Medicare Program; CY 2018 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement, 55365-55367 [2017-24912]
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Federal Register / Vol. 82, No. 223 / Tuesday, November 21, 2017 / Notices
1. 1831 Bancorp, MHC and 1831
Bancorp, Inc., both of Dedham,
Massachusetts; to acquire an indirect 20
percent ownership interest in Plimoth
Trust Company LLC, Plymouth,
Massachusetts, and thereby engage in
trust company activities, financial and
investment advisory activities and
employee benefits consulting services
pursuant to sections 225.28(b)(5), (6)
and (9)(ii).
Board of Governors of the Federal Reserve
System, November 15, 2017.
Ann E. Misback,
Secretary of the Board.
[FR Doc. 2017–25106 Filed 11–20–17; 8:45 am]
BILLING CODE 6210–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8066–N]
RIN 0938–AT06
Medicare Program; CY 2018 Part A
Premiums for the Uninsured Aged and
for Certain Disabled Individuals Who
Have Exhausted Other Entitlement
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This annual notice announces
Medicare’s Hospital Insurance (Part A)
premium for uninsured enrollees in
calendar year (CY) 2018. This premium
is paid by enrollees age 65 and over who
are not otherwise eligible for benefits
under Medicare Part A (hereafter known
as the ‘‘uninsured aged’’) and by certain
disabled individuals who have
exhausted other entitlement. The
monthly Part A premium for the 12
months beginning January 1, 2018 for
these individuals will be $422. The
premium for certain other individuals as
described in this notice will be $232.
DATES: Effective Date: This notice is
effective on January 1, 2018.
FOR FURTHER INFORMATION CONTACT:
Clare McFarland, (410) 786 6390.
SUPPLEMENTARY INFORMATION:
SUMMARY:
asabaliauskas on DSKBBXCHB2PROD with NOTICES
I. Background
Section 1818 of the Social Security
Act (the Act) provides for voluntary
enrollment in the Medicare Hospital
Insurance Program (Medicare Part A),
subject to payment of a monthly
premium, of certain persons aged 65
and older who are uninsured under the
Old-Age, Survivors, and Disability
Insurance (OASDI) program or the
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Jkt 244001
Railroad Retirement Act and do not
otherwise meet the requirements for
entitlement to Medicare Part A. These
‘‘uninsured aged’’ individuals are
uninsured under the OASDI program or
the Railroad Retirement Act, because
they do not have 40 quarters of coverage
under Title II of the Act (or are/were not
married to someone who did). (Persons
insured under the OASDI program or
the Railroad Retirement Act and certain
others do not have to pay premiums for
Medicare Part A.)
Section 1818A of the Act provides for
voluntary enrollment in Medicare Part
A, subject to payment of a monthly
premium for certain disabled
individuals who have exhausted other
entitlement. These are individuals who
were entitled to coverage due to a
disabling impairment under section
226(b) of the Act, but who are no longer
entitled to disability benefits and free
Medicare Part A coverage because they
have gone back to work and their
earnings exceed the statutorily defined
‘‘substantial gainful activity’’ amount
(section 223(d)(4) of the Act).
Section 1818A(d)(2) of the Act
specifies that the provisions relating to
premiums under section 1818(d)
through section 1818(f) of the Act for
the aged will also apply to certain
disabled individuals as described above.
Section 1818(d)(1) of the Act requires
us to estimate, on an average per capita
basis, the amount to be paid from the
Federal Hospital Insurance Trust Fund
for services incurred in the upcoming
calendar year (CY) (including the
associated administrative costs) on
behalf of individuals aged 65 and over
who will be entitled to benefits under
Medicare Part A. We must then
determine the monthly actuarial rate for
the following year (the per capita
amount estimated above divided by 12)
and publish the dollar amount for the
monthly premium in the succeeding CY.
If the premium is not a multiple of $1,
the premium is rounded to the nearest
multiple of $1 (or, if it is a multiple of
50 cents but not of $1, it is rounded to
the next highest $1).
