Federal Register / Vol. 79, No. 197 / Friday, October 10, 2014 / Notices 61309 

DATES: Comments on the collection(s) of 

information must be received by the 

OMB desk officer by November 10, 

2014. 

ADDRESSES: When commenting on the 

proposed information collections, 

please reference the document identifier 

or OMB control number. To be assured 

consideration, comments and 

recommendations must be received by 

the OMB desk officer via one of the 

following transmissions: OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Fax 

Number: (202) 395–5806 OR Email: 

OIRA_submission@omb.eop.gov. 

To obtain copies of a supporting 

statement and any related forms for the 

proposed collection(s) summarized in 

this notice, you may make your request 

using one of following: 

1. Access CMS’ Web site address at 

http://www.cms.hhs.gov/Paperwork

ReductionActof1995. 

2. Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov. 

3. Call the Reports Clearance Office at 

(410) 786–1326. 

FOR FURTHER INFORMATION CONTACT: 

Reports Clearance Office at (410) 786– 

1326. 

SUPPLEMENTARY INFORMATION: Under the 

Paperwork Reduction Act of 1995 (PRA) 

(44 U.S.C. 3501–3520), federal agencies 

must obtain approval from the Office of 

Management and Budget (OMB) for each 

collection of information they conduct 

or sponsor. The term ‘‘collection of 

information’’ is defined in 44 U.S.C. 

3502(3) and 5 CFR 1320.3(c) and 

includes agency requests or 

requirements that members of the public 

submit reports, keep records, or provide 

information to a third party. Section 

3506(c)(2)(A) of the PRA (44 U.S.C. 

3506(c)(2)(A)) requires federal agencies 

to publish a 30-day notice in the 

Federal Register concerning each 

proposed collection of information, 

including each proposed extension or 

reinstatement of an existing collection 

of information, before submitting the 

collection to OMB for approval. To 

comply with this requirement, CMS is 

publishing this notice that summarizes 

the following proposed collection(s) of 

information for public comment: 

1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: State Medicaid 

HIT Plan, Planning Advance Planning 

Document, and Implementation 

Advance Planning Document for 

Section 4201 of the Recovery Act; Use: 

To assess the appropriateness of state 

requests for the administrative Federal 

financial participation for expenditures 

under their Medicaid Electronic Health 

Record Incentive Program related to 

health information exchange, our staff 

will review the submitted information 

and documentation to make an approval 

determination of the state advance 

planning document. Form Number: 

CMS–10292 (OMB control number 

0938–1088); Frequency: Once and 

occasionally; Affected Public: State, 

Local, and Tribal Governments; Number 

of Respondents: 56; Total Annual 

Responses: 56; Total Annual Hours: 

896. (For policy questions regarding this 

collection contact Thomas Romano at 

410–786–0465). 

2. Type of Information Collection 

Request: Extension of currently 

approved collection; Title of 

Information Collection: Granting and 

Withdrawal of Deeming Authority to 

Private Nonprofit Accreditation 

Organizations and of State Exemption 

Under State Laboratory Programs and 

Supporting Regulations; Use: The 

information required is necessary to 

determine whether a private 

accreditation organization/State 

licensure program standards and 

accreditation/licensure process is at 

least equal to or more stringent than 

those of the Clinical Laboratory 

Improvement Amendments of 1988 

(CLIA). If an accreditation organization 

is approved, the laboratories that it 

accredits are ‘‘deemed’’ to meet the 

CLIA requirements based on this 

accreditation. Similarly, if a State 

licensure program is determined to have 

requirements that are equal to or more 

stringent than those of CLIA, its 

laboratories are considered to be exempt 

from CLIA certification and 

requirements. The information collected 

will be used by HHS to: determine 

comparability/equivalency of the 

accreditation organization standards 

and policies or State licensure program 

standards and policies to those of the 

CLIA program; to ensure the continued 

comparability/equivalency of the 

standards; and to fulfill certain statutory 

reporting requirements. Form No.: 

CMS–R–185 (OMB control number: 

0938–0686); Frequency: Occasionally; 

Affected Public: Private Sector— 

Business or other for-profits and Notfor-profit institutions; Number of 

Respondents: 12; Total Annual 

Responses: 96; Total Annual Hours: 

384. (For policy questions regarding this 

collection contact Arlene Lopez at 410– 

786–6782.) 

3. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: Home 

Office Cost Statement Form; Use: 

Providers of services participating in the 

Medicare program are required under 

sections 1815(a) and 1861(v)(1)(A) of the 

Social Security Act (42 U.S.C. 1395g) to 

submit annual information to achieve 

settlement of costs for health care 

services rendered to Medicare 

beneficiaries. In addition, regulations at 

42 CFR 413.17, 413.20 and 413.24 

require adequate cost data and cost 

reports from providers on an annual 

basis. The home office cost statement 

form is filed annually by chain 

organizations to report costs directly 

related to services furnished to 

individual providers that are related to 

patient care plus an appropriate share of 

indirect costs. Form Number: CMS– 

287–05 (OMB control number: 0938– 

0202); Frequency: Yearly; Affected 

Public: Private sector—Business or other 

for-profit and Not-for-profit institutions; 

Number of Respondents: 1,686; Total 

Annual Responses: 1,686; Total Annual 

Hours: 785,676. (For policy questions 

regarding this collection contact Yaakov 

Feinstein at 410–786–5834.) 

Dated: October 7, 2014. 

Martique Jones, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2014–24244 Filed 10–9–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8056–N] 

RIN 0938–AR94 

Medicare Program; CY 2015 Inpatient 

Hospital Deductible and Hospital and 

Extended Care Services Coinsurance 

Amounts 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

inpatient hospital deductible and the 

hospital and extended care services 

coinsurance amounts for services 

furnished in calendar year (CY) 2015 

under Medicare’s Hospital Insurance 

Program (Medicare Part A). The 

Medicare statute specifies the formulae 

used to determine these amounts. For 

CY 2015, the inpatient hospital 

deductible will be $1,260. The daily 

coinsurance amounts for CY 2015 will 

be: (1) $315 for the 61st through 90th 

day of hospitalization in a benefit 

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61310 Federal Register / Vol. 79, No. 197 / Friday, October 10, 2014 / Notices 

period; (2) $630 for lifetime reserve 

days; and (3) $157.50 for the 21st 

through 100th day of extended care 

services in a skilled nursing facility in 

a benefit period. 

DATES: Effective Date: This notice is 

effective on January 1, 2015. 

FOR FURTHER INFORMATION: Clare 

McFarland, (410) 786–6390 for general 

information; Gregory J. Savord, (410) 

786–1521 for case-mix analysis. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1813 of the Social Security 

Act (the Act) provides for an inpatient 

hospital deductible to be subtracted 

from the amount payable by Medicare 

for inpatient hospital services furnished 

to a beneficiary. It also provides for 

certain coinsurance amounts to be 

subtracted from the amounts payable by 

Medicare for inpatient hospital and 

extended care services. Section 

1813(b)(2) of the Act requires us to 

determine and publish each year the 

amount of the inpatient hospital 

deductible and the hospital and 

extended care services coinsurance 

amounts applicable for services 

furnished in the following calendar year 

(CY). 

II. Computing the Inpatient Hospital 

Deductible for CY 2015 

Section 1813(b) of the Act prescribes 

the method for computing the amount of 

the inpatient hospital deductible. The 

inpatient hospital deductible is an 

amount equal to the inpatient hospital 

deductible for the preceding CY, 

adjusted by our best estimate of the 

payment-weighted average of the 

applicable percentage increases (as 

defined in section 1886(b)(3)(B) of the 

Act) used for updating the payment 

rates to hospitals for discharges in the 

fiscal year (FY) that begins on October 

1 of the same preceding CY, and 

adjusted to reflect changes in real casemix. The adjustment to reflect real casemix is determined on the basis of the 

most recent case-mix data available. The 

amount determined under this formula 

is rounded to the nearest multiple of $4 

(or, if midway between two multiples of 

$4, to the next higher multiple of $4). 

