[Federal Register: June 27, 2008 (Volume 73, Number 125)]
[Rules and Regulations]
[Page 36463-36469]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27jn08-17]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 406, 407, and 408
[CMS-4129-F]
RIN 0938-AO77
Medicare Program; Special Enrollment Period and Medicare Premium
Changes
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This final rule provides 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 final rule also codifies 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 the 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: Effective Date: These regulations are effective on August 26,
2008.
FOR FURTHER INFORMATION CONTACT: Denise Cox, (410) 786-3195.
SUPPLEMENTARY INFORMATION:
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
[[Page 36464]]
disabilities and those who have permanent kidney failure (end-stage
renal disease).
Medicare Parts A and B are the subject of this final 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 aged enrollees. 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) of the Act 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 (DRA) (Pub.
L. 109-171) 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 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.
[[Page 36465]]
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 a 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 will be
used to establish four income-related monthly adjustment amounts that
will 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
2007 income ranges, as set forth in section 1839(i)(3)(C)(i) of the
Act, started 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 Joint tax filers with Premium
income: income: percentage
------------------------------------------------------------------------
Greater than $80,000 and less Greater than $160,000 35
than or equal to $100,000. and less than or equal
to $200,000.
Greater than $100,000 and less Greater than $200,000 50
than or equal to $150,000. and less than or equal
to $300,000.
Greater than $150,000 and less Greater than $300,000 65
than or equal to $200,000. and less than or equal
to $400,000.
Greater than $200,000.......... Greater than $400,000.. 80
------------------------------------------------------------------------
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 will
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.
In the October 27, 2006 Federal Register (71 FR 62923), SSA issued
a final rule establishing regulations governing the determination of
income-related monthly adjustment amounts. 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 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 SSA's October 27, 2006 final rule (71 FR
62923).
II. Provisions of the Proposed Regulation and Analysis of and Responses
to Public Comments
We received four timely public comments in response to the Special
Enrollment Period and Medicare Premium Changes proposed rule published
in the September 28, 2007 Federal Register. In this section of the
final rule, we address all comments received regarding the provisions
of our proposed rule.
We proposed 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). 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, which we have provided
for in new Sec. 407.21. 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.
Comment: Three commenters expressed concern that although Sec.
406.25 of the September 2007 proposed rule tracks the language of
section 5115 of the DRA, Sec. 407.21 is not worded exactly the same as
Sec. 406.25 and could be interpreted as imposing different standards.
Specifically, they believe that the requirements of Sec. 406.25 (``an
individual [that] is serving as a volunteer outside the United States
through a program that covers at least a 12-month period'') and the
requirement of Sec. 407.21 (``if while serving as a volunteer outside
of the United States the individual is in a program that covers a 12-
month period of service outside of the United States'') are two
different standards.
[[Page 36466]]
The commenters also note that there is a slight difference between
the wordings in the preamble for these two sections. They believe that
Sec. 406.25 and Sec. 407.21 should be substantively identical.
Response: To ensure that the SEP standards are interpreted
consistently, we are revising the regulation text of Sec. 406.25 and
Sec. 407.21.
In Sec. 406.33(a)(3), we proposed 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.'' We did not receive any public
comment on this proposal and are adopting the provision with only a
technical change, as discussed further in this section.
In Sec. 406.33(a)(5) and (6), we proposed to exclude from the
calculation of the premium surcharge those months the individual
qualifies for the SEP described in Sec. 406.25(a). We did not receive
any public comment on this proposal and are adopting the provision with
technical changes, as discussed further in this section.
We proposed 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.
Comment: Two commenters noted that section 5115 of the DRA requires
that volunteers serve in a program that covers at least a 12-month
period, as opposed to requiring that their actual service outside the
country last for at least 12 months. These commenters stated that,
under rare, unforeseeable circumstances, a volunteer in a program that
covers at least a 12-month period may be required to return to the
United States in less than 12 months. They believe that these
volunteers should qualify for the SEP provided by section 5115 of the
DRA.
Response: We agree and have revised Sec. 407.21 to clarify that
the volunteer has to serve in a program that covers at least a 12-month
period.
In Sec. 408.20 (e)(3)(iii), we proposed to 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. We
did not receive any public comment on this proposal and are adopting
the provision as proposed.
In Sec. 408.24(a)(10), we proposed to 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 also proposed to make 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). We did not receive any public
comment on these proposals and are adopting the provisions as proposed.
Finally, we proposed to add a new Sec. 408.28 to specify that,
beginning January 1, 2007, Medicare beneficiaries will be informed 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. We did not receive any public comment on this proposal and
are adopting the provision as proposed.
After review and analysis of public comment, we are also making the
following technical changes in this final rule:
In Sec. 406.33(a)(3), the cross-reference ``Sec. 406.24
of this part'' is revised to read ``Sec. 406.24 of this subpart''.
In Sec. 406.33(a)(5), the cross-reference ``Sec. 406.25
of this subpart'' is revised to read ``for a SEP under 406.25(a) of
this subpart''.
In Sec. 406.33(a)(6), the cross-reference ``Sec.
406.25(b) of this part'' is revised to read ``Sec. 406.25(b) of this
subpart''.
In Sec. 407.21(b), the cross-reference ``paragraph (b) of
this section'' is revised to read ``paragraph (a) of this section''.
Lastly, we are making a technical change to the section heading for
Sec. 406.24 to clarify that the special enrollment period relates to
coverage under group health plans.
