83 FR 52459 - Medicare Program; CY 2019 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services Federal Register Volume 83, Issue 201 (October 17, 2018)
Centers for Medicare & Medicaid Services
Federal Register Volume 83, Issue 201 (October 17, 2018)
| Page Range | 52459-52462 | |
| FR Document | 2018-22526 |
[Federal Register Volume 83, Number 201 (Wednesday, October 17, 2018)] [Notices] [Pages 52459-52462] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2018-22526] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-8068-N] RIN 0938-AT33 Medicare Program; CY 2019 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: This notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year (CY) 2019 under Medicare's Hospital Insurance Program (Medicare Part A). The Medicare statute specifies the formulae used to determine these amounts. For CY 2019, the inpatient hospital deductible will be $1,364. The daily coinsurance amounts for CY 2019 will be: $341 for the 61st through 90th day of hospitalization in a benefit period; $682 for lifetime reserve days; and $170.50 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period. DATES: Effective Date: This notice is effective on January 1, 2019. FOR FURTHER INFORMATION CONTACT: Yaminee Thaker, (410) 786-7921 for general information. Gregory J. Savord, (410) 786-1521 for case-mix analysis. SUPPLEMENTARY INFORMATION: I. Background Section 1813 of the Social Security Act (the Act) provides for an inpatient hospital deductible to be subtracted from the amount payable by Medicare for inpatient hospital services furnished to a beneficiary. It also provides for certain coinsurance amounts to be subtracted from the amounts payable by Medicare for inpatient hospital and extended care services. Section 1813(b)(2) of the Act requires the Secretary of the Department of Health and Human Services (the Secretary) to determine and publish each year the amount of the inpatient hospital deductible and the hospital and [[Page 52460]] extended care services coinsurance amounts applicable for services furnished in the following calendar year (CY). II. Computing the Inpatient Hospital Deductible for CY 2019 Section 1813(b) of the Act prescribes the method for computing the amount of the inpatient hospital deductible. The inpatient hospital deductible is an amount equal to the inpatient hospital deductible for the preceding CY, adjusted by our best estimate of the payment-weighted average of the applicable percentage increases (as defined in section 1886(b)(3)(B) of the Act) used for updating the payment rates to hospitals for discharges in the fiscal year (FY) that begins on October 1 of the same preceding CY, and adjusted to reflect changes in real case-mix. The adjustment to reflect real case-mix is determined on the basis of the most recent case-mix data available. The amount determined under this formula is rounded to the nearest multiple of $4 (or, if midway between two multiples of $4, to the next higher multiple of $4). Under section 1886(b)(3)(B)(i)(XX) of the Act, the percentage increase used to update the payment rates for FY 2019 for hospitals paid under the inpatient prospective payment system is the market basket percentage increase, otherwise known as the market basket update, reduced by 0.75 percentage points (see section 1886(b)(3)(B)(xii)(V) of the Act), and an adjustment based on changes in the economy-wide productivity (the multifactor productivity (MFP) adjustment) (see section 1886(b)(3)(B)(xi)(II) of the Act). Under section 1886(b)(3)(B)(viii) of the Act, for FY 2019, the applicable percentage increase for hospitals that do not submit quality data as specified by the Secretary is reduced by one quarter of the market basket update. We are estimating that after accounting for those hospitals receiving the lower market basket update in the payment- weighted average update, the calculated deductible will not be affected, since the majority of hospitals submit quality data and receive the full market basket update. Section 1886(b)(3)(B)(ix) of the Act requires that any hospital that is not a meaningful electronic health record (EHR) user (as defined in section 1886(n)(3) of the Act) will have three-quarters of the market basket update reduced by 100 percent for FY 2017 and each subsequent fiscal year. We are estimating that after accounting for these hospitals receiving the lower market basket update, the calculated deductible will not be affected, since the majority of hospitals are meaningful EHR users and are expected to receive the full market basket update. Under section 1886 of the Act, the percentage increase used to update the payment rates for FY 2019 for hospitals excluded from the inpatient prospective payment system is as follows:The percentage increase for long term care hospitals is the market basket percentage increase reduced by 0.75 percentage points and the MFP adjustment (see sections 1886(m)(3)(A) and 1886(m)(4)(F) of the Act). In addition, these hospitals may also be impacted by the quality reporting adjustments and the site-neutral payment rates (see