Federal Register / Vol. 78, No. 210 / Wednesday, October 30, 2013 / Notices 64951 

Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate 

tax return from their spouse: 

Incomerelated 

monthly 

adjustment 

amount 

Total 

monthly 

premium 

amount 

Less than or equal to $85,000 ........................................................................................................................ $0.00 $104.90 

Greater than $85,000 and less than or equal to $129,000 ............................................................................. 167.80 272.70 

Greater than $129,000 .................................................................................................................................... 230.80 335.70 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses, 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 $7.0 million to $34.5 

million in any 1 year. Individuals and 

States are not included in the definition 

of a small entity. This notice announces 

the monthly actuarial rates for aged (age 

65 and over) and disabled (under 65) 

beneficiaries enrolled in Part B of the 

Medicare SMI program beginning 

January 1, 2014. Also, this notice 

announces the monthly premium for 

aged and disabled beneficiaries as well 

as the income-related monthly 

adjustment amounts to be paid by 

beneficiaries with modified adjusted 

gross income above certain threshold 

amounts. 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 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. As we discussed 

previously, 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 effect on 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 2013, that 

threshold is approximately $141 

million. This notice does not impose 

mandates that will have a consequential 

effect of $142 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 publishes a proposed 

rule (and subsequent final rule) that 

imposes substantial direct compliance 

costs on State and local governments, 

preempts State law, or otherwise has 

Federalism implications. We have 

determined that this notice does not 

significantly affect the rights, roles, and 

responsibilities of States. 

For 2014, the standard Part B 

premium rate, the Part B income-related 

premium rates, and the Part B 

deductible are the same as the 

respective amounts for 2013. Therefore, 

this notice is not a major rule as defined 

in 5 U.S.C. 804(2) and is not an 

economically significant rule under 

Executive Order 12866. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

IV. Waiver of Proposed Notice 

The Medicare statute requires the 

publication of the monthly actuarial 

rates and the Part B premium amounts 

in September. We ordinarily use general 

notices, rather than notice and comment 

rulemaking procedures, to make such 

announcements. In doing so, we note 

that, under the Administrative 

Procedure Act, interpretive rules, 

general statements of policy, and rules 

of agency organization, procedure, or 

practice are excepted from the 

requirements of notice and comment 

rulemaking. 

We considered publishing a proposed 

notice to provide a period for public 

comment. However, we may waive that 

procedure if we find, for good cause, 

that prior notice and comment are 

impracticable, unnecessary, or contrary 

to the public interest. The statute 

establishes the time period for which 

the premium rates will apply, and 

delaying publication of the Part B 

premium rate such that it would not be 

published before that time would be 

contrary to the public interest. 

Moreover, we find that notice and 

comment are unnecessary because the 

formulas used to calculate the Part B 

premiums are statutorily directed. 

Therefore, we find good cause to waive 

publication of a proposed notice and 

solicitation of public comments. 

(Catalog of Federal Domestic Assistance 

Program No. 93.774, Medicare— 

Supplementary Medical Insurance Program) 

Dated: September 20, 2013. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: October 18, 2013 

Kathleen Sebelius, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2013–25668 Filed 10–28–13; 11:15 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8054–N] 

RIN 0938–AR57 

Medicare Program; Part A Premiums 

for CY 2014 for the Uninsured Aged 

and for Certain Disabled Individuals 

Who Have Exhausted Other 

Entitlement 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This annual notice announces 

Medicare’s Hospital Insurance (Part A) 

premium for uninsured enrollees in 

calendar year (CY) 2014. This premium 

is paid by enrollees age 65 and over who 

are not otherwise eligible for benefits 

under Medicare Part A (hereafter known 

as the ‘‘uninsured aged’’) and by certain 

disabled individuals who have 

exhausted other entitlement. The 

monthly Part A premium for the 12 

months beginning January 1, 2014, for 

these individuals will be $426. The 

premium for certain other individuals as 

described in this notice will be $234. 

