Medicare Program; CY 2024 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement, 71570-71573 [2023-22848]
Download as PDF
71570
Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices
Publication of this notice is consistent
with section 1839 of the Act, and we
believe that any potential delay in the
effective date of the notice, if such delay
were required at all, could cause
unnecessary confusion for both the
agency and Medicare beneficiaries.
Chiquita Brooks-LaSure,
Administrator of the Centers for
Medicare & Medicaid Services,
approved this document on October 11,
2023.
Dated: October 11, 2023.
Xavier Becerra,
Secretary, Department of Health and Human
Services.
[FR Doc. 2023–22823 Filed 10–12–23; 4:15 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–576 and CMS–
576A]
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
Centers for Medicare &
Medicaid Services, Health and Human
Services (HHS).
ACTION: Notice.
AGENCY:
The Centers for Medicare &
Medicaid Services (CMS) is announcing
an opportunity for the public to
comment on CMS’ intention to collect
information from the public. Under the
Paperwork Reduction Act of 1995
(PRA), federal agencies are required to
publish notice in the Federal Register
concerning each proposed collection of
information, including each proposed
extension or reinstatement of an existing
collection of information, and to allow
a second opportunity for public
comment on the notice. Interested
persons are invited to send comments
regarding the burden estimate or any
other aspect of this collection of
information, including the necessity and
utility of the proposed information
collection for the proper performance of
the agency’s functions, the accuracy of
the estimated burden, ways to enhance
the quality, utility, and clarity of the
information to be collected, and the use
of automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
lotter on DSK11XQN23PROD with NOTICES1
SUMMARY:
Comments on the collection(s) of
information must be received by the
DATES:
VerDate Sep<11>2014
17:02 Oct 16, 2023
Jkt 262001
OMB desk officer by November 16,
2023.
ADDRESSES: Written comments and
recommendations for the proposed
information collection should be sent
within 30 days of publication of this
notice to www.reginfo.gov/public/do/
PRAMain. Find this particular
information collection by selecting
‘‘Currently under 30-day Review—Open
for Public Comments’’ or by using the
search function.
To obtain copies of a supporting
statement and any related forms for the
proposed collection(s) summarized in
this notice, please access the CMS PRA
website by copying and pasting the
following web address into your web
browser: https://www.cms.gov/
Regulations-and-Guidance/Legislation/
PaperworkReductionActof1995/PRAListing.
FOR FURTHER INFORMATION CONTACT:
William Parham at (410) 786–4669.
SUPPLEMENTARY INFORMATION: Under the
Paperwork Reduction Act of 1995 (PRA)
(44 U.S.C. 3501–3520), federal agencies
must obtain approval from the Office of
Management and Budget (OMB) for each
collection of information they conduct
or sponsor. The term ‘‘collection of
information’’ is defined in 44 U.S.C.
3502(3) and 5 CFR 1320.3(c) and
includes agency requests or
requirements that members of the public
submit reports, keep records, or provide
information to a third party. Section
3506(c)(2)(A) of the PRA (44 U.S.C.
3506(c)(2)(A)) requires federal agencies
to publish a 30-day notice in the
Federal Register concerning each
proposed collection of information,
including each proposed extension or
reinstatement of an existing collection
of information, before submitting the
collection to OMB for approval. To
comply with this requirement, CMS is
publishing this notice that summarizes
the following proposed collection(s) of
information for public comment:
1. Type of Information Collection
Request: Reinstatement with change of a
previously approved collection; Title of
Information Collection: Organ
Procurement Organization (OPO)
Request for Designation as an OPO,
Health Insurance Benefits Agreement,
and Supporting Regulations; Use: We
are seeking reinstatement of a revised
version of the CMS–576 form. We are
also seeking reinstatement for the CMS–
576A form. The CMS–576 and CMS–
576A forms have been updated to a
fillable .pdf format. In addition,
multiple changes were made to the
CMS–576 and CMS–576A forms.