sections 1886(m)(5) and 1886(m)(6) of the Act). The percentage increase for inpatient rehabilitation facilities is the market basket percentage increase reduced by a productivity adjustment in accordance with section 1886(j)(3)(C)(ii)(I) of the Act, and further reduced by 0.75 percentage points in accordance with sections 1886(j)(3)(C)(ii)(II) and 1886(j)(3)(D)(v) of the Act. In addition, these hospitals may also be impacted by the quality reporting adjustments (see section 1886(j)(7)of the Act). The percentage increase used to update the payment rate for inpatient psychiatric facilities is the market basket percentage increase reduced by 0.75 percentage points and the MFP adjustment (see sections 1886(s)(2)(A)(i), 1886(s)(2)(A)(ii), and 1886(s)(3)(E) of the Act). In addition, these hospitals may also be impacted by the quality reporting adjustments (see section 1886(s)(4) of the Act). The percentage increase for other types of hospitals excluded from the inpatient prospective payment system (for example, cancer hospitals, children's hospitals, and hospitals located outside the 50 States, the District of Columbia, and Puerto Rico) is the market basket percentage increase (see section 1886(b)(3)(B)(ii)(VIII) of the Act). The Inpatient Prospective Payment System market basket percentage increase for FY 2019 is 2.9 percent and the MFP adjustment is 0.8 percentage point, as announced in the final rule that appeared in the Federal Register on August 17, 2018 entitled, ``Hospital Inpatient Prospective Payment System for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2019 Rates'' (83 FR 41144). Therefore, the percentage increase for hospitals paid under the inpatient prospective payment system that submit quality data and are meaningful EHR users is 1.35 percent (that is, the FY 2019 market basket update of 2.9 percent less the MFP adjustment of 0.8 percentage point and less 0.75 percentage point). The average payment percentage increase for hospitals excluded from the inpatient prospective payment system is 1.62 percent. This average includes long term care hospitals, inpatient rehabilitation facilities, and other hospitals excluded from the inpatient prospective payment system. Weighting these percentages in accordance with payment volume, our best estimate of the payment-weighted average of the increases in the payment rates for FY 2019 is 1.39 percent. To develop the adjustment to reflect changes in real case-mix, we first calculated an average case-mix for each hospital that reflects the relative costliness of that hospital's mix of cases compared to those of other hospitals. We then computed the change in average case- mix for hospitals paid under the Medicare inpatient prospective payment system in FY 2018 compared to FY 2017. (We excluded from this calculation hospitals whose payments are not based on the inpatient prospective payment system because their payments are based on alternate prospective payment systems or reasonable costs.) We used Medicare bills from prospective payment hospitals that we received as of July 2018. These bills represent a total of about 7.3 million Medicare discharges for FY 2018 and provide the most recent case-mix data available at this time. Based on these bills, the change in average case-mix in FY 2018 is 1.33 percent. Based on these bills and past experience, we expect the overall case mix change to be 1.8 percent as the year progresses and more FY 2018 data become available. Section 1813 of the Act requires that the inpatient hospital deductible be adjusted only by that portion of the case-mix change that is determined to be real. Real case-mix is that portion of case-mix that is due to changes in the mix of cases in the hospital and not due to coding optimization. Over the past several years, we have observed total case mix increases of about 0.5 percent per year and have assumed that they are real. Thus, since we do not have further information at this time, we expect that 0.5 percent of the 1.8 percent change in average case-mix for FY 2018 will be real. Thus as stated above, the estimate of the payment-weighted average of the applicable percentage increases used for updating the payment rates is 1.39 percent, and the real case-mix adjustment factor for the deductible is 0.5 percent. Therefore, using the statutory formula as stated in section [[Page 52461]] 1813(b) of the Act, we calculate the inpatient hospital deductible for services furnished in CY 2019 to be $1,364. This deductible amount is determined by multiplying $1,340 (the inpatient hospital deductible for CY 2018 (82 FR 55367)) by the payment-weighted average increase in the payment rates of 1.0139 multiplied by the increase in real case-mix of 1.005, which equals $1,365.42 and is rounded to $1,364. III. Computing the Inpatient Hospital and Extended Care Services Coinsurance Amounts for CY 2019 The coinsurance amounts provided for in section 1813 of the Act are defined as fixed percentages of the inpatient hospital deductible for services furnished in the same CY. The increase in the deductible generates increases