Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rates, and Annual Deductible Beginning January 1, 2018, 55370-55378 [2017-24877]
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Federal Register / Vol. 82, No. 223 / Tuesday, November 21, 2017 / Notices
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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. As discussed
above, we are not preparing an analysis
for section 1102(b) of the Act because
the Secretary has determined that this
notice will 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 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 2017, that threshold is approximately
$148 million. This notice does not
impose mandates that will have a
consequential effect of $148 million or
more on state, local, or tribal
governments or on the private sector.
Executive Order 13771, titled
‘‘Reducing Regulation and Controlling
Regulatory Costs,’’ was issued on
January 30, 2017 (82 FR 9339, February
3, 2017). It has been determined that
this notice is a transfer notice that does
not impose more than de minimis costs
and thus is not a regulatory action for
the purposes of E.O. 13771.
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
direct effect on state or local
governments, preempt state law, or
otherwise have Federalism implications.
Although this notice merely
announces the Medicare Part A
deductible and coinsurance amounts for
CY 2018 and does not constitute a
substantive rule, we nevertheless
prepared this Impact Analysis in the
interest of ensuring that the impacts of
this notice are fully understood.
Dated: October 27, 2017.
Seema Verma,
Administrator, Centers for Medicare &
Medicaid Services.
Dated: November 1, 2017.
Eric D. Hargan,
Acting Secretary, Department of Health and
Human Services.
[FR Doc. 2017–24913 Filed 11–17–17; 4:15 pm]
BILLING CODE 4120–01–P
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8067–N]
RIN 0938–AS72
Medicare Program; Medicare Part B
Monthly Actuarial Rates, Premium
Rates, and Annual Deductible
Beginning January 1, 2018
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This notice announces the
monthly actuarial rates for aged (age 65
and over) and disabled (under age 65)
beneficiaries enrolled in Part B of the
Medicare Supplementary Medical
Insurance (SMI) program beginning
January 1, 2018. In addition, this notice
announces the monthly premium for
aged and disabled beneficiaries, the
deductible for 2018, and the incomerelated monthly adjustment amounts to
be paid by beneficiaries with modified
adjusted gross income above certain
threshold amounts. The monthly
actuarial rates for 2018 are $261.90 for
aged enrollees and $295.00 for disabled
enrollees. The standard monthly Part B
premium rate for all enrollees for 2018
is $134.00, which is equal to 50 percent
of the monthly actuarial rate for aged
enrollees (or approximately 25 percent
of the expected average total cost of Part
B coverage for aged enrollees) plus
$3.00. (The 2017 standard premium rate
was $134.00, which included the $3.00
repayment amount.) The Part B
deductible for 2018 is $183.00 for all
Part B beneficiaries. If a beneficiary has
to pay an income-related monthly
adjustment, he or she will have to pay
a total monthly premium of about 35,
50, 65, or 80 percent of the total cost of
Part B coverage plus $4.20, $6.00, $7.80,
or $9.60.
DATES: Effective Date: January 1, 2018.
FOR FURTHER INFORMATION CONTACT: M.
Kent Clemens, (410) 786–6391.
SUPPLEMENTARY INFORMATION:
SUMMARY:
I. Background
Part B is the voluntary portion of the
Medicare program that pays all or part
of the costs for physicians’ services;
outpatient hospital services; certain
home health services; services furnished
by rural health clinics, ambulatory
surgical centers, and comprehensive
outpatient rehabilitation facilities; and
certain other medical and health
services not covered by Medicare Part
A, Hospital Insurance. Medicare Part B
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is available to individuals who are
entitled to Medicare Part A, as well as
to U.S. residents who have attained age
65 and are citizens and to aliens who
were lawfully admitted for permanent
residence and have resided in the
United States for 5 consecutive years.
Part B requires enrollment and payment
of monthly premiums, as described in
42 CFR part 407, subpart B, and part
408, respectively. The premiums paid
by (or on behalf of) all enrollees fund
approximately one-fourth of the total
incurred costs, and transfers from the
general fund of the Treasury pay
approximately three-fourths of these
costs.
The Secretary of the Department of
Health and Human Services (the
Secretary) is required by section 1839 of
the Social Security Act (the Act) to
announce the Part B monthly actuarial
rates for aged and disabled beneficiaries
as well as the monthly Part B premium.
The Part B annual deductible is
included because its determination is
directly linked to the aged actuarial rate.
The monthly actuarial rates for aged
and disabled enrollees are used to
determine the correct amount of general
revenue financing per beneficiary each
month. These amounts, according to
actuarial estimates, will equal,
respectively, one-half of the expected
average monthly cost of Part B for each
aged enrollee (age 65 or over) and onehalf of the expected average monthly
cost of Part B for each disabled enrollee
(under age 65).
The Part B deductible to be paid by
enrollees is also announced. Prior to the
Medicare Prescription Drug,
Improvement, and Modernization Act of
2003 (MMA) (Pub. L. 108–173), the Part
B deductible was set in statute. After
setting the 2005 deductible amount at
$110, section 629 of the MMA
(amending section 1833(b) of the Act)
required that the Part B deductible be
indexed beginning in 2006. The
inflation factor to be used each year is
the annual percentage increase in the
Part B actuarial rate for enrollees age 65
and over. Specifically, the 2018 Part B
deductible is calculated by multiplying
the 2017 deductible by the ratio of the
2018 aged actuarial rate to the 2017 aged
actuarial rate. The amount determined
under this formula is then rounded to
the nearest $1.
The monthly Part B premium rate to
be paid by aged and disabled enrollees
is also announced. (Although the costs
to the program per disabled enrollee are
different than for the aged, the statute
provides that they pay the same
premium amount.) Beginning with the
passage of section 203 of the Social
Security Amendments of 1972 (Pub. L.
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92–603), the premium rate, which was
determined on a fiscal-year basis, was
limited to the lesser of the actuarial rate
for aged enrollees, or the current
monthly premium rate increased by the
same percentage as the most recent
general increase in monthly Title II
Social Security benefits.
However, the passage of section 124
of the Tax Equity and Fiscal
Responsibility Act of 1982 (TEFRA)
(Pub. L. 97–248) suspended this
premium determination process.
Section 124 of TEFRA changed the
premium basis to 50 percent of the
monthly actuarial rate for aged enrollees
(that is, 25 percent of program costs for
aged enrollees). Section 606 of the
Social Security Amendments of 1983
(Pub. L. 98–21), section 2302 of the
Deficit Reduction Act of 1984 (DEFRA
84) (Pub. L. 98–369), section 9313 of the
Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA 85)
(Pub. L. 99–272), section 4080 of the
Omnibus Budget Reconciliation Act of
1987 (OBRA 87) (Pub. L. 100–203), and
section 6301 of the Omnibus Budget
Reconciliation Act of 1989 (OBRA 89)
(Pub. L. 101–239) extended the
provision that the premium be based on
50 percent of the monthly actuarial rate
for aged enrollees (that is, 25 percent of
program costs for aged enrollees). This
extension expired at the end of 1990.
The premium rate for 1991 through
1995 was legislated by section
1839(e)(1)(B) of the Act, as added by
section 4301 of the Omnibus Budget
Reconciliation Act of 1990 (OBRA 90)
(Pub. L. 101–508). In January 1996, the
premium determination basis would
have reverted to the method established
by the 1972 Social Security Act
Amendments. However, section 13571
of the Omnibus Budget Reconciliation
Act of 1993 (OBRA 93) (Pub. L. 103–66)
changed the premium basis to 50
percent of the monthly actuarial rate for
aged enrollees (that is, 25 percent of
program costs for aged enrollees) for
1996 through 1998.
Section 4571 of the Balanced Budget
Act of 1997 (BBA) (Pub. L. 105–33)
permanently extended the provision
that the premium be based on 50
percent of the monthly actuarial rate for
aged enrollees (that is, 25 percent of
program costs for aged enrollees).
The BBA included a further provision
affecting the calculation of the Part B
actuarial rates and premiums for 1998
through 2003. Section 4611 of the BBA
modified the home health benefit
payable under Part A for individuals
enrolled in Part B. Under this section,
beginning in 1998, expenditures for
home health services not considered
‘‘post-institutional’’ are payable under
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Part B rather than Part A. However,
section 4611(e)(1) of the BBA required
that there be a transition from 1998
through 2002 for the aggregate amount
of the expenditures transferred from
Part A to Part B. Section 4611(e)(2) of
the BBA also provided a specific yearly
proportion for the transferred funds.
The proportions were one-sixth for
1998, one-third for 1999, one-half for
2000, two-thirds for 2001, and fivesixths for 2002. For the purpose of
determining the correct amount of
financing from general revenues of the
Federal Government, it was necessary to
include only these transitional amounts
in the monthly actuarial rates for both
aged and disabled enrollees, rather than
the total cost of the home health
services being transferred.
Section 4611(e)(3) of the BBA also
specified, for the purpose of
determining the premium, that the
monthly actuarial rate for enrollees age
65 and over be computed as though the
transition would occur for 1998 through
2003 and that one-seventh of the cost be
transferred in 1998, two-sevenths in
1999, three-sevenths in 2000, foursevenths in 2001, five-sevenths in 2002,
and six-sevenths in 2003. Therefore, the
transition period for incorporating this
home health transfer into the premium
was 7 years while the transition period
for including these services in the
actuarial rate was 6 years.
Section 811 of the MMA, which
amended section 1839 of the Act,
requires that, starting on January 1,
2007, the Part B premium a beneficiary
pays each month be based on his or her
annual income. Specifically, if a
beneficiary’s modified adjusted gross
income is greater than the legislated
threshold amounts (for 2018, $85,000
for a beneficiary filing an individual
income tax return and $170,000 for a
beneficiary filing a joint tax return), the
beneficiary is responsible for a larger
portion of the estimated total cost of
Part B benefit coverage. In addition to
the standard 25-percent premium, these
beneficiaries now have to pay an
income-related monthly adjustment
amount. The MMA made no change to
the actuarial rate calculation, and the
standard premium, which will continue
to be paid by beneficiaries whose
modified adjusted gross income is
below the applicable thresholds, still
represents 25 percent of the estimated
total cost to the program of Part B
coverage for an aged enrollee. However,
depending on income and tax filing
status, a beneficiary can now be
responsible for 35, 50, 65, or 80 percent
of the estimated total cost of Part B
coverage, rather than 25 percent. (For
2018 and subsequent years, the income
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thresholds are lower for the two highest
income ranges because of the Medicare
Access and CHIP Reauthorization Act of
2015 (MACRA) (Pub. L. 114–10).) The
end result of the higher premium is that
the Part B premium subsidy is reduced,
and less general revenue financing is
required, for beneficiaries with higher
income because they are paying a larger
share of the total cost with their
premium. That is, the premium subsidy
continues to be approximately 75
percent for beneficiaries with income
below the applicable income thresholds,
but it will be reduced for beneficiaries
with income above these thresholds.