Organizations seeking designation
from CMS as a qualified and approved
PO 00000
Frm 00044
Fmt 4703
Sfmt 4703
Organ Procurement Organization (OPO),
as per §§ 371(a) and 1138 of the Social
Security Act (‘‘the Act’’) must complete
and submit the CMS–576 form. After
designation as an OPO, the organization
must sign CMS–576A form in order to
be reimbursed by Medicare for their
services. The CMS–576A form requires
the OPO ‘‘to maintain compliance with
the requirements of titles XVIII and XIX
of the Act, § 1138 of the Act, applicable
regulations including the conditions set
forth in Part 486, subpart G, title 42 of
the Code of Federal Regulations, those
conditions of the Organ Procurement
and Transplantation Network
established under § 372 of the Public
Health Service Act that have been
approved by the Secretary, and to report
promptly to CMS. Form Number: CMS–
576 and 576A (OMB Control Number:
0938–0512); Frequency: Occasionally;
Affected Public: Private Sector (Business
or other for-profit and Not-for-profit
institutions); Number of Respondents:
16; Total Annual Responses: 16; Total
Annual Hours: 32. (For policy questions
regarding this collection contact
Caroline Gallaher at 410–786–8705.)
Dated: October 12, 2023.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2023–22892 Filed 10–16–23; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–8084–N]
RIN 0938–AV12
Medicare Program; CY 2024 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 notice announces the
monthly premium for uninsured
enrollees under the Medicare Hospital
Insurance (Part A) program in calendar
year 2024. This premium is paid by
enrollees aged 65 and over who are not
otherwise eligible for benefits under
Part A (hereafter known as the
‘‘uninsured aged’’) and by certain
individuals with disabilities who have
exhausted other entitlement. The
monthly Part A premium for the 12
months beginning January 1, 2024 for
SUMMARY:
E:\FR\FM\17OCN1.SGM
17OCN1
Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices
these individuals will be $505. The
premium for certain other individuals as
described in this notice will be $278.
DATES: The premium announced in this
notice is effective on January 1, 2024.
FOR FURTHER INFORMATION CONTACT:
Yaminee Thaker, (410) 786–7921.
SUPPLEMENTARY INFORMATION:
lotter on DSK11XQN23PROD with NOTICES1
I. Background
Section 1818 of the Social Security
Act (the Act) provides for voluntary
enrollment in the Medicare Hospital
Insurance (Part A) program, 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
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
Part A.)
Section 1818A of the Act provides for
voluntary enrollment in Medicare Part
A, subject to payment of a monthly
premium, for certain individuals with
disabilities 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
premium-free 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 for the aged, under section
1818(d) through section 1818(f), will
also apply to certain individuals with
disabilities, 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
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
VerDate Sep<11>2014
17:02 Oct 16, 2023
Jkt 262001
not a multiple of $1, it 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 (sections 1818 and 1818A).
The reduction applies to an individual
who is eligible to buy into the 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 who at
the time of divorce had at least 30
quarters of coverage if the marriage
lasted at least 10 years.
Section 1818(d)(4)(A) of the Act
specifies that the premium that these
individuals will pay for CY 2024 will be
equal to the premium for uninsured
aged enrollees reduced by 45 percent.
Section 1818(g) of the Act requires the
Secretary of Health and Human Services
(the Secretary), at the request of a state,
to enter into a Medicare Part A buy-in
agreement with the state to pay Part A
premiums for Qualified Medicare
Beneficiaries (QMBs).1 Under the QMB
eligibility group, state Medicaid
agencies must pay the Part A premium
for those not eligible for premium-free
Part A, if those individuals meet all of
the eligibility requirements for the QMB
eligibility group under the state’s
Medicaid state plan. (Entering into a
Part A buy-in agreement would permit
states to avoid any Part A late
enrollment penalties that individuals
may owe and would allow states to
enroll persons in Part A at any time of
the year, without regard to Medicare
enrollment periods.) Other individuals
may be eligible for the Qualified
Disabled and Working Individuals
(QDWIs) eligibility group, through
which state Medicaid programs provide
coverage for the Part A premiums for
individuals who are eligible to enroll in
1 Effective on January 1, 2023, the regulatory
definition of qualified Medicare beneficiaries at 42
CFR 435.123 has been expanded to include
additional individuals. These individuals are only
entitled to limited Medicare coverage under Part B
for immunosuppressive drugs. Because the new
individuals are not entitled to Part A, the expansion
of the QMB definition does not change the analysis
in this notice.