Under section 1886(b)(3)(B)(i)(XX) of 

the Act, the percentage increase used to 

update the payment rates for FY 2015 

for hospitals paid under the inpatient 

prospective payment system is the 

market basket percentage increase, 

otherwise known as the market basket 

update, reduced by 0.2 percentage 

points (see section 1886(b)(3)(B)(xii)(IV) 

of the Act), and an adjustment based on 

changes in the economy-wide 

productivity (the multifactor 

productivity (MFP) adjustment) (see 

section 1886(b)(3)(B)(xi)(II) of the Act). 

Under section 1886(b)(3)(B)(viii) of the 

Act, beginning with fiscal year 2015, the 

applicable percentage increase for 

hospitals that do not submit quality data 

as specified by the Secretary of the 

Department of Health and Human 

Services (the Secretary) is reduced by 

one quarter of the market basket update. 

We are estimating that after accounting 

for those hospitals receiving the lower 

market basket update in the paymentweighted average update, the calculated 

deductible will not be affected, since the 

majority of hospitals submit quality data 

and receive the full market basket 

update. Beginning with FY 2015, 

section 1886(b)(3)(B)(ix) of the Act 

requires that any hospital that is not a 

meaningful electronic health record 

(EHR) user (as defined in section 

1886(n)(3) of the Act) will have threequarters of the market basket update 

reduced by 331⁄3 percent for FY 2015, 

662⁄3 percent for FY 2016, and 100 

percent for FY 2017 and each 

subsequent fiscal year. We are 

estimating that after accounting for 

these hospitals receiving the lower 

market basket update, the calculated 

deductible will not be affected, since the 

majority of hospitals are meaningful 

EHR users and are expected to receive 

the full market basket update. 

Under section 1886(b)(3)(B)(ii)(VIII) of 

the Act, the percentage increase used to 

update the payment rates for FY 2015 

for hospitals excluded from the 

inpatient prospective payment system is 

as follows: 

• The percentage increase for long 

term care hospitals is the market basket 

percentage increase reduced by 0.2 

percentage points and the MFP 

adjustment (see sections 1886(m)(3)(A) 

and 1886(m)(4)(E) of the Act). 

• The percentage increase for 

inpatient rehabilitation facilities is the 

market basket percentage increase 

reduced by 0.2 percentage points and 

the MFP adjustment (see sections 

1886(j)(3)(C) and 1886(j)(3)(D)(iv) of the 

Act). 

• The percentage increase used to 

update the payment rate for psychiatric 

hospitals is the market basket 

percentage increase reduced by 0.3 

percentage points and the MFP 

adjustment (see sections 

1886(s)(2)(A)(i), 1886(s)(2)(A)(ii), and 

1886(s)(3)(C) of the Act). 

The Inpatient Prospective Payment 

System market basket percentage 

increase for 2015 is 2.9 percent and the 

MFP adjustment is 0.5 percent, as 

announced in the final rule that 

appeared in the Federal Register on 

August 22, 2014 entitled, ‘‘Hospital 

Inpatient Prospective Payment Systems 

for Acute Care Hospitals and the Long 

Term Care Hospital Prospective 

Payment System and Fiscal Year 2015 

Rates; Quality Reporting Requirements 

for Specific Providers; Reasonable 

Compensation Equivalents’’ (79 FR 

49854). Therefore, the percentage 

increase for hospitals paid under the 

inpatient prospective payment system 

that submit quality data and are 

meaningful EHR users is 2.2 percent 

(that is, the FY 2015 market basket 

update of 2.9 percent less the MFP 

adjustment of 0.5 percentage point and 

less 0.2 percentage point). The average 

payment percentage increase for 

hospitals excluded from the inpatient 

prospective payment system is 2.3 

percent. Weighting these percentages in 

accordance with payment volume, our 

best estimate of the payment-weighted 

average of the increases in the payment 

rates for FY 2015 is 2.22 percent. 

