Medicare Program; CY 2019 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement, 52455-52458 [2018-22529]
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Federal Register / Vol. 83, No. 201 / Wednesday, October 17, 2018 / Notices
PHS Act. The notification provisions,
including the definition of ‘‘emergency
response employee,’’ were then
removed from the Ryan White HIV/
AIDS Treatment Modernization Act of
2006 and the PHS Act.4 The term
‘‘emergency response employee,’’
however, continued to be used in a
different part of the statutes pertaining
to responsibilities assigned to the Health
Resources and Services Administration
(HRSA).5 When Congress reinstated the
notification provisions in Part G of the
Ryan White HIV/AIDS Treatment
Extension Act of 2009, a definition of
ERE was not included.
NIOSH has interpreted the legislative
history and the development of the
Ryan White CARE Act of 1990 and
subsequent reauthorizations to indicate
that Congress’s failure to restore the
original definition of ERE was
unintentional and merely an oversight.
Including the original statutory
definition in the NIOSH list and
guidelines would allow the notification
provisions to be implemented as
Congress originally intended.
Including the definition of
‘‘emergency response employee’’ in the
definitions section of the list and
guidelines is within NIOSH’s authority,
pursuant to the August 27, 2018 redelegation for the sec. 2695 duties.
Implicit in this directive is the need to
identify the types of EREs who transport
or serve victims of emergencies taken to
medical facilities, in order to improve
the notification system allowing EREs to
receive timely diagnosis and postexposure medical treatment for
infectious disease exposures. NIOSH
therefore has the authority to include
the definition of ‘‘emergency response
employees’’ in the list and guidelines.
After consideration of public
comment submitted to the docket for
this action, NIOSH will update the
guidelines and list with the ERE
definition and re-publish them on the
NIOSH Ryan White HIV/AIDS
Treatment Extension Act of 2009 topic
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4 The
notification provisions now included in
Part G were formerly found in Part E, which was
deleted because the intent of the 2006
reauthorization was, in part, to eliminate programs
‘‘which had never been funded or re-examined in
the last two reauthorizations.’’ Congress then
‘‘deleted definitions which were no longer relevant
(e.g., designated officer of emergency response
employees, emergency, emergency response
employee, employer of emergency response
employees, and exposed),’’ which were located in
Part D of the original statute. See H.R. REP. NO.
109–695, at 12 (2006).
5 42 U.S.C. 300ff–62.
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page, at https://www.cdc.gov/niosh/
topics/ryanwhite/.
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
John J. Howard,
Director, National Institute for Occupational
Safety and Health, Centers for Disease Control
and Prevention.
Centers for Disease Control and
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ACTION: Notice of charter renewal.
AGENCY:
This gives notice under the
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Centers for Disease Control and
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The Chief Operating Officer, Centers
for Disease Control and Prevention, has
been delegated the authority to sign
Federal Register notices pertaining to
announcements of meetings and other
committee management activities, for
both the Centers for Disease Control and
Prevention and the Agency for Toxic
Substances and Disease Registry.
SUMMARY:
Sherri Berger,
Chief Operating Officer, Centers for Disease
Control and Prevention.
[FR Doc. 2018–22616 Filed 10–16–18; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8069–N]
RIN 0938–AT34
Medicare Program; CY 2019 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
SUMMARY:
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calendar year (CY) 2019. 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, 2019 for
these individuals will be $437. The
premium for certain other individuals as
described in this notice will be $240.
DATES: Effective Date: This notice is
effective on January 1, 2019.
FOR FURTHER INFORMATION CONTACT:
Yaminee Thaker, (410) 786–7921.
SUPPLEMENTARY INFORMATION:
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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
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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 2019 will be
equal to the premium for uninsured
aged enrollees reduced by 45 percent.
Section 1818(g) of the Act requires the
Secretary, at the request of a state, to
enter into a Part A buy-in agreement
with a state to pay Medicare Part A
premiums for Qualified Medicare
Beneficiaries (QMBs). Under the QMB
program, state Medicaid agencies must
pay the Medicare Part A premium for
those not eligible for premium-free Part
A. (Entering into a Part A buy-in
agreement would permit a state to avoid
late enrollment penalties and enroll
persons in Part A at any time of the year
(without regard to Medicare enrollment
periods)).