in the coinsurance amounts. For inpatient hospital and extended care services furnished in CY 2019, in accordance with the fixed percentages defined in the law, the daily coinsurance for the 61st through 90th day of hospitalization in a benefit period will be $341 (one-fourth of the inpatient hospital deductible as stated in section 1813(a)(1)(A) of the Act); the daily coinsurance for lifetime reserve days will be $682 (one-half of the inpatient hospital deductible as stated in section 1813(a)(1)(B) of the Act); and the daily coinsurance for the 21st through 100th day of extended care services in a skilled nursing facility (SNF) in a benefit period will be $170.50 (one-eighth of the inpatient hospital deductible as stated in section 1813(a)(3) of the Act). IV. Cost to Medicare Beneficiaries The Table below summarizes the deductible and coinsurance amounts for CYs 2018 and 2019, as well as the number of each that is estimated to be paid. Part A Deductible and Coinsurance Amounts for Calendar Years 2018 and 2019 ---------------------------------------------------------------------------------------------------------------- Value Number paid (in millions) Type of cost sharing --------------------------------------------------------------- 2018 2019 2018 2019 ---------------------------------------------------------------------------------------------------------------- Inpatient hospital deductible................... $1,340 $1,364 7.19 7.23 Daily coinsurance for 61st-90th Day............. 335 341 1.72 1.72 Daily coinsurance for lifetime reserve days..... 670 682 0.84 0.85 SNF coinsurance................................. 167.50 170.50 33.15 33.34 ---------------------------------------------------------------------------------------------------------------- The estimated total increase in costs to beneficiaries is about $390 million (rounded to the nearest $10 million) due to: (1) The increase in the deductible and coinsurance amounts; and (2) the increase in the number of deductibles and daily coinsurance amounts paid. We determine the increase in cost to beneficiaries by calculating the difference between the 2018 and 2019 deductible and coinsurance amounts multiplied by the estimated increase in the number of deductible and coinsurance amounts paid. V. Waiver of Proposed Notice and Comment Period Section 1813(b)(2) of the Act requires publication of the inpatient hospital deductible and all coinsurance amounts--the hospital and extended care services coinsurance amounts--between September 1 and September 15 of the year preceding the year to which they will apply. We ordinarily publish a notice of proposed rulemaking in the Federal Register and invite public comment prior to a rule taking effect in accordance with section 553(b) of the Administrative Procedure Act (APA) and section 1871 of the Act. However, we believe that the policies being publicized in this document do not constitute agency rulemaking. Rather, the statute requires that the agency determine and publish the inpatient hospital deductible and hospital and extended care services coinsurance amounts for each calendar year in accordance with the statutory formulae, and we are simply notifying the public of the changes to the Medicare Part A deductible and coinsurance amounts for CY 2019. To the extent any of the policies articulated in this document constitute interpretations of the statute's requirements or procedures that will be used to implement the statute's directive, they are interpretive rules, general statements of policy, and rules of agency organization, procedure, or practice, which are not subject to notice and comment rulemaking under the APA. To the extent that notice and comment rulemaking would otherwise apply, we find good cause to waive this requirement. Under the APA, we may waive notice and public procedure if we find good cause that prior notice and comment are impracticable, unnecessary, or contrary to the public interest. We find that the procedure for notice and comment is unnecessary here, because this document does not propose to make any substantive changes to the policies or methodologies, but simply applies the formulae used to calculate the inpatient hospital deductible and hospital and extended care services coinsurance amounts as statutorily directed and we can exercise no discretion in following the formulae. Moreover, the statute establishes the time period for which the deductible and coinsurance amounts will apply, so we also do not have any discretion in that regard. Therefore, we find good cause to waive notice and comment procedures, if such procedures are required at all. VI. Collection of Information Requirements This document does not impose information collection requirements, that is, reporting, recordkeeping or third-party disclosure requirements. Consequently, there is no need for review by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.). VII. Regulatory Impact Analysis A. Statement of Need Section 1813(b)(2) of the Act requires the Secretary to publish, between September 1 and September 15 of each