[Federal Register: September 28, 2007 (Volume 72, Number 188)]
[Proposed Rules]
[Page 55152-55157]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28se07-41]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 406, 407, and 408
[CMS-4129-P]
RIN 0938-A077
Medicare Program; Special Enrollment Period and Medicare Premium
Changes
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
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SUMMARY: This proposed rule would provide a special enrollment period
(SEP) for Medicare Part B and premium Part A for certain individuals
who are sponsored by prescribed organizations as volunteers outside of
the United States and who have health insurance that covers them while
outside the United States. Under the SEP provision, qualifying
volunteers can delay enrollment in Part B and premium Part A, or
terminate such coverage, for the period of service outside of the
United States and reenroll without incurring a premium surcharge for
late enrollment or reenrollment.
This proposed rule would also codify provisions that require
certain beneficiaries to pay an income-related monthly adjustment
amount (IRMAA) in addition to the standard Medicare Part B premium,
plus any applicable increase for late enrollment or reenrollment. The
income-related monthly adjustment amount is to be paid by beneficiaries
who have a modified adjusted gross income that exceeds certain
threshold amounts. It also represents the amount of decreases in
Medicare Part B premium subsidy, that is, the amount of the Federal
government's contribution to the Federal Supplementary Medicare
Insurance (SMI) Trust Fund.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on November 27,
2007.
ADDRESSES: In commenting, please refer to file code CMS-4129-P. Because
of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of four ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to http://www.cms.hhs.gov/eRulemaking. Click
on the link ``Submit electronic comments on CMS regulations with an
open comment period.'' (Attachments should be in Microsoft Word,
WordPerfect, or Excel; however, we prefer Microsoft Word.)
2. By regular mail. You may mail written comments (one original and
two copies) to the following address ONLY: Centers for Medicare &
Medicaid Services, Department of Health and Human Services, Attention:
CMS-4129-P, P.O. Box 8017, Baltimore, MD 21244-8017.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments (one
original and two copies) to the following address ONLY: Centers for
Medicare & Medicaid Services, Department of Health and Human Services,
Attention: CMS-4129-P, Mail Stop C4-26-05, 7500 Security Boulevard,
Baltimore, MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to one of the following addresses. If you
intend to deliver your comments to the Baltimore address, please call
telephone number (410) 786-7195 in advance to schedule your arrival
with one of our staff members. Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security
Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
Submission of comments on paperwork requirements. You may
[[Page 55153]]
submit comments on this document's paperwork requirements by mailing
your comments to the addresses provided at the end of the ``Collection
of Information Requirements'' section in this document.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Sam DellaVecchia, (410) 786-4481.
Denise Cox, (410) 786-3195.
SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome comments from the public on all
issues set forth in this rule to assist us in fully considering issues
and developing policies. You can assist us by referencing the file code
CMS-4129-P and the specific ``issue identifier'' that precedes the
section on which you choose to comment.
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all comments
received before the close of the comment period on the following Web
site as soon as possible after they have been received: http://www.cms.hhs.gov/eRulemaking.
Click on the link ``Electronic Comments on
CMS Regulations'' on that Web site to view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately 3
weeks after publication of a document, at the headquarters of the
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an appointment to view public comments,
phone 1-800-743-3951.
I. Background
A. General
Medicare is a Federal health insurance program that helps millions
of Americans pay for health care. Beneficiaries include eligible
individuals age 65 or older and certain people younger than age 65 who
also qualify to receive Medicare. These individuals include those who
have disabilities and those who have permanent kidney failure (end
stage renal disease).
Medicare Parts A and B are the subject of this proposed rule.
Hospital insurance (Part A) helps to pay for inpatient care in
hospitals, skilled nursing facilities, as well as home health care and
hospice care. Part B or supplementary medical insurance (SMI) helps to
pay for physicians' services, outpatient hospital services, durable
medical equipment, and a number of other medical services and supplies
that are not covered under Part A.
