 12
months beginning January 1, 2010 for these individuals will be $461.
The reduced premium for certain other individuals as described in this
notice will be $254.
DATES: Effective Date: This notice is effective on January 1, 2010.
FOR FURTHER INFORMATION CONTACT: Clare McFarland, (410) 786-6390.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1818 of the Social Security Act (the Act) provides for
voluntary enrollment in the Medicare Hospital Insurance Program
(Medicare Part A), subject to payment of a monthly premium, of certain
persons aged 65 and older who are uninsured under the Old-Age,
Survivors, and Disability Insurance (OASDI) program or the Railroad
Retirement Act and do not otherwise meet the requirements for
entitlement to Medicare Part A. (Persons insured under the OASDI
program or the Railroad Retirement Act and certain others do not have
to pay premiums for Medicare Part A.)
Section 1818A of the Act provides for voluntary enrollment in
Medicare Part A, subject to payment of a monthly premium of certain
disabled individuals who have exhausted other entitlement. These are
individuals who were entitled to coverage due to a disabling impairment
under section 226(b) of the Act, but are no longer entitled to
disability benefits and free Medicare Part A coverage because they have
gone back to work and their earnings exceed the statutorily defined
``substantial gainful activity'' amount (section 223(d)(4) of the Act).
Section 1818A(d)(2) of the Act specifies that the provisions
relating to premiums under section 1818(d) through section 1818(f) of
the Act for the aged will also apply to certain disabled individuals as
described above.
Section 1818(d) of the Act requires us to estimate, on an average
per capita basis, the amount to be paid from the Federal Hospital
Insurance Trust Fund for services incurred in the following calendar
year (CY) (including the associated administrative costs) on behalf of
individuals aged 65 and over who will be entitled to benefits under
Medicare Part A. We must then determine, during September of each year,
the monthly actuarial rate for the following year (the per capita
amount estimated above divided by 12) and publish the dollar amount for
the monthly premium in the succeeding CY. If the premium is not a
multiple of $1, the premium is rounded to the nearest multiple of $1
(or, if it is a multiple of
[[Page 54582]]
50 cents but not of $1, it is rounded to the next highest $1).
Section 13508 of the Omnibus Budget Reconciliation Act of 1993
(Pub. L. 103-66) amended section 1818(d) of the Act to provide for a
reduction in the premium amount for certain voluntary enrollees
(section 1818 and section 1818A of the Act). The reduction applies to
an individual who is eligible to buy into the Medicare Part A program
and who, as of the last day of the previous month--
Had at least 30 quarters of coverage under Title II of the
Act;
Was married, and had been married for the previous 1-year
period, to a person who had at least 30 quarters of coverage;
Had been married to a person for at least 1 year at the
time of the person's death if, at the time of death, the person had at
least 30 quarters of coverage; or
Is divorced from a person and had been married to the
person for at least 10 years at the time of the divorce if, at the time
of the divorce, the person had at least 30 quarters of coverage.
Section 1818(d)(4)(A) of the Act specifies that the premium that
these individuals will pay for CY 2010 will be equal to the premium for
uninsured aged enrollees reduced by 45 percent.
II. Monthly Premium Amount for CY 2010
The monthly premium for the uninsured aged and certain disabled
individuals who have exhausted other entitlement for the 12 months
beginning January 1, 2010, is $461.
The monthly premium for those individuals subject to the 45 percent
reduction in the monthly premium is $254.
III. Monthly Premium Rate Calculation
As discussed in section I of this notice, the monthly Medicare Part
A premium is equal to the estimated monthly actuarial rate for CY 2010
rounded to the nearest multiple of $1 and equals one-twelfth of the
average per capita amount, which is determined by projecting the number
of Part A enrollees aged 65 years and over as well as the benefits and
administrative costs that will be incurred on their behalf.