DATES: Effective Date: This notice is 

effective on January 1, 2014. 


emcdonald on DSK67QTVN1PROD with NOTICES
64952 Federal Register / Vol. 78, No. 210 / Wednesday, October 30, 2013 / Notices 

FOR FURTHER INFORMATION CONTACT: 

Clare McFarland, (410) 786–6390. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1818 of the Social Security 

Act (the Act) provides for voluntary 

enrollment in the Medicare Hospital 

Insurance Program (Medicare Part A), 

subject to payment of a monthly 

premium, of certain persons aged 65 

and older who are uninsured under the 

Old-Age, Survivors, and Disability 

Insurance (OASDI) program or the 

Railroad Retirement Act and do not 

otherwise meet the requirements for 

entitlement to Medicare Part A. These 

‘‘uninsured aged’’ individuals are 

uninsured under the OASDI program or 

the Railroad Retirement Act, because 

they do not have 40 quarters of coverage 

under Title II of the Act (or are/were not 

married to someone who did). (Persons 

insured under the OASDI program or 

the Railroad Retirement Act and certain 

others do not have to pay premiums for 

Medicare Part A.) 

Section 1818A of the Act provides for 

voluntary enrollment in Medicare Part 

A, subject to payment of a monthly 

premium for certain disabled 

individuals who have exhausted other 

entitlement. These are individuals who 

were entitled to coverage due to a 

disabling impairment under section 

226(b) of the Act, but who are no longer 

entitled to disability benefits and free 

Medicare Part A coverage because they 

have gone back to work and their 

earnings exceed the statutorily defined 

‘‘substantial gainful activity’’ amount 

(section 223(d)(4) of the Act). 

Section 1818A(d)(2) of the Act 

specifies that the provisions relating to 

premiums under section 1818(d) 

through section 1818(f) of the Act for 

the aged will also apply to certain 

disabled individuals as described above. 

Section 1818(d) of the Act requires us 

to estimate, on an average per capita 

basis, the amount to be paid from the 

Federal Hospital Insurance Trust Fund 

for services incurred in the upcoming 

calendar year (CY) (including the 

associated administrative costs) on 

behalf of individuals aged 65 and over 

who will be entitled to benefits under 

Medicare Part A. We must then 

determine the monthly actuarial rate for 

the following year (the per capita 

amount estimated above divided by 12) 

and publish the dollar amount for the 

monthly premium in the succeeding CY. 

If the premium is not a multiple of $1, 

the premium is rounded to the nearest 

multiple of $1 (or, if it is a multiple of 

50 cents but not of $1, it is rounded to 

the next highest $1). 

Section 13508 of the Omnibus Budget 

Reconciliation Act of 1993 (Pub. L. 103– 

66) amended section 1818(d) of the Act 

to provide for a reduction in the 

premium amount for certain voluntary 

enrollees (section 1818 and section 

1818A of the Act). The reduction 

applies to an individual who is eligible 

to buy into the Medicare Part A program 

and who, as of the last day of the 

previous month: 

• Had at least 30 quarters of coverage 

under Title II of the Act; 

• Was married, and had been married 

for the previous 1-year period, to a 

person who had at least 30 quarters of 

coverage; 

• Had been married to a person for at 

least 1 year at the time of the person’s 

death if, at the time of death, the person 

had at least 30 quarters of coverage; or 

• Is divorced from a person and had 

been married to the person for at least 

10 years at the time of the divorce if, at 

the time of the divorce, the person had 

at least 30 quarters of coverage. 

Section 1818(d)(4)(A) of the Act 

specifies that the premium that these 

individuals will pay for CY 2014 will be 

equal to the premium for uninsured 

aged enrollees reduced by 45 percent. 

II. Monthly Premium Amount for CY 

2014 

The monthly premium for the 

uninsured aged and certain disabled 

individuals who have exhausted other 

entitlement for the 12 months beginning 

January 1, 2014, is $426. 

The monthly premium for the 

individuals eligible under Section 

1818(d)(4)(B) of the Act, and therefore 

subject to the 45 percent reduction in 

the monthly premium, is $234. 