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 (ICRs).
A. ICRs Related to Special Enrollment Period for Volunteers Outside 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)(1) and (2) state that an
individual volunteer must demonstrate that his or her volunteer service
is through a program that covers at least a 12-month period and 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 verifying that the volunteer was in a 12-month program
and 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 1,500 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) 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 1,500 individuals will be
subject to this requirement on a yearly basis. The total
[[Page 36467]]
estimated burden is 375 annual burden hours.
B. ICRs Related to 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) Serve as a volunteer in a program that covers at least a 12-
month period of service; (2) be a 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) be able to 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.
The burden associated with the requirements in Sec. 407.21(a)(1)
and (2) is the time and effort associated with verifying that the
volunteer was in a 12-month program, and demonstrating the tax-exempt
status of the organization sponsoring the individual, and submitting
the information to CMS. The burden associated with these requirements
is discussed in detail in the explanation of the burden for Sec.
406.25.
The burden associated with the Sec. 407.21(a)(3) is the time and
effort 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. The burden
associated with this requirement is discussed in detail in the
explanation of the burden for Sec. 406.25.
Table A.--Estimated Annual Reporting and Recordkeeping Burden
----------------------------------------------------------------------------------------------------------------
Burden per
Regulation section(s) OMB Control No. Respondents Responses response Total annual
(hours) burden (hours)
----------------------------------------------------------------------------------------------------------------
Sec. 406.25(a)(1 and 2) and 0938-New........ 1500 1500 .25 375
Sec. 407.21(a)(1 and 2).
Sec. 406.25(a)(3) and Sec. 0938-New........ 1500 1500 .25 375
407.21(a)(3).
---------------------------------------------------------------------------------
Total..................... ................ .............. .............. .............. 750
----------------------------------------------------------------------------------------------------------------
We have submitted a copy of this final rule to OMB for its review
of the information collection requirements contained in this section.
In addition, we are seeking OMB approval for the aforementioned
information collection requirements under a separate notice and comment
process. These requirements are not final until they are approved by
OMB.
IV. 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 1,500 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 in 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 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. We are not preparing an
analysis for section 1102(b) of the Act, because we have determined
that this final 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 (and subsequent final
rule)
[[Page 36468]]
that imposes substantial direct requirement costs on State and local
governments, preempts State law, or otherwise has Federalism
implications. We have determined that this final 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.
0
For the reasons set forth in the preamble, the Centers for Medicare &
Medicaid Services amends 42 CFR Chapter IV as follows:
PART 406--HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT
0
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
0
2. Section 406.24 is amended by revising the section heading to read as
follows:
Sec. 406.24 Special enrollment period related to coverage under group
health plans.
* * * * *
0
3. Section 406.25 is added to read as follows:
Sec. 406.25 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 that meets the following
requirements:
(1) The individual is serving as a volunteer outside of the United
States in a program that covers at least a 12-month period.
(2) The individual is in a program that is sponsored by an
organization described in section 501(c)(3) of the Internal Revenue
Code of 1986 and is exempt from taxation under section 501(a) of
Internal Revenue Code of 1986.
(3) The individual 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.
(4) The individual--
(i) At the time he or she first met the requirements of Sec.
406.10 through 406.15 or Sec. 406.20(b), elected not to enroll in
premium hospital insurance during the individual's initial enrollment
period; or
(ii) Terminated enrollment in premium hospital insurance during a
month in which the individual met the requirements of this section for
a SEP.
(b) Duration of SEP. The SEP is the 6-month period beginning on the
first day of the month that includes the date that the individual no
longer meets the requirements of paragraph (a) of this section.
(c) Effective date of coverage. Coverage under a SEP authorized by
this section begins on the first day of the month following the month
in which the individual enrolls.
0
4. Section 406.33 is amended by--
0
A. Revising paragraph (a)(3).
0
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 subpart,
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 requirements for a SEP under Sec.
406.25(a) of this subpart.
(6) Any months during the 6-month SEP described in Sec. 406.25(b)
of this subpart during which premium hospital insurance coverage is in
effect.
* * * * *
PART 407--SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND
ENTITLEMENT
0
5. 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
0
6. 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 SMI when first eligible, or who terminates
SMI enrollment, if the individual meets the following requirements:
(1) The individual is serving as a volunteer outside of the United
States in a program that covers at least a 12-month period.
(2) The individual is in a program that is sponsored by an
organization described in section 501(c)(3) of the Internal Revenue
Code of 1986 and is exempt from taxation under section 501(a) of the
Internal Revenue Code of 1986.
(3) The individual demonstrates that he or she has health insurance
that covers medical services that the individual receives outside of
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 that includes the date that the individual no
longer satisfies the provisions of paragraph (a) of this section.
(c) Effective date of coverage. Coverage under a SEP authorized by
this section, begins on the first day of the month following the month
in which the individual enrolls.
PART 408--PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE
0
7. 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
0
8. 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.
* * * * *
0
9. Section 408.24 is amended by--
0
A. Adding paragraph (a)(10).
0
B. Revising paragraph (b)(2)(i).
The addition and revision read as follows:
[[Page 36469]]
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 Part B (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) of this section;
and
* * * * *
0
10. 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
(SMI) 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.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: January 31, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
Approved: April 7, 2008.
Michael O. Leavitt,
Secretary.
[FR Doc. E8-14040 Filed 6-26-08; 8:45 am]
BILLING CODE 4120-01-P