81 FR 80071 - Medicare Program; CY 2017 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 81, Issue 220 (November 15, 2016)
Centers for Medicare & Medicaid Services
Federal Register Volume 81, Issue 220 (November 15, 2016)
| Page Range | 80071-80073 | |
| FR Document | 2016-27388 |
[Federal Register Volume 81, Number 220 (Tuesday, November 15, 2016)] [Notices] [Pages 80071-80073] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-27388] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-8063-N] RIN 0938-AS71 Medicare Program; CY 2017 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) 2017. 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, 2017, for these individuals will be $413. The premium for certain other individuals as described in this notice will be $227. DATES: Effective Date: This notice is effective on January 1, 2017. [[Page 80072]] 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 2017 will be equal to the premium for uninsured aged enrollees reduced by 45 percent. II. Monthly Premium Amount for CY 2017 The monthly premium for the uninsured aged and certain disabled individuals who have exhausted other entitlement for the 12 months beginning January 1, 2017, is $413. 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 $227. 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 2017 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 2017 on--(1) current historical data; and (2) projection assumptions derived from current law and the Mid-Session Review of the President's Fiscal Year 2017 Budget. We estimate that in CY 2017, 48,634,512 people aged 65 years and over will be entitled to (enrolled in) benefits (without premium payment) and that they will incur about $240.891 billion in benefits and related administrative costs. Thus, the estimated monthly average per capita amount is $412.76 and the monthly premium is $413. Subsequently, the full monthly premium reduced by 45 percent is $227. IV. Costs to Beneficiaries The CY 2017 premium of $413 is approximately 0.5 percent higher than the CY 2016 premium of $411. We estimate that approximately 654,000 enrollees will voluntarily enroll in Medicare Part A, by paying the full premium. Note that states pay Part A premiums for persons who are enrolled in the Qualified Medicare Beneficiary Program (a Medicaid program which helps certain low-income individuals with Medicare premium and cost-sharing liability). Furthermore, the CY 2017 reduced premium of $227 is approximately 0.5 percent higher than the CY 2016 premium of $226. We estimate an additional 67,000 enrollees will pay the reduced premium. Therefore, we estimate that the total aggregate cost to enrollees paying these premiums in CY 2017, compared to the amount that they paid in CY 2016, will be about $17 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. [[Page 80073]] We are not using notice and comment rulemaking in this notification of Medicare Part A premiums for CY 2017 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 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 notice as required by Executive Order 12866 on Regulatory Planning and Review (September 30, 1993), Executive Order 13563 on Improving Regulation and Regulatory Review (January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104-4), Executive Order 13132 on Federalism (August 4, 1999) and the Congressional Review Act (5 U.S.C. 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 $17 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 entity. As discussed above, this annual notice announces Medicare's Hospital Insurance (Part A) premium for uninsured enrollees in CY 2017. 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 2016, that threshold is approximately $146 million. This notice does not impose mandates that will have a consequential effect of $146 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: September 23, 2016. Andrew M. Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services. Dated: November 8, 2016. Sylvia M. Burwell, Secretary, Department of Health and Human Services. [FR Doc. 2016-27388 Filed 11-10-16; 4:15 pm] BILLING CODE 4120-01-P
![Federal Register / Vol. 81, No. 220 / Tuesday, November 15, 2016 / Notices 80071
In addition, the monthly premium any time during the taxable year, but file are also announced and listed in the
rates to be paid by beneficiaries who are a separate tax return from their spouse, following chart:
married and lived with their spouse at
Income-related Total
Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax re- monthly monthly
turn from their spouse: adjustment premium
amount amount
Less than or equal to $85,000 .................................................................................................................................. $0.00 $134.00
Greater than $85,000 and less than or equal to $129,000 ....................................................................................... 214.30 348.30
Greater than $129,000 .............................................................................................................................................. 294.60 428.60
The RFA requires agencies to analyze enrolled in Medicaid have their Moreover, we find that notice and
options for regulatory relief of small monthly Part B premiums paid by comment are unnecessary because the
businesses, if a rule has a significant Medicaid. The 2017 premium increase formulas used to calculate the Part B
impact on a substantial number of small is estimated to be a cost to each state premiums are statutorily directed.
entities. For purposes of the RFA, small Medicaid program that is less than the Therefore, we find good cause to waive
entities include small businesses, threshold. This notice does not impose publication of a proposed notice and
nonprofit organizations, and small mandates that will have a consequential solicitation of public comments.
governmental jurisdictions. Individuals effect of the threshold amount or more Dated: November 8, 2016.
and states are not included in the on state, local, or tribal governments or
Andrew M. Slavitt,
definition of a small entity. This notice on the private sector.
Executive Order 13132 establishes Acting Administrator, Centers for Medicare
announces the monthly actuarial rates & Medicaid Services.
for aged (age 65 and over) and disabled certain requirements that an agency
must meet when it publishes a proposed Dated: November 8, 2016.