PO 00000
Frm 00045
Fmt 4703
Sfmt 4703
71571
Part A by virtue of section 1818A of the
Act and meet certain financial eligibility
criteria.
II. Monthly Premium Amount for CY
2024
The monthly premium for the
uninsured aged and certain individuals
with disabilities who have exhausted
other entitlement, for the 12 months
beginning January 1, 2024, is $505. The
monthly premium for the individuals
who are eligible under section
1818(d)(4)(B) of the Act, and who are
therefore subject to the 45-percent
reduction in the monthly premium, is
$278.
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 2024
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 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 as follows:
• 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 2024
on (1) current historical data and (2)
projection assumptions derived from
current law and the President’s Fiscal
Year 2024 Budget.
For CY 2024, we estimate that
59,121,430 people aged 65 years and
over will be entitled to (enrolled in)
benefits (without premium payment)
and that they will incur about $358,251
billion in benefits and related
administrative costs. Thus, the
estimated monthly average per capita
amount is $504.97, and the monthly
premium is $505. Subsequently, the full
monthly premium reduced by 45
percent is $278.
IV. Costs to Beneficiaries
The CY 2024 premium of $505 is
approximately 0.2 percent lower than
the CY 2023 premium of $506. We
estimate that approximately 729,000
enrollees will voluntarily enroll in
Medicare Part A by paying the full
premium and that over 90 percent of
these individuals will have their Part A
E:\FR\FM\17OCN1.SGM
17OCN1
71572
Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices
lotter on DSK11XQN23PROD with NOTICES1
premium paid for by states, since they
are entitled to Part A and enrolled in the
QMB program eligibility group.
Furthermore, the CY 2024 reduced
premium is the same as for CY 2023, at
$278, and we estimate that an additional
94,000 enrollees will pay this premium.
Therefore, for enrollees paying these
premiums in CY 2024, we estimate that
the total aggregate savings, compared
with the amount that they paid in CY
2023, will be about $9 million.
V. Waiver of Proposed Rulemaking
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 1871 of the Act
and section 553(b) of the Administrative
Procedure Act (APA). Section 1871(a)(2)
of the Act provides that no rule,
requirement, or other statement of
policy (other than a national coverage
determination) that establishes or
changes a substantive legal standard
governing the scope of benefits, the
payment for services, or the eligibility of
individuals, entities, or organizations to
furnish or receive services or benefits
under Medicare shall take effect unless
it is promulgated through notice and
comment rulemaking. Unless there is a
statutory exception, section 1871(b)(1)
of the Act generally requires the
Secretary to provide for notice of a
proposed rule in the Federal Register
and provide a period of not less than 60
days for public comment before
establishing or changing a substantive
legal standard regarding the matters
enumerated by the statute. Similarly,
under 5 U.S.C. 553(b) of the APA, the
agency is required to publish a notice of
proposed rulemaking in the Federal
Register before a substantive rule takes
effect. Section 553(d) of the APA and
section 1871(e)(1)(B)(i) of the Act
usually require a 30-day delay in
effective date after issuance or
publication of a rule, subject to
exceptions. Sections 553(b)(B) and
553(d)(3) of the APA provide for
exceptions from the advance notice and
comment requirement and the delay in
effective date requirements. Sections
1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the
Act also provide exceptions from the
notice and 60-day comment period and
the 30-day delay in effective date.
Section 553(b)(B) of the APA and
section 1871(b)(2)(C) of the Act
expressly authorize an agency to
dispense with notice and comment
rulemaking for good cause if the agency
makes a finding that notice and
comment procedures are impracticable,
unnecessary, or contrary to the public
interest.