The MMA specified that there be a 5year transition period to reach full
implementation of this provision.
However, section 5111 of the Deficit
Reduction Act of 2005 (DRA) (Pub. L.
109–171) modified the transition to a 3year period.
Section 4732(c) of the BBA added
section 1933(c) of the Act, which
required the Secretary to allocate money
from the Part B trust fund to the State
Medicaid programs for the purpose of
providing Medicare Part B premium
assistance from 1998 through 2002 for
the low-income Medicaid beneficiaries
who qualify under section 1933 of the
Act. This allocation, while not a benefit
expenditure, was an expenditure of the
trust fund and was included in
calculating the Part B actuarial rates
through 2002. For 2003 through 2015,
the expenditure was made from the trust
fund because the allocation was
temporarily extended. However,
because the extension occurred after the
financing was determined, the
allocation was not included in the
calculation of the financing rates for
these years. Section 211 of MACRA
permanently extended this expenditure,
which is included in the calculation of
the Part B actuarial rates for 2016 and
subsequent years.
Another provision affecting the
calculation of the Part B premium is
section 1839(f) of the Act, as amended
by section 211 of the Medicare
Catastrophic Coverage Act of 1988
(MCCA 88) (Pub. L. 100–360). (The
Medicare Catastrophic Coverage Repeal
Act of 1989 (Pub. L. 101–234) did not
repeal the revisions to section 1839(f) of
the Act made by MCCA 88.) Section
1839(f) of the Act, referred to as the
‘‘hold-harmless’’ provision, provides
that if an individual is entitled to
benefits under section 202 or 223 of the
Act (the Old-Age and Survivors
Insurance Benefit and the Disability
Insurance Benefit, respectively) and has
the Part B premium deducted from these
benefit payments, the premium increase
will be reduced, if necessary, to avoid
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causing a decrease in the individual’s
net monthly payment. This decrease in
payment occurs if the increase in the
individual’s Social Security benefit due
to the cost-of-living adjustment under
section 215(i) of the Act is less than the
increase in the premium. Specifically,
the reduction in the premium amount
applies if the individual is entitled to
benefits under section 202 or 223 of the
Act for November and December of a
particular year and the individual’s Part
B premiums for December and the
following January are deducted from the
respective month’s section 202 or 223
benefits. The hold-harmless provision
does not apply to beneficiaries who are
required to pay an income-related
monthly adjustment amount.
A check for benefits under section 202
or 223 of the Act is received in the
month following the month for which
the benefits are due. The Part B
premium that is deducted from a
particular check is the Part B payment
for the month in which the check is
received. Therefore, a benefit check for
November is not received until
December, but December’s Part B
premium has been deducted from it.
Generally, if a beneficiary qualifies for
hold-harmless protection, the reduced
premium for the individual for that
January and for each of the succeeding
11 months is the greater of either—
• The monthly premium for January
reduced as necessary to make the
December monthly benefits, after the
deduction of the Part B premium for
January, at least equal to the preceding
November’s monthly benefits, after the
deduction of the Part B premium for
December; or
• The monthly premium for that
individual for that December.
In determining the premium
limitations under section 1839(f) of the
Act, the monthly benefits to which an
individual is entitled under section 202
or 223 of the Act do not include
retroactive adjustments or payments and
deductions on account of work. Also,
once the monthly premium amount is
established under section 1839(f) of the
Act, it will not be changed during the
year even if there are retroactive
adjustments or payments and
deductions on account of work that
apply to the individual’s monthly
benefits.
Individuals who have enrolled in Part
B late or who have re-enrolled after the
termination of a coverage period are
subject to an increased premium under
section 1839(b) of the Act. The increase
is a percentage of the premium and is
based on the new premium rate before
any reductions under section 1839(f) of
the Act are made.
Section 1839 of the Act, as amended
by section 601(a) of the Bipartisan
Budget Act of 2015 (Pub. L. 114–74),
specified that the 2016 actuarial rate for
enrollees age 65 and older be
determined as if the hold-harmless
provision did not apply. The premium
revenue that was lost by using the
resulting lower premium (excluding the
foregone income-related premium
revenue) was replaced by a transfer of
general revenue from the Treasury,
which will be repaid over time to the
general fund.
Starting in 2016, in order to repay the
balance due (which includes the
transfer amount and the foregone
income-related premium revenue), the
Part B premium otherwise determined
will be increased by $3.00. These
repayment amounts will be added to the
Part B premium otherwise determined
each year and paid back to the general
fund of the Treasury and will continue
until the balance due is paid back.
High-income enrollees pay the $3
repayment amount plus an additional
$1.20, $3.00, $4.80, or $6.60 in
repayment as part of the income-related
monthly adjustment amount (IRMAA)
premium dollars, which reduce (dollar
for dollar) the amount of general
revenue received by Part B from the
general fund of the Treasury. Because of
this general revenue offset, the
repayment IRMAA premium dollars are
not included in the direct repayments
made to the general fund of the Treasury
from Part B in order to avoid a double
repayment. (Only the $3.00 monthly
repayment amounts are included in the
direct repayments).
These repayment amounts will
continue until the total amount
collected is equal to the beginning
balance due. (In the final year of the
repayment, the additional amounts may
be modified to avoid an overpayment.)
The repayment amounts (excluding the
repayment amounts for high-income
enrollees) are subject to the holdharmless provision. The beginning
balance due was $9,066,409,000,
consisting of $1,625,761,000 in foregone
income-related premium revenue plus a
transfer amount of $7,440,648,000. It is
estimated that $1,404,616,000 will have
been collected for repayment to the
general fund by the end of 2017.
II. Provisions of the Notice
A. Notice of Medicare Part B Monthly
Actuarial Rates, Monthly Premium
Rates, and Annual Deductible
The Medicare Part B monthly
actuarial rates applicable for 2018 are
$261.90 for enrollees age 65 and over
and $295.00 for disabled enrollees
under age 65. In section II.B. of this
notice, we present the actuarial
assumptions and bases from which
these rates are derived. The Part B
standard monthly premium rate for all
enrollees for 2018 is $134.00.
The following are the 2018 Part B
monthly premium rates to be paid by (or
on behalf of) beneficiaries who file
either individual tax returns (and are
single individuals, heads of households,
qualifying widows or widowers with
dependent children, or married
individuals filing separately who lived
apart from their spouses for the entire
taxable year), or joint tax returns.
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Beneficiaries who file individual tax returns with
income:
Beneficiaries who file joint tax returns with
income:
Less than or equal to $85,000 ...............................
Greater than $85,000 and less than or equal to
$107,000.
Greater than $107,000 and less than or equal to
$133,500.
Greater than $133,500 and less than or equal to
$160,000.
Greater than $160,000 ...........................................
Income-related
monthly
adjustment
amount
Less than or equal to $170,000 .............................
Greater than $170,000 and less than or equal to
$214,000.
Greater than $214,000 and less than or equal to
$267,000.
Greater than $267,000 and less than or equal to
$320,000.
Greater than $320,000 ...........................................
In addition, the monthly premium
rates to be paid by (or on behalf of)
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beneficiaries who are married and lived
with their spouses at any time during
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Total monthly
premium amount
$0.00
53.50
$134.00
187.50
133.90
267.90
214.30
348.30
294.60
428.60
the taxable year, but who file separate
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tax returns from their spouses, are as
follows:
Income-related
monthly
adjustment
amount
Beneficiaries who are married and lived with their spouses at any time during the year, but who file
separate tax returns from their spouses:
Less than or equal to $85,000 ....................................................................................................................
Greater than $85,000 ..................................................................................................................................
The Part B annual deductible for 2018
is $183.00 for all beneficiaries.
B. Statement of Actuarial Assumptions
and Bases Employed in Determining the
Monthly Actuarial Rates and the
Monthly Premium Rate for Part B
Beginning January 2018
The actuarial assumptions and bases
used to determine the monthly actuarial
rates and the monthly premium rates for
Part B are established by the Centers for
Medicare & Medicaid Services Office of
the Actuary. The estimates underlying
these determinations are prepared by
actuaries meeting the qualification
standards and following the actuarial
standards of practice established by the
Actuarial Standards Board.
1. Actuarial Status of the Part B Account
in the Supplementary Medical
Insurance Trust Fund
Under section 1839 of the Act, the
starting point for determining the
standard monthly premium is the
amount that would be necessary to
finance Part B on an incurred basis. This
is the amount of income that would be
sufficient to pay for services furnished
during that year (including associated
administrative costs) even though
payment for some of these services will
not be made until after the close of the
year. The portion of income required to
cover benefits not paid until after the
close of the year is added to the trust
fund and used when needed.
The premium rates are established
prospectively and are, therefore, subject
to projection error. Additionally,
legislation enacted after the financing
was established, but effective for the
period in which the financing is set,
may affect program costs. As a result,
the income to the program may not
equal incurred costs. Therefore, trust
fund assets must be maintained at a
level that is adequate to cover an
appropriate degree of variation between
Total monthly
premium amount
$0.00
294.60
$134.00
428.60
actual and projected costs, and the
amount of incurred, but unpaid,
expenses. Numerous factors determine
what level of assets is appropriate to
cover variation between actual and
projected costs. The three most
important of these factors are (1) the
difference from prior years between the
actual performance of the program and
estimates made at the time financing
was established; (2) the likelihood and
potential magnitude of expenditure
changes resulting from enactment of
legislation affecting Part B costs in a
year subsequent to the establishment of
financing for that year; and (3) the
expected relationship between incurred
and cash expenditures. These factors are
analyzed on an ongoing basis, as the
trends can vary over time.
Table 1 summarizes the estimated
actuarial status of the trust fund as of
the end of the financing period for 2016
and 2017.
TABLE 1—ESTIMATED ACTUARIAL STATUS OF THE PART B ACCOUNT IN THE SUPPLEMENTARY MEDICAL INSURANCE TRUST
FUND AS OF THE END OF THE FINANCING PERIOD
Assets
(in millions)
Financing period ending
December 31, 2016 .....................................................................................................................
December 31, 2017 .....................................................................................................................
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2. Monthly Actuarial Rate for Enrollees
Age 65 and Older
The monthly actuarial rate for
enrollees age 65 and older is one-half of
the sum of monthly amounts for (1) the
projected cost of benefits; and (2)
administrative expenses for each
enrollee age 65 and older, after
adjustments to this sum to allow for
interest earnings on assets in the trust
fund and an adequate contingency
margin. The contingency margin is an
amount appropriate to provide for
possible variation between actual and
projected costs and to amortize any
surplus assets or unfunded liabilities.
The monthly actuarial rate for
enrollees age 65 and older for 2018 is
determined by first establishing per
enrollee costs by type of service from
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program data through 2016 and then
projecting these costs for subsequent
years. The projection factors used for
financing periods from January 1, 2015
through December 31, 2018 are shown
in Table 2.
