Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2016, 75680-75681 [2015-30686]

Agencies

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

[Federal Register Volume 80, Number 232 (Thursday, December 3, 2015)]
[Notices]
[Pages 75680-75681]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-30686]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-6066-N]


Medicare, Medicaid, and Children's Health Insurance Programs; 
Provider Enrollment Application Fee Amount for Calendar Year 2016

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

ACTION: Notice.

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SUMMARY: This notice announces a $554.00 calendar year (CY) 2016 
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, 2016 and on or before December 31, 2016.

DATES: This notice is effective on January 1, 2016.

FOR FURTHER INFORMATION CONTACT: Frank Whelan, (410) 786-1302.

SUPPLEMENTARY INFORMATION:

I. Background

    In the February 2, 2011 Federal Register (76 FR 5862), we published 
a final rule with comment period titled ``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 provided in section 
1866(j)(2)(C)(i) of the Social Security Act (the Act) (as amended by 
section 6401 of the Affordable Care Act) and in 42 CFR 424.514, 
``institutional providers'' that are initially enrolling in the 
Medicare or Medicaid programs or CHIP, revalidating their enrollment, 
or adding a new Medicare practice location are required to submit a fee 
with their enrollment application. An ``institutional provider'' for 
purposes of Medicare is defined at Sec.  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 we explained in the February 2, 2011 
final rule (76 FR 5914), in addition to the providers and suppliers 
subject to the application fee under Medicare, Medicaid-only, and CHIP-
only institutional providers would include nursing facilities, 
intermediate care facilities for persons with intellectual disabilities 
(ICF/IID), psychiatric residential treatment facilities, and may 
include other institutional provider types designated by a state in 
accordance with their approved state plan.
    As indicated in Sec. Sec.  424.514 and Sec.  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 revalidating 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.

II. Provisions of the Notice

A. CY 2015 Fee Amount

    In the December 5, 2014 Federal Register (79 FR 72183), we 
published a notice announcing a fee amount for the period of January 1, 
2015 through December 31, 2015 of $553.00. This figure was calculated 
as follows:
     Section 1866(j)(2)(C)(i)(I) of 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, 
Sec.  424.514(d)(2) states that for CY 2011 and subsequent years, the 
preceding year's fee will be adjusted by the percentage change in the 
consumer price index (CPI) for all urban consumers (all items; United 
States city average, CPI-U) for the 12-month period ending on June 30 
of the previous year.
     The CPI-U increase for CY 2011 was 1.0 percent, based on 
data obtained from the Bureau of Labor Statistics (BLS). This resulted 
in an application fee amount for CY 2011 of $505 (or $500 x 1.01).
     The CPI-U increase for the period of July 1, 2010 through 
June 30, 2011 was 3.54 percent, based on BLS data. This resulted in an 
application fee amount for CY 2012 of $522.87 (or $505 x 1.0354). In 
the aforementioned February 2, 2011 final rule, 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, 
or $523.00.
     The CPI-U increase for the period of July 1, 2011 through 
June 30, 2012 was 1.664 percent, based on BLS data. This resulted in an 
application fee amount for CY 2013 of $531.70 ($523 x 1.01664). 
Rounding this figure to the nearest whole dollar amount resulted in a 
CY 2013 application fee amount of $532.00.
     The CPI-U increase for the period of July 1, 2012 through 
June 30, 2013 was 1.8 percent, based on BLS data. This resulted in an 
application fee amount for CY 2014 of $541.576 ($532 x 1.018). Rounding 
this figure to the nearest whole dollar amount resulted in a CY 2014 
application fee amount of $542.00.
     The CPI-U increase for the period of July 1, 2013 through 
June 30, 2014 was 2.1 percent, based on BLS data. This resulted in an 
application fee amount for CY 2015 of $553.382 ($542 x 1.021). Rounding 
this figure to the nearest whole dollar amount resulted in a CY 2015 
application fee amount of $553.00.

B. CY 2016 Fee Amount

    Using BLS data, the CPI-U increase for the period of July 1, 2014 
through June 30, 2015 was 0.2 percent. This results in a CY 2016 
application fee amount of $554.106 ($553 x 1.002). As we must round 
this to the nearest whole dollar amount, the resultant application fee 
amount for CY 2016 is $554.00.

III. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping, or third-party disclosure 
requirements. Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995. However, it does reference previously approved information 
collections. The forms CMS-855A, CMS-855B, and CMS-855I are approved 
under OMB

[[Page 75681]]

control number 0938-0685; the CMS-855S is approved under OMB control 
number 0938-1056.

IV. Regulatory Impact Statement

A. Background

    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 this section of the notice, we estimate that the total 
cost of the increase in the application fee will not exceed $100 
million. Therefore, this notice does not reach the $100 million 
economic threshold and is not considered a major notice.

B. Costs

    The costs associated with this notice involve the increase in the 
application fee amount that certain providers and suppliers must pay in 
CY 2016.
1. Estimates of Number of Affected Institutional Providers in December 
5, 2014 Fee Notice
    In the December 5, 2014 application fee notice, we estimated that 
based on CMS statistics--
     10,000 newly enrolling Medicare institutional providers 
would be subject to and pay an application fee in CY 2015.
     35,000 revalidating Medicare institutional providers would 
be subject to and pay an application fee in CY 2015.
     8,438 newly enrolling Medicaid and CHIP providers would be 
subject to and pay an application fee in CY 2015.
     19,421 revalidating Medicaid and CHIP providers would be 
subject to and pay an application fee in CY 2015.
2. CY 2016 Estimates
a. Medicare
    Based on CMS data, we estimate that in CY 2016 approximately--
     10,000 newly enrolling institutional providers will be 
subject to and pay an application fee; and
     45,000 revalidating institutional providers will be 
subject to and pay an application fee.
    Using a figure of 55,000 (10,000 newly enrolling + 45,000 
revalidating) institutional providers, we estimate an increase in the 
cost of the Medicare application fee requirement in CY 2016 of 
$5,585,000 (or (10,000 additional newly enrolling or revalidating 
institutional providers x $554) + (45,000 x $1.00) from our CY 2015 
projections and as previously described.
b. Medicaid and CHIP
    Based on CMS and state statistics, we estimate that approximately 
30,000 (9,000 newly enrolling + 21,000 revalidating) Medicaid and CHIP 
institutional providers will be subject to an application fee in CY 
2016. Using this figure, we project an increase in the cost of the 
Medicaid and CHIP application fee requirement in CY 2016 of $1,213,973 
(or ((562 additional newly enrolling institutional providers + 1,579 
additional revalidating institutional providers, or 2,141 total 
additional institutional providers) x $554) + 27,859 x $1.00) from our 
CY 2015 projections and as previously described.
c. 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 2016 to be $6,798,973 ($5,585,000 + 
$1,213,973) from our CY 2015 projections.
    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 
less than $7.5 million to $38.5 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), 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 2015, that 
threshold is approximately $144 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.
    In accordance with the provisions of Executive Order 12866, this 
notice was reviewed by the Office of Management and Budget.

    Dated: November 14, 2015.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2015-30686 Filed 12-2-15; 8:45 am]
 BILLING CODE 4120-01-P