Section 13508 of the Omnibus Budget
Reconciliation Act of 1993 (Pub. L. 103–
66) amended section 1818(d) of the Act
to provide for a reduction in the
premium amount for certain voluntary
enrollees (section 1818 and section
1818A of the Act). The reduction
applies to an individual who is eligible
to buy into the Medicare Part A program
and who, as of the last day of the
previous month:
• Had at least 30 quarters of coverage
under Title II of the Act;
• Was married, and had been married
for the previous 1 year period, to a
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55365
person who had at least 30 quarters of
coverage;
• Had been married to a person for at
least 1 year at the time of the person’s
death if, at the time of death, the person
had at least 30 quarters of coverage; or
• Is divorced from a person and had
been married to the person for at least
10 years at the time of the divorce if, at
the time of the divorce, the person had
at least 30 quarters of coverage.
Section 1818(d)(4)(A) of the Act
specifies that the premium that these
individuals will pay for CY 2018 will be
equal to the premium for uninsured
aged enrollees reduced by 45 percent.
II. Monthly Premium Amount for CY
2018
The monthly premium for the
uninsured aged and certain disabled
individuals who have exhausted other
entitlement for the 12 months beginning
January 1, 2018, is $422.
The monthly premium for the
individuals eligible under section
1818(d)(4)(B) of the Act, and therefore,
subject to the 45 percent reduction in
the monthly premium, is $232.
III. Monthly Premium Rate Calculation
As discussed in section I of this
notice, the monthly Medicare Part A
premium is equal to the estimated
monthly actuarial rate for CY 2018
rounded to the nearest multiple of $1
and equals one-twelfth of the average
per capita amount, which is determined
by projecting the number of Medicare
Part A enrollees aged 65 years and over
as well as the benefits and
administrative costs that will be
incurred on their behalf.
The steps involved in projecting these
future costs to the Federal Hospital
Insurance Trust Fund are:
• Establishing the present cost of
services furnished to beneficiaries, by
type of service, to serve as a projection
base;
• Projecting increases in payment
amounts for each of the service types;
and
• Projecting increases in
administrative costs.
We base our projections for CY 2018
on—(1) current historical data; and (2)
projection assumptions derived from
current law and the Mid-Session Review
of the President’s Fiscal Year 2018
Budget.
We estimate that in CY 2018,
50,295,843 people aged 65 years and
over will be entitled to (enrolled in)
benefits (without premium payment)
and that they will incur about $254.518
billion in benefits and related
administrative costs. Thus, the
estimated monthly average per capita
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55366
Federal Register / Vol. 82, No. 223 / Tuesday, November 21, 2017 / Notices
amount is $421.70 and the monthly
premium is $422. Subsequently, the full
monthly premium reduced by 45
percent is $232.
asabaliauskas on DSKBBXCHB2PROD with NOTICES
IV. Costs to Beneficiaries
The CY 2018 premium of $422 is
approximately 2 percent higher than the
CY 2017 premium of $413. We estimate
that approximately 668,000 enrollees
will voluntarily enroll in Medicare Part
A, by paying the full premium. We
estimate that over 90 percent of these
individuals will have their Part A
premium paid for by states, since they
are enrolled in the Qualified Medicare
Beneficiary Program (a Medicaid
program which helps certain lowincome individuals with Medicare
premium and cost-sharing liability).
Furthermore, the CY 2018 reduced
premium of $232 is approximately 2
percent higher than the CY 2017
premium of $227. We estimate an
additional 71,000 enrollees will pay the
reduced premium. Therefore, we
estimate that the total aggregate cost to
enrollees paying these premiums in CY
2018, compared to the amount that they
paid in CY 2017, will be about $76
million.
V. Waiver of Proposed Notice and
Comment Period
We ordinarily publish a notice of
proposed rulemaking in the Federal
Register and invite public comment
prior to a rule taking effect in
accordance with section 553(b) of the
Administrative Procedure Act (APA)
and section 1871 of the Act. However,
we believe that the policies being
publicized in this document do not
constitute agency rulemaking. Rather,
the statute requires that the agency
determine the applicable premium
amount for each calendar year in
accordance with the statutory formula,
and we are simply notifying the public
of the changes to the Medicare Part A
premiums for CY 2018. To the extent
any of the policies articulated in this
document constitute interpretations of
the statute’s requirements or procedures
that will be used to implement the
statute’s directive, they are interpretive
rules, general statements of policy, and
rules of agency organization, procedure,
or practice, which are not subject to
notice and comment rulemaking under
the APA.
