80 FR 70805 - Medicare Program; CY 2016 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services Federal Register Volume 80, Issue 220 (November 16, 2015)
Centers for Medicare & Medicaid Services
Federal Register Volume 80, Issue 220 (November 16, 2015)
| Page Range | 70805-70807 | |
| FR Document | 2015-29176 |
[Federal Register Volume 80, Number 220 (Monday, November 16, 2015)] [Notices] [Pages 70805-70807] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2015-29176] ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-8060-N] RIN 0938-AS37 Medicare Program; CY 2016 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: This annual notice announces Medicare's Hospital Insurance (Part A) premium for uninsured enrollees in calendar year (CY) 2016. 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, 2016, for these individuals will be $411. The premium for certain other individuals as described in this notice will be $226. DATES: Effective Date: This notice is effective on January 1, 2016. FOR FURTHER INFORMATION CONTACT: Clare McFarland, (410) 786-6390. SUPPLEMENTARY INFORMATION: I. Background Section 1818 of the Social Security Act (the Act) provides for voluntary enrollment in the Medicare Hospital Insurance Program (Medicare Part A), subject to payment of a monthly premium, of certain persons aged 65 and older who are uninsured under the Old-Age, Survivors, and Disability Insurance (OASDI) program or the Railroad Retirement Act and do not otherwise meet the requirements for entitlement to Medicare Part A. These ``uninsured aged'' individuals are uninsured under the OASDI program or the Railroad Retirement Act, because they do not have 40 quarters of coverage under Title II of the Act (or are/were not married to someone who did). (Persons insured under the OASDI program or the Railroad Retirement Act and certain others do not have to pay premiums for Medicare Part A.) Section 1818A of the Act provides for voluntary enrollment in Medicare Part A, subject to payment of a monthly premium for certain disabled individuals who have exhausted other entitlement. These are individuals who were entitled to coverage due to a disabling impairment under section 226(b) of the Act, but who are no longer entitled to disability benefits and free Medicare Part A coverage because they have gone back to work and their earnings exceed the statutorily defined ``substantial gainful activity'' amount (section 223(d)(4) of the Act). Section 1818A(d)(2) of the Act specifies that the provisions relating to premiums under section 1818(d) through section 1818(f) of the Act for the aged will also apply to certain disabled individuals as described above. Section 1818(d)(1) of the Act requires us to estimate, on an average per capita basis, the amount to be paid from the Federal Hospital Insurance Trust Fund for services incurred in the upcoming calendar year (CY) (including the associated administrative costs) on behalf of individuals aged 65 and over who will be entitled to benefits under Medicare Part A. We must then determine the monthly actuarial rate for the following year (the per capita amount estimated above divided by 12) and publish the dollar amount for the monthly premium in the succeeding CY. If the premium is not a multiple of $1, the premium is rounded to the nearest multiple of $1 (or, if it is a multiple of 50 cents but not of $1, it is rounded to the next highest $1). Section 13508 of the Omnibus Budget Reconciliation Act of 1993 (Pub. L. 103-66) amended section 1818(d) of the Act to provide for a reduction in the premium amount for certain voluntary enrollees (section 1818 and section 1818A of the Act). The reduction applies to an individual who is eligible to buy into the Medicare Part A program and who, as of the last day of the previous month:Had at least 30 quarters of coverage under Title II of the Act; Was married, and had been married for the previous 1-year period, to a person who had at least 30 quarters of coverage; Had been married to a person for at least 1 year at the time of the person's death if, at the time of death, the person had at least 30 quarters of coverage; or Is divorced from a person and had been married to the person for at least 10 years at the time of the divorce if, at the time of the divorce, the person had at least 30 quarters of coverage. Section 1818(d)(4)(A) of the Act specifies that the premium that these individuals will pay for CY 2016 will be equal to the premium for uninsured aged enrollees reduced by 45 percent. [[Page 70806]] II. Monthly Premium Amount for CY 2016 The monthly premium for the uninsured aged and certain disabled individuals who have exhausted other entitlement for the 12 months beginning January 1, 2016, is $411. 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 $226. 