Part A is financed primarily through compulsory payroll taxes under
the Federal Insurance Contributions Act (``FICA''). Individuals age 65
or over who are entitled to receive Social Security or railroad
retirement benefits, or who are eligible for Social Security benefits
and have filed an application for hospital insurance, are entitled to
receive Part A benefits without paying a monthly premium. However,
individuals who do not qualify for premium-free Part A, may voluntarily
enroll in Part A but are required to pay a monthly premium. These
individuals generally include those who have not worked 10 years in
Medicare-covered employment or are not the spouse, divorced spouse or
widow(er) of an individual who has worked 10 years in Medicare-covered
employment. In addition, they must meet the following requirements: (1)
Be at least age 65; (2) a resident of the United States; (3) a United
States citizen or an alien who has been lawfully admitted for permanent
residence and who has resided continuously in the United States for the
5 year period immediately preceding the month of enrollment; (4) not
otherwise eligible to receive Part A benefits without having to pay a
premium; and (5) entitled to Part B or are eligible and have enrolled.
Enrollment in Part B is open to all persons who are entitled to
Part A benefits, as well as to persons who are not entitled to Part A
benefits provided certain requirements are satisfied. Part B is
financed primarily through premiums paid by or on behalf of
beneficiaries, along with transfers made from the General Fund of the
Treasury. Section 1839(a) of the Social Security Act (the Act) requires
the Secretary of Health and Human Services to determine the Medicare
Part B standard monthly premium amount annually. Currently, the
standard monthly premium represents approximately 25 percent of the
estimated total Part B program cost for each aged enrollee. The
remaining 75 percent of the total estimated cost is subsidized by the
Federal government through transfers to the Federal SMI Trust Fund from
the General Fund of the Treasury.
Individuals who do not enroll in Part B or premium Part A when
first eligible or who enroll and later terminate their coverage may
only enroll during the general enrollment period, which is January
through March of each year, unless an exception applies. The coverage
will be effective the following July 1. Under section 1839(b) of the
Act, individuals who delay enrolling in premium Part A or Part B for 12
or more months must pay a premium surcharge.
B. General Enrollment Period Exceptions
1. Special Enrollment Period (SEP)
Currently, section 1837(i) provides a special enrollment period
(SEP) for individuals age 65 or over who are working or who are the
spouses of working individuals who are covered under a group health
plan (GHP). For disabled individuals, who are under age 65, the SEP
applies if the individual is covered by a GHP by reason of the current
employment status of the individual or the individual's spouse, or if
the individual is covered by a large group health plan (LGHP) by reason
of the current employment status of the individual or a member of the
individual's family. In this type of situation, enrollment in Part B
can take place anytime the individual is covered under the GHP or LGHP
based on current employment status or during the 8-month period that
begins the first full month after the GHP or LGHP coverage ends.
Because section 1818(c) of the Act provides that the enrollment
provisions in section 1837 (except subsection f thereof) apply to
persons authorized to enroll in premium Part A, we have extended this
SEP to premium Part A enrollments.
2. Transfer Enrollment Period (TEP)
Another exception is the transfer enrollment period (TEP) for
enrollment in premium Part A. The TEP is for individuals age 65 or
older who are otherwise eligible to enroll in premium Part A; are
enrolled in a plan with an organization listed in section 1876 of the
Act; and whose coverage under the plan is terminated for any reason.
Here, an individual may enroll in premium Part A beginning any month
that the individual is enrolled in the plan, and ending with the last
day of the 8-month period following the last month in which the
individual is no longer enrolled in the plan.
3. Statutory Changes
Section 5115(a)(2) of the Deficit Reduction Act of 2005 (Pub. L.
109-171) (DRA) amended section 1837 of the Act to add a new subsection
(k), which provides a SEP for certain international volunteers.
Beginning January 1, 2007, a SEP for Part B is provided to qualifying
international volunteers who are eligible
[[Page 55154]]
to enroll in Part B because they meet the requirements in section
1836(1) or (2) of the Act, but who do not enroll in Part B during the
initial enrollment period or who terminate enrollment during a month in
which they qualify as an international volunteer. Enrollment can take
place during the 6-month period beginning on the first day of the month
which includes the date the individual no longer qualifies under this
provision. Coverage for an individual who enrolls during a SEP in
accordance with this provision begins on the first day of the month
following the month in which the individual enrolls.