To the extent that notice and
comment rulemaking would otherwise
apply, we find good cause to waive this
requirement. Under the APA, we may
waive notice and public procedure if we
find good cause that prior notice and
comment are impracticable,
unnecessary, or contrary to the public
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interest. We believe that notice and
comment rulemaking for this
notification of Medicare Part A
premiums for CY 2018 is unnecessary
because of the lack of CMS discretion in
the statutory formula that is used to
calculate the premium and the solely
ministerial function that this notice
serves. Therefore, we find good cause to
waive notice and comment procedures,
if such procedures are required at all.
VI. 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.).
VII. Regulatory Impact Statement
A. Statement of Need
Section 1818(d) of the Act requires
the Secretary of the Department of
Health and Human Services (the
Secretary) during September of each
year to determine and publish the
amount to be paid, on an average per
capita basis, from the Federal Hospital
Insurance Trust Fund for services
incurred in the impending CY
(including the associated administrative
costs) on behalf of individuals aged 65
and over who will be entitled to benefits
under Medicare Part A.
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), the Congressional
Review Act (5 U.S.C. 804(2)) and
Executive Order 13771 on Reducing
Regulation and Controlling Regulatory
Costs (January 30, 2017).
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
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equity). Section 3(f) of Executive Order
12866 defines a ‘‘significant regulatory
action’’ as an action that is likely to
result in a rule: (1) Having an annual
effect on the economy of $100 million
or more in any 1 year, or adversely and
materially affecting a sector of the
economy, productivity, competition,
jobs, the environment, public health or
safety, or state, local or tribal
governments or communities (also
referred to as ‘‘economically
significant’’); (2) creating a serious
inconsistency or otherwise interfering
with an action taken or planned by
another agency; (3) materially altering
the budgetary impacts of entitlement
grants, user fees, or loan programs or the
rights and obligations of recipients
thereof; or (4) raising novel legal or
policy issues arising out of legal
mandates, the President’s priorities, or
the principles set forth in the Executive
Order. As stated in section IV of this
notice, we estimate that the overall
effect of the changes in the Part A
premium will be a cost to voluntary
enrollees (section 1818 and section
1818A of the Act) of about $76 million.
As a result, this notice is noneconomically significant under section
3(f)(1) of Executive Order 12866. In
accordance with the provisions of
Executive Order 12866, this notice was
reviewed by the Office of Management
and Budget.
The RFA requires agencies to analyze
options for regulatory relief of small
entities, 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. Most
hospitals and most other providers and
suppliers are small entities, either by
nonprofit status or by having revenues
of less than $7.5 million to $38.5
million in any 1 year (for details, see the
Small Business Administration’s Web
site at https://www.sba.gov/sites/default/
files/files/Size_Standards_Table.pdf).
Individuals and states are not
included in the definition of a small
entity. As discussed above, this annual
notice announces the Medicare Part A
premiums for CY 2018. 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
Social Security Act (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
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asabaliauskas on DSKBBXCHB2PROD with NOTICES
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 Medicare’s Part A premiums
for CY 2018 and does not constitute a
substantive rule, we nevertheless
prepared this Impact Statement 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. 2017–24912 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–8065–N]
RIN 0938–AT05
Medicare Program; CY 2018 Inpatient
Hospital Deductible and Hospital and
Extended Care Services Coinsurance
Amounts
Centers for Medicare &
Medicaid Services (CMS), HHS.
AGENCY:
ACTION:
Notice.
This notice announces the
inpatient hospital deductible and the
hospital and extended care services
coinsurance amounts for services
furnished in calendar year (CY) 2018
under Medicare’s Hospital Insurance
Program (Medicare Part A). The
Medicare statute specifies the formulae
used to determine these amounts. For
CY 2018, the inpatient hospital
deductible will be $1,340. The daily
coinsurance amounts for CY 2018 will
be: $335 for the 61st through 90th day
of hospitalization in a benefit period;
$670 for lifetime reserve days; and
$167.50 for the 21st through 100th day
of extended care services in a skilled
nursing facility in a benefit period.
SUMMARY:
Effective Date: This notice is
effective on January 1, 2018.