II. Monthly Premium Amount for CY
2019
The monthly premium for the
uninsured aged and certain disabled
individuals who have exhausted other
entitlement for the 12 months beginning
January 1, 2019, is $437. The monthly
premium for the individuals eligible
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under section 1818(d)(4)(B) of the Act,
and therefore, subject to the 45 percent
reduction in the monthly premium, is
$240.
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 2019
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 2019
on—(1) current historical data; and (2)
projection assumptions derived from
current law and the Mid-Session Review
of the President’s Fiscal Year 2019
Budget.
We estimate that in CY 2019,
51,601,049 people aged 65 years and
over will be entitled to (enrolled in)
benefits (without premium payment)
and that they will incur about $270.703
billion in benefits and related
administrative costs. Thus, the
estimated monthly average per capita
amount is $437.17 and the monthly
premium is $437. Subsequently, the full
monthly premium reduced by 45
percent is $240.
IV. Costs to Beneficiaries
The CY 2019 premium of $437 is
approximately 3.6 percent higher than
the CY 2018 premium of $422. We
estimate that approximately 679,000
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 QMB
program. Furthermore, the CY 2019
reduced premium of $240 is
approximately 3.4 percent higher than
the CY 2018 premium of $232. We
estimate an additional 75,000 enrollees
will pay the reduced premium.
Therefore, we estimate that the total
aggregate cost to enrollees paying these
premiums in CY 2019, compared to the
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amount that they paid in CY 2018, will
be about $129 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 2019. 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 2019 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.
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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 Analysis
A. Statement of Need
Section 1818(d) of the Act requires
the Secretary of the Department of
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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 in accordance with 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.
A regulatory impact analysis (RIA)
must be prepared for major rules with
economically significant effects ($100
million or more in any 1 year). Although
we do not consider this notice to
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constitute a substantive rule, this notice
is economically significant under
section 3(f)(1) of Executive Order 12866.
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 $129 million.
The RFA requires agencies to analyze
options for regulatory relief 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. Individuals and
states are not included in the definition
of a small entity. This annual notice
announces the Medicare Part A
premiums for CY 2019 and will have an
impact on the Medicare beneficiaries.
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 an RIA if a rule
may have a significant impact on the
operations of a substantial number of
small rural hospitals. This analysis must
conform to the provisions of section 604
of the RFA. For purposes of section
1102(b) of the Act, we define a small
rural hospital as a hospital that is
located outside of a Metropolitan
Statistical Area for Medicare payment
regulations and has fewer than 100
beds. This annual notice announces the
Medicare Part A premiums for CY 2019
and will have an impact on the
Medicare beneficiaries. As a result, 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 2018, that threshold is approximately
$150 million. This notice does not
impose mandates that will have a
consequential effect of $150 million 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 promulgates a
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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.
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.
Consistent with the Congressional
Review Act provisions of the Small
Business Regulatory Enforcement
Fairness Act of 1996 (5 U.S.C. 801 et
seq.), this notice has been transmitted to
the Congress and the Comptroller
General for review.
In accordance with the provisions of
Executive Order 12866, this notice was
reviewed by the Office of Management
and Budget.
Although this notice 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 3, 2018.
Seema Verma,
Administrator, Centers for Medicare &
Medicaid Services.
Dated: October 11, 2018.
Alex M. Azar II,
Secretary, Department of Health and Human
Services.
[FR Doc. 2018–22529 Filed 10–12–18; 11:15 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
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[CMS–3370–PN]
Medicare and Medicaid Program;
Application from the Accreditation
Association for Hospitals/Health
Systems-Healthcare Facilities
Accreditation Program (AAHHS–HFAP)
for Approval of its Hospital
Accreditation Program
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice with request for
comment.