Under new section 1837(k)(3) of the Act, an individual qualifies as
an international volunteer if he or she is serving in a program outside
of the United States that covers at least a 12-month period, and that
is sponsored by an organization described in section 501(c)(3) of the
Internal Revenue Code of 1986 (the Code) and exempt from taxation under
section 501(a) of the same Code. The individual must also have health
insurance coverage to cover medical services while serving overseas in
the program. Specifically, qualifying organizations under section
501(c)(3) of the Code that are exempt from taxation under section
501(a) of the Code are ``corporations, and any community chest, fund,
or foundation, organized and operated exclusively for religious,
charitable, scientific, testing for public safety, literary, or
educational purposes, or to foster national or international amateur
sports competition (but only if no part of its activities involve the
provision of athletic facilities or equipment), or for the prevention
of cruelty to children or animals * * *''. Furthermore, to qualify for
this exemption, no part of the net earnings of the organization can
inure to the benefit of any private shareholder or individual and no
substantial part of the activities can be used for propaganda, or
otherwise attempt to influence legislation (except as otherwise
provided in section 510(h) of the Code) or participate or intervene
(including the publishing or distributing of statements) in political
campaigns on behalf of (or in opposition to) any candidate for public
office.
C. Income-Related Monthly Adjustment Amount under Medicare Part B
Section 811 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (Pub. L. 108-173) amends section 1839
of the Act and establishes a Medicare Part B premium subsidy reduction
referred to as the ``Income-Related Monthly Adjustment Amount''
(IRMAA). Section 1839(i) of the Act requires that an income-related
monthly adjustment amount be added to beneficiary's Part B premium if
his or her modified adjusted gross income exceeds the established
threshold amounts. The IRMAA reduces the amount that the beneficiary's
premium is subsidized by the Federal government. All beneficiaries will
continue to receive some subsidy of their premium.
Section 1839(i) of the Act establishes a sliding scale that we
would use to establish four income-related monthly adjustment amounts
that would increase a beneficiary's Medicare Part B premium by specific
percentages. If a beneficiary's modified adjusted gross income is
greater than the statutory threshold amounts, the beneficiary will pay
a larger portion of the estimated total cost of Part B coverage. The
income ranges, as set forth in section 1839(i)(3)(C)(i) of the Act,
start at $80,000 for a beneficiary filing an individual tax return, and
$160,000 for a beneficiary filing a joint income tax return, and are
listed in the following table:
------------------------------------------------------------------------
Individual tax filers with income: Joint tax filers Premium
with income: percentage
------------------------------------------------------------------------
Greater than $80,000 and less than Greater than 35
or equal to $100,000. $160,000 and less
than or equal to
$200,000.
Greater than $100,000 and less Greater than 50
than or equal to $150,000. $200,000 and less
than or equal to
$300,000.
Greater than $150,000 and less Greater than 65
than or equal to $200,000. $300,000 and less
than or equal to
$400,000.
Greater than $200,000............. Greater than 80
$400,000.
------------------------------------------------------------------------
In calendar year (CY) 2007, individual tax filers with income less
than or equal to $80,000 and joint tax filers with income less than or
equal to $160,000 will continue to pay the standard premium which
represents roughly 25 percent of the estimated total Part B program
costs. As specified in section 1839(i)(5) of the Act, each dollar
amount in this table would be adjusted annually based on the Consumer
Price Index.
Section 811 of the MMA also provided for a 5-year phase-in of the
Medicare Part B premium subsidy reduction. However, section 1839(i) was
subsequently amended by section 5111 of the DRA to provide for a 3-year
phase-in period. Therefore, the percentages presented in this table
reflect the Part B premium percentages that certain beneficiaries would
pay once IRMAA is fully phased-in.