As indicated in Table 3, the projected
per enrollee amount required to pay for
one-half of the total of benefits and
administrative costs for enrollees age 65
and over for 2018 is $247.91. Based on
current estimates, the assets associated
with the aged Medicare beneficiaries at
the end of 2017 are not sufficient to
cover the amount of incurred, but
unpaid, expenses and to provide for a
significant degree of variation between
actual and projected costs. Thus, a
positive contingency margin is needed.
The monthly actuarial rate of $261.90
provides an adjustment of $15.88 for a
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$87,983
79,236
Liabilities
(in millions)
$28,494
30,559
Assets less
liabilities
(in millions)
$59,489
48,677
contingency margin and ¥$1.89 for
interest earnings.
The contingency margin for 2018 is
affected by several factors. Starting in
2011, manufacturers and importers of
brand-name prescription drugs pay a fee
that is allocated to the Part B account of
the SMI trust. For 2018, the total of
these brand-name drug fees is estimated
to be $4.1 billion. The contingency
margin has been reduced to account for
this additional revenue.
Another factor affecting the
contingency margin is attributable to the
requirement that certain payment
incentives, to encourage the
development and use of health
information technology (HIT) by
Medicare physicians, are to be excluded
from the premium determination. HIT
positive incentive payments or penalties
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will be directly offset through transfers
with the general fund of the Treasury.
The monthly actuarial rate includes an
adjustment of $0.17 for HIT incentives
in 2018.
The traditional goal for the Part B
reserve has been that assets minus
liabilities at the end of a year should
represent between 15 and 20 percent of
the following year’s total incurred
expenditures. To accomplish this goal, a
17-percent reserve ratio, which is a fully
adequate contingency reserve level, has
been the normal target used to calculate
the Part B premium. Assets at the end
of 2017 are expected to be below the
fully adequate level. The financing rates
for 2018 are set to restore the asset level
in the Part B account to the fully
adequate level by the end of 2018 under
current law. The actuarial rate of
$261.90 per month for aged
beneficiaries, as announced in this
notice for 2018, reflects that combined
effect of the factors previously described
and the projected assumptions listed in
Table 2.
one-half of the total of benefits and
administrative costs for disabled
enrollees for 2018 is $303.70. The
monthly actuarial rate of $295.00 also
provides an adjustment of ¥$2.73 for
interest earnings and ¥$5.97 for a
contingency margin, reflecting the same
factors described previously for the aged
actuarial rate at magnitudes appropriate
to the disabled rate determination.
Based on current estimates, the assets
associated with the disabled Medicare
beneficiaries at the end of 2017 are
sufficient to cover the amount of
incurred, but unpaid, expenses and to
provide for a significant degree of
variation between actual and projected
costs. A negative contingency margin is
needed to maintain assets at an
appropriate level.
The actuarial rate of $295.00 per
month for disabled beneficiaries, as
announced in this notice for 2018,
reflects the combined net effect of the
factors described previously for aged
beneficiaries and the projection
assumptions listed in Table 2.
3. Monthly Actuarial Rate for Disabled
Enrollees
Disabled enrollees are those persons
under age 65 who are enrolled in Part
B because of entitlement to Social
Security disability benefits for more
than 24 months or because of
entitlement to Medicare under the endstage renal disease (ESRD) program.
Projected monthly costs for disabled
enrollees (other than those with ESRD)
are prepared in a manner parallel to the
projection for the aged using
appropriate actuarial assumptions (see
Table 2). Costs for the ESRD program are
projected differently because of the
different nature of services offered by
the program.
As shown in Table 4, the projected
per enrollee amount required to pay for
4. Sensitivity Testing
Several factors contribute to
uncertainty about future trends in
medical care costs. It is appropriate to
test the adequacy of the rates using
alternative cost growth rate
assumptions. The results of those
assumptions are shown in Table 5. One
set represents increases that are higher
and, therefore, more pessimistic than
the current estimate. The other set
represents increases that are lower and,
therefore, more optimistic than the
current estimate. The values for the
alternative assumptions were
determined from a statistical analysis of
the historical variation in the respective
increase factors.
As indicated in Table 5, the monthly
actuarial rates would result in an excess
asabaliauskas on DSKBBXCHB2PROD with NOTICES
Beneficiaries who file individual tax returns with
income:
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5. Premium Rates and Deductible
As determined in accordance with
section 1839 of the Act, the following
are the 2018 Part B monthly premium
rates to be paid by beneficiaries who file
either individual tax returns (and are
single individuals, heads of households,
qualifying widows or widowers with
dependent children, or married
individuals filing separately who lived
apart from their spouses for the entire
taxable year), or joint tax returns.
Beneficiaries who file joint tax returns with income:
Less than or equal to $85,000 .....................................
Greater than $85,000 and less than or equal to
$107,000.
Greater than $107,000 and less than or equal to
$133,500.
Greater than $133,500 and less than or equal to
$160,000.
Greater than $160,000 .................................................
In addition, the monthly premium
rates to be paid by beneficiaries who are
of assets over liabilities of $65,598
million by the end of December 2018
under the cost growth rate assumptions
shown in Table 2 and assuming that the
provisions of current law are fully
implemented. This result amounts to
17.8 percent of the estimated total
incurred expenditures for the following
year.
Assumptions that are somewhat more
pessimistic (and that therefore test the
adequacy of the assets to accommodate
projection errors) produce a surplus of
$16,355 million by the end of December
2018 under current law, which amounts
to 3.9 percent of the estimated total
incurred expenditures for the following
year. Under fairly optimistic
assumptions, the monthly actuarial rates
would result in a surplus of $114,191
million by the end of December 2018, or
35.6 percent of the estimated total
incurred expenditures for the following
year.
The sensitivity analysis indicates that
the premium and general revenue
financing established for 2018, together
with existing Part B account assets,
would be adequate to cover estimated
Part B costs for 2018 under current law
should actual costs prove to be
somewhat greater than expected.
Less than or equal to $170,000 ...................................
Greater than $170,000 and less than or equal to
$214,000.
Greater than $214,000 and less than or equal to
$267,000.
Greater than $267,000 and less than or equal to
$320,000.
Greater than $320,000 .................................................
married and lived with their spouses at
any time during the taxable year, but
PO 00000
Income-related
monthly
adjustment
amount
Frm 00031
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Total monthly
premium
amount
$0.00
53.50
$134.00
187.50
133.90
267.90
214.30
348.30
294.60
428.60
who file separate tax returns from their
spouses, are as follows:
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Income-related
monthly
adjustment
amount
Beneficiaries who are married and lived with their spouses at any time during the year, but who file
separate tax returns from their spouses:
Less than or equal to $85,000 ....................................................................................................................
Greater than $85,000 ..................................................................................................................................
Total monthly
premium
amount
$0.00
294.60
$134.00
428.60
TABLE 2—PROJECTION FACTORS 1 12-MONTH PERIODS ENDING DECEMBER 31 OF 2015–2018
[In percent]
Physicians’ services
Calendar year
Fees 2
Aged:
2015
2016
2017
2018
Disabled:
2015
2016
2017
2018
Residual 3
Durable
medical
equipment
Carrier lab 4
Other
carrier
services 5
Outpatient
hospital
Home
health
agency
Other
intermediary
services 7
Hospital
Lab 6
Managed
care
.......
.......
.......
.......
¥0.5
¥0.3
0.4
¥0.2
0.7
¥1.2
1.0
2.0
5.8
¥10.4
¥3.1
5.1
1.6
¥2.5
4.8
0.0
4.4
6.4
5.8
4.3
7.3
4.9
8.1
7.8
1.4
¥0.6
2.5
3.0
2.4
2.9
4.0
¥1.9
5.0
2.1
5.4
¥4.6
2.9
3.4
2.6
6.4
.......
.......
.......
.......
¥0.5
¥0.3
0.4
¥0.2
0.3
¥0.5
1.1
1.9
6.2
¥7.2
0.2
4.9
5.8
¥14.0
3.3
¥0.1
5.2
6.9
7.3
4.8
7.1
5.5
7.5
7.7
¥1.1
0.0
3.1
3.4
0.4
5.2
2.9
¥2.0
10.1
7.2
5.7
¥4.4
3.1
4.9
3.5
6.6
1 All
values for services other than managed care are per fee-for-service enrollee. Managed care values are per managed care enrollee.
recognized for payment under the program.
in the number of services received per enrollee and greater relative use of more expensive services.
4 Includes services paid under the lab fee schedule furnished in the physician’s office or an independent lab.
5 Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc.
6 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
7 Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitation and psychiatric hospitals, etc.
2 As
3 Increase
TABLE 3—DERIVATION OF MONTHLY ACTUARIAL RATE FOR ENROLLEES AGE 65 AND OVER FOR FINANCING PERIODS
ENDING DECEMBER 31, 2015 THROUGH DECEMBER 31, 2018
CY 2015
Covered services (at level recognized):
Physician fee schedule .............................................................................
Durable medical equipment ......................................................................
Carrier lab 1 ...............................................................................................
Other carrier services 2 .............................................................................
Outpatient hospital ....................................................................................
Home health .............................................................................................
Hospital lab 3 .............................................................................................
Other intermediary services 4 ...................................................................
Managed care ...........................................................................................
CY 2016
CY 2017
CY 2018
$75.43
6.28
4.33
22.51
43.25
9.64
2.25
17.25
78.97
$73.63
5.57
4.18
23.72
44.93
9.49
2.29
17.44
83.20
$72.71
5.27
4.27
24.47
47.37
9.48
2.33
17.92
89.11
$73.35
5.48
4.23
25.26
50.57
9.67
2.26
16.94
96.37
259.92
264.46
272.94
284.13
¥5.64
¥27.95
¥4.52
¥1.08
¥6.35
¥27.65
¥4.61
¥0.56
¥7.00
¥27.79
¥4.76
¥0.02
¥7.00
¥28.27
¥4.97
0.17
Total benefits .....................................................................................
Administrative expenses ..................................................................................
220.73
2.82
225.29
4.07
233.37
3.45
244.04
3.87
Incurred expenditures ......................................................................................
Value of interest ...............................................................................................
Contingency margin for projection error and to amortize the surplus or deficit .................................................................................................................
asabaliauskas on DSKBBXCHB2PROD with NOTICES
Total services ....................................................................................
Cost sharing:
Deductible .................................................................................................
Coinsurance ..............................................................................................
Sequestration of benefits .................................................................................
HIT payment incentives ...................................................................................
223.55
¥1.86
229.36
¥1.49
236.82
¥1.67
247.91
¥1.89
¥11.89
9.73
26.75
15.88
Monthly actuarial rate ........................................................................