DATES:
FOR FURTHER INFORMATION CONTACT:
Clare McFarland, (410) 786–6390 for
general information. Gregory J. Savord,
(410) 786–1521 for case-mix analysis.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1813 of the Social Security
Act (the Act) provides for an inpatient
hospital deductible to be subtracted
from the amount payable by Medicare
for inpatient hospital services furnished
to a beneficiary. It also provides for
certain coinsurance amounts to be
subtracted from the amounts payable by
Medicare for inpatient hospital and
extended care services. Section
1813(b)(2) of the Act requires the
Secretary of the Department of Health
and Human Services (the Secretary) to
determine and publish each year the
amount of the inpatient hospital
deductible and the hospital and
extended care services coinsurance
amounts applicable for services
furnished in the following calendar year
(CY).
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55367
II. Computing the Inpatient Hospital
Deductible for CY 2018
Section 1813(b) of the Act prescribes
the method for computing the amount of
the inpatient hospital deductible. The
inpatient hospital deductible is an
amount equal to the inpatient hospital
deductible for the preceding CY,
adjusted by our best estimate of the
payment-weighted average of the
applicable percentage increases (as
defined in section 1886(b)(3)(B) of the
Act) used for updating the payment
rates to hospitals for discharges in the
fiscal year (FY) that begins on October
1 of the same preceding CY, and
adjusted to reflect changes in real casemix. The adjustment to reflect real casemix is determined on the basis of the
most recent case-mix data available. The
amount determined under this formula
is rounded to the nearest multiple of $4
(or, if midway between two multiples of
$4, to the next higher multiple of $4).
Under section 1886(b)(3)(B)(i)(XX) of
the Act, the percentage increase used to
update the payment rates for FY 2018
for hospitals paid under the inpatient
prospective payment system is the
market basket percentage increase,
otherwise known as the market basket
update, reduced by 0.75 percentage
points (see section 1886(b)(3)(B)(xii)(V)
of the Act), and an adjustment based on
changes in the economy-wide
productivity (the multifactor
productivity (MFP) adjustment) (see
section 1886(b)(3)(B)(xi)(II) of the Act).
Under section 1886(b)(3)(B)(viii) of the
Act, for FY 2018, the applicable
percentage increase for hospitals that do
not submit quality data as specified by
the Secretary is reduced by one quarter
of the market basket update. We are
estimating that after accounting for
those hospitals receiving the lower
market basket update in the paymentweighted average update, the calculated
deductible will not be affected, since the
majority of hospitals submit quality data
and receive the full market basket
update. Section 1886(b)(3)(B)(ix) of the
Act requires that any hospital that is not
a meaningful electronic health record
(EHR) user (as defined in section
1886(n)(3) of the Act) will have threequarters of the market basket update
reduced by 100 percent for FY 2017 and
each subsequent fiscal year. We are
estimating that after accounting for
these hospitals receiving the lower
market basket update, the calculated
deductible will not be affected, since the
majority of hospitals are meaningful
EHR users and are expected to receive
the full market basket update.
Under section 1886 of the Act, the
percentage increase used to update the
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]]>Agencies
[Federal Register Volume 82, Number 223 (Tuesday, November 21, 2017)]
[Notices]
[Pages 55365-55367]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-24912]
=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-8066-N]
RIN 0938-AT06
Medicare Program; CY 2018 Part A Premiums for the Uninsured Aged
and for Certain Disabled Individuals Who Have Exhausted Other
Entitlement
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This annual notice announces Medicare's Hospital Insurance
(Part A) premium for uninsured enrollees in calendar year (CY) 2018.
This premium is paid by enrollees age 65 and over who are not otherwise
eligible for benefits under Medicare Part A (hereafter known as the
``uninsured aged'') and by certain disabled individuals who have
exhausted other entitlement. The monthly Part A premium for the 12
months beginning January 1, 2018 for these individuals will be $422.
The premium for certain other individuals as described in this notice
will be $232.
DATES: Effective Date: This notice is effective on January 1, 2018.
FOR FURTHER INFORMATION CONTACT: Clare McFarland, (410) 786 6390.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1818 of the Social Security Act (the Act) provides for
voluntary enrollment in the Medicare Hospital Insurance Program
(Medicare Part A), subject to payment of a monthly premium, of certain
persons aged 65 and older who are uninsured under the Old-Age,
Survivors, and Disability Insurance (OASDI) program or the Railroad
Retirement Act and do not otherwise meet the requirements for
entitlement to Medicare Part A. These ``uninsured aged'' individuals
are uninsured under the OASDI program or the Railroad Retirement Act,
because they do not have 40 quarters of coverage under Title II of the
Act (or are/were not married to someone who did). (Persons insured
under the OASDI program or the Railroad Retirement Act and certain
others do not have to pay premiums for Medicare Part A.)