III. Monthly Premium Rate Calculation 

As discussed in section I of this 

notice, the monthly Medicare Part A 

premium is equal to the estimated 

monthly actuarial rate for CY 2014 

rounded to the nearest multiple of $1 

and equals one-twelfth of the average 

per capita amount, which is determined 

by projecting the number of Part A 

enrollees aged 65 years and over as well 

as the benefits and administrative costs 

that will be incurred on their behalf. 

The steps involved in projecting these 

future costs to the Federal Hospital 

Insurance Trust Fund are: 

• Establishing the present cost of 

services furnished to beneficiaries, by 

type of service, to serve as a projection 

base; 

• Projecting increases in payment 

amounts for each of the service types; 

and 

• Projecting increases in 

administrative costs. 

We base our projections for CY 2014 

on: (1) Current historical data, and (2) 

projection assumptions derived from 

current law and the Mid-Session Review 

of the President’s Fiscal Year 2014 

Budget. 

We estimate that in CY 2014, 

43,923,567 people aged 65 years and 

over will be entitled to benefits (without 

premium payment) and that they will 

incur about $224.753 billion in benefits 

and related administrative costs. Thus, 

the estimated monthly average per 

capita amount is $426.41 and the 

monthly premium is $426. 

Subsequently, the full monthly 

premium reduced by 45 percent is $234. 

IV. Costs to Beneficiaries 

The CY 2014 premium of $426 is 

approximately 3.40 percent lower than 

the CY 2013 premium of $441. We 

estimate that approximately 626,000 

enrollees will voluntarily enroll in 

Medicare Part A by paying the full 

premium. Furthermore, the CY 2014 

reduced premium of $234 is 

approximately 3.70 percent lower than 

the CY 2013 premium of $243. We 

estimate an additional 55,000 enrollees 

will pay the reduced premium. 

Therefore, we estimate that the total 

aggregate savings to enrollees paying 

these premiums in CY 2014, compared 

to the amount that they paid in CY 

2013, will be about $119 million. 

V. Waiver of Proposed Notice and 

Comment Period 

We use general notices, rather than 

notice and comment rulemaking 

procedures, to make announcements 

such as this premium notice. In doing 

so, we acknowledge that, under the 

Administrative Procedure Act (APA), 

interpretive rules, general statements of 

policy, and rules of agency organization, 

procedure, or practice are excepted from 

the requirements of notice and comment 

rulemaking. The agency may also waive 

notice and comment if there is ‘‘good 

cause,’’ as defined by the statute. We 

considered publishing a proposed 

notice to provide a period for public 

comment. However, under the APA, we 

may waive that procedure if we find 

good cause that prior notice and 

comment are impracticable, 

unnecessary, or contrary to the public 

interest. 

We are not using notice and comment 

rulemaking in this notification of 

Medicare Part A premiums for CY 2014 

as that procedure is unnecessary 

because of the lack of discretion in the 

statutory formula that is used to 

calculate the premium and the solely 

ministerial function that this notice 

serves. The APA permits agencies to 


emcdonald on DSK67QTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 210 / Wednesday, October 30, 2013 / Notices 64953 

waive notice and comment rulemaking 

when notice and public comment 

thereon are unnecessary. On this basis, 

we waive publication of a proposed 

notice and a solicitation of public 

comments. 

VI. Collection of Information 

Requirements 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

VII. Regulatory Impact Analysis 

A. Statement of Need 

Section 1818(d) of the Act requires 

the Secretary of the Department of 

Health and Human Services (the 

Secretary) during September of each 

year to determine and publish the 

amount to be paid, on an average per 

capita basis, from the Federal Hospital 

Insurance Trust Fund for services 

incurred in the impending calendar year 

(CY) (including the associated 

administrative costs) on behalf of 

individuals aged 65 and over who will 

be entitled to benefits under Medicare 

Part A. 