The ``hold-harmless'' provision in section 1839(f) of the Act
provides for a reduction to the Part B premium for beneficiaries whose
Social Security [or Railroad Board (RRB) annuity] cost of living
adjustments (COLAs) are not sufficient to cover the Part B premium
increase. If in a given year, the increase in the Part B premium would
cause an individual's Social Security or RRB check to be less than it
was the year before, the premium is reduced to ensure that the amount
of the individual's Social Security benefit (or RRB annuity) stays the
same. To be held harmless, a beneficiary must have had the Part B
premium deducted from both the December check of the prior year and the
January check of the next year. Under section 1839(f) of the Act, the
``hold-harmless'' provision does not apply to beneficiaries who are
required to pay an IRMAA based on their modified adjusted gross income.
These beneficiaries must pay the full Medicare Part B standard monthly
premium, plus any applicable penalty for late enrollment or
reenrollment, plus the income-related monthly adjustment amount.
Section 702(a)(5) of the Act allows SSA to make the rules and
regulations necessary or appropriate to carry out the functions of SSA.
Other provisions in section 811 of the MMA provide SSA with additional
specific authorization to make rules and regulations to determine which
beneficiaries are required to pay the different income-related monthly
adjustment amounts.
On October 27, 2006, SSA issued a final rule implementing
regulations governing SSA's determination of income-related monthly
adjustment amounts (71 FR 62923). This final rule explains: (1) The
statutory requirement to implement an income-related adjustment to the
Part B premium subsidy; (2) the information that would be used to
determine whether a beneficiary must pay an income-related monthly
adjusted amount and the amount of any adjustment; (3) when SSA will
consider a major life-changing event that results in a significant
reduction in a beneficiary's modified
[[Page 55155]]
adjusted gross income; and (4) how a beneficiary can appeal SSA's
determination about the beneficiary's income-related monthly adjustment
amount. For a more detailed discussion see the October 27, 2006 SSA
final rule (71 FR 62923).
II. Provisions of the Proposed Rule
We are proposing to add a new Sec. 406.25, which would allow
certain individuals who are sponsored by prescribed organizations as
volunteers outside of the United States and have health care insurance
to qualify for a SEP for premium hospital insurance (Part A) special
enrollment period. We recognize that section 5115 of the DRA, in
amending section 1839(b) of the Act, explicitly provides only for a SEP
for Part B. However, since section 1818(c) of the Act applies all of
the provisions of section 1837 of the Act (except subsection (f)
thereof) to persons authorized to enroll under section 1818 of the Act,
we believe that the SEP provided in section 5115 of the DRA also
applies to enrollment in premium Part A.
In Sec. 406.33(a)(3), we propose to make a technical correction by
removing an incorrect phrase ``the 7-month special enrollment period
under Sec. 406.21(e)'' and replacing it with the phrase ``the special
enrollment period under Sec. 406.24.''
In Sec. 406.33(a)(5) and (6), we propose to exclude from the
calculation of the premium surcharge those months the individual
qualifies for the SEP described in Sec. 406.25(a).
We are proposing to add a new Sec. 407.21, which implements
section 5115 of the DRA by allowing certain individuals who are
sponsored by prescribed organizations as volunteers outside of the
United States and have health care insurance that covers medical
services while serving overseas to qualify for a Medicare Part B SEP.
In proposed Sec. 408.20(e)(3)(iii), we would implement section
811(b)(1)(c) of the MMA by excluding from the ``hold harmless''
provision (known as the ``nonstandard premium'') individuals who are
required to pay the income-related monthly adjustment amount (IRMAA).
Such beneficiaries must pay the full Medicare Part B standard monthly
premium plus any applicable premium surcharge for late enrollment or
re-enrollment, plus the income-related monthly adjustment amount.
In proposed Sec. 408.24(a)(10), we would implement section 5115(a)
of the DRA by excluding from the calculation of the premium surcharge
those months the individual meets the requirements of proposed Sec.
407.21. We are also making a conforming change in Sec. 408.24(b)(2)(i)
of this section by revising the cross reference to include the new
paragraph Sec. 408.24(a)(10).
Finally, we propose to add a new Sec. 408.28, to specify that,
beginning January 1, 2007, we would inform Medicare beneficiaries that
they may be required to pay an income-related monthly adjustment amount
in addition to the standard Part B premium, plus any applicable
increase for late enrollment or reenrollment, if their modified
adjusted gross income exceeds the threshold limits specified in 20 CFR
418.1115.
III. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995, we are required to
provide 60-day notice in the Federal Register and solicit public
comment before a collection of information requirement is submitted to
the Office of Management and Budget (OMB) for review and approval. In
order to fairly evaluate whether an information collection should be
approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act
of 1995 requires that we solicit comment on the following issues:
The need for the information collection and its usefulness
in carrying out the proper functions of our agency.
The accuracy of our estimate of the information collection
burden.
The quality, utility, and clarity of the information to be
collected.
Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
We are soliciting public comment on each of these issues for the
following sections of this document that contain information collection
requirements.
Special Enrollment Period for Volunteers Outside of the United States
(Sec. 406.25)
Section 406.25 outlines the requirements that an individual
volunteer must meet to qualify for a SEP. A qualifying individual can
enroll or reenroll without incurring a surcharge for a late enrollment
or reenrollment. Specifically, Sec. 406.25(a)(3)(i) states that an
individual volunteer must demonstrate that his or her period of service
is sponsored by an organization described in section 501(c)(3) of the
Internal Revenue Code of 1986 and exempt from taxation under section
501(a) of the Internal Revenue Code.
The burden associated with this requirement is the time and effort
associated with demonstrating the tax-exempt status of the organization
sponsoring the individual. The estimated burden associated with this
requirement is 15 minutes per individual. We estimate that 1500
individuals will be subject to this requirement on a yearly basis for a
total annual burden of 375 burden hours.
In addition, Sec. 406.25(a)(3)(ii) requires that an individual
demonstrate that he or she has health insurance that covers medical
services received outside of the United States during his or her period
of service. The burden associated with this requirement is the time and
effort associated with demonstrating possession of health insurance
coverage that covers the medical services received outside of the
United States. We estimate the burden for verifying coverage to be 15
minutes per individual; we also estimate that 1500 individuals will be
subject to this requirement on a yearly basis. The total estimated
burden is 375 annual burden hours.
Special Enrollment Period for Volunteers Outside the United States
(Sec. 407.21)
Section 407.21 addresses the provision of a SEP for an individual
who elects not to enroll or to be deemed enrolled in SMI when first
eligible and an individual who terminates SMI enrollment. To be
eligible for the SEP, the individual must meet the criteria outlined in
the regulations text. As stated in Sec. 407.21(a), the individual
must: (1) Volunteer in a program for a 12-month or longer period of
service outside of the United States; (2) volunteer in a program
sponsored by an organization described in section 501(c)(3) of the
Internal Revenue Code of 1986 and exempt from taxation under 501(a) of
such Code; and (3) demonstrate that he or she had health insurance
coverage that covers medical services received outside of the United
States during his or her period of service, respectively.
The burden associated with the introductory text to Sec.
407.21(a), as well as Sec. 407.21(a)(1) and (a)(2), is the time and
effort associated with verifying the individual's volunteer period of
service, verifying the tax-exempt status of the organization sponsoring
the individual, and submitting the information to CMS. The estimated
burden associated with these requirements is 15 minutes per individual.
We estimate that 1500 individuals will be required to verify their
volunteer service. The total annual burden associated with this
requirement is 375 burden hours.
The burden associated with the Sec. 407.21(a)(3) is the time and
effort
[[Page 55156]]
associated with an individual demonstrating that he or she has health
insurance that covers medical services received outside of the United
States during his or her period of service. We estimate the burden for
verifying coverage to be 15 minutes per individual; we also estimate
that 1500 individuals will be subject to this requirement on a yearly
basis. The total estimated burden is 375 annual burden hours.
We have submitted a copy of this proposed rule to OMB for its
review of the information collection requirements contained in this
section. These requirements are not final until they are approved by
OMB.
If you comment on these information collection and recordkeeping
requirements, please mail copies directly to the following:
Centers for Medicare & Medicaid Services, Office of Strategic
Operations and Regulatory Affairs, Regulations Development Group, Attn:
William N. Parham III, CMS-4129-P, Room C4-26-05, 7500 Security
Boulevard, Baltimore, MD 21244-1850; and
Office of Information and Regulatory Affairs, Office of Management and
Budget, Room 10235, New Executive Office Building, Washington, DC
20503, Attn: Carolyn Lovett, CMS Desk Officer, CMS-4129-P,
carolyn_lovett@omb.eop.gov. Fax (202) 395-6974.