year, the amounts of the inpatient hospital deductible and hospital and extended care services coinsurance applicable for services furnished in the following CY. B. Overall Impact We have examined the impacts of this notice in accordance with Executive Order 12866 on Regulatory Planning and Review (September 30, 1993), Executive Order 13563 on Improving Regulation and Regulatory Review (January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19, [[Page 52462]] 1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104-4), Executive Order 13132 on Federalism (August 4, 1999), the Congressional Review Act (5 U.S.C. 804(2)), and Executive Order 13771 on Reducing Regulation and Controlling Regulatory Costs (January 30, 2017). Executive Orders 12866 and 13563 direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). Section 3(f) of Executive Order 12866 defines a ``significant regulatory action'' as an action that is likely to result in a rule: (1) Having an annual effect on the economy of $100 million or more in any 1 year, or adversely and materially affecting a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or state, local or tribal governments or communities (also referred to as ``economically significant''); (2) creating a serious inconsistency or otherwise interfering with an action taken or planned by another agency; (3) materially altering the budgetary impacts of entitlement grants, user fees, or loan programs or the rights and obligations of recipients thereof; or (4) raising novel legal or policy issues arising out of legal mandates, the President's priorities, or the principles set forth in the Executive Order. A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). Although we do not consider this notice to constitute a substantive rule, this notice is economically significant under section 3(f)(1) of Executive Order 12866. As stated in section IV of this notice, we estimate that the total increase in costs to beneficiaries associated with this notice is about $390 million due to: (1) The increase in the deductible and coinsurance amounts; and (2) the increase in the number of deductibles and daily coinsurance amounts paid. 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 website at http://www.sba.gov/content/small-business-size-standards). Individuals and states are not included in the definition of a small entity. This annual notice announces the Medicare Part A deductible and coinsurance amounts for CY 2019 and will have an impact on the Medicare beneficiaries. As a result, we are not preparing an analysis for the RFA because the Secretary has determined that this notice will not have a significant economic impact on a substantial number of small entities. In addition, section 1102(b) of the Social Security 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 deductible and coinsurance amounts for CY 2019 and will have an impact on the Medicare beneficiaries. As a result, we are not preparing an analysis for section 1102(b) of the Act because the Secretary has determined that this notice will not have a significant impact on the operations of a substantial number of small rural hospitals. Section 202 of the Unfunded Mandates Reform Act of 1995 (UMRA) also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. In 2018, that threshold is approximately $150 million. This notice does not impose mandates that will have a consequential effect of $150 million or more on state, local, or tribal governments or on the private sector. Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on state and local governments, preempts state law, or otherwise has Federalism implications. This notice will not have a substantial direct effect on state or local governments, preempt state law, or otherwise have Federalism implications. Executive Order 13771, titled ``Reducing Regulation and Controlling Regulatory Costs,'' was issued on January 30, 2017 (82 FR 9339, February 3, 2017). It has been determined that this notice is a transfer notice that does not impose more than de minimis costs and thus is not a regulatory action for the purposes of E.O. 13771. Consistent with the Congressional Review Act provisions of the Small Business Regulatory Enforcement Fairness Act of 1996 (5 U.S.C. 801 et seq.), this notice has been transmitted to the Congress and the Comptroller General for review. In accordance with the provisions of Executive Order 12866, this notice was reviewed by the Office of Management and Budget. Although this notice does not constitute a substantive rule, we nevertheless prepared this Impact Analysis in the interest of ensuring that the impacts of this notice are fully understood. Dated: October 3, 2018. Seema Verma, Administrator, Centers for Medicare & Medicaid Services. Dated: October 11, 2018. Alex M. Azar II, Secretary, Department of Health and Human Services. [FR Doc. 2018-22526 Filed 10-12-18; 11:15 am] BILLING CODE 4120-01-P
![Federal Register / Vol. 83, No. 201 / Wednesday, October 17, 2018 / Notices 52459
findings concerning review and AAHHS–HFAP’s program requirements. Dated: October 10, 2018.