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 2016 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 2016 on--(1) current historical data; and (2) projection assumptions derived from current law and the Mid-Session Review of the President's Fiscal Year 2016 Budget. We estimate that in CY 2016, 47,251,107 people aged 65 years and over will be entitled to benefits (without premium payment) and that they will incur about $233.221 billion in benefits and related administrative costs. Thus, the estimated monthly average per capita amount is $411.31 and the monthly premium is $411. Subsequently, the full monthly premium reduced by 45 percent is $226. IV. Costs to Beneficiaries The CY 2016 premium of $411 is approximately 1 percent higher than the CY 2015 premium of $407. We estimate that approximately 652,000 enrollees will voluntarily enroll in Medicare Part A, by paying the full premium. Furthermore, the CY 2016 reduced premium of $226 is approximately 0.9 percent higher than the CY 2015 premium of $224. We estimate an additional 61,000 enrollees will pay the reduced premium. Therefore, we estimate that the total aggregate cost to enrollees paying these premiums in CY 2016, compared to the amount that they paid in CY 2015, will be about $32 million. V. Waiver of Proposed Notice and Comment Period We use general notices, rather than notice and comment rulemaking procedures, to make announcements such as this premium notice. In doing so, we acknowledge that, under the Administrative Procedure Act (APA), interpretive rules, general statements of policy, and rules of agency organization, procedure, or practice are excepted from the requirements of notice and comment rulemaking. The agency may also waive notice and comment if there is ``good cause,'' as defined by the statute. We considered publishing a proposed notice to provide a period for public comment. However, under the APA, we may waive that procedure if we find good cause that prior notice and comment are impracticable, unnecessary, or contrary to the public interest. We are not using notice and comment rulemaking in this notification of Medicare Part A premiums for CY 2016 as that procedure is unnecessary because of the lack of discretion in the statutory formula that is used to calculate the premium and the solely ministerial function that this notice serves. The APA permits agencies to waive notice and comment rulemaking when notice and public comment thereon are unnecessary. On this basis, we waive publication of a proposed notice and a solicitation of public comments. 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 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. B. Overall Impact We have examined the impact 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), 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. Part I, Ch. 8). Executive Orders 12866 and 13563 direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major notices with economically significant effects ($100 million or more in any 1 year). 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 $32 million. As a result, this notice is non-economically significant under section 3(f)(1) of Executive Order 12866 and is not a major action under the Congressional Review Act. In accordance with the provisions of Executive Order 12866, this notice was reviewed by the Office of Management and Budget. The RFA requires agencies to analyze options for regulatory relief of small entities, if a rule has a significant impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of less than $7.5 million to $38.5 million in any 1 year (for details, see the Small Business Administration's Web site at http://www.sba.gov/sites/default/files/files/Size_Standards_Table.pdf). Individuals and states are not included in the definition of a small [[Page 70807]] entity. As discussed above, this annual notice announces Medicare's Hospital Insurance (Part A) premium for uninsured enrollees in calendar year (CY) 2016. As a result, we are not preparing an analysis for the RFA because the Secretary has determined that this notice will not have a significant economic impact on a substantial number of small entities. In addition, section 1102(b) of the Social Security Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area for Medicare payment regulations and has fewer than 100 beds. As discussed above, we are not preparing an analysis for section 1102(b) of the Act, because the Secretary has determined that this notice will not have a significant impact on the operations of a substantial number of small rural hospitals. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. In 2015, that threshold is approximately $144 million. This notice does not impose mandates that will have a consequential effect of $144 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 proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on state and local governments, preempts state law, or otherwise has Federalism implications. Since this notice does not impose any costs on state or local governments, the requirements of Executive Order 13132 are not applicable. Dated: November 6, 2015. Andrew M. Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services. Dated: November 9, 2015 Sylvia M. Burwell, Secretary, Department of Health and Human Services. [FR Doc. 2015-29176 Filed 11-10-15; 4:15 pm] BILLING CODE 4120-01-P
![Federal Register / Vol. 80, No. 220 / Monday, November 16, 2015 / Notices 70805
receipt of your comment(s), please DEPARTMENT OF HEALTH AND disabling impairment under section
check http://www.regulations.gov, HUMAN SERVICES 226(b) of the Act, but who are no longer
approximately two to three days after entitled to disability benefits and free
submission to verify posting (except Centers for Medicare & Medicaid Medicare Part A coverage because they
allow 30 days for posting of comments Services have gone back to work and their
submitted by mail). [CMS–8060–N] earnings exceed the statutorily defined
‘‘substantial gainful activity’’ amount
FOR FURTHER INFORMATION CONTACT: Visit RIN 0938–AS37 (section 223(d)(4) of the Act).