Section 1818A of the Act provides for voluntary enrollment in
Medicare Part A, subject to payment of a monthly premium for certain
disabled individuals who have exhausted other entitlement. These are
individuals who were entitled to coverage due to a disabling impairment
under section 226(b) of the Act, but who are no longer entitled to
disability benefits and free Medicare Part A coverage because they have
gone back to work and their earnings exceed the statutorily defined
``substantial gainful activity'' amount (section 223(d)(4) of the Act).
Section 1818A(d)(2) of the Act specifies that the provisions
relating to premiums under section 1818(d) through section 1818(f) of
the Act for the aged will also apply to certain disabled individuals as
described above.
Section 1818(d)(1) of the Act requires us to estimate, on an
average per capita basis, the amount to be paid from the Federal
Hospital Insurance Trust Fund for services incurred in the upcoming
calendar year (CY) (including the associated administrative costs) on
behalf of individuals aged 65 and over who will be entitled to benefits
under Medicare Part A. We must then determine the monthly actuarial
rate for the following year (the per capita amount estimated above
divided by 12) and publish the dollar amount for the monthly premium in
the succeeding CY. If the premium is not a multiple of $1, the premium
is rounded to the nearest multiple of $1 (or, if it is a multiple of 50
cents but not of $1, it is rounded to the next highest $1).
Section 13508 of the Omnibus Budget Reconciliation Act of 1993
(Pub. L. 103-66) amended section 1818(d) of the Act to provide for a
reduction in the premium amount for certain voluntary enrollees
(section 1818 and section 1818A of the Act). The reduction applies to
an individual who is eligible to buy into the Medicare Part A program
and who, as of the last day of the previous month:
Had at least 30 quarters of coverage under Title II of the
Act;
Was married, and had been married for the previous 1 year
period, to a person who had at least 30 quarters of coverage;
Had been married to a person for at least 1 year at the
time of the person's death if, at the time of death, the person had at
least 30 quarters of coverage; or
Is divorced from a person and had been married to the
person for at least 10 years at the time of the divorce if, at the time
of the divorce, the person had at least 30 quarters of coverage.
Section 1818(d)(4)(A) of the Act specifies that the premium that
these individuals will pay for CY 2018 will be equal to the premium for
uninsured aged enrollees reduced by 45 percent.
II. Monthly Premium Amount for CY 2018
The monthly premium for the uninsured aged and certain disabled
individuals who have exhausted other entitlement for the 12 months
beginning January 1, 2018, is $422.
The monthly premium for the individuals eligible under section
1818(d)(4)(B) of the Act, and therefore, subject to the 45 percent
reduction in the monthly premium, is $232.
III. Monthly Premium Rate Calculation
As discussed in section I of this notice, the monthly Medicare Part
A premium is equal to the estimated monthly actuarial rate for CY 2018
rounded to the nearest multiple of $1 and equals one-twelfth of the
average per capita amount, which is determined by projecting the number
of Medicare Part A enrollees aged 65 years and over as well as the
benefits and administrative costs that will be incurred on their
behalf.
The steps involved in projecting these future costs to the Federal
Hospital Insurance Trust Fund are:
Establishing the present cost of services furnished to
beneficiaries, by type of service, to serve as a projection base;
Projecting increases in payment amounts for each of the
service types; and
Projecting increases in administrative costs.
We base our projections for CY 2018 on--(1) current historical
data; and (2) projection assumptions derived from current law and the
Mid-Session Review of the President's Fiscal Year 2018 Budget.
We estimate that in CY 2018, 50,295,843 people aged 65 years and
over will be entitled to (enrolled in) benefits (without premium
payment) and that they will incur about $254.518 billion in benefits
and related administrative costs. Thus, the estimated monthly average
per capita
[[Page 55366]]
amount is $421.70 and the monthly premium is $422. Subsequently, the
full monthly premium reduced by 45 percent is $232.