IV. Response to Comments
Because of the large number of public comments we normally receive
on Federal Register documents, we are not able to acknowledge or
respond to them individually. We will consider all comments we receive
by the date and time specified in the DATES section of this preamble,
and, when we proceed with a subsequent document, we will respond to the
comments in the preamble to that document.
V. Regulatory Impact Statement
We have examined the impact of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354),
section 1102(b) of the Social Security Act, the Unfunded Mandates
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 directs 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 rules with economically
significant effects ($100 million or more in any 1 year). We do not
anticipate that there will be more than 1500 beneficiaries
(international volunteers) at any one time who will qualify for a SEP.
To qualify under this SEP, the Medicare beneficiary must have elected
not to enroll in Part B or premium Part A during the initial enrollment
period, or terminated enrollment, because the individual was serving as
a volunteer outside the United States. In addition, the individual must
have served as a volunteer outside of the United States through a
program that covers at least a 12-month period, and that is sponsored
by an organization described in section 501(C)(3) of the Internal
Revenue Code of 1986 and exempt from taxation under section 501(a) of
that Code, and must have health care insurance coverage that covers
medical services while serving overseas in the program. It is for this
reason, that we anticipate that the overall expenditure for this
provision of the Medicare program projected over a 5-year period would
be negligible. In addition, this rule only codifies the income-related
monthly adjustment amount provision of MMA. It is for these reasons
that this rule does not reach the economic threshold and thus is not
considered a major rule.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. 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
$6 million to $29 million in any 1 year. Individuals and States are not
included in the definition of a small entity. We are not preparing an
analysis for the RFA because we have determined that this rule will not
have a significant economic impact on a substantial number of small
entities.
In addition, section 1102(b) of the Act requires us to prepare a
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 603 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. We are not preparing an
analysis for section 1102(b) of the Act, because we have determined
that this proposed rule 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. That threshold
level is currently approximately $120 million. This rule will have no
consequential effect 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. We have determined that this proposed rule does not
impose any costs on State or local governments, therefore the
requirements of E.O. 13132 are not applicable.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
List of Subjects
42 CFR Part 406
Health facilities, Kidney diseases, Medicare.
42 CFR Part 407
Medicare.
42 CFR Part 408
Medicare.
For the reasons set forth in the preamble, the Centers for Medicare
& Medicaid Services would amend 42 CFR Chapter IV as follows:
PART 406--HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT
1. The authority citation for part 406 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart C--Premium Hospital Insurance
2. Section 406.25 is added to read as follows:
Sec. 406.25 Special enrollment period for volunteers outside the
United States.
(a) General rule. An individual described in paragraph (a)(2) may
use a SEP as defined in Sec. 406.24(a)(4) of this section if--
[[Page 55157]]
(1) At the time the individual first met the requirements of Sec.
406.10 through 406.15 or Sec. 406.20(b), the individual elected not to
enroll in premium Part A during the individual's initial enrollment
period; or
(2) The individual terminated enrollment in premium hospital
insurance during a month in which the individual was described in
paragraph (a)(2) of this section.
(3) For purposes of paragraphs (a)(1) and (a)(2) of this section,
an individual--
(i) Is serving as a volunteer outside of the United States through
a program that covers at least a 12-month period and that is sponsored
by an organization described in section 501(c)(3) of the Internal
Revenue Code of 1986 and exempt from taxation under section 501(a) of
such Code; and
(ii) Can demonstrate that he or she has health insurance that
covers medical services that the individual receives outside the United
States while serving in the program.
(b) Duration of SEP. The SEP is the 6-month period beginning on the
first day of the month which includes the date that the individual no
longer meets the description in paragraph (a)(2) of this section.
(c) Effective date of coverage. If the individual enrolls in
premium hospital insurance in accordance with a SEP authorized by this
section, coverage begins on the first day of the month following the
month in which the individual enrolls.