VerDate Sep<11>2014
17:02 Oct 16, 2023
Jkt 262001
The annual Medicare Part A premium
announcement set forth in this notice
does not establish or change a
substantive legal standard regarding the
matters enumerated by the statute or
constitute a substantive rule that would
be subject to the notice requirements in
section 553(b) of the APA. However, to
the extent that an opportunity for public
notice and comment could be construed
as required for this notice, we find good
cause to waive this requirement.
Section 1818(d) of the Act requires
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 Part A. Further, the statute
requires that the agency determine the
applicable premium amount for each CY
in accordance with the statutory
formula. In this notice, we are simply
notifying the public of the changes to
the Part A premiums for CY 2024. We
have calculated the Part A premiums as
directed by the statute, which
establishes both when the premium
amounts must be published and what
information must be factored by the
Secretary into these amounts; we do not
have any discretion in that regard. We
find notice and comment procedures to
be unnecessary for this notice, and we
find good cause to waive such
procedures under section 553(b)(B) of
the APA and section 1871(b)(2)(C) of the
Act, if such procedures may be
construed to be required at all. Through
this notice, we are simply notifying the
public of the updates to the Part A
premiums, in accordance with the
statute, for CY 2024. As such, we also
note that even if notice and comment
procedures were required for this
notice, for the reasons stated above we
would find good cause to waive the
delay in effective date of the notice, as
additional delay would be contrary to
the public interest under section
1871(e)(1)(B)(ii) of the Act. Publication
of this notice is consistent with section
1818(d) of the Act, and we believe that
any potential delay in the effective date
of the notice, if such delay were
required at all, could cause unnecessary
confusion for both the agency and
Medicare beneficiaries.
VI. Collection of Information
Requirements
This document does not impose
information collection requirements—
that is, reporting, recordkeeping, or
third-party disclosure requirements.
PO 00000
Frm 00046
Fmt 4703
Sfmt 4703
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
Although this notice does not
constitute a substantive rule, we
nevertheless prepared this Regulatory
Impact Analysis section in the interest
of ensuring that the impacts of this
notice are fully understood.
A. Statement of Need
This notice announces the CY 2024
Medicare Part A premiums for the
uninsured aged and for certain disabled
individuals who have exhausted other
entitlement, as required by sections
1818 and 1818A of the Act. It also
responds to section 1818(d) of the Act,
which requires the Secretary to provide
for publication of these amounts in the
Federal Register during the September
that precedes the start of each CY. As
this statutory provision prescribes a
detailed methodology for calculating
these amounts, we do not have the
discretion to adopt an alternative
approach on these issues.
B. Overall Impact
We have examined the impacts of this
rule 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); Executive Order 14094 entitled
‘‘Modernizing Regulatory Review’’
(April 6, 2023); 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). Executive Order 14094,
‘‘Modernizing Regulatory Review,’’
amends section 3(f)(1) of Executive
Order 12866 (Regulatory Planning and
Review). The amended 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 $200 million or more in any
E:\FR\FM\17OCN1.SGM
17OCN1
Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices
lotter on DSK11XQN23PROD with NOTICES1
1 year (adjusted every 3 years by the
Administrator of the Office of
Information and Regulatory Affairs
(OIRA) for changes in gross domestic
product) or adversely affecting in a
material way the economy, a sector of
the economy, productivity, competition,
jobs, the environment, public health or
safety, or State, local, territorial, or tribal
governments or communities; (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 legal or policy issues, for which
centralized review would meaningfully
further the President’s priorities or the
principles set forth in this Executive
order, as specifically authorized in a
timely manner by the Administrator of
OIRA in each case.
A regulatory impact analysis (RIA)
must be prepared for major rules with
significant regulatory action/s and/or
with significant effects as per section
3(f)(1) of Executive Order 12866 ($200
million or more in any 1 year). Based on
our estimates, OMB’s Office of
Information and Regulatory Affairs has
determined that this rulemaking is not
significant and not major under Subtitle
E of the Small Business Regulatory
Enforcement Fairness Act of 1996 (also
known as the Congressional Review
Act).