The steps involved in projecting these future costs to the Federal
Hospital Insurance Trust Fund are:
Establishing the present cost of services furnished to
beneficiaries, by type of service, to serve as a projection base;
Projecting increases in payment amounts for each of the
service types; and
Projecting increases in administrative costs.
We base our projections for CY 2010 on--(1) current historical
data; and (2) projection assumptions derived from current law and the
Mid-Session Review of the President's Fiscal Year 2010 Budget.
We estimate that in CY 2010, 38,086,139 people aged 65 years and
over will be entitled to benefits (without premium payment) and that
they will incur about $210.795 billion in benefits and related
administrative costs. Thus, the estimated monthly average per capita
amount is $461.22 and the monthly premium is $461. The full monthly
premium reduced by 45 percent is $254.
IV. Costs to Beneficiaries
The CY 2010 premium of $461 is approximately 4 percent higher than
the CY 2009 premium of $443.
We estimate that approximately 558,000 enrollees will voluntarily
enroll in Medicare Part A by paying the full premium. We estimate an
additional 40,000 enrollees will pay the reduced premium. We estimate
that the aggregate cost to enrollees paying these premiums will be
about $125 million in CY 2010 more than the amount that they paid in CY
2009.
V. Waiver of Proposed Notice and Comment Period
We are not using notice and comment rulemaking in this notification
of Medicare Part A premiums for CY 2010, as that procedure is
unnecessary because of the lack of discretion in the statutory formula
that is used to calculate the premium and the solely ministerial
function that this notice serves. The Administrative Procedure Act
(APA) permits agencies to waive notice and comment rulemaking when
notice and public comment thereon are unnecessary. On this basis, we
waive publication of a proposed notice and a solicitation of public
comments.
VI. Regulatory Impact Statement
We have examined the impacts of this final rule as required by
Executive Order 12866 on Regulatory Planning and Review (September 30,
1993), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub.
L. 96-354), section 1102(b) of the Social Security Act, section 202 of
the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), Executive
Order 13132 on Federalism (August 4, 1999), and the Congressional
Review Act (5 U.S.C. 804(2)).
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, if regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity). A regulatory impact
analysis (RIA) must be prepared for major rules with economically
significant effects ($100 million or more in any 1 year). As stated in
section IV of this notice, we estimate that the overall effect of these
changes in the Part A premium will be an increased cost to voluntary
enrollees (section 1818 and section 1818A of the Act) of about $125
million. Therefore, this notice is a major rule as defined in Title 5,
United States Code, section 804(2) and is an economically significant
rule under Executive Order 12866.
The RFA requires agencies to analyze options for regulatory relief
of small businesses, if a rule has a significant impact on a
substantial number of small entities. For purposes of the RFA, small
entities include small businesses, nonprofit organizations, and
government agencies. Most hospitals and most other providers and
suppliers are small entities, either by nonprofit status or by having
revenues of $7 million to $34.5 million in any 1 year. Individuals and
States are not included in the definition of a small entity. We have
determined that this notice will not have a significant economic impact
on a substantial number of small entities. Therefore, we are not
preparing an analysis under the RFA.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 604 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a Metropolitan
Statistical Area and has fewer than 100 beds. The Secretary has
determined that this notice will not have a significant impact on the
operations of a substantial number of small rural hospitals. Therefore,
we are not preparing an analysis under section 1102(b) of the Act.
Section 202 of the Unfunded Mandates Reform Act of 1995 (UMRA)
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 2009, that
threshold is approximately $133 million. This notice has no
consequential effect on State, local, or tribal governments or on the
private sector. However, States are required to
[[Page 54583]]
pay the premiums for dually-eligible beneficiaries.
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. This notice will not have a substantial effect on State
or local governments.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance)
Dated: September 1, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare & Medicaid Services.
Dated: September 17, 2009.
Kathleen Sebelius,
Secretary.
[FR Doc. E9-25371 Filed 10-16-09; 4:15 pm]
BILLING CODE 4120-01-P