AGENCY:
This proposed notice
acknowledges the receipt of an
SUMMARY:
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application from the Accreditation
Association for Hospitals/Health
Systems-Healthcare Facilities
Accreditation Program (AAHHS–HFAP)
for recognition as a national accrediting
organization for hospitals that wish to
participate in the Medicare or Medicaid
programs.
DATES: To be assured consideration,
comments must be received at one of
the addresses provided below, no later
than 5 p.m. on November 16, 2018.
ADDRESSES: In commenting, refer to file
code CMS–3370–PN. Because of staff
and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.
Comments, including mass comment
submissions, must be submitted in one
of the following three ways (please
choose only one of the ways listed):
1. Electronically. You may submit
electronic comments on this regulation
to https://www.regulations.gov. Follow
the ‘‘Submit a comment’’ instructions.
2. By regular mail. You may mail
written comments to the following
address ONLY: Centers for Medicare &
Medicaid Services, Department of
Health and Human Services, Attention:
CMS–3370–PN, P.O. Box 8016,
Baltimore, MD 21244–8010.
Please allow sufficient time for mailed
comments to be received before the
close of the comment period.
3. By express or overnight mail. You
may send written comments to the
following address ONLY: Centers for
Medicare & Medicaid Services,
Department of Health and Human
Services, Attention: CMS–3370–PN,
Mail Stop C4–26–05, 7500 Security
Boulevard, Baltimore, MD 21244–1850.
For information on viewing public
comments, see the beginning of the
SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Monda Shaver, (410) 786–3410, Mary
Ellen Palowitch, (410) 786–4496, or
Renee Henry, (410) 786–7828.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All
comments received before the close of
the comment period are available for
viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. We post all comments
received before the close of the
comment period on the following
website as soon as possible after they
have been received: https://
www.regulations.gov. Follow the search
instructions on that website to view
public comments.
services from a hospital, provided that
certain requirements are met. Section
1861(e) of the Social Security Act (the
Act), establishes distinct criteria for
facilities seeking designation as a
hospital. Regulations concerning
provider agreements are at 42 CFR part
489 and those pertaining to activities
relating to the survey and certification
of facilities are at 42 CFR part 488. The
regulations at 42 CFR part 482 specify
the minimum conditions that a hospital
must meet to participate in the Medicare
program.
Generally, to enter into an agreement,
a hospital must first be certified by a
state survey agency as complying with
the conditions or requirements set forth
in part 482 of our regulations.
Thereafter, the hospital is subject to
regular surveys by a state survey agency
to determine whether it continues to
meet these requirements. There is an
alternative; however, to surveys by state
agencies.
Section 1865(a)(1) of the Act provides
that, if a provider entity demonstrates
through accreditation by an approved
national accrediting organization that all
applicable Medicare conditions are met
or exceeded, we may deem those
provider entities as having met the
requirements. Accreditation by an
accrediting organization is voluntary
and is not required for Medicare
participation.
If an accrediting organization is
recognized by the Secretary of the
Department of Health and Human
Services (the Secretary) as having
standards for accreditation that meet or
exceed Medicare requirements, any
provider entity accredited by the
national accrediting body’s approved
program may be deemed to meet the
Medicare conditions. A national
accrediting organization applying for
approval of its accreditation program
under part 488, subpart A, must provide
the Centers for Medicare and Medicaid
Services (CMS) with reasonable
assurance that the accrediting
organization requires the accredited
provider entities to meet requirements
that are at least as stringent as the
Medicare conditions. Our regulations
concerning the approval of accrediting
organizations are set forth at § 488.5.
The regulations at § 488.5(e)(2)(i)
require accrediting organizations to
reapply for continued approval of its
accreditation program every 6 years or
sooner as determined by CMS.
I. Background
Under the Medicare program, eligible
beneficiaries may receive covered
A. Approval of Deeming Organizations
Section 1865(a)(2) of the Act and our
regulations at § 488.5 require that our
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II. Provisions of the Proposed Notice
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]]>Agencies
[Federal Register Volume 83, Number 201 (Wednesday, October 17, 2018)]
[Notices]
[Pages 52455-52458]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-22529]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-8069-N]
RIN 0938-AT34
Medicare Program; CY 2019 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
[[Page 52456]]
calendar year (CY) 2019. 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, 2019 for these
individuals will be $437. The premium for certain other individuals as
described in this notice will be $240.