As stated in section IV of this notice,
we estimate that the overall effect of the
changes in the Medicare Part A
premium will be a savings to voluntary
enrollees (sections 1818 and 1818A of
the Act) of about $9 million.
C. Accounting Statement and Table
As required by OMB Circular A–4
(available at https://
www.whitehouse.gov/wp-content/
uploads/legacy_drupal_files/omb/
circulars/A4/a-4.pdf), in the Table
below we have prepared an accounting
statement showing the total aggregate
savings to enrollees paying premiums in
CY 2024, compared with the amount
that they paid in CY 2023. The amount
of savings will be about $9 million. As
stated in section IV of this notice, the
CY 2024 premium of $505 is
approximately 0.2 percent lower than
the CY 2023 premium of $506. We
estimate that approximately 729,000
enrollees will voluntarily enroll in
Medicare Part A by paying the full
premium and that over 90 percent of
these individuals will have their Part A
premium paid for by states, since they
are enrolled in the QMB eligibility
group. Furthermore, the CY 2024
VerDate Sep<11>2014
17:02 Oct 16, 2023
Jkt 262001
reduced premium of $278 is the same as
for CY 2023.
TABLE—ESTIMATED TRANSFERS FOR
CY 2024 MEDICARE PART A PREMIUMS
Category
Annualized Monetized
Transfers.
From Whom to Whom
Transfers
¥$9 million.
Beneficiaries to Federal Government.
D. Regulatory Flexibility Act
The Regulatory Flexibility Act (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 being nonprofit
organizations or by meeting the Small
Business Administration’s definition of
a small business (having revenues of
less than $9.0 million to $47 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
2024 and will have an impact on certain
Medicare beneficiaries. As a result, we
are not preparing an analysis for the
RFA because the Secretary has certified
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 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 and has fewer than 100
beds. This annual notice announces the
Medicare Part A premiums for CY 2024
and will have an impact on certain
Medicare beneficiaries. As a result, we
are not preparing an analysis for section
1102(b) of the Act because the Secretary
has certified that this notice will not
have a significant impact on the
operations of a substantial number of
small rural hospitals.
E. Unfunded Mandates Reform Act
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
PO 00000
Frm 00047
Fmt 4703
Sfmt 4703
71573
in any 1 year of $100 million in 1995
dollars, updated annually for inflation.
In 2023, that threshold is approximately
$177 million. This notice would not
impose a mandate that will result in
expenditures by state, local, and Tribal
Governments, in the aggregate, or by the
private sector, of more than $177
million in any 1 year.
F. Federalism
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.
G. Congressional Review
This final regulation is subject to the
Congressional Review Act provisions of
the Small Business Regulatory
Enforcement Fairness Act of 1996 (5
U.S.C. 801 et seq.) and has been
transmitted to the Congress and the
Comptroller General for review.
Chiquita Brooks-LaSure,
Administrator of the Centers for
Medicare & Medicaid Services,
approved this document on October 11,
2023.
Xavier Becerra,
Secretary, Department of Health and Human
Services.
[FR Doc. 2023–22848 Filed 10–12–23; 4:15 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10450, CMS–
10383, and CMS–10466]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, Health and Human
Services (HHS).
ACTION: Notice.
AGENCY:
The Centers for Medicare &
Medicaid Services (CMS) is announcing
an opportunity for the public to
comment on CMS’ intention to collect
information from the public. Under the
Paperwork Reduction Act of 1995 (the
PRA), federal agencies are required to
publish notice in the Federal Register
SUMMARY:
E:\FR\FM\17OCN1.SGM
17OCN1
Agencies
[Federal Register Volume 88, Number 199 (Tuesday, October 17, 2023)]
[Notices]
[Pages 71570-71573]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-22848]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-8084-N]
RIN 0938-AV12
Medicare Program; CY 2024 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 notice announces the monthly premium for uninsured
enrollees under the Medicare Hospital Insurance (Part A) program in
calendar year 2024. This premium is paid by enrollees aged 65 and over
who are not otherwise eligible for benefits under Part A (hereafter
known as the ``uninsured aged'') and by certain individuals with
disabilities who have exhausted other entitlement. The monthly Part A
premium for the 12 months beginning January 1, 2024 for
[[Page 71571]]
these individuals will be $505. The premium for certain other
individuals as described in this notice will be $278.