approval of a national accrediting These monitoring procedures are used Seema Verma,
organization’s requirements consider, only when the AAHHS–HFAP identifies Administrator, Centers for Medicare &
among other factors, the applying noncompliance. If noncompliance is Medicaid Services.
accrediting organization’s requirements identified through validation reviews or [FR Doc. 2018–22546 Filed 10–16–18; 8:45 am]
for accreditation; survey procedures; complaint surveys, the state survey BILLING CODE 4120–01–P
resources for conducting required agency monitors corrections as specified
surveys; capacity to furnish information at § 488.9(c).
for use in enforcement activities; ++ AAHHS–HFAP’s capacity to DEPARTMENT OF HEALTH AND
monitoring procedures for provider report deficiencies to the surveyed HUMAN SERVICES
entities found not in compliance with facilities and respond to the facility’s
the conditions or requirements; and plan of correction in a timely manner. Centers for Medicare & Medicaid
ability to provide us with the necessary Services
data for validation. ++ AAHHS–HFAP’s capacity to
provide CMS with electronic data and [CMS–8068–N]
Section 1865(a)(3)(A) of the Act
further requires that we publish, within reports necessary for effective validation RIN 0938–AT33
60 days of receipt of an organization’s and assessment of the organization’s
complete application, a notice survey process. Medicare Program; CY 2019 Inpatient
identifying the national accrediting ++ The adequacy of AAHHS–HFAP’s Hospital Deductible and Hospital and
body making the request, describing the staff and other resources, and its Extended Care Services Coinsurance
nature of the request, and providing at financial viability. Amounts
least a 30-day public comment period. ++ AAHHS–HFAP’s capacity to AGENCY: Centers for Medicare &
We have 210 days from the receipt of a adequately fund required surveys. Medicaid Services (CMS), HHS.
complete application to publish notice ACTION: Notice.
++ AAHHS–HFAP’s policies with
of approval or denial of the application.
The purpose of this proposed notice respect to whether surveys are
SUMMARY: This notice announces the
is to inform the public of AAHHS– announced or unannounced, to assure
inpatient hospital deductible and the
HFAP’s request for approval of its that surveys are unannounced.
hospital and extended care services
hospital accreditation program. This ++ AAHHS–HFAP’s agreement to coinsurance amounts for services
notice also solicits public comment on provide CMS with a copy of the most furnished in calendar year (CY) 2019
whether AAHHS–HFAP’s requirements current accreditation survey together under Medicare’s Hospital Insurance
meet or exceed the Medicare conditions with any other information related to Program (Medicare Part A). The
of participation (CoPs) for hospitals. the survey as we may require (including Medicare statute specifies the formulae
corrective action plans). used to determine these amounts. For
B. Evaluation of Deeming Authority
Request C. Notice Upon Completion of CY 2019, the inpatient hospital
Evaluation deductible will be $1,364. The daily
AAHHS–HFAP submitted all the coinsurance amounts for CY 2019 will
necessary materials to enable us to make Upon completion of our evaluation, be: $341 for the 61st through 90th day
a determination concerning its request including evaluation of public of hospitalization in a benefit period;
for continued approval of its hospital comments received as a result of this $682 for lifetime reserve days; and
accreditation program. This application notice, we will publish a final notice in $170.50 for the 21st through 100th day
was determined to be complete on the Federal Register announcing the of extended care services in a skilled
August 17, 2018. Under section result of our evaluation. nursing facility in a benefit period.
1865(a)(2) of the Act and our regulations DATES: Effective Date: This notice is
at § 488.5 (Application and re- III. Collection of Information
Requirements effective on January 1, 2019.
application procedures for national
FOR FURTHER INFORMATION CONTACT:
accrediting organizations), our review This document does not impose
and evaluation of AAHHS–HFAP will Yaminee Thaker, (410) 786–7921 for
information collection requirements, general information. Gregory J. Savord,
be conducted in accordance with, but that is, reporting, recordkeeping or
not necessarily limited to, the following (410) 786–1521 for case-mix analysis.
third-party disclosure requirements. SUPPLEMENTARY INFORMATION:
factors: Consequently, there is no need for
• The equivalency of AAHHS– I. Background
review by the Office of Management and
HFAP’s standards for hospitals as
Budget under the authority of the Section 1813 of the Social Security
compared with CMS’ hospital CoPs.