(under 65) beneficiaries enrolled in Part
B of the Medicare SMI program rule (and subsequent final rule) that Sylvia M. Burwell,
beginning January 1, 2017. Also, this imposes substantial direct compliance Secretary, Department of Health and Human
notice announces the monthly premium costs on state and local governments, Services.
for aged and disabled beneficiaries as preempts state law, or otherwise has [FR Doc. 2016–27425 Filed 11–10–16; 4:15 pm]
well as the income-related monthly Federalism implications. We have BILLING CODE 4120–01–P
adjustment amounts to be paid by determined that this notice does not
beneficiaries with modified adjusted significantly affect the rights, roles, and
gross income above certain threshold responsibilities of states. Accordingly, DEPARTMENT OF HEALTH AND
amounts. As a result, we are not the requirements of Executive Order HUMAN SERVICES
preparing an analysis for the RFA 13132 do not apply to this notice.
In accordance with the provisions of Centers for Medicare & Medicaid
because the Secretary has determined Services
that this notice will not have a Executive Order 12866, this notice was
significant economic impact on a reviewed by the Office of Management
and Budget. [CMS–8063–N]
substantial number of small entities.
In addition, section 1102(b) of the Act V. Waiver of Proposed Notice
RIN 0938–AS71
requires us to prepare a regulatory The Medicare statute requires the
impact analysis if a rule may have a publication of the monthly actuarial Medicare Program; CY 2017 Part A
significant impact on the operations of rates and the Part B premium amounts Premiums for the Uninsured Aged and
a substantial number of small rural in September. We ordinarily use general for Certain Disabled Individuals Who
hospitals. This analysis must conform to notices, rather than notice and comment Have Exhausted Other Entitlement
the provisions of section 604 of the rulemaking procedures, to make such
RFA. For purposes of section 1102(b) of announcements. In doing so, we note AGENCY: Centers for Medicare &
the Act, we define a small rural hospital that, under the Administrative Medicaid Services (CMS), HHS.
as a hospital that is located outside of Procedure Act, interpretive rules, ACTION: Notice.
a Metropolitan Statistical Area and has general statements of policy, and rules
fewer than 100 beds. As we discussed of agency organization, procedure, or SUMMARY: This annual notice announces
previously, we are not preparing an practice are excepted from the Medicare’s Hospital Insurance (Part A)
analysis for section 1102(b) of the Act requirements of notice and comment premium for uninsured enrollees in
because the Secretary has determined rulemaking. calendar year (CY) 2017. This premium
that this notice will not have a We considered publishing a proposed is paid by enrollees age 65 and over who
significant effect on a substantial notice to provide a period for public are not otherwise eligible for benefits
number of small rural hospitals. comment. However, we may waive that under Medicare Part A (hereafter known
Section 202 of the Unfunded procedure if we find, for good cause, as the ‘‘uninsured aged’’) and by certain
Mandates Reform Act of 1995 (UMRA) that prior notice and comment are disabled individuals who have
also requires that agencies assess impracticable, unnecessary, or contrary exhausted other entitlement. The
mstockstill on DSK3G9T082PROD with NOTICES
anticipated costs and benefits before to the public interest. The statute monthly Part A premium for the 12
issuing any rule whose mandates establishes the time period for which months beginning January 1, 2017, for
require spending in any 1-year of $100 the premium rates will apply, and these individuals will be $413. The
million in 1995 dollars, updated delaying publication of the Part B premium for certain other individuals as
annually for inflation. In 2016, that premium rate such that it would not be described in this notice will be $227.
threshold is approximately $146 published before that time would be DATES: Effective Date: This notice is
million. Part B enrollees who are also contrary to the public interest. effective on January 1, 2017.
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![Federal Register / Vol. 81, No. 220 / Tuesday, November 15, 2016 / Notices 80073
We are not using notice and comment effects, distributive impacts, and requires that agencies assess anticipated
rulemaking in this notification of equity). A regulatory impact analysis costs and benefits before issuing any
Medicare Part A premiums for CY 2017 (RIA) must be prepared for major rule whose mandates require spending
as that procedure is unnecessary notices with economically significant in any 1 year of $100 million in 1995
because of the lack of discretion in the effects ($100 million or more in any 1 dollars, updated annually for inflation.
statutory formula that is used to year). As stated in section IV of this In 2016, that threshold is approximately
calculate the premium and the solely notice, we estimate that the overall $146 million. This notice does not
ministerial function that this notice effect of the changes in the Part A impose mandates that will have a
serves. The APA permits agencies to premium will be a cost to voluntary consequential effect of $146 million or
waive notice and comment rulemaking enrollees (section 1818 and section more on state, local, or tribal
when notice and public comment 1818A of the Act) of about $17 million. governments or on the private sector.