IV. Costs to Beneficiaries
The CY 2018 premium of $422 is approximately 2 percent higher than
the CY 2017 premium of $413. We estimate that approximately 668,000
enrollees will voluntarily enroll in Medicare Part A, by paying the
full premium. We estimate that over 90 percent of these individuals
will have their Part A premium paid for by states, since they are
enrolled in the Qualified Medicare Beneficiary Program (a Medicaid
program which helps certain low-income individuals with Medicare
premium and cost-sharing liability). Furthermore, the CY 2018 reduced
premium of $232 is approximately 2 percent higher than the CY 2017
premium of $227. We estimate an additional 71,000 enrollees will pay
the reduced premium. Therefore, we estimate that the total aggregate
cost to enrollees paying these premiums in CY 2018, compared to the
amount that they paid in CY 2017, will be about $76 million.
V. Waiver of Proposed Notice and Comment Period
We ordinarily publish a notice of proposed rulemaking in the
Federal Register and invite public comment prior to a rule taking
effect in accordance with section 553(b) of the Administrative
Procedure Act (APA) and section 1871 of the Act. However, we believe
that the policies being publicized in this document do not constitute
agency rulemaking. Rather, the statute requires that the agency
determine the applicable premium amount for each calendar year in
accordance with the statutory formula, and we are simply notifying the
public of the changes to the Medicare Part A premiums for CY 2018. To
the extent any of the policies articulated in this document constitute
interpretations of the statute's requirements or procedures that will
be used to implement the statute's directive, they are interpretive
rules, general statements of policy, and rules of agency organization,
procedure, or practice, which are not subject to notice and comment
rulemaking under the APA.
To the extent that notice and comment rulemaking would otherwise
apply, we find good cause to waive this requirement. Under the APA, we
may waive notice and public procedure if we find good cause that prior
notice and comment are impracticable, unnecessary, or contrary to the
public interest. We believe that notice and comment rulemaking for this
notification of Medicare Part A premiums for CY 2018 is unnecessary
because of the lack of CMS discretion in the statutory formula that is
used to calculate the premium and the solely ministerial function that
this notice serves. Therefore, we find good cause to waive notice and
comment procedures, if such procedures are required at all.
VI. 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.).
VII. Regulatory Impact Statement
A. Statement of Need
Section 1818(d) of the Act requires the Secretary of the Department
of Health and Human Services (the Secretary) during September of each
year to determine and publish the amount to be paid, on an average per
capita basis, from the Federal Hospital Insurance Trust Fund for
services incurred in the impending CY (including the associated
administrative costs) on behalf of individuals aged 65 and over who
will be entitled to benefits under Medicare Part A.
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), the Congressional Review Act (5 U.S.C. 804(2)) and
Executive Order 13771 on Reducing Regulation and Controlling Regulatory
Costs (January 30, 2017).
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). Section
3(f) of Executive Order 12866 defines a ``significant regulatory
action'' as an action that is likely to result in a rule: (1) Having an
annual effect on the economy of $100 million or more in any 1 year, or
adversely and materially affecting a sector of the economy,
productivity, competition, jobs, the environment, public health or
safety, or state, local or tribal governments or communities (also
referred to as ``economically significant''); (2) creating a serious
inconsistency or otherwise interfering with an action taken or planned
by another agency; (3) materially altering the budgetary impacts of
entitlement grants, user fees, or loan programs or the rights and
obligations of recipients thereof; or (4) raising novel legal or policy
issues arising out of legal mandates, the President's priorities, or
the principles set forth in the Executive Order. As stated in section
IV of this notice, we estimate that the overall effect of the changes
in the Part A premium will be a cost to voluntary enrollees (section
1818 and section 1818A of the Act) of about $76 million. As a result,
this notice is non-economically significant under section 3(f)(1) of
Executive Order 12866. In accordance with the provisions of Executive
Order 12866, this notice was reviewed by the Office of Management and
Budget.
The RFA requires agencies to analyze options for regulatory relief
of small entities, 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. Most hospitals and most other providers and
suppliers are small entities, either by nonprofit status or by having
revenues of less than $7.5 million to $38.5 million in any 1 year (for
details, see the Small Business Administration's Web site at https://www.sba.gov/sites/default/files/files/Size_Standards_Table.pdf).
Individuals and states are not included in the definition of a
small entity. As discussed above, this annual notice announces the
Medicare Part A premiums for CY 2018. 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 Social Security Act (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
[[Page 55367]]
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 Medicare's Part A premiums
for CY 2018 and does not constitute a substantive rule, we nevertheless
prepared this Impact Statement 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. 2017-24912 Filed 11-17-17; 4:15 pm]
BILLING CODE 4120-01-P