DATES: Effective Date: This notice is effective on January 1, 2019.
FOR FURTHER INFORMATION CONTACT: Yaminee Thaker, (410) 786-7921.
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 2019 will be equal to the premium for
uninsured aged enrollees reduced by 45 percent.
Section 1818(g) of the Act requires the Secretary, at the request
of a state, to enter into a Part A buy-in agreement with a state to pay
Medicare Part A premiums for Qualified Medicare Beneficiaries (QMBs).
Under the QMB program, state Medicaid agencies must pay the Medicare
Part A premium for those not eligible for premium-free Part A.
(Entering into a Part A buy-in agreement would permit a state to avoid
late enrollment penalties and enroll persons in Part A at any time of
the year (without regard to Medicare enrollment periods)).
II. Monthly Premium Amount for CY 2019
The monthly premium for the uninsured aged and certain disabled
individuals who have exhausted other entitlement for the 12 months
beginning January 1, 2019, is $437. 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 $240.
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 2019
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 2019 on--(1) current historical
data; and (2) projection assumptions derived from current law and the
Mid-Session Review of the President's Fiscal Year 2019 Budget.
We estimate that in CY 2019, 51,601,049 people aged 65 years and
over will be entitled to (enrolled in) benefits (without premium
payment) and that they will incur about $270.703 billion in benefits
and related administrative costs. Thus, the estimated monthly average
per capita amount is $437.17 and the monthly premium is $437.
Subsequently, the full monthly premium reduced by 45 percent is $240.
IV. Costs to Beneficiaries
The CY 2019 premium of $437 is approximately 3.6 percent higher
than the CY 2018 premium of $422. We estimate that approximately
679,000 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 QMB program. Furthermore, the CY 2019 reduced premium
of $240 is approximately 3.4 percent higher than the CY 2018 premium of
$232. We estimate an additional 75,000 enrollees will pay the reduced
premium. Therefore, we estimate that the total aggregate cost to
enrollees paying these premiums in CY 2019, compared to the
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amount that they paid in CY 2018, will be about $129 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 2019. 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 2019 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 Analysis
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 in accordance with
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.
A regulatory impact analysis (RIA) must be prepared for major rules
with economically significant effects ($100 million or more in any 1
year). Although we do not consider this notice to constitute a
substantive rule, this notice is economically significant under section
3(f)(1) of Executive Order 12866. 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 $129 million.
The RFA requires agencies to analyze options for regulatory relief
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. Individuals and
states are not included in the definition of a small entity. This
annual notice announces the Medicare Part A premiums for CY 2019 and
will have an impact on the Medicare beneficiaries. 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 an
RIA if a rule may have a significant impact on the operations of a
substantial number of small rural hospitals. This analysis must conform
to the provisions of section 604 of the RFA. For purposes of section
1102(b) of the Act, we define a small rural hospital as a hospital that
is located outside of a Metropolitan Statistical Area for Medicare
payment regulations and has fewer than 100 beds. This annual notice
announces the Medicare Part A premiums for CY 2019 and will have an
impact on the Medicare beneficiaries. As a result, 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 2018, that
threshold is approximately $150 million. This notice does not impose
mandates that will have a consequential effect of $150 million 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 promulgates a
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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.
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.
Consistent with the Congressional Review Act provisions of the
Small Business Regulatory Enforcement Fairness Act of 1996 (5 U.S.C.
801 et seq.), this notice has been transmitted to the Congress and the
Comptroller General for review.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
Although this notice 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 3, 2018.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
Dated: October 11, 2018.
Alex M. Azar II,
Secretary, Department of Health and Human Services.
[FR Doc. 2018-22529 Filed 10-12-18; 11:15 am]
BILLING CODE 4120-01-P