DATES: The premium announced in this notice is effective on January 1,
2024.
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 (Part A)
program, 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 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 Part
A.)
Section 1818A of the Act provides for voluntary enrollment in
Medicare Part A, subject to payment of a monthly premium, for certain
individuals with disabilities 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 premium-free 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 for the aged, under section 1818(d) through
section 1818(f), will also apply to certain individuals with
disabilities, 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 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, it 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
(sections 1818 and 1818A). The reduction applies to an individual who
is eligible to buy into the 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 who at the time of divorce had
at least 30 quarters of coverage if the marriage lasted at least 10
years.
Section 1818(d)(4)(A) of the Act specifies that the premium that
these individuals will pay for CY 2024 will be equal to the premium for
uninsured aged enrollees reduced by 45 percent.
Section 1818(g) of the Act requires the Secretary of Health and
Human Services (the Secretary), at the request of a state, to enter
into a Medicare Part A buy-in agreement with the state to pay Part A
premiums for Qualified Medicare Beneficiaries (QMBs).\1\ Under the QMB
eligibility group, state Medicaid agencies must pay the Part A premium
for those not eligible for premium-free Part A, if those individuals
meet all of the eligibility requirements for the QMB eligibility group
under the state's Medicaid state plan. (Entering into a Part A buy-in
agreement would permit states to avoid any Part A late enrollment
penalties that individuals may owe and would allow states to enroll
persons in Part A at any time of the year, without regard to Medicare
enrollment periods.) Other individuals may be eligible for the
Qualified Disabled and Working Individuals (QDWIs) eligibility group,
through which state Medicaid programs provide coverage for the Part A
premiums for individuals who are eligible to enroll in Part A by virtue
of section 1818A of the Act and meet certain financial eligibility
criteria.
---------------------------------------------------------------------------
\1\ Effective on January 1, 2023, the regulatory definition of
qualified Medicare beneficiaries at 42 CFR 435.123 has been expanded
to include additional individuals. These individuals are only
entitled to limited Medicare coverage under Part B for
immunosuppressive drugs. Because the new individuals are not
entitled to Part A, the expansion of the QMB definition does not
change the analysis in this notice.
---------------------------------------------------------------------------
II. Monthly Premium Amount for CY 2024
The monthly premium for the uninsured aged and certain individuals
with disabilities who have exhausted other entitlement, for the 12
months beginning January 1, 2024, is $505. The monthly premium for the
individuals who are eligible under section 1818(d)(4)(B) of the Act,
and who are therefore subject to the 45-percent reduction in the
monthly premium, is $278.
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 2024
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 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 as follows:
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 2024 on (1) current historical data
and (2) projection assumptions derived from current law and the
President's Fiscal Year 2024 Budget.
For CY 2024, we estimate that 59,121,430 people aged 65 years and
over will be entitled to (enrolled in) benefits (without premium
payment) and that they will incur about $358,251 billion in benefits
and related administrative costs. Thus, the estimated monthly average
per capita amount is $504.97, and the monthly premium is $505.
Subsequently, the full monthly premium reduced by 45 percent is $278.
IV. Costs to Beneficiaries
The CY 2024 premium of $505 is approximately 0.2 percent lower than
the CY 2023 premium of $506. We estimate that approximately 729,000
enrollees will voluntarily enroll in Medicare Part A by paying the full
premium and that over 90 percent of these individuals will have their
Part A
[[Page 71572]]
premium paid for by states, since they are entitled to Part A and
enrolled in the QMB program eligibility group. Furthermore, the CY 2024
reduced premium is the same as for CY 2023, at $278, and we estimate
that an additional 94,000 enrollees will pay this premium. Therefore,
for enrollees paying these premiums in CY 2024, we estimate that the
total aggregate savings, compared with the amount that they paid in CY
2023, will be about $9 million.