• AAHHS–HFAP’s survey process to Paperwork Reduction Act of 1995 (44 Act (the Act) provides for an inpatient
determine the following: U.S.C. Chapter 35). hospital deductible to be subtracted
++ The composition of the survey IV. Response to Comments from the amount payable by Medicare
team, surveyor qualifications, and the for inpatient hospital services furnished
ability of the organization to provide Because of the large number of public to a beneficiary. It also provides for
continuing surveyor training. comments we normally receive on certain coinsurance amounts to be
++ The comparability of AAHHS– Federal Register documents, we are not subtracted from the amounts payable by
HFAP’s processes to those of state able to acknowledge or respond to them Medicare for inpatient hospital and
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agencies, including survey frequency, individually. We will consider all extended care services. Section
and the ability to investigate and comments we receive by the date and 1813(b)(2) of the Act requires the
respond appropriately to complaints time specified in the DATES section of Secretary of the Department of Health
against accredited facilities. this preamble, and, when we proceed and Human Services (the Secretary) to
++ AAHHS–HFAP’s processes and with a subsequent document, we will determine and publish each year the
procedures for monitoring a hospital respond to the comments in the amount of the inpatient hospital
found out of compliance with the preamble to that document. deductible and the hospital and
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![52462 Federal Register / Vol. 83, No. 201 / Wednesday, October 17, 2018 / Notices
1980, Pub. L. 96–354), section 1102(b) of nonprofit status or by having revenues January 30, 2017 (82 FR 9339, February
the Social Security Act, section 202 of of less than $7.5 million to $38.5 3, 2017). It has been determined that
the Unfunded Mandates Reform Act of million in any 1 year (for details, see the this notice is a transfer notice that does
1995 (March 22, 1995; Pub. L. 104–4), Small Business Administration’s not impose more than de minimis costs
Executive Order 13132 on Federalism website at http://www.sba.gov/content/ and thus is not a regulatory action for
(August 4, 1999), the Congressional small-business-size-standards). the purposes of E.O. 13771.
Review Act (5 U.S.C. 804(2)), and Individuals and states are not included Consistent with the Congressional
Executive Order 13771 on Reducing in the definition of a small entity. This Review Act provisions of the Small
Regulation and Controlling Regulatory annual notice announces the Medicare Business Regulatory Enforcement
Costs (January 30, 2017). Part A deductible and coinsurance Fairness Act of 1996 (5 U.S.C. 801 et
Executive Orders 12866 and 13563 amounts for CY 2019 and will have an seq.), this notice has been transmitted to
direct agencies to assess all costs and impact on the Medicare beneficiaries. the Congress and the Comptroller
benefits of available regulatory As a result, we are not preparing an General for review.
alternatives and, if regulation is analysis for the RFA because the In accordance with the provisions of
necessary, to select regulatory Secretary has determined that this Executive Order 12866, this notice was
approaches that maximize net benefits notice will not have a significant reviewed by the Office of Management
(including potential economic, economic impact on a substantial and Budget.
environmental, public health and safety number of small entities. Although this notice does not
effects, distributive impacts, and In addition, section 1102(b) of the constitute a substantive rule, we
equity). Section 3(f) of Executive Order Social Security Act requires us to nevertheless prepared this Impact
12866 defines a ‘‘significant regulatory prepare a RIA if a rule may have a Analysis in the interest of ensuring that
action’’ as an action that is likely to significant impact on the operations of the impacts of this notice are fully
result in a rule: (1) Having an annual a substantial number of small rural understood.
effect on the economy of $100 million hospitals. This analysis must conform to Dated: October 3, 2018.
or more in any 1 year, or adversely and the provisions of section 604 of the
Seema Verma,
materially affecting a sector of the RFA. For purposes of section 1102(b) of
economy, productivity, competition, the Act, we define a small rural hospital Administrator, Centers for Medicare &
Medicaid Services.