thereon are unnecessary. On this basis, As a result, this notice is non- Executive Order 13132 establishes
we waive publication of a proposed economically significant under section certain requirements that an agency
notice and a solicitation of public 3(f)(1) of Executive Order 12866 and is must meet when it promulgates a
comments. not a major action under the proposed rule (and subsequent final
Congressional Review Act. In rule) that imposes substantial direct
VI. Collection of Information accordance with the provisions of requirement costs on state and local
Requirements Executive Order 12866, this notice was governments, preempts state law, or
This document does not impose reviewed by the Office of Management otherwise has Federalism implications.
information collection requirements, and Budget. Since this notice does not impose any
that is, reporting, recordkeeping or The RFA requires agencies to analyze costs on state or local governments, the
third-party disclosure requirements. options for regulatory relief of small requirements of Executive Order 13132
Consequently, there is no need for entities, if a rule has a significant impact are not applicable.
review by the Office of Management and on a substantial number of small
entities. For purposes of the RFA, small Dated: September 23, 2016.
Budget under the authority of the
entities include small businesses, Andrew M. Slavitt,
Paperwork Reduction Act of 1995 (44
U.S.C. 3501 et seq.). nonprofit organizations, and small Acting Administrator, Centers for Medicare
governmental jurisdictions. Most & Medicaid Services.
VII. Regulatory Impact Analysis hospitals and most other providers and Dated: November 8, 2016.
A. Statement of Need suppliers are small entities, either by Sylvia M. Burwell,
nonprofit status or by having revenues Secretary, Department of Health and Human
Section 1818(d) of the Act requires of less than $7.5 million to $38.5 Services.
the Secretary of the Department of million in any 1 year (for details, see the [FR Doc. 2016–27388 Filed 11–10–16; 4:15 pm]
Health and Human Services (the Small Business Administration’s Web BILLING CODE 4120–01–P
Secretary) during September of each site at http://www.sba.gov/sites/default/
year to determine and publish the files/files/Size_Standards_Table.pdf).
amount to be paid, on an average per Individuals and states are not DEPARTMENT OF HEALTH AND
capita basis, from the Federal Hospital included in the definition of a small HUMAN SERVICES
Insurance Trust Fund for services entity. As discussed above, this annual
incurred in the impending CY notice announces Medicare’s Hospital Food and Drug Administration
(including the associated administrative Insurance (Part A) premium for [Docket No. FDA–2016–N–1311]
costs) on behalf of individuals aged 65 uninsured enrollees in CY 2017. As a
and over who will be entitled to benefits result, we are not preparing an analysis Paul S. Singh: Debarment Order
under Medicare Part A. for the RFA because the Secretary has
determined that this notice will not AGENCY: Food and Drug Administration,
B. Overall Impact
have a significant economic impact on HHS.
We have examined the impact of this a substantial number of small entities. ACTION: Notice.
notice as required by Executive Order In addition, section 1102(b) of the
12866 on Regulatory Planning and Social Security Act requires us to SUMMARY: The U.S. Food and Drug
Review (September 30, 1993), Executive prepare a regulatory impact analysis if Administration (FDA or Agency) is
Order 13563 on Improving Regulation a rule may have a significant impact on issuing an order under the Federal
and Regulatory Review (January 18, the operations of a substantial number Food, Drug, and Cosmetic Act (the
2011), the Regulatory Flexibility Act of small rural hospitals. This analysis FD&C Act) permanently debarring Paul
(RFA) (September 19, 1980, Pub. L. 96– must conform to the provisions of S. Singh from providing services in any
354), section 1102(b) of the Social section 604 of the RFA. For purposes of capacity to a person that has an
Security Act, section 202 of the section 1102(b) of the Act, we define a approved or pending drug product
Unfunded Mandates Reform Act of 1995 small rural hospital as a hospital that is application. FDA bases this order on a
(March 22, 1995; Pub. L. 104–4), located outside of a Metropolitan finding that Dr. Singh was convicted of
Executive Order 13132 on Federalism Statistical Area for Medicare payment a felony under Federal law for conduct
(August 4, 1999) and the Congressional regulations and has fewer than 100 relating to the regulation of a drug
Review Act (5 U.S.C. Part I, Ch. 8). beds. As discussed above, we are not product under the FD&C Act. Dr. Singh
Executive Orders 12866 and 13563 preparing an analysis for section 1102(b) was given notice of the proposed
mstockstill on DSK3G9T082PROD with NOTICES
direct agencies to assess all costs and of the Act, because the Secretary has permanent debarment and an
benefits of available regulatory determined that this notice will not opportunity to request a hearing within
alternatives and, if regulation is have a significant impact on the the timeframe prescribed by regulation.
necessary, to select regulatory operations of a substantial number of Dr. Singh failed to request a hearing. Dr.
approaches that maximize net benefits small rural hospitals. Singh’s failure to request a hearing
(including potential economic, Section 202 of the Unfunded constitutes a waiver of his right to a
environmental, public health and safety Mandates Reform Act of 1995 also hearing concerning this action.
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Document Created: 2016-11-15 00:48:26
Document Modified: 2016-11-15 00:48:26
| 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 | 81 FR 80071 | |
| RIN Number | 0938-AS71 |
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