209.80
237.60
261.90
261.90
1 Includes
2 Includes
services paid under the lab fee schedule furnished in the physician’s office or an independent lab.
physician-administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, sup-
plies, etc.
3 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
4 Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitation and psychiatric hospitals,
etc.
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TABLE 4—DERIVATION OF MONTHLY ACTUARIAL RATE FOR DISABLED ENROLLEES FOR FINANCING PERIODS ENDING
DECEMBER 31, 2015 THROUGH DECEMBER 31, 2018
CY 2015
Covered services (at level recognized):
Physician fee schedule .............................................................................
Durable medical equipment ......................................................................
Carrier lab 1 ...............................................................................................
Other carrier services 2 .............................................................................
Outpatient hospital ....................................................................................
Home health .............................................................................................
Hospital lab 3 .............................................................................................
Other intermediary services 4 ...................................................................
Managed care ...........................................................................................
CY 2016
CY 2017
CY 2018
$80.64
12.28
7.19
25.33
61.51
7.94
2.78
45.11
73.38
$78.54
11.17
6.08
26.16
63.46
7.75
2.86
46.59
81.53
$77.23
10.85
6.09
27.12
66.36
7.73
2.86
48.13
90.23
$77.31
11.18
5.98
27.88
70.26
7.84
2.76
50.79
99.74
Total services ....................................................................................
Cost sharing:
Deductible .................................................................................................
Coinsurance ..............................................................................................
Sequestration of benefits .................................................................................
HIT payment incentives ...................................................................................
316.16
324.13
336.60
353.74
¥5.27
¥42.47
¥5.37
¥1.14
¥5.94
¥42.17
¥5.52
¥0.59
¥6.54
¥42.63
¥5.75
¥0.02
¥6.54
¥43.95
¥6.06
0.17
Total benefits .....................................................................................
Administrative expenses ..................................................................................
261.92
3.34
269.91
4.88
281.67
5.70
297.36
6.34
Incurred expenditures ......................................................................................
Value of interest ...............................................................................................
Contingency margin for projection error and to amortize the surplus or deficit .................................................................................................................
265.26
¥2.21
274.79
¥2.56
287.37
¥3.63
303.70
¥2.73
¥8.25
10.37
¥29.54
¥5.97
Monthly actuarial rate ........................................................................
254.80
282.60
254.20
295.00
1 Includes
2 Includes
services paid under the lab fee schedule furnished in the physician’s office or an independent lab.
physician-administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, sup-
plies, etc.
3 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
4 Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitation and psychiatric hospitals,
etc.
TABLE 5—ACTUARIAL STATUS OF THE PART B ACCOUNT IN THE SMI TRUST FUND UNDER THREE SETS OF ASSUMPTIONS
FOR FINANCING PERIODS THROUGH DECEMBER 31, 2018
As of December 31,
2016
Actuarial status (in millions):
Assets ...................................................................................................................................
Liabilities ...............................................................................................................................
Assets less liabilities .............................................................................................................
Ratio 1 ...................................................................................................................................
Low-cost projection:
Actuarial status (in millions):
Assets ............................................................................................................................
Liabilities ........................................................................................................................
2017
2018
$87,983
$28,494
$79,236
$30,559
$97,686
$32,089
$59,489
18.9%
$48,677
14.4%
$65,598
17.8%
$87,983
$28,494
$96,444
$28,647
$144,913
$30,722
$59,489
20.2%
$67,797
22.2%
$114,191
35.6%
$87,983
$28,494
$63,188
$32,342
$50,044
$33,708
Assets less liabilities .....................................................................................................
Ratio 1 ............................................................................................................................
asabaliauskas on DSKBBXCHB2PROD with NOTICES
Assets less liabilities .....................................................................................................
Ratio 1 ............................................................................................................................
High-cost projection:
Actuarial status (in millions):
Assets ............................................................................................................................
Liabilities ........................................................................................................................
$59,489
17.9%
$30,846
8.3%
$16,335
3.9%
1 Ratio
of assets less liabilities at the end of the year to the total incurred expenditures during the following year, expressed as a percent.
III. Collection of Information
Requirements
This document does not impose
information collection requirements—
that is, reporting, recordkeeping, or
third-party disclosure requirements.
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18:56 Nov 20, 2017
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Consequently, there is no need for
review by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. 3501 et seq.).
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IV. Regulatory Impact Analysis
A. Statement of Need
Section 1839 of the Act requires us to
annually announce (that is, by
September 30th of each year) the Part B
monthly actuarial rates for aged and
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Federal Register / Vol. 82, No. 223 / Tuesday, November 21, 2017 / Notices
disabled beneficiaries as well as the
monthly Part B premium. We also
announce the Part B annual deductible
because its determination is directly
linked to the aged actuarial rate.
B. Overall Impact
We have examined the impacts 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
notices with economically significant
effects ($100 million or more in any one
year). For 2018 the standard Part B
premium rate, the Part B income-related
premium rates, and the Part B
deductible are the same as the
respective amounts for 2017. However,
approximately 70 percent of Part B
enrollees who were held harmless from
the full increase in the Part B premium
in 2017 will pay an increase in their
Part B premium, which will have an
annual effect on the economy of $100
million or more. As a result, this notice
is economically significant under
section 3(f)(1) of Executive Order 12866
and is a major action as defined under
the Congressional Review Act (5 U.S.C.
804(2)).
As discussed earlier, this notice
announces that the monthly actuarial
rates applicable for 2018 are $261.90 for
enrollees age 65 and over and $295.00
for disabled enrollees under age 65. It
also announces the 2018 monthly Part B
premium rates to be paid by
beneficiaries who file either individual
tax returns (and are single individuals,
heads of households, qualifying widows
or widowers with dependent children,
or married individuals filing separately
who lived apart from their spouses for
the entire taxable year), or joint tax
returns.
Income-related
monthly
adjustment
amount
Beneficiaries who file individual tax returns with
income:
Beneficiaries who file joint tax returns with
income:
Less than or equal to $85,000 ...............................
Greater than $85,000 and less than or equal to
$107,000.
Greater than $107,000 and less than or equal to
$133,500.
Greater than $133,500 and less than or equal to
$160,000.
Greater than $160,000 ...........................................
Less than or equal to $170,000 .............................
Greater than $170,000 and less than or equal to
$214,000.
Greater than $214,000 and less than or equal to
$267,000.
Greater than $267,000 and less than or equal to
$320,000.
Greater than $320,000 ...........................................
In addition, the monthly premium
rates to be paid by beneficiaries who are
married and lived with their spouses at
any time during the taxable year, but
who file separate tax returns from their
$0.00
53.50
asabaliauskas on DSKBBXCHB2PROD with NOTICES
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$134.00
187.50
133.90
267.90
214.30
348.30
294.60
428.60
Income-related
monthly
adjustment
amount
Less than or equal to $85,000 ....................................................................................................................
Greater than $85,000 ..................................................................................................................................
adjustment amounts to be paid by
beneficiaries with modified adjusted
gross income above certain threshold
amounts. As a result, we are not
preparing an analysis for the RFA
because the Secretary has determined
that this notice will not have a
significant economic impact on a
substantial number of 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
Total monthly
premium
amount
spouses, are also announced and listed
in the following chart:
Beneficiaries who are married and lived with their spouses at any time during the year, but who file
separate tax returns from their spouses:
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 small
governmental jurisdictions. Individuals
and states are not included in the
definition of a small entity. This notice
announces the monthly actuarial rates
for aged (age 65 and over) and disabled
(under 65) beneficiaries enrolled in Part
B of the Medicare SMI program
beginning January 1, 2018. Also, this
notice announces the monthly premium
for aged and disabled beneficiaries as
well as the income-related monthly
55377
$0.00
294.60
Total monthly
premium
amount
$134.00
428.60
as a hospital that is located outside of
a Metropolitan Statistical Area and has
fewer than 100 beds. As we discussed
previously, we are not preparing an
analysis for section 1102(b) of the Act
because the Secretary has determined
that this notice will not have a
significant effect on 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 one year of
$100 million in 1995 dollars, updated
annually for inflation. In 2017, that
threshold is approximately $156
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Federal Register / Vol. 82, No. 223 / Tuesday, November 21, 2017 / Notices
million. Part B enrollees who are also
enrolled in Medicaid have their
monthly Part B premiums paid by
Medicaid. The cost to each state
Medicaid program from the 2018
premium increase is estimated to be less
than the threshold. This notice does not
impose mandates that will have a
consequential effect of the threshold
amount or more on state, local, or tribal
governments or on the private sector.
Executive Order 13132 establishes
certain requirements that an agency
must meet when it publishes a proposed
rule (and subsequent final rule) that
imposes substantial direct compliance
costs on state and local governments,
preempts state law, or otherwise has
Federalism implications. We have
determined that this notice does not
significantly affect the rights, roles, and
responsibilities of states. Accordingly,
the requirements of Executive Order
13132 do not apply to this notice.
In accordance with the provisions of
Executive Order 12866, this notice was
reviewed by the Office of Management
and Budget.
asabaliauskas on DSKBBXCHB2PROD with NOTICES
V. Waiver of Proposed Notice
18:56 Nov 20, 2017
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[FR Doc. 2017–24877 Filed 11–17–17; 4:15 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket Nos. FDA–2017–P–3989, FDA–
2017–P–4195, FDA–2017–P–5114, FDA–
2017–P–5909, FDA–2017–P–5910, and FDA–
2017–P–5967]
Determination That TRINTELLIX
(Vortioxetine Hydrobromide) Oral
Tablet, EQ 15 Milligram Base, Was Not
Withdrawn From Sale for Reasons of
Safety or Effectiveness
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice.
The Food and Drug
Administration (FDA or Agency) has
determined that TRINTELLIX
(vortioxetine hydrobromide) oral tablet,
equivalent to (EQ) 15 milligram (mg)
base, was not withdrawn from sale for
reasons of safety or effectiveness. This
determination will allow FDA to
approve abbreviated new drug
applications (ANDAs) for vortioxetine
hydrobromide oral tablet, 15 mg base, if
all other legal and regulatory
requirements are met.
FOR FURTHER INFORMATION CONTACT:
Meadow W. Platt, Center for Drug
Evaluation and Research, Food and
Drug Administration, 10903 New
Hampshire Ave., Bldg. 51, Rm. 6228,
Silver Spring, MD 20993–0002, 301–
796–1830.
SUPPLEMENTARY INFORMATION: In 1984,
Congress enacted the Drug Price
Competition and Patent Term
Restoration Act of 1984 (Pub. L. 98–417)
(the 1984 amendments), which
authorized the approval of duplicate
versions of drug products under an
ANDA procedure. ANDA applicants
must, with certain exceptions, show that
the drug for which they are seeking
approval contains the same active
ingredient in the same strength and
dosage form as the ‘‘listed drug,’’ which
is a version of the drug that was
previously approved. ANDA applicants
do not have to repeat the extensive
clinical testing otherwise necessary to
SUMMARY:
The Medicare statute requires the
publication of the monthly actuarial
rates and the Part B premium amounts
in September. We ordinarily use general
notices, rather than notice and comment
rulemaking procedures, to make such
announcements. In doing so, we note
that, under the Administrative
Procedure Act, interpretive rules,
general statements of policy, and rules
of agency organization, procedure, or
practice are excepted from the
requirements of notice and comment
rulemaking.