jobs, the environment, public health or as a hospital that is located outside of
safety, or state, local or tribal a metropolitan statistical area and has Dated: October 11, 2018.
governments or communities (also fewer than 100 beds. This annual notice Alex M. Azar II,
referred to as ‘‘economically announces the Medicare Part A Secretary, Department of Health and Human
significant’’); (2) creating a serious deductible and coinsurance amounts for Services.
inconsistency or otherwise interfering CY 2019 and will have an impact on the [FR Doc. 2018–22526 Filed 10–12–18; 11:15 am]
with an action taken or planned by Medicare beneficiaries. As a result, we BILLING CODE 4120–01–P
another agency; (3) materially altering are not preparing an analysis for section
the budgetary impacts of entitlement 1102(b) of the Act because the Secretary
grants, user fees, or loan programs or the has determined that this notice will not DEPARTMENT OF HEALTH AND
rights and obligations of recipients have a significant impact on the HUMAN SERVICES
thereof; or (4) raising novel legal or operations of a substantial number of
policy issues arising out of legal small rural hospitals. Centers for Medicare & Medicaid
mandates, the President’s priorities, or Section 202 of the Unfunded Services
the principles set forth in the Executive Mandates Reform Act of 1995 (UMRA) [CMS–8070–N]
Order. also requires that agencies assess
A regulatory impact analysis (RIA) anticipated costs and benefits before RIN 0938–AT35
must be prepared for major rules with issuing any rule whose mandates
Medicare Program; Medicare Part B
economically significant effects ($100 require spending in any 1 year of $100
Monthly Actuarial Rates, Premium
million or more in any 1 year). Although million in 1995 dollars, updated
Rates, and Annual Deductible
we do not consider this notice to annually for inflation. In 2018, that
Beginning January 1, 2019
constitute a substantive rule, this notice threshold is approximately $150
is economically significant under million. This notice does not impose AGENCY: Centers for Medicare &
section 3(f)(1) of Executive Order 12866. mandates that will have a consequential Medicaid Services (CMS), HHS.
As stated in section IV of this notice, we effect of $150 million or more on state, ACTION: Notice.
estimate that the total increase in costs local, or tribal governments or on the
to beneficiaries associated with this private sector. SUMMARY: This notice announces the
notice is about $390 million due to: (1) Executive Order 13132 establishes monthly actuarial rates for aged (age 65
The increase in the deductible and certain requirements that an agency and over) and disabled (under age 65)
coinsurance amounts; and (2) the must meet when it promulgates a beneficiaries enrolled in Part B of the
increase in the number of deductibles proposed rule (and subsequent final Medicare Supplementary Medical
and daily coinsurance amounts paid. rule) that imposes substantial direct Insurance (SMI) program beginning
The RFA requires agencies to analyze requirement costs on state and local January 1, 2019. In addition, this notice
options for regulatory relief of small governments, preempts state law, or announces the monthly premium for
entities, if a rule has a significant impact otherwise has Federalism implications. aged and disabled beneficiaries, the
daltland on DSKBBV9HB2PROD with NOTICES
on a substantial number of small This notice will not have a substantial deductible for 2019, and the income-
entities. For purposes of the RFA, small direct effect on state or local related monthly adjustment amounts to
entities include small businesses, governments, preempt state law, or be paid by beneficiaries with modified
nonprofit organizations, and small otherwise have Federalism implications. adjusted gross income above certain
governmental jurisdictions. Most Executive Order 13771, titled threshold amounts. The monthly
hospitals and most other providers and ‘‘Reducing Regulation and Controlling actuarial rates for 2019 are $264.90 for
suppliers are small entities, either by Regulatory Costs,’’ was issued on aged enrollees and $315.40 for disabled
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Document Created: 2018-10-17 01:48:27
Document Modified: 2018-10-17 01:48:27
| 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. | |
| Dates | Effective Date: This notice is effective on January 1, 2019. | |
| Contact | Yaminee Thaker, (410) 786-7921 for general information. Gregory J. Savord, (410) 786-1521 for case-mix analysis. | |
| FR Citation | 83 FR 52459 | |
| RIN Number | 0938-AT33 |
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