V. Waiver of Proposed Rulemaking
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 1871 of the Act and section 553(b) of
the Administrative Procedure Act (APA). Section 1871(a)(2) of the Act
provides that no rule, requirement, or other statement of policy (other
than a national coverage determination) that establishes or changes a
substantive legal standard governing the scope of benefits, the payment
for services, or the eligibility of individuals, entities, or
organizations to furnish or receive services or benefits under Medicare
shall take effect unless it is promulgated through notice and comment
rulemaking. Unless there is a statutory exception, section 1871(b)(1)
of the Act generally requires the Secretary to provide for notice of a
proposed rule in the Federal Register and provide a period of not less
than 60 days for public comment before establishing or changing a
substantive legal standard regarding the matters enumerated by the
statute. Similarly, under 5 U.S.C. 553(b) of the APA, the agency is
required to publish a notice of proposed rulemaking in the Federal
Register before a substantive rule takes effect. Section 553(d) of the
APA and section 1871(e)(1)(B)(i) of the Act usually require a 30-day
delay in effective date after issuance or publication of a rule,
subject to exceptions. Sections 553(b)(B) and 553(d)(3) of the APA
provide for exceptions from the advance notice and comment requirement
and the delay in effective date requirements. Sections 1871(b)(2)(C)
and 1871(e)(1)(B)(ii) of the Act also provide exceptions from the
notice and 60-day comment period and the 30-day delay in effective
date. Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act
expressly authorize an agency to dispense with notice and comment
rulemaking for good cause if the agency makes a finding that notice and
comment procedures are impracticable, unnecessary, or contrary to the
public interest.
The annual Medicare Part A premium announcement set forth in this
notice does not establish or change a substantive legal standard
regarding the matters enumerated by the statute or constitute a
substantive rule that would be subject to the notice requirements in
section 553(b) of the APA. However, to the extent that an opportunity
for public notice and comment could be construed as required for this
notice, we find good cause to waive this requirement.
Section 1818(d) of the Act requires 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 Part A. Further, the
statute requires that the agency determine the applicable premium
amount for each CY in accordance with the statutory formula. In this
notice, we are simply notifying the public of the changes to the Part A
premiums for CY 2024. We have calculated the Part A premiums as
directed by the statute, which establishes both when the premium
amounts must be published and what information must be factored by the
Secretary into these amounts; we do not have any discretion in that
regard. We find notice and comment procedures to be unnecessary for
this notice, and we find good cause to waive such procedures under
section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act, if
such procedures may be construed to be required at all. Through this
notice, we are simply notifying the public of the updates to the Part A
premiums, in accordance with the statute, for CY 2024. As such, we also
note that even if notice and comment procedures were required for this
notice, for the reasons stated above we would find good cause to waive
the delay in effective date of the notice, as additional delay would be
contrary to the public interest under section 1871(e)(1)(B)(ii) of the
Act. Publication of this notice is consistent with section 1818(d) of
the Act, and we believe that any potential delay in the effective date
of the notice, if such delay were required at all, could cause
unnecessary confusion for both the agency and Medicare beneficiaries.
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
Although this notice does not constitute a substantive rule, we
nevertheless prepared this Regulatory Impact Analysis section in the
interest of ensuring that the impacts of this notice are fully
understood.
A. Statement of Need
This notice announces the CY 2024 Medicare Part A premiums for the
uninsured aged and for certain disabled individuals who have exhausted
other entitlement, as required by sections 1818 and 1818A of the Act.
It also responds to section 1818(d) of the Act, which requires the
Secretary to provide for publication of these amounts in the Federal
Register during the September that precedes the start of each CY. As
this statutory provision prescribes a detailed methodology for
calculating these amounts, we do not have the discretion to adopt an
alternative approach on these issues.
B. Overall Impact
We have examined the impacts of this rule 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); Executive Order 14094 entitled ``Modernizing
Regulatory Review'' (April 6, 2023); 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).
