Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2013, 71423-71425 [2012-29003]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 77, Number 231 (Friday, November 30, 2012)]
[Notices]
[Pages 71423-71425]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-29003]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-6044-N]


Medicare, Medicaid, and Children's Health Insurance Programs; 
Provider Enrollment Application Fee Amount for Calendar Year 2013

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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SUMMARY: This notice announces a $532.00 calendar year (CY) 2013 
application fee for institutional providers that are initially 
enrolling in the Medicare or Medicaid program or the Children's Health 
Insurance Program (CHIP); revalidating their Medicare, Medicaid or CHIP 
enrollment; or adding a new Medicare practice location. This fee is 
required with any enrollment application submitted on or after January 
1, 2013 and on or before December 31, 2013.

DATES: Effective Date: This notice is effective on January 1, 2013.

FOR FURTHER INFORMATION CONTACT:  Frank Whelan, (410) 786-1302 for 
Medicare enrollment issues. Claudia Simonson, (312) 353-2115 for 
Medicaid and CHIP enrollment issues.

SUPPLEMENTARY INFORMATION: 

[[Page 71424]]

I. Background

    In the February 2, 2011 Federal Register (76 FR 5862), we published 
a final rule with comment period entitled: ``Medicare, Medicaid, and 
Children's Health Insurance Programs; Additional Screening 
Requirements, Application Fees, Temporary Enrollment Moratoria, Payment 
Suspensions and Compliance Plans for Providers and Suppliers.'' This 
rule finalized, among other things, provisions related to the 
submission of application fees as part of the Medicare, Medicaid, and 
CHIP provider enrollment processes. As stated in 42 CFR 424.514, 
``institutional providers'' that are initially enrolling in the 
Medicare, Medicaid or CHIP program, revalidating their enrollment, or 
adding a new Medicare practice location are required to submit a fee 
with their enrollment application. An ``institutional provider'' is 
defined at 42 CFR 424.502 as ``(a)ny provider or supplier that submits 
a paper Medicare enrollment application using the CMS-855A, CMS-855B 
(not including physician and non-physician practitioner organizations), 
CMS-855S or associated Internet-based PECOS enrollment application.''
    As indicated in 42 CFR 424.514 and 455.460, the application fee is 
not required for either of the following:
     A Medicare physician or non-physician practitioner 
submitting a CMS-855I.
     A prospective or re-enrolling Medicaid or CHIP provider--
    ++ Who is an individual physician or non-physician practitioner; or
    ++ That is enrolled in Title XVIII of the Act or another state's 
title XIX or XXI plan and has paid the application fee to a Medicare 
contractor or another state.
    In the March 23, 2011 Federal Register (76 FR 16422), we published 
a notice entitled ``Medicare, Medicaid, and Children's Health Insurance 
Programs; Provider Enrollment Application Fee Amount for Calendar Year 
2012''. This notice announced the following:
     A CY 2011 application fee of $505 for institutional 
providers that were initially enrolling in the Medicare, Medicaid, or 
CHIP program; revalidating their enrollment; or adding a new Medicare 
practice location.
     That institutional providers were required to submit the 
$505 fee with enrollment applications submitted on or after March 25, 
2011 and on or before December 31, 2011.
     That prospective or re-enrolling Medicaid or CHIP 
providers must submit the application fee unless: (1) The provider is 
an individual physician or non-physician practitioner; or (2) the 
provider is enrolled in Title XVIII of the Act or another state's title 
XIX or XXI plan and has paid the application fee to a Medicare 
contractor or another state.

II. Provisions of the Notice

A. CY 2012 Fee Amount

    In the November 2, 2011 Federal Register (76 FR 67743), we 
published a notice announcing a fee amount for the period of January 1, 
2012 through December 31, 2012 of $523.00. This figure was calculated 
as follows:
     Section 1866(j)(2)(C)(i)(I) of the Social Security Act 
(the Act) established a $500 application fee for institutional 
providers in CY 2010.
     Consistent with section 1866(j)(2)(C)(i)(II) of the Act, 
42 CFR Sec.  424.514(d)(2) states that for CY 2011 and subsequent 
years, the fee will be adjusted by the percentage change in the 
consumer price index (CPI) for all urban consumers (all items; United 
States city average) for the 12-month period ending in June of the 
previous year.
     The CPI increase for CY 2011, which was calculated to be 
1.0 percent, was based on data obtained from the Bureau of Labor 
Statistics. This resulted in an application fee for CY 2011 of $505 (or 
$500 x 1.01). (For more detailed information on the CPI and how the 
$505 application fee was calculated, see the February 2, 2011 final 
rule with comment period (76 FR 5955) and the March 23, 2011 notice (76 
FR 16423)).
     The CPI increase for the period of July 2010 through June 
2011 was 3.54 percent, based on data obtained from the Bureau of Labor 
Statistics. This resulted in an application fee amount for the period 
of January 1, 2012 through December 31, 2012 of $522.87 ($505 x 
1.0354). In the February 2, 2011 final rule with comment period (76 FR 
5907), we stated that if the adjustment sets the fee at an uneven 
dollar amount, we would round the fee to the nearest whole dollar 
amount. Accordingly, the application fee amount for CY 2012 was rounded 
to the nearest whole dollar amount, which was $523.00.