To develop the adjustment to reflect 

changes in real case-mix, we first 

calculated an average case-mix for each 

hospital that reflects the relative 

costliness of that hospital’s mix of cases 

compared to those of other hospitals. 

We then computed the change in 

average case-mix for hospitals paid 

under the Medicare prospective 

payment system in FY 2014 compared 

to FY 2013. (We excluded from this 

calculation hospitals whose payments 

are not based on the inpatient 

prospective payment system because 

their payments are based on alternate 

prospective payment systems or 

reasonable costs.) We used Medicare 

bills from prospective payment 

hospitals that we received as of July 

2014. These bills represent a total of 

about 7.4 million Medicare discharges 

for FY 2014 and provide the most recent 

case-mix data available at this time. 

Based on these bills, the change in 

average case-mix in FY 2014 is 1.48 

percent. Based on these bills and past 

experience, we expect the overall case 

mix change to be 1.5 percent as the year 

progresses and more FY 2014 data 

become available. 

Section 1813 of the Act requires that 

the inpatient hospital deductible be 

adjusted only by that portion of the 

case-mix change that is determined to 

be real. Real case-mix is that portion of 

case-mix that is due to changes in the 

mix of cases in the hospital and not due 

to coding optimization. We expect that 

all of the change in average case-mix 

will be real and estimate that this 

change will be 1.5 percent. 

Thus as stated above, the estimate of 

the payment-weighted average of the 

applicable percentage increases used for 

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Federal Register / Vol. 79, No. 197 / Friday, October 10, 2014 / Notices 61311 

updating the payment rates is 2.22 

percent, and the real case-mix 

adjustment factor for the deductible is 

1.5 percent. Therefore, using the 

statutory formula as stated in section 

1813(b) of the Act, we calculate the 

inpatient hospital deductible for 

services furnished in CY 2015 to be 

$1,260. This deductible amount is 

determined by multiplying $1,216 (the 

inpatient hospital deductible for CY 

2014 (78 FR 64953)) by the paymentweighted average increase in the 

payment rates of 1.0222 multiplied by 

the increase in real case-mix of 1.015, 

which equals $1,261.64 and is rounded 

to $1,260. 

III. Computing the Inpatient Hospital 

and Extended Care Services 

Coinsurance Amounts for CY 2015 

The coinsurance amounts provided 

for in section 1813 of the Act are 

defined as fixed percentages of the 

inpatient hospital deductible for 

services furnished in the same CY. The 

increase in the deductible generates 

increases in the coinsurance amounts. 

For inpatient hospital and extended care 

services furnished in CY 2015, in 

accordance with the fixed percentages 

defined in the law, the daily 

coinsurance for the 61st through 90th 

day of hospitalization in a benefit 

period will be $315 (one-fourth of the 

inpatient hospital deductible as stated 

in section 1813(a)(1)(A) of the Act); the 

daily coinsurance for lifetime reserve 

days will be $630 (one-half of the 

inpatient hospital deductible as stated 

in section 1813(a)(1)(B) of the Act); and 

the daily coinsurance for the 21st 

through 100th day of extended care 

services in a skilled nursing facility in 

a benefit period will be $157.50 (oneeighth of the inpatient hospital 

deductible as stated in section 

1813(a)(3) of the Act). 

IV. Cost to Medicare Beneficiaries 

Table 1 below summarizes the 

deductible and coinsurance amounts for 

CYs 2014 and 2015, as well as the 

number of each that is estimated to be 

paid. 

TABLE 1—PART A DEDUCTIBLE AND COINSURANCE AMOUNTS FOR CALENDAR YEARS 2014 AND 2015 TYPE OF COST

SHARING

Value Number paid 

(in millions) 

2014 2015 2014 2015 

Inpatient hospital deductible ............................................................................................ $1,216 $1,260 7.23 7.39 

Daily coinsurance for 61st–90th Day .............................................................................. 304 315 1.87 1.91 

Daily coinsurance for lifetime reserve days .................................................................... 608 630 0.93 0.95 

SNF coinsurance ............................................................................................................. 152 157.50 41.80 43.73 

The estimated total increase in costs 

to beneficiaries is about $1,120 million 

(rounded to the nearest $10 million) due 

to: (1) The increase in the deductible 

and coinsurance amounts, and (2) the 

increase in the number of deductibles 

and daily coinsurance amounts paid. 