the CECANF Web site at https://
eliminatechildabusefatalities.sites.usa. Medicare Program; CY 2016 Part A Section 1818A(d)(2) of the Act
gov/ or contact Patricia Brincefield, Premiums for the Uninsured Aged and specifies that the provisions relating to
Communications Director, at 202–818– for Certain Disabled Individuals Who premiums under section 1818(d)
9596, U.S. General Services Have Exhausted Other Entitlement through section 1818(f) of the Act for
the aged will also apply to certain
Administration, 1800 F Street NW., AGENCY: Centers for Medicare & disabled individuals as described above.
Room 7003D, Washington, DC 20405, Medicaid Services (CMS), HHS.
Attention: Tom Hodnett (CD) for ACTION: Notice.
Section 1818(d)(1) of the Act requires
CECANF. us to estimate, on an average per capita
SUMMARY: This annual notice announces basis, the amount to be paid from the
SUPPLEMENTARY INFORMATION: Medicare’s Hospital Insurance (Part A) Federal Hospital Insurance Trust Fund
Background: CECANF was premium for uninsured enrollees in for services incurred in the upcoming
established to develop a national calendar year (CY) 2016. This premium calendar year (CY) (including the
strategy and recommendations for is paid by enrollees age 65 and over who associated administrative costs) on
reducing fatalities resulting from child are not otherwise eligible for benefits behalf of individuals aged 65 and over
abuse and neglect. under Medicare Part A (hereafter known who will be entitled to benefits under
as the ‘‘uninsured aged’’) and by certain Medicare Part A. We must then
Agenda: Commission members will disabled individuals who have determine the monthly actuarial rate for
continue discussing the work plans of exhausted other entitlement. The the following year (the per capita
the Commission subcommittees, the monthly Part A premium for the 12 amount estimated above divided by 12)
information that they have obtained to months beginning January 1, 2016, for and publish the dollar amount for the
date, and emerging recommendations. these individuals will be $411. The monthly premium in the succeeding CY.
Attendance at the Meeting: premium for certain other individuals as If the premium is not a multiple of $1,
Individuals interested in attending the described in this notice will be $226. the premium is rounded to the nearest
meeting in person or participating by DATES: Effective Date: This notice is multiple of $1 (or, if it is a multiple of
webinar and teleconference must effective on January 1, 2016. 50 cents but not of $1, it is rounded to
register in advance. To register to attend FOR FURTHER INFORMATION CONTACT: the next highest $1).