We considered publishing a proposed
notice to provide a period for public
comment. However, we may waive that
procedure if we find, for good cause,
that prior notice and comment are
impracticable, unnecessary, or contrary
to the public interest. The statute
establishes the time period for which
the premium rates will apply, and
delaying publication of the Part B
premium rate such that it would not be
published before that time would be
contrary to the public interest.
Moreover, we find that notice and
comment are unnecessary because the
formulas used to calculate the Part B
premiums are statutorily directed.
Therefore, we find good cause to waive
publication of a proposed notice and
solicitation of public comments.
VerDate Sep<11>2014
Dated: October 27, 2017.
Seema Verma,
Administrator, Centers for Medicare &
Medicaid Services.
Dated: November 1, 2017.
Eric D. Hargan,
Acting Secretary, Department of Health and
Human Services.
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gain approval of a new drug application
(NDA).
The 1984 amendments include what
is now section 505(j)(7) of the Federal
Food, Drug, and Cosmetic Act (21 U.S.C.
355(j)(7)), which requires FDA to
publish a list of all approved drugs.
FDA publishes this list as part of the
‘‘Approved Drug Products With
Therapeutic Equivalence Evaluations,’’
which is known generally as the
‘‘Orange Book.’’ Under FDA regulations,
drugs are removed from the list if the
Agency withdraws or suspends
approval of the drug’s NDA or ANDA
for reasons of safety or effectiveness or
if FDA determines that the listed drug
was withdrawn from sale for reasons of
safety or effectiveness (21 CFR 314.162).
A person may petition the Agency to
determine, or the Agency may
determine on its own initiative, whether
a listed drug was withdrawn from sale
for reasons of safety or effectiveness.
This determination may be made at any
time after the drug has been withdrawn
from sale, but must be made prior to
approving an ANDA that refers to the
listed drug (§ 314.161 (21 CFR 314.161)).
FDA may not approve an ANDA that
does not refer to a listed drug.
TRINTELLIX (vortioxetine
hydrobromide) oral tablets, EQ 5 mg
base, EQ 10 mg base, EQ 15 mg base,
and EQ 20 mg base, are the subject of
NDA 204447, held by Takeda
Pharmaceuticals, USA, Inc., and
initially approved on September 30,
2013. TRINTELLIX is indicated for the
treatment of major depressive disorder.
TRINTELLIX (vortioxetine
hydrobromide) oral tablets, EQ 5 mg
base, EQ 10 mg base, and EQ 20 mg
base, are listed in the ‘‘Prescription Drug
Product List’’ section of the Orange
Book, and TRINTELLIX (vortioxetine
hydrobromide) oral tablet, EQ 15 mg
base, is listed in the ‘‘Discontinued Drug
Product List’’ section of the Orange
Book. Takeda Pharmaceuticals, USA,
Inc., has never marketed TRINTELLIX
(vortioxetine hydrobromide) oral tablet,
EQ 15 mg base. In previous instances
(see, e.g., 72 FR 9763 (March 5, 2007),
61 FR 25497 (May 21, 1996)), the
Agency has determined that, for
purposes of §§ 314.161 and 314.162,
never marketing an approved drug
product is equivalent to withdrawing
the drug from sale.
Lachman Consultant Services, Inc.;
INC Research, LLC; Locke Lord, LLP;
Goodwin Procter, LLP; Cipla USA Inc.;
and Apotex, Inc., submitted citizen
petitions dated June 29, 2017; July 12,
2017; August 21, 2017; September 25,
2017; September 25, 2017; and
September 27, 2017, respectively
(Docket Nos. FDA–2017–P–3989, FDA–
E:\FR\FM\21NON1.SGM
21NON1
]]>Agencies
[Federal Register Volume 82, Number 223 (Tuesday, November 21, 2017)]
[Notices]
[Pages 55370-55378]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-24877]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-8067-N]
RIN 0938-AS72
Medicare Program; Medicare Part B Monthly Actuarial Rates,
Premium Rates, and Annual Deductible Beginning January 1, 2018
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces the monthly actuarial rates for aged
(age 65 and over) and disabled (under age 65) beneficiaries enrolled in
Part B of the Medicare Supplementary Medical Insurance (SMI) program
beginning January 1, 2018. In addition, this notice announces the
monthly premium for aged and disabled beneficiaries, the deductible for
2018, and the income-related monthly adjustment amounts to be paid by
beneficiaries with modified adjusted gross income above certain
threshold amounts. The monthly actuarial rates for 2018 are $261.90 for
aged enrollees and $295.00 for disabled enrollees. The standard monthly
Part B premium rate for all enrollees for 2018 is $134.00, which is
equal to 50 percent of the monthly actuarial rate for aged enrollees
(or approximately 25 percent of the expected average total cost of Part
B coverage for aged enrollees) plus $3.00. (The 2017 standard premium
rate was $134.00, which included the $3.00 repayment amount.) The Part
B deductible for 2018 is $183.00 for all Part B beneficiaries. If a
beneficiary has to pay an income-related monthly adjustment, he or she
will have to pay a total monthly premium of about 35, 50, 65, or 80
percent of the total cost of Part B coverage plus $4.20, $6.00, $7.80,
or $9.60.
DATES: Effective Date: January 1, 2018.
FOR FURTHER INFORMATION CONTACT: M. Kent Clemens, (410) 786-6391.
SUPPLEMENTARY INFORMATION:
I. Background
Part B is the voluntary portion of the Medicare program that pays
all or part of the costs for physicians' services; outpatient hospital
services; certain home health services; services furnished by rural
health clinics, ambulatory surgical centers, and comprehensive
outpatient rehabilitation facilities; and certain other medical and
health services not covered by Medicare Part A, Hospital Insurance.
Medicare Part B is available to individuals who are entitled to
Medicare Part A, as well as to U.S. residents who have attained age 65
and are citizens and to aliens who were lawfully admitted for permanent
residence and have resided in the United States for 5 consecutive
years. Part B requires enrollment and payment of monthly premiums, as
described in 42 CFR part 407, subpart B, and part 408, respectively.
The premiums paid by (or on behalf of) all enrollees fund approximately
one-fourth of the total incurred costs, and transfers from the general
fund of the Treasury pay approximately three-fourths of these costs.
The Secretary of the Department of Health and Human Services (the
Secretary) is required by section 1839 of the Social Security Act (the
Act) to announce the Part B monthly actuarial rates for aged and
disabled beneficiaries as well as the monthly Part B premium. The Part
B annual deductible is included because its determination is directly
linked to the aged actuarial rate.
The monthly actuarial rates for aged and disabled enrollees are
used to determine the correct amount of general revenue financing per
beneficiary each month. These amounts, according to actuarial
estimates, will equal, respectively, one-half of the expected average
monthly cost of Part B for each aged enrollee (age 65 or over) and one-
half of the expected average monthly cost of Part B for each disabled
enrollee (under age 65).
The Part B deductible to be paid by enrollees is also announced.
Prior to the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (MMA) (Pub. L. 108-173), the Part B deductible was set in
statute. After setting the 2005 deductible amount at $110, section 629
of the MMA (amending section 1833(b) of the Act) required that the Part
B deductible be indexed beginning in 2006. The inflation factor to be
used each year is the annual percentage increase in the Part B
actuarial rate for enrollees age 65 and over. Specifically, the 2018
Part B deductible is calculated by multiplying the 2017 deductible by
the ratio of the 2018 aged actuarial rate to the 2017 aged actuarial
rate. The amount determined under this formula is then rounded to the
nearest $1.
The monthly Part B premium rate to be paid by aged and disabled
enrollees is also announced. (Although the costs to the program per
disabled enrollee are different than for the aged, the statute provides
that they pay the same premium amount.) Beginning with the passage of
section 203 of the Social Security Amendments of 1972 (Pub. L.
[[Page 55371]]
92-603), the premium rate, which was determined on a fiscal-year basis,
was limited to the lesser of the actuarial rate for aged enrollees, or
the current monthly premium rate increased by the same percentage as
the most recent general increase in monthly Title II Social Security
benefits.
However, the passage of section 124 of the Tax Equity and Fiscal
Responsibility Act of 1982 (TEFRA) (Pub. L. 97-248) suspended this
premium determination process. Section 124 of TEFRA changed the premium
basis to 50 percent of the monthly actuarial rate for aged enrollees
(that is, 25 percent of program costs for aged enrollees). Section 606
of the Social Security Amendments of 1983 (Pub. L. 98-21), section 2302
of the Deficit Reduction Act of 1984 (DEFRA 84) (Pub. L. 98-369),
section 9313 of the Consolidated Omnibus Budget Reconciliation Act of
1985 (COBRA 85) (Pub. L. 99-272), section 4080 of the Omnibus Budget
Reconciliation Act of 1987 (OBRA 87) (Pub. L. 100-203), and section
6301 of the Omnibus Budget Reconciliation Act of 1989 (OBRA 89) (Pub.
L. 101-239) extended the provision that the premium be based on 50
percent of the monthly actuarial rate for aged enrollees (that is, 25
percent of program costs for aged enrollees). This extension expired at
the end of 1990.
The premium rate for 1991 through 1995 was legislated by section
1839(e)(1)(B) of the Act, as added by section 4301 of the Omnibus
Budget Reconciliation Act of 1990 (OBRA 90) (Pub. L. 101-508). In
January 1996, the premium determination basis would have reverted to
the method established by the 1972 Social Security Act Amendments.
However, section 13571 of the Omnibus Budget Reconciliation Act of 1993
(OBRA 93) (Pub. L. 103-66) changed the premium basis to 50 percent of
the monthly actuarial rate for aged enrollees (that is, 25 percent of
program costs for aged enrollees) for 1996 through 1998.
Section 4571 of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105-
33) permanently extended the provision that the premium be based on 50
percent of the monthly actuarial rate for aged enrollees (that is, 25
percent of program costs for aged enrollees).
The BBA included a further provision affecting the calculation of
the Part B actuarial rates and premiums for 1998 through 2003. Section
4611 of the BBA modified the home health benefit payable under Part A
for individuals enrolled in Part B. Under this section, beginning in
1998, expenditures for home health services not considered ``post-
institutional'' are payable under Part B rather than Part A. However,
section 4611(e)(1) of the BBA required that there be a transition from
1998 through 2002 for the aggregate amount of the expenditures
transferred from Part A to Part B. Section 4611(e)(2) of the BBA also
provided a specific yearly proportion for the transferred funds. The
proportions were one-sixth for 1998, one-third for 1999, one-half for
2000, two-thirds for 2001, and five-sixths for 2002. For the purpose of
determining the correct amount of financing from general revenues of
the Federal Government, it was necessary to include only these
transitional amounts in the monthly actuarial rates for both aged and
disabled enrollees, rather than the total cost of the home health
services being transferred.