Executive Order 14094, ``Modernizing Regulatory Review,'' amends
section 3(f)(1) of Executive Order 12866 (Regulatory Planning and
Review). The amended 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 $200 million or
more in any
[[Page 71573]]
1 year (adjusted every 3 years by the Administrator of the Office of
Information and Regulatory Affairs (OIRA) for changes in gross domestic
product) or adversely affecting in a material way the economy, a sector
of the economy, productivity, competition, jobs, the environment,
public health or safety, or State, local, territorial, or tribal
governments or communities; (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 legal or policy issues, for which
centralized review would meaningfully further the President's
priorities or the principles set forth in this Executive order, as
specifically authorized in a timely manner by the Administrator of OIRA
in each case.
A regulatory impact analysis (RIA) must be prepared for major rules
with significant regulatory action/s and/or with significant effects as
per section 3(f)(1) of Executive Order 12866 ($200 million or more in
any 1 year). Based on our estimates, OMB's Office of Information and
Regulatory Affairs has determined that this rulemaking is not
significant and not major under Subtitle E of the Small Business
Regulatory Enforcement Fairness Act of 1996 (also known as the
Congressional Review Act).
As stated in section IV of this notice, we estimate that the
overall effect of the changes in the Medicare Part A premium will be a
savings to voluntary enrollees (sections 1818 and 1818A of the Act) of
about $9 million.
C. Accounting Statement and Table
As required by OMB Circular A-4 (available at https://www.whitehouse.gov/wp-content/uploads/legacy_drupal_files/omb/circulars/A4/a-4.pdf), in the Table below we have prepared an
accounting statement showing the total aggregate savings to enrollees
paying premiums in CY 2024, compared with the amount that they paid in
CY 2023. The amount of savings will be about $9 million. As stated in
section IV of this notice, the CY 2024 premium of $505 is approximately
0.2 percent lower than the CY 2023 premium of $506. We estimate that
approximately 729,000 enrollees will voluntarily enroll in Medicare
Part A by paying the full premium and that over 90 percent of these
individuals will have their Part A premium paid for by states, since
they are enrolled in the QMB eligibility group. Furthermore, the CY
2024 reduced premium of $278 is the same as for CY 2023.
Table--Estimated Transfers for CY 2024 Medicare Part A Premiums
------------------------------------------------------------------------
Category Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............ -$9 million.
From Whom to Whom......................... Beneficiaries to Federal
Government.
------------------------------------------------------------------------
D. Regulatory Flexibility Act
The Regulatory Flexibility Act (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 being
nonprofit organizations or by meeting the Small Business
Administration's definition of a small business (having revenues of
less than $9.0 million to $47 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 2024 and
will have an impact on certain Medicare beneficiaries. As a result, we
are not preparing an analysis for the RFA because the Secretary has
certified 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
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 and has fewer
than 100 beds. This annual notice announces the Medicare Part A
premiums for CY 2024 and will have an impact on certain Medicare
beneficiaries. As a result, we are not preparing an analysis for
section 1102(b) of the Act because the Secretary has certified that
this notice will not have a significant impact on the operations of a
substantial number of small rural hospitals.
E. Unfunded Mandates Reform Act
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 2023, that
threshold is approximately $177 million. This notice would not impose a
mandate that will result in expenditures by state, local, and Tribal
Governments, in the aggregate, or by the private sector, of more than
$177 million in any 1 year.
F. Federalism
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.
G. Congressional Review
This final regulation is subject to the Congressional Review Act
provisions of the Small Business Regulatory Enforcement Fairness Act of
1996 (5 U.S.C. 801 et seq.) and has been transmitted to the Congress
and the Comptroller General for review.
Chiquita Brooks-LaSure, Administrator of the Centers for Medicare &
Medicaid Services, approved this document on October 11, 2023.
Xavier Becerra,
Secretary, Department of Health and Human Services.
[FR Doc. 2023-22848 Filed 10-12-23; 4:15 pm]
BILLING CODE 4120-01-P