B. Overall Impact 

We have examined the impacts of this 

rule as required by Executive Order 

12866 on Regulatory Planning and 

Review (September 30, 1993), Executive 

Order 13563 on Improving Regulation 

and Regulatory Review (January 18, 

2011), the Regulatory Flexibility Act 

(RFA) (September 19, 1980, Pub. L. 96– 

354), section 1102(b) of the Social 

Security Act, section 202 of the 

Unfunded Mandates Reform Act of 1995 

(March 22, 1995; Pub. L. 104–4), 

Executive Order 13132 on Federalism 

(August 4, 1999), and the Congressional 

Review Act (5 U.S.C., Part I, Ch. 8). 

Executive Orders 12866 and 13563 

direct agencies to assess all costs and 

benefits of available regulatory 

alternatives and, if regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). A regulatory impact analysis 

(RIA) must be prepared for major 

notices with economically significant 

effects ($100 million or more in any 1 

year). As stated in section IV of this 

notice, we estimate that the overall 

effect of the changes in the Part A 

premium will be a savings to voluntary 

enrollees (section 1818 and section 

1818A of the Act) of about $119 million. 

As a result, this notice is economically 

significant under section 3(f)(1) of 

Executive Order 12866 and thus, a 

major action under the Congressional 

Review Act. In accordance with the 

provisions of Executive Order 12866, 

this notice was reviewed by the Office 

of Management and Budget. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

entities, if a rule has a significant impact 

on a substantial number of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of less than $7.0 million to $35.5 

million in any 1 year (for details, see the 

Small Business Administration’s Web 

site at http://www.sba.gov/sites/default/ 

files/files/Size_Standards_Table.pdf). 

Individuals and states are not 

included in the definition of a small 

entity. As discussed above, this annual 

notice announces Medicare’s Hospital 

Insurance (Part A) premium for 

uninsured enrollees in calendar year 

(CY) 2014. As a result, we are not 

preparing an analysis for the RFA 

because the Secretary has determined 

that this notice will not have a 

significant economic impact on a 

substantial number of small entities. 

In addition, section 1102(b) of the 

Social Security Act requires us to 

prepare a regulatory impact analysis if 

a rule may have a significant impact on 

the operations of a substantial number 

of small rural hospitals. This analysis 

must conform to the provisions of 

section 604 of the RFA. For purposes of 

section 1102(b) of the Act, we define a 

small rural hospital as a hospital that is 

located outside of a Metropolitan 

Statistical Area for Medicare payment 

regulations and has fewer than 100 

beds. As discussed above, we are not 

preparing an analysis for section 1102(b) 

of the Act, because the Secretary has 

determined that this notice will not 

have a significant impact on the 

operations of a substantial number of 

small rural hospitals. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule whose mandates require spending 

in any 1 year of $100 million in 1995 

dollars, updated annually for inflation. 

In 2013, that threshold is approximately 

$141 million. This notice does not 

impose mandates that will have a 

consequential effect of $141 million or 

more on state, local, or tribal 

governments or on the private sector. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on state and local 

governments, preempts state law, or 

otherwise has Federalism implications. 

Since this notice does not impose any 

costs on state or local governments, the 

requirements of Executive Order 13132 

are not applicable. 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance) 

Dated: September 20, 2013. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Dated: October 18, 2013. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2013–25591 Filed 10–28–13; 11:15 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8053–N] 

RIN 0938–AR59 

Medicare Program; Inpatient Hospital 

Deductible and Hospital and Extended 

Care Services Coinsurance Amounts 

for CY 2014 

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) 2014 

under Medicare’s Hospital Insurance 

Program (Medicare Part A). The 

Medicare statute specifies the formulae 

used to determine these amounts. For 

CY 2014, the inpatient hospital 

deductible will be $1,216. The daily 

coinsurance amounts for CY 2014 will 

be: $304 for the 61st through 90th day 

of hospitalization in a benefit period; 

$608 for lifetime reserve days; and $152 

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, 2014. 

FOR FURTHER INFORMATION CONTACT: 

Clare McFarland, (410) 786–6390 for 


emcdonald on DSK67QTVN1PROD with NOTICES