Section 4611(e)(3) of the BBA also specified, for the purpose of
determining the premium, that the monthly actuarial rate for enrollees
age 65 and over be computed as though the transition would occur for
1998 through 2003 and that one-seventh of the cost be transferred in
1998, two-sevenths in 1999, three-sevenths in 2000, four-sevenths in
2001, five-sevenths in 2002, and six-sevenths in 2003. Therefore, the
transition period for incorporating this home health transfer into the
premium was 7 years while the transition period for including these
services in the actuarial rate was 6 years.
Section 811 of the MMA, which amended section 1839 of the Act,
requires that, starting on January 1, 2007, the Part B premium a
beneficiary pays each month be based on his or her annual income.
Specifically, if a beneficiary's modified adjusted gross income is
greater than the legislated threshold amounts (for 2018, $85,000 for a
beneficiary filing an individual income tax return and $170,000 for a
beneficiary filing a joint tax return), the beneficiary is responsible
for a larger portion of the estimated total cost of Part B benefit
coverage. In addition to the standard 25-percent premium, these
beneficiaries now have to pay an income-related monthly adjustment
amount. The MMA made no change to the actuarial rate calculation, and
the standard premium, which will continue to be paid by beneficiaries
whose modified adjusted gross income is below the applicable
thresholds, still represents 25 percent of the estimated total cost to
the program of Part B coverage for an aged enrollee. However, depending
on income and tax filing status, a beneficiary can now be responsible
for 35, 50, 65, or 80 percent of the estimated total cost of Part B
coverage, rather than 25 percent. (For 2018 and subsequent years, the
income thresholds are lower for the two highest income ranges because
of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
(Pub. L. 114-10).) The end result of the higher premium is that the
Part B premium subsidy is reduced, and less general revenue financing
is required, for beneficiaries with higher income because they are
paying a larger share of the total cost with their premium. That is,
the premium subsidy continues to be approximately 75 percent for
beneficiaries with income below the applicable income thresholds, but
it will be reduced for beneficiaries with income above these
thresholds. The MMA specified that there be a 5-year transition period
to reach full implementation of this provision. However, section 5111
of the Deficit Reduction Act of 2005 (DRA) (Pub. L. 109-171) modified
the transition to a 3-year period.
Section 4732(c) of the BBA added section 1933(c) of the Act, which
required the Secretary to allocate money from the Part B trust fund to
the State Medicaid programs for the purpose of providing Medicare Part
B premium assistance from 1998 through 2002 for the low-income Medicaid
beneficiaries who qualify under section 1933 of the Act. This
allocation, while not a benefit expenditure, was an expenditure of the
trust fund and was included in calculating the Part B actuarial rates
through 2002. For 2003 through 2015, the expenditure was made from the
trust fund because the allocation was temporarily extended. However,
because the extension occurred after the financing was determined, the
allocation was not included in the calculation of the financing rates
for these years. Section 211 of MACRA permanently extended this
expenditure, which is included in the calculation of the Part B
actuarial rates for 2016 and subsequent years.
Another provision affecting the calculation of the Part B premium
is section 1839(f) of the Act, as amended by section 211 of the
Medicare Catastrophic Coverage Act of 1988 (MCCA 88) (Pub. L. 100-360).
(The Medicare Catastrophic Coverage Repeal Act of 1989 (Pub. L. 101-
234) did not repeal the revisions to section 1839(f) of the Act made by
MCCA 88.) Section 1839(f) of the Act, referred to as the ``hold-
harmless'' provision, provides that if an individual is entitled to
benefits under section 202 or 223 of the Act (the Old-Age and Survivors
Insurance Benefit and the Disability Insurance Benefit, respectively)
and has the Part B premium deducted from these benefit payments, the
premium increase will be reduced, if necessary, to avoid
[[Page 55372]]
causing a decrease in the individual's net monthly payment. This
decrease in payment occurs if the increase in the individual's Social
Security benefit due to the cost-of-living adjustment under section
215(i) of the Act is less than the increase in the premium.
Specifically, the reduction in the premium amount applies if the
individual is entitled to benefits under section 202 or 223 of the Act
for November and December of a particular year and the individual's
Part B premiums for December and the following January are deducted
from the respective month's section 202 or 223 benefits. The hold-
harmless provision does not apply to beneficiaries who are required to
pay an income-related monthly adjustment amount.
A check for benefits under section 202 or 223 of the Act is
received in the month following the month for which the benefits are
due. The Part B premium that is deducted from a particular check is the
Part B payment for the month in which the check is received. Therefore,
a benefit check for November is not received until December, but
December's Part B premium has been deducted from it.
Generally, if a beneficiary qualifies for hold-harmless protection,
the reduced premium for the individual for that January and for each of
the succeeding 11 months is the greater of either--
The monthly premium for January reduced as necessary to
make the December monthly benefits, after the deduction of the Part B
premium for January, at least equal to the preceding November's monthly
benefits, after the deduction of the Part B premium for December; or
The monthly premium for that individual for that December.
In determining the premium limitations under section 1839(f) of the
Act, the monthly benefits to which an individual is entitled under
section 202 or 223 of the Act do not include retroactive adjustments or
payments and deductions on account of work. Also, once the monthly
premium amount is established under section 1839(f) of the Act, it will
not be changed during the year even if there are retroactive
adjustments or payments and deductions on account of work that apply to
the individual's monthly benefits.
Individuals who have enrolled in Part B late or who have re-
enrolled after the termination of a coverage period are subject to an
increased premium under section 1839(b) of the Act. The increase is a
percentage of the premium and is based on the new premium rate before
any reductions under section 1839(f) of the Act are made.
Section 1839 of the Act, as amended by section 601(a) of the
Bipartisan Budget Act of 2015 (Pub. L. 114-74), specified that the 2016
actuarial rate for enrollees age 65 and older be determined as if the
hold-harmless provision did not apply. The premium revenue that was
lost by using the resulting lower premium (excluding the foregone
income-related premium revenue) was replaced by a transfer of general
revenue from the Treasury, which will be repaid over time to the
general fund.
Starting in 2016, in order to repay the balance due (which includes
the transfer amount and the foregone income-related premium revenue),
the Part B premium otherwise determined will be increased by $3.00.
These repayment amounts will be added to the Part B premium otherwise
determined each year and paid back to the general fund of the Treasury
and will continue until the balance due is paid back.
High-income enrollees pay the $3 repayment amount plus an
additional $1.20, $3.00, $4.80, or $6.60 in repayment as part of the
income-related monthly adjustment amount (IRMAA) premium dollars, which
reduce (dollar for dollar) the amount of general revenue received by
Part B from the general fund of the Treasury. Because of this general
revenue offset, the repayment IRMAA premium dollars are not included in
the direct repayments made to the general fund of the Treasury from
Part B in order to avoid a double repayment. (Only the $3.00 monthly
repayment amounts are included in the direct repayments).
These repayment amounts will continue until the total amount
collected is equal to the beginning balance due. (In the final year of
the repayment, the additional amounts may be modified to avoid an
overpayment.) The repayment amounts (excluding the repayment amounts
for high-income enrollees) are subject to the hold-harmless provision.
The beginning balance due was $9,066,409,000, consisting of
$1,625,761,000 in foregone income-related premium revenue plus a
transfer amount of $7,440,648,000. It is estimated that $1,404,616,000
will have been collected for repayment to the general fund by the end
of 2017.
II. Provisions of the Notice
A. Notice of Medicare Part B Monthly Actuarial Rates, Monthly Premium
Rates, and Annual Deductible
The Medicare Part B monthly actuarial rates applicable for 2018 are
$261.90 for enrollees age 65 and over and $295.00 for disabled
enrollees under age 65. In section II.B. of this notice, we present the
actuarial assumptions and bases from which these rates are derived. The
Part B standard monthly premium rate for all enrollees for 2018 is
$134.00.
The following are the 2018 Part B monthly premium rates to be paid
by (or on behalf of) beneficiaries who file either individual tax
returns (and are single individuals, heads of households, qualifying
widows or widowers with dependent children, or married individuals
filing separately who lived apart from their spouses for the entire
taxable year), or joint tax returns.
----------------------------------------------------------------------------------------------------------------
Income-related
Beneficiaries who file individual tax Beneficiaries who file joint monthly Total monthly
returns with income: tax returns with income: adjustment amount premium amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $85,000.............. Less than or equal to $0.00 $134.00
$170,000.
Greater than $85,000 and less than or equal Greater than $170,000 and 53.50 187.50
to $107,000. less than or equal to
$214,000.
Greater than $107,000 and less than or Greater than $214,000 and 133.90 267.90
equal to $133,500. less than or equal to
$267,000.
Greater than $133,500 and less than or Greater than $267,000 and 214.30 348.30
equal to $160,000. less than or equal to
$320,000.
Greater than $160,000...................... Greater than $320,000........ 294.60 428.60
----------------------------------------------------------------------------------------------------------------
In addition, the monthly premium rates to be paid by (or on behalf
of) beneficiaries who are married and lived with their spouses at any
time during the taxable year, but who file separate
[[Page 55373]]
tax returns from their spouses, are as follows:
------------------------------------------------------------------------
Beneficiaries who are married and
lived with their spouses at any Income-related
time during the year, but who file monthly Total monthly
separate tax returns from their adjustment amount premium amount
spouses:
------------------------------------------------------------------------
Less than or equal to $85,000..... $0.00 $134.00
Greater than $85,000.............. 294.60 428.60
------------------------------------------------------------------------
The Part B annual deductible for 2018 is $183.00 for all
beneficiaries.
B. Statement of Actuarial Assumptions and Bases Employed in Determining
the Monthly Actuarial Rates and the Monthly Premium Rate for Part B
Beginning January 2018
The actuarial assumptions and bases used to determine the monthly
actuarial rates and the monthly premium rates for Part B are
established by the Centers for Medicare & Medicaid Services Office of
the Actuary. The estimates underlying these determinations are prepared
by actuaries meeting the qualification standards and following the
actuarial standards of practice established by the Actuarial Standards
Board.
1. Actuarial Status of the Part B Account in the Supplementary Medical
Insurance Trust Fund
Under section 1839 of the Act, the starting point for determining
the standard monthly premium is the amount that would be necessary to
finance Part B on an incurred basis. This is the amount of income that
would be sufficient to pay for services furnished during that year
(including associated administrative costs) even though payment for
some of these services will not be made until after the close of the
year. The portion of income required to cover benefits not paid until
after the close of the year is added to the trust fund and used when
needed.