We determine the increase in cost to 

beneficiaries by calculating the 

difference between the 2014 and 2015 

deductible and coinsurance amounts 

multiplied by the increase in the 

number of deductible and coinsurance 

amounts paid. 

V. Waiver of Proposed Notice and 

Comment Period 

Section 1813(b)(2) of the Act requires 

publication of the inpatient hospital 

deductible and all coinsurance 

amounts—the hospital and extended 

care services coinsurance amounts— 

between September 1 and September 15 

of the year preceding the year to which 

they will apply. These amounts are 

determined according to the statute as 

discussed above. As has been our 

custom, we use general notices, rather 

than notice and comment rulemaking 

procedures, to make the 

announcements. 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. 

We considered publishing a proposed 

notice to provide a period for public 

comment. However, 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 find that the 

procedure for notice and comment is 

unnecessary here, because the formulae 

used to calculate the inpatient hospital 

deductible and hospital and extended 

care services coinsurance amounts are 

statutorily directed, and we can exercise 

no discretion in following the formulae. 

Moreover, the statute establishes the 

time period for which the deductible 

and coinsurance amounts will apply 

and delaying publication would be 

contrary to the public interest. 

Therefore, we find good cause to waive 

publication of a proposed notice and 

solicitation of public comments. 

VI. Collection of Information 

Requirements 

This document does not impose 

information collection requirements, 

that is, reporting, recordkeeping or 

third-party disclosure requirements. 

Consequently, there is no need for 

review by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995. 

VII. Regulatory Impact Analysis 

A. Statement of Need 

Section 1813(b)(2) of the Act requires 

the Secretary to publish, between 

September 1 and September 15 of each 

year, the amounts of the inpatient 

hospital deductible and hospital and 

extended care services coinsurance 

applicable for services furnished in the 

following calendar year (CY). 

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 

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61312 Federal Register / Vol. 79, No. 197 / Friday, October 10, 2014 / Notices 

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 total 

increase in costs to beneficiaries 

associated with this notice is about 

$1,120 million due to: (1) the increase 

in the deductible and coinsurance 

amounts, and (2) the increase in the 

number of deductibles and daily 

coinsurance amounts paid. As a result, 

this notice is economically significant 

under section 3(f)(1) of Executive Order 

12866 and thus, is a major action under 

the Congressional Review Act. In 

accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

entities, if a rule has a significant impact 

on a substantial number of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of less than $7.5 million to $38.5 

million in any 1 year (for details, see the 

Small Business Administration’s Web 

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

files/files/Size_Standards_Table.pdf). 

Individuals and states are not included 

in the definition of a small entity. As 

discussed above, this annual notice 

announces the inpatient hospital 

deductible and the hospital and 

extended care services coinsurance 

amounts for services furnished in CY 

2015 under Medicare’s Hospital 

Insurance Program (Medicare Part A). 

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. 

For 2014, that threshold accounting for 

inflation 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, 

preempt state law, or have Federalism 

implications, the requirements of 

Executive Order 13132 are not 

applicable. 

Dated: September 12, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Dated: September 26, 2014. 

Sylvia M. Burwell, 

Secretary. 

[FR Doc. 2014–24257 Filed 10–9–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8057–N] 

RIN 0938–AR96 

Medicare Program; CY 2015 Part A 

Premiums for the Uninsured Aged and 

for Certain Disabled Individuals Who 

Have Exhausted Other Entitlement 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This annual notice announces 

Medicare’s Hospital Insurance (Part A) 

premium for uninsured enrollees in 

calendar year (CY) 2015. 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, 2015, for 

these individuals will be $407. The 

premium for certain other individuals as 

described in this notice will be $224. 

DATES: Effective Date: This notice is 

effective on January 1, 2015. 

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 

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