in person or by webinar/phone, please Clare McFarland, (410) 786–6390. Section 13508 of the Omnibus Budget
go to http://meetingtomorrow.com/ SUPPLEMENTARY INFORMATION: Reconciliation Act of 1993 (Pub. L. 103–
webcast/CECANF and follow the 66) amended section 1818(d) of the Act
I. Background
prompts. Once you register, you will to provide for a reduction in the
receive a confirmation email with the Section 1818 of the Social Security premium amount for certain voluntary
teleconference number. Detailed Act (the Act) provides for voluntary enrollees (section 1818 and section
meeting minutes will be posted within enrollment in the Medicare Hospital 1818A of the Act). The reduction
90 days of the meeting. Members of the Insurance Program (Medicare Part A), applies to an individual who is eligible
public will not have the opportunity to subject to payment of a monthly to buy into the Medicare Part A program
ask questions or otherwise participate in premium, of certain persons aged 65 and who, as of the last day of the
the meeting. and older who are uninsured under the previous month:
Old-Age, Survivors, and Disability
However, members of the public • Had at least 30 quarters of coverage
Insurance (OASDI) program or the
wishing to comment should follow the under Title II of the Act;
Railroad Retirement Act and do not
steps detailed under the heading otherwise meet the requirements for • Was married, and had been married
ADDRESSES in this publication or contact entitlement to Medicare Part A. These for the previous 1-year period, to a
us via the CECANF Web site at https:// ‘‘uninsured aged’’ individuals are person who had at least 30 quarters of
eliminatechildabusefatalities.sites.usa. uninsured under the OASDI program or coverage;
gov/contact-us/. the Railroad Retirement Act, because • Had been married to a person for at
Dated: November 9, 2015. they do not have 40 quarters of coverage least 1 year at the time of the person’s
under Title II of the Act (or are/were not death if, at the time of death, the person
Karen White,
married to someone who did). (Persons had at least 30 quarters of coverage; or
Executive Assistant. insured under the OASDI program or
[FR Doc. 2015–29002 Filed 11–13–15; 8:45 am] • Is divorced from a person and had
the Railroad Retirement Act and certain
others do not have to pay premiums for been married to the person for at least
BILLING CODE 6820–34–P
Medicare Part A.) 10 years at the time of the divorce if, at
the time of the divorce, the person had
tkelley on DSK3SPTVN1PROD with NOTICES
Section 1818A of the Act provides for
voluntary enrollment in Medicare Part at least 30 quarters of coverage.
A, subject to payment of a monthly Section 1818(d)(4)(A) of the Act
premium for certain disabled specifies that the premium that these
individuals who have exhausted other individuals will pay for CY 2016 will be
entitlement. These are individuals who equal to the premium for uninsured
were entitled to coverage due to a aged enrollees reduced by 45 percent.
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![Federal Register / Vol. 80, No. 220 / Monday, November 16, 2015 / Notices 70807
entity. As discussed above, this annual DEPARTMENT OF HEALTH AND To obtain copies of a supporting
notice announces Medicare’s Hospital HUMAN SERVICES statement and any related forms for the
Insurance (Part A) premium for proposed collection(s) summarized in
uninsured enrollees in calendar year Centers for Medicare & Medicaid this notice, you may make your request
(CY) 2016. As a result, we are not Services using one of following:
preparing an analysis for the RFA [Document Identifiers: CMS–3427] 1. Access CMS’ Web site address at
because the Secretary has determined http://www.cms.hhs.gov/
that this notice will not have a Agency Information Collection PaperworkReductionActof1995.
significant economic impact on a Activities: Proposed Collection; 2. Email your request, including your
substantial number of small entities. Comment Request address, phone number, OMB number,
and CMS document identifier, to
In addition, section 1102(b) of the AGENCY: Centers for Medicare & Paperwork@cms.hhs.gov.
Social Security Act requires us to Medicaid Services. 3. Call the Reports Clearance Office at
prepare a regulatory impact analysis if ACTION: Notice. (410) 786–1326.
a rule may have a significant impact on
SUMMARY: The Centers for Medicare & FOR FURTHER INFORMATION CONTACT:
the operations of a substantial number
Medicaid Services (CMS) is announcing Reports Clearance Office at (410) 786–
of small rural hospitals. This analysis
an opportunity for the public to 1326.
must conform to the provisions of
section 604 of the RFA. For purposes of comment on CMS’ intention to collect SUPPLEMENTARY INFORMATION:
section 1102(b) of the Act, we define a information from the public. Under the
Paperwork Reduction Act of 1995 (the Contents
small rural hospital as a hospital that is
located outside of a Metropolitan PRA), federal agencies are required to This notice sets out a summary of the
publish notice in the Federal Register use and burden associated with the
Statistical Area for Medicare payment
concerning each proposed collection of following information collections. More
regulations and has fewer than 100
information (including each proposed detailed information can be found in
beds. As discussed above, we are not
extension or reinstatement of an existing each collection’s supporting statement
preparing an analysis for section 1102(b) collection of information) and to allow
of the Act, because the Secretary has and associated materials (see
60 days for public comment on the ADDRESSES).