3. Section 406.33 is amended by--
A. Revising paragraph (a)(3).
B. Adding paragraphs (a)(5) and (a)(6).
The revision and additions read as follows:
Sec. 406.33 Determination of months to be counted for premium
increase: Enrollment.
* * * * *
(a) * * *
* * * * *
(3) Any months during the SEP under Sec. 406.24 of this part,
during which premium hospital insurance coverage is in effect.
* * * * *
(5) For premiums due for months after December 2006, any months
during which the individual met the provisions of Sec. 406.25(a) of
this subpart.
(6) Any months during the 6-month SEP described in Sec. 406.25(b)
of this part during which premium hospital insurance coverage is in
effect.
PART 407--SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND
ENTITLEMENT
4. The authority citation for part 407 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart B--Individual Enrollment and Entitlement for SMI
5. Section 407.21 is added to read as follows:
Sec. 407.21 Special enrollment period for volunteers outside the
United States.
(a) General rule. A SEP, as defined in Sec. 406.24(a)(4) of this
subchapter, is provided for an individual who does not elect to enroll
or to be deemed enrolled in Part B (SMI) when first eligible, or who
terminates SMI enrollment, if while serving as a volunteer outside of
the United States--
(1) The individual is in a program that covers at least a 12-month
period of service outside of the United States;
(2) The program is sponsored by an organization described in
section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from
taxation under section 501(a) of such Code; and
(3) The individual demonstrates that he or she has health insurance
that covers medical services that the individual receives outside of
the United States during his or her period of service.
(b) Duration of SEP. The SEP is the 6-month period beginning on the
first day of the month which includes the date that the individual no
longer satisfies the provisions of paragraph (b) of this section.
(c) Effective date of coverage. For individuals enrolling in an SEP
under this section, coverage begins on the first day of the month
following the month in which the individual enrolls.
PART 408--PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE
6. The authority citation for part 408 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart B--Amount of Monthly Premiums
7. Section 408.20 is amended by adding paragraph (e)(3)(iii) to
read as follows:
Sec. 408.20 Monthly premiums.
* * * * *
(e) * * *
(3) * * *
(iii) Beginning with CY 2007, a nonstandard premium may not be
applied to individuals who are required to pay an income-related
monthly adjustment amount described in Sec. 408.28 of this part.
* * * * *
8. Section 408.24 is amended by--
A. Adding paragraph (a)(10).
B. Revising paragraph (b)(2)(i).
The addition and revision read as follows:
Sec. 408.24 Individuals who enrolled or reenrolled before April 1,
1981 or after September 30, 1981.
(a) * * *
* * * * *
(10) For premiums due for months beginning with January 1, 2007,
the following:
(i) Any months after December 2006 during which the individual met
the conditions under Sec. 407.21(a) of this chapter.
(ii) Any months of SMI coverage for which the individual enrolled
during a special enrollment period as provided in Sec. 407.21(b) of
this chapter.
(b) * * *
(2) * * *
(i) Any of the periods specified in paragraph (a); and
* * * * *
9. Section 408.28 is added to read as follows:
Sec. 408.28 Increased premiums due to the income-related monthly
adjustment amount (IRMAA).
Beginning January 1, 2007, Medicare beneficiaries must pay an
income-related monthly adjustment amount in addition to the Part B
standard monthly premium plus any applicable increase for late
enrollment or reenrollment if the beneficiary's modified adjusted gross
income exceeds the threshold amounts specified in 20 CFR 418.1115.
(Authority: Catalog of Federal Domestic Assistance Program No.
93.773, Medicare--Hospital Insurance; and Program No. 93.774,
Medicare--Supplementary Medical Insurance Program.)
Dated: March 1 2007.
Leslie V. Norwalk,
Acting Administrator, Centers for Medicare & Medicaid Services.
Approved: June 4, 2007.
Michael O. Leavitt,
Secretary.
Editorial Note: This document was received at the Office of the
Federal Register on September 14, 2007.
[FR Doc. E7-18467 Filed 9-27-07; 8:45 am]
BILLING CODE 4120-01-P