The premium rates are established prospectively and are, therefore,
subject to projection error. Additionally, legislation enacted after
the financing was established, but effective for the period in which
the financing is set, may affect program costs. As a result, the income
to the program may not equal incurred costs. Therefore, trust fund
assets must be maintained at a level that is adequate to cover an
appropriate degree of variation between actual and projected costs, and
the amount of incurred, but unpaid, expenses. Numerous factors
determine what level of assets is appropriate to cover variation
between actual and projected costs. The three most important of these
factors are (1) the difference from prior years between the actual
performance of the program and estimates made at the time financing was
established; (2) the likelihood and potential magnitude of expenditure
changes resulting from enactment of legislation affecting Part B costs
in a year subsequent to the establishment of financing for that year;
and (3) the expected relationship between incurred and cash
expenditures. These factors are analyzed on an ongoing basis, as the
trends can vary over time.
Table 1 summarizes the estimated actuarial status of the trust fund
as of the end of the financing period for 2016 and 2017.
Table 1--Estimated Actuarial Status of the Part B Account in the Supplementary Medical Insurance Trust Fund as
of the End of the Financing Period
----------------------------------------------------------------------------------------------------------------
Assets less
Financing period ending Assets (in Liabilities liabilities
millions) (in millions) (in millions)
----------------------------------------------------------------------------------------------------------------
December 31, 2016............................................... $87,983 $28,494 $59,489
December 31, 2017............................................... 79,236 30,559 48,677
----------------------------------------------------------------------------------------------------------------
2. Monthly Actuarial Rate for Enrollees Age 65 and Older
The monthly actuarial rate for enrollees age 65 and older is one-
half of the sum of monthly amounts for (1) the projected cost of
benefits; and (2) administrative expenses for each enrollee age 65 and
older, after adjustments to this sum to allow for interest earnings on
assets in the trust fund and an adequate contingency margin. The
contingency margin is an amount appropriate to provide for possible
variation between actual and projected costs and to amortize any
surplus assets or unfunded liabilities.
The monthly actuarial rate for enrollees age 65 and older for 2018
is determined by first establishing per enrollee costs by type of
service from program data through 2016 and then projecting these costs
for subsequent years. The projection factors used for financing periods
from January 1, 2015 through December 31, 2018 are shown in Table 2.
As indicated in Table 3, the projected per enrollee amount required
to pay for one-half of the total of benefits and administrative costs
for enrollees age 65 and over for 2018 is $247.91. Based on current
estimates, the assets associated with the aged Medicare beneficiaries
at the end of 2017 are not sufficient to cover the amount of incurred,
but unpaid, expenses and to provide for a significant degree of
variation between actual and projected costs. Thus, a positive
contingency margin is needed. The monthly actuarial rate of $261.90
provides an adjustment of $15.88 for a contingency margin and -$1.89
for interest earnings.
The contingency margin for 2018 is affected by several factors.
Starting in 2011, manufacturers and importers of brand-name
prescription drugs pay a fee that is allocated to the Part B account of
the SMI trust. For 2018, the total of these brand-name drug fees is
estimated to be $4.1 billion. The contingency margin has been reduced
to account for this additional revenue.
Another factor affecting the contingency margin is attributable to
the requirement that certain payment incentives, to encourage the
development and use of health information technology (HIT) by Medicare
physicians, are to be excluded from the premium determination. HIT
positive incentive payments or penalties
[[Page 55374]]
will be directly offset through transfers with the general fund of the
Treasury. The monthly actuarial rate includes an adjustment of $0.17
for HIT incentives in 2018.
The traditional goal for the Part B reserve has been that assets
minus liabilities at the end of a year should represent between 15 and
20 percent of the following year's total incurred expenditures. To
accomplish this goal, a 17-percent reserve ratio, which is a fully
adequate contingency reserve level, has been the normal target used to
calculate the Part B premium. Assets at the end of 2017 are expected to
be below the fully adequate level. The financing rates for 2018 are set
to restore the asset level in the Part B account to the fully adequate
level by the end of 2018 under current law. The actuarial rate of
$261.90 per month for aged beneficiaries, as announced in this notice
for 2018, reflects that combined effect of the factors previously
described and the projected assumptions listed in Table 2.
3. Monthly Actuarial Rate for Disabled Enrollees
Disabled enrollees are those persons under age 65 who are enrolled
in Part B because of entitlement to Social Security disability benefits
for more than 24 months or because of entitlement to Medicare under the
end-stage renal disease (ESRD) program. Projected monthly costs for
disabled enrollees (other than those with ESRD) are prepared in a
manner parallel to the projection for the aged using appropriate
actuarial assumptions (see Table 2). Costs for the ESRD program are
projected differently because of the different nature of services
offered by the program.
As shown in Table 4, the projected per enrollee amount required to
pay for one-half of the total of benefits and administrative costs for
disabled enrollees for 2018 is $303.70. The monthly actuarial rate of
$295.00 also provides an adjustment of -$2.73 for interest earnings and
-$5.97 for a contingency margin, reflecting the same factors described
previously for the aged actuarial rate at magnitudes appropriate to the
disabled rate determination. Based on current estimates, the assets
associated with the disabled Medicare beneficiaries at the end of 2017
are sufficient to cover the amount of incurred, but unpaid, expenses
and to provide for a significant degree of variation between actual and
projected costs. A negative contingency margin is needed to maintain
assets at an appropriate level.
The actuarial rate of $295.00 per month for disabled beneficiaries,
as announced in this notice for 2018, reflects the combined net effect
of the factors described previously for aged beneficiaries and the
projection assumptions listed in Table 2.
4. Sensitivity Testing
Several factors contribute to uncertainty about future trends in
medical care costs. It is appropriate to test the adequacy of the rates
using alternative cost growth rate assumptions. The results of those
assumptions are shown in Table 5. One set represents increases that are
higher and, therefore, more pessimistic than the current estimate. The
other set represents increases that are lower and, therefore, more
optimistic than the current estimate. The values for the alternative
assumptions were determined from a statistical analysis of the
historical variation in the respective increase factors.
As indicated in Table 5, the monthly actuarial rates would result
in an excess of assets over liabilities of $65,598 million by the end
of December 2018 under the cost growth rate assumptions shown in Table
2 and assuming that the provisions of current law are fully
implemented. This result amounts to 17.8 percent of the estimated total
incurred expenditures for the following year.
Assumptions that are somewhat more pessimistic (and that therefore
test the adequacy of the assets to accommodate projection errors)
produce a surplus of $16,355 million by the end of December 2018 under
current law, which amounts to 3.9 percent of the estimated total
incurred expenditures for the following year. Under fairly optimistic
assumptions, the monthly actuarial rates would result in a surplus of
$114,191 million by the end of December 2018, or 35.6 percent of the
estimated total incurred expenditures for the following year.
The sensitivity analysis indicates that the premium and general
revenue financing established for 2018, together with existing Part B
account assets, would be adequate to cover estimated Part B costs for
2018 under current law should actual costs prove to be somewhat greater
than expected.
5. Premium Rates and Deductible
As determined in accordance with section 1839 of the Act, the
following are the 2018 Part B monthly premium rates to be paid by
beneficiaries who file either individual tax returns (and are single
individuals, heads of households, qualifying widows or widowers with
dependent children, or married individuals filing separately who lived
apart from their spouses for the entire taxable year), or joint tax
returns.
----------------------------------------------------------------------------------------------------------------
Income-related
Beneficiaries who file individual tax returns Beneficiaries who file joint tax monthly Total monthly
with income: returns with income: adjustment premium amount
amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $85,000................. Less than or equal to $170,000.. $0.00 $134.00
Greater than $85,000 and less than or equal to Greater than $170,000 and less 53.50 187.50
$107,000. than or equal to $214,000.
Greater than $107,000 and less than or equal Greater than $214,000 and less 133.90 267.90
to $133,500. than or equal to $267,000.
Greater than $133,500 and less than or equal Greater than $267,000 and less 214.30 348.30
to $160,000. than or equal to $320,000.
Greater than $160,000......................... Greater than $320,000........... 294.60 428.60
----------------------------------------------------------------------------------------------------------------
In addition, the monthly premium rates to be paid by beneficiaries
who are married and lived with their spouses at any time during the
taxable year, but who file separate tax returns from their spouses, are
as follows:
[[Page 55375]]
------------------------------------------------------------------------
Beneficiaries who are married and
lived with their spouses at any Income-related
time during the year, but who file monthly Total monthly
separate tax returns from their adjustment amount premium amount
spouses:
------------------------------------------------------------------------
Less than or equal to $85,000..... $0.00 $134.00
Greater than $85,000.............. 294.60 428.60
------------------------------------------------------------------------
Table 2--Projection Factors \1\ 12-Month Periods Ending December 31 of 2015-2018
[In percent]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Physicians' services Other
-------------------------- Durable Carrier lab carrier Outpatient Home health Hospital Other Managed
Calendar year Residual medical \4\ services hospital agency Lab \6\ intermediary care
Fees \2\ \3\ equipment \5\ services \7\
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Aged:
2015................................................... -0.5 0.7 5.8 1.6 4.4 7.3 1.4 2.4 5.0 2.9
2016................................................... -0.3 -1.2 -10.4 -2.5 6.4 4.9 -0.6 2.9 2.1 3.4
2017................................................... 0.4 1.0 -3.1 4.8 5.8 8.1 2.5 4.0 5.4 2.6
2018................................................... -0.2 2.0 5.1 0.0 4.3 7.8 3.0 -1.9 -4.6 6.4
Disabled:
2015................................................... -0.5 0.3 6.2 5.8 5.2 7.1 -1.1 0.4 10.1 3.1
2016................................................... -0.3 -0.5 -7.2 -14.0 6.9 5.5 0.0 5.2 7.2 4.9
2017................................................... 0.4 1.1 0.2 3.3 7.3 7.5 3.1 2.9 5.7 3.5
2018................................................... -0.2 1.9 4.9 -0.1 4.8 7.7 3.4 -2.0 -4.4 6.6
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All values for services other than managed care are per fee-for-service enrollee. Managed care values are per managed care enrollee.
\2\ As recognized for payment under the program.
\3\ Increase in the number of services received per enrollee and greater relative use of more expensive services.
\4\ Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab.
\5\ Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc.
\6\ Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
\7\ Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitation and psychiatric hospitals, etc.