determined that this notice will not proposed action. Interested persons are
have a significant impact on the invited to send comments regarding our CMS–3427 End Stage Renal Disease
operations of a substantial number of burden estimates or any other aspect of Application and Survey and
small rural hospitals. this collection of information, including Certification Report
Section 202 of the Unfunded any of the following subjects: (1) The Under the PRA (44 U.S.C. 3501–
Mandates Reform Act of 1995 also necessity and utility of the proposed 3520), federal agencies must obtain
requires that agencies assess anticipated information collection for the proper approval from the Office of Management
costs and benefits before issuing any performance of the agency’s functions; and Budget (OMB) for each collection of
rule whose mandates require spending (2) the accuracy of the estimated information they conduct or sponsor.
in any 1 year of $100 million in 1995 burden; (3) ways to enhance the quality, The term ‘‘collection of information’’ is
dollars, updated annually for inflation. utility, and clarity of the information to defined in 44 U.S.C. 3502(3) and 5 CFR
In 2015, that threshold is approximately be collected; and (4) the use of 1320.3(c) and includes agency requests
$144 million. This notice does not automated collection techniques or or requirements that members of the
impose mandates that will have a other forms of information technology to public submit reports, keep records, or
consequential effect of $144 million or minimize the information collection provide information to a third party.
more on state, local, or tribal burden. Section 3506(c)(2)(A) of the PRA
governments or on the private sector. DATES: Comments must be received by requires federal agencies to publish a
Executive Order 13132 establishes January 15, 2016. 60-day notice in the Federal Register
certain requirements that an agency ADDRESSES: When commenting, please concerning each proposed collection of
must meet when it promulgates a reference the document identifier or information, including each proposed
proposed rule (and subsequent final OMB control number. To be assured extension or reinstatement of an existing
rule) that imposes substantial direct consideration, comments and collection of information, before
requirement costs on state and local recommendations must be submitted in submitting the collection to OMB for
any one of the following ways: approval. To comply with this
governments, preempts state law, or
1. Electronically. You may send your requirement, CMS is publishing this
otherwise has Federalism implications.
comments electronically to http:// notice.
Since this notice does not impose any
www.regulations.gov. Follow the
costs on state or local governments, the Information Collection
instructions for ‘‘Comment or
requirements of Executive Order 13132 1. Type of Information Collection
Submission’’ or ‘‘More Search Options’’
are not applicable. Request: Reinstatement with change of a
to find the information collection
Dated: November 6, 2015. document(s) that are accepting previously approved collection; Title of
Andrew M. Slavitt, comments. Information Collection: End Stage Renal
Acting Administrator, Centers for Medicare 2. By regular mail. You may mail Disease Application and Survey and
& Medicaid Services. written comments to the following Certification Report; Use: Part I of this
tkelley on DSK3SPTVN1PROD with NOTICES
address: CMS, Office of Strategic form is a facility identification and
Dated: November 9, 2015
Operations and Regulatory Affairs, screening measurement used to initiate
Sylvia M. Burwell, Division of Regulations Development, the certification and recertification of
Secretary, Department of Health and Human Attention: Document Identifier/OMB ESRD facilities. Part II is completed by
Services. Control Number lll, Room C4–26– the Medicare/Medicaid State survey
[FR Doc. 2015–29176 Filed 11–10–15; 4:15 pm] 05, 7500 Security Boulevard, Baltimore, agency to determine facility compliance
BILLING CODE 4120–01–P Maryland 21244–1850. with ESRD conditions for coverage.
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Document Created: 2015-12-14 14:13:14
Document Modified: 2015-12-14 14:13:14
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Notice. | |
| Contact | Clare McFarland, (410) 786-6390. | |
| FR Citation | 80 FR 70805 | |
| RIN Number | 0938-AS37 |
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