B. CY 2013 Fee Amount

    Using data obtained from the Bureau of Labor Statistics, the CPI 
increase for the 12-month period ending on June 30, 2012 was 1.664 
percent, a figure lower than the 2.0 percent CPI increase we estimated 
for CY 2013 in the February 2, 2011 final rule with comment period (76 
FR 5953). This results in an application fee amount for the period of 
January 1, 2013 through December 31, 2013 of $531.70 ($523 x 1.01664). 
As prescribed in the February 2, 2011 final rule with comment period 
(76 FR 5909), we must round this figure to the nearest whole dollar 
amount. The application fee amount for CY 2013 is therefore $532.00. 
This represents a $7.00 difference from the $525 fee that we had 
originally projected for CY 2013 in the February 2, 2011 final rule 
with comment period (76 FR 5958).

III. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35). However, it 
does reference previously approved information collections. The forms 
CMS-855A, CMS-855B, and CMS-855I are approved under OMB control number 
0938-0685; the CMS-855S is approved under OMB control number 0938-1056.

IV. Regulatory Impact Statement

A. Introduction

    We have examined the impact of this notice as required by Executive 
Order 12866 on Regulatory Planning and Review (September 30, 1993), 
Executive Order 13563 on Improving Regulation and Regulatory Review 
(January 18, 2011), 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 (March 22, 
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 Orders 12866 and 13563 direct 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 explained in section of the notice (section IV.), we estimate that 
the total cost of the increase in the application fee will not exceed 
$100 million. This notice therefore does not reach the $100 million 
economic threshold and is not considered a major notice.

[[Page 71425]]

    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and small governmental 
jurisdictions. 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. As we stated in the 
RIA for the February 2, 2011 final rule with comment period (76 FR 
5952), the regulatory impact statement of the March 23, 2011 notice (76 
FR 16423), and the regulatory impact statement of the November 2, 2011 
notice (76 FR 67744), we do not believe that the application fee will 
have a significant impact on small entities.
    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 for Medicare payment regulations and has fewer than 
100 beds. We are not preparing an analysis for section 1102(b) of the 
Act because we have determined, and the Secretary certifies, that this 
notice would not have a significant impact on the operations of a 
substantial number of small rural hospitals.
    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 2012, that 
threshold is approximately $139 million. The Agency has determined that 
there will be minimal impact from the costs of this notice, as the 
threshold is not met under the UMRA.
    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. Since this notice does not impose substantial direct 
costs on state or local governments, the requirements of Executive 
Order 13132 are not applicable.

B. Estimated Costs

    The costs associated with this notice involve the increase in the 
application fee that certain providers and suppliers must pay in CY 
2013. As alluded to earlier, in the RIA for the February 2, 2011 final 
rule with comment period (76 FR 5955 through 5958), we estimated the 
total amount of application fees for CYs 2011 through 2015. For CY 
2013, and based on a $525 application fee, we projected in tables 11 
and 12 (76 FR 5955 and 5956) a total cost in fees of $60,913,125 
($16,380,000 + $44,533,125) for Medicare institutional providers (or 
116,025 providers x $525). We also projected in tables 13 and 14 (76 FR 
5957 and 5958) the total cost in CY 2013 for Medicaid providers to be 
$13,195,350 ($4,429,950 + $8,765,400 or 25,134 (8,438 newly enrolling + 
16,696 re-enrolling) providers x $525).
    Based on CY 2009 and CY 2010 data furnished by State Medicaid 
agencies through the annual State Program Integrity Assessment, we are 
increasing the estimated number of affected Medicaid providers from 
25,134 to 27,859. We are also changing the Medicare provider estimate 
based on our ongoing program of revalidating all Medicare providers and 
suppliers by the end of 2015--even if the revalidation is considered 
``off-cycle'' per 42 CFR 424.515(e).
1. Medicare
    For purposes of this notice only, we estimate that approximately 
400,000 Medicare providers and suppliers will be subject to 
revalidation in CY 2013. Of this total, and based on our experience, we 
believe that roughly 80 percent will be exempt from the application fee 
requirement because the provider or supplier: (1) Is of a type (for 
example, a physician) that is exempt from the requirement; or (2) 
qualifies for a hardship exception under 42 CFR 424.514(c). This leaves 
80,000 revalidating providers and suppliers that will have to pay the 
fee.
    In the February 2, 2011 final rule with comment period (76 FR 
5955), we estimated that 31,200 newly-enrolling institutional providers 
would be subject to the application fee in CY 2013. In the first 
quarter of CY 2012, there were 1,030 initial enrollments that required 
a fee. Based on this, we must dramatically reduce our earlier estimate 
of 31,200 Medicare institutional providers to 4,120 (1,030 x 4) for 
purposes of this notice. Using a figure of 84,120 (80,000 + 4,120) 
institutional providers, we estimate an increase in the cost of the 
Medicare application fee requirement in CY 2013 of $588,840 (84,120 x 
$7.00) from CY 2012 estimates.
2. Medicaid and CHIP
    We estimate that 27,859 (8,438 newly enrolling + 19,421 re-
enrolling) Medicaid and CHIP providers would be subject to an 
application fee in CY 2013. Using this figure, we estimate an increase 
in the cost of the Medicaid and CHIP application fee requirements in CY 
2013 of $195,013 (27,859 x $7.00) from CY 2012 estimates.
3. Total
    Based on the foregoing, we estimate the total increase in the cost 
of the application fee requirement for Medicare, Medicaid, and CHIP 
providers and suppliers in CY 2013 to be $783,853 ($588,840 + $195,013) 
from CY 2012.
    In accordance with the provisions of Executive Order 12866, this 
notice was not reviewed by the Office of Management and Budget.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program; No. 93.773 Medicare--Hospital Insurance Program; 
and No. 93.774, Medicare--Supplementary Medical Insurance Program)

    Dated: October 9, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2012-29003 Filed 11-29-12; 8:45 am]
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