Table 3--Derivation of Monthly Actuarial Rate for Enrollees Age 65 and Over for Financing Periods Ending
December 31, 2015 Through December 31, 2018
----------------------------------------------------------------------------------------------------------------
CY 2015 CY 2016 CY 2017 CY 2018
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
Physician fee schedule...................... $75.43 $73.63 $72.71 $73.35
Durable medical equipment................... 6.28 5.57 5.27 5.48
Carrier lab \1\............................. 4.33 4.18 4.27 4.23
Other carrier services \2\.................. 22.51 23.72 24.47 25.26
Outpatient hospital......................... 43.25 44.93 47.37 50.57
Home health................................. 9.64 9.49 9.48 9.67
Hospital lab \3\............................ 2.25 2.29 2.33 2.26
Other intermediary services \4\............. 17.25 17.44 17.92 16.94
Managed care................................ 78.97 83.20 89.11 96.37
---------------------------------------------------------------
Total services.......................... 259.92 264.46 272.94 284.13
Cost sharing:
Deductible.................................. -5.64 -6.35 -7.00 -7.00
Coinsurance................................. -27.95 -27.65 -27.79 -28.27
Sequestration of benefits....................... -4.52 -4.61 -4.76 -4.97
HIT payment incentives.......................... -1.08 -0.56 -0.02 0.17
---------------------------------------------------------------
Total benefits.......................... 220.73 225.29 233.37 244.04
Administrative expenses......................... 2.82 4.07 3.45 3.87
---------------------------------------------------------------
Incurred expenditures........................... 223.55 229.36 236.82 247.91
Value of interest............................... -1.86 -1.49 -1.67 -1.89
Contingency margin for projection error and to -11.89 9.73 26.75 15.88
amortize the surplus or deficit................
---------------------------------------------------------------
Monthly actuarial rate.................. 209.80 237.60 261.90 261.90
----------------------------------------------------------------------------------------------------------------
\1\ Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab.
\2\ Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services,
parenteral and enteral drug costs, supplies, etc.
\3\ Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
\4\ Includes services furnished in dialysis facilities, rural health clinics, federally qualified health
centers, rehabilitation and psychiatric hospitals, etc.
[[Page 55376]]
Table 4--Derivation of Monthly Actuarial Rate for Disabled Enrollees for Financing Periods Ending December 31,
2015 Through December 31, 2018
----------------------------------------------------------------------------------------------------------------
CY 2015 CY 2016 CY 2017 CY 2018
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
Physician fee schedule...................... $80.64 $78.54 $77.23 $77.31
Durable medical equipment................... 12.28 11.17 10.85 11.18
Carrier lab \1\............................. 7.19 6.08 6.09 5.98
Other carrier services \2\.................. 25.33 26.16 27.12 27.88
Outpatient hospital......................... 61.51 63.46 66.36 70.26
Home health................................. 7.94 7.75 7.73 7.84
Hospital lab \3\............................ 2.78 2.86 2.86 2.76
Other intermediary services \4\............. 45.11 46.59 48.13 50.79
Managed care................................ 73.38 81.53 90.23 99.74
---------------------------------------------------------------
Total services.......................... 316.16 324.13 336.60 353.74
Cost sharing:
Deductible.................................. -5.27 -5.94 -6.54 -6.54
Coinsurance................................. -42.47 -42.17 -42.63 -43.95
Sequestration of benefits....................... -5.37 -5.52 -5.75 -6.06
HIT payment incentives.......................... -1.14 -0.59 -0.02 0.17
---------------------------------------------------------------
Total benefits.......................... 261.92 269.91 281.67 297.36
Administrative expenses......................... 3.34 4.88 5.70 6.34
---------------------------------------------------------------
Incurred expenditures........................... 265.26 274.79 287.37 303.70
Value of interest............................... -2.21 -2.56 -3.63 -2.73
Contingency margin for projection error and to -8.25 10.37 -29.54 -5.97
amortize the surplus or deficit................
---------------------------------------------------------------
Monthly actuarial rate.................. 254.80 282.60 254.20 295.00
----------------------------------------------------------------------------------------------------------------
\1\ Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab.
\2\ Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services,
parenteral and enteral drug costs, supplies, etc.
\3\ Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
\4\ Includes services furnished in dialysis facilities, rural health clinics, federally qualified health
centers, rehabilitation and psychiatric hospitals, etc.
Table 5--Actuarial Status of the Part B Account in the SMI Trust Fund Under Three Sets of Assumptions for
Financing Periods Through December 31, 2018
----------------------------------------------------------------------------------------------------------------
As of December 31, 2016 2017 2018
----------------------------------------------------------------------------------------------------------------
Actuarial status (in millions):
Assets...................................................... $87,983 $79,236 $97,686
Liabilities................................................. $28,494 $30,559 $32,089
-----------------------------------------------
Assets less liabilities..................................... $59,489 $48,677 $65,598
Ratio \1\................................................... 18.9% 14.4% 17.8%
Low-cost projection:
Actuarial status (in millions):
Assets.................................................. $87,983 $96,444 $144,913
Liabilities............................................. $28,494 $28,647 $30,722
-----------------------------------------------
Assets less liabilities................................. $59,489 $67,797 $114,191
Ratio \1\............................................... 20.2% 22.2% 35.6%
High-cost projection:
Actuarial status (in millions):
Assets.................................................. $87,983 $63,188 $50,044
Liabilities............................................. $28,494 $32,342 $33,708
-----------------------------------------------
Assets less liabilities................................. $59,489 $30,846 $16,335
Ratio \1\............................................... 17.9% 8.3% 3.9%
----------------------------------------------------------------------------------------------------------------
\1\ Ratio of assets less liabilities at the end of the year to the total incurred expenditures during the
following year, expressed as a percent.
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 (44 U.S.C. 3501 et seq.).
IV. Regulatory Impact Analysis
A. Statement of Need
Section 1839 of the Act requires us to annually announce (that is,
by September 30th of each year) the Part B monthly actuarial rates for
aged and
[[Page 55377]]
disabled beneficiaries as well as the monthly Part B premium. We also
announce the Part B annual deductible because its determination is
directly linked to the aged actuarial rate.
B. Overall Impact
We have examined the impacts 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 notices
with economically significant effects ($100 million or more in any one
year). For 2018 the standard Part B premium rate, the Part B income-
related premium rates, and the Part B deductible are the same as the
respective amounts for 2017. However, approximately 70 percent of Part
B enrollees who were held harmless from the full increase in the Part B
premium in 2017 will pay an increase in their Part B premium, which
will have an annual effect on the economy of $100 million or more. As a
result, this notice is economically significant under section 3(f)(1)
of Executive Order 12866 and is a major action as defined under the
Congressional Review Act (5 U.S.C. 804(2)).
As discussed earlier, this notice announces that the monthly
actuarial rates applicable for 2018 are $261.90 for enrollees age 65
and over and $295.00 for disabled enrollees under age 65. It also
announces the 2018 monthly Part B premium rates to be paid by
beneficiaries who file either individual tax returns (and are single
individuals, heads of households, qualifying widows or widowers with
dependent children, or married individuals filing separately who lived
apart from their spouses for the entire taxable year), or joint tax
returns.
----------------------------------------------------------------------------------------------------------------
Income-related
Beneficiaries who file individual tax Beneficiaries who file joint monthly Total monthly
returns with income: tax returns with income: adjustment amount premium amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $85,000.............. Less than or equal to $0.00 $134.00
$170,000.
Greater than $85,000 and less than or equal Greater than $170,000 and 53.50 187.50
to $107,000. less than or equal to
$214,000.
Greater than $107,000 and less than or Greater than $214,000 and 133.90 267.90
equal to $133,500. less than or equal to
$267,000.
Greater than $133,500 and less than or Greater than $267,000 and 214.30 348.30
equal to $160,000. less than or equal to
$320,000.
Greater than $160,000...................... Greater than $320,000........ 294.60 428.60
----------------------------------------------------------------------------------------------------------------
In addition, the monthly premium rates to be paid by beneficiaries
who are married and lived with their spouses at any time during the
taxable year, but who file separate tax returns from their spouses, are
also announced and listed in the following chart:
------------------------------------------------------------------------
Beneficiaries who are married and
lived with their spouses at any Income-related
time during the year, but who file monthly Total monthly
separate tax returns from their adjustment amount premium amount
spouses:
------------------------------------------------------------------------
Less than or equal to $85,000..... $0.00 $134.00
Greater than $85,000.............. 294.60 428.60
------------------------------------------------------------------------
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 small
governmental jurisdictions. Individuals and states are not included in
the definition of a small entity. This notice announces the monthly
actuarial rates for aged (age 65 and over) and disabled (under 65)
beneficiaries enrolled in Part B of the Medicare SMI program beginning
January 1, 2018. Also, this notice announces the monthly premium for
aged and disabled beneficiaries as well as the income-related monthly
adjustment amounts to be paid by beneficiaries with modified adjusted
gross income above certain threshold amounts. As a result, we are not
preparing an analysis for the RFA because the Secretary has determined
that this notice will not have a significant economic impact on a
substantial number of 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 and has fewer than 100 beds. As we discussed
previously, we are not preparing an analysis for section 1102(b) of the
Act because the Secretary has determined that this notice will not have
a significant effect on 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 one year of
$100 million in 1995 dollars, updated annually for inflation. In 2017,
that threshold is approximately $156
[[Page 55378]]
million. Part B enrollees who are also enrolled in Medicaid have their
monthly Part B premiums paid by Medicaid. The cost to each state
Medicaid program from the 2018 premium increase is estimated to be less
than the threshold. This notice does not impose mandates that will have
a consequential effect of the threshold amount or more on state, local,
or tribal governments or on the private sector.
Executive Order 13132 establishes certain requirements that an
agency must meet when it publishes a proposed rule (and subsequent
final rule) that imposes substantial direct compliance costs on state
and local governments, preempts state law, or otherwise has Federalism
implications. We have determined that this notice does not
significantly affect the rights, roles, and responsibilities of states.
Accordingly, the requirements of Executive Order 13132 do not apply to
this notice.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
V. Waiver of Proposed Notice
The Medicare statute requires the publication of the monthly
actuarial rates and the Part B premium amounts in September. We
ordinarily use general notices, rather than notice and comment
rulemaking procedures, to make such announcements. In doing so, we note
that, under the Administrative Procedure Act, interpretive rules,
general statements of policy, and rules of agency organization,
procedure, or practice are excepted from the requirements of notice and
comment rulemaking.
We considered publishing a proposed notice to provide a period for
public comment. However, we may waive that procedure if we find, for
good cause, that prior notice and comment are impracticable,
unnecessary, or contrary to the public interest. The statute
establishes the time period for which the premium rates will apply, and
delaying publication of the Part B premium rate such that it would not
be published before that time would be contrary to the public interest.
Moreover, we find that notice and comment are unnecessary because the
formulas used to calculate the Part B premiums are statutorily
directed. Therefore, we find good cause to waive publication of a
proposed notice and solicitation of public comments.
Dated: October 27, 2017.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
Dated: November 1, 2017.
Eric D. Hargan,
Acting Secretary, Department of Health and Human Services.
[FR Doc. 2017-24877 Filed 11-17-17; 4:15 pm]
BILLING CODE 4120-01-P
