48976 Federal Register / Vol. 74, No. 185 / Friday, September 25, 2009 / Notices 

ensure that facilities with condition 

level non-compliance on an initial 

survey receive an onsite follow-up full 

survey, in order to meet the 

requirements at section 2005A2 of the 

SOM; 

• AOA developed and incorporated 

measures to improve the accuracy and 

consistency of data submissions to CMS 

in order to meet the requirements at 

§ 488.4(b); 

• AOA revised its policies on 

blackout dates to meet the requirements 

at 2700A of the SOM; 

• AOA revised its accreditation 

decision letters to ensure that they are 

accurate and contain all the required 

elements for our Regional Office to 

render a decision regarding the deemed 

status of an accredited ASC; 

• AOA revised and updated its 

surveyor team handbook to include 

references to its ASC deeming program; 

• AOA extended its onsite survey 

time allotted for review of the CfCs from 

1 day to 2 days in order to meet the 

requirements at § 488.26; and 

• AOA removed all references to 

mandatory consultative services from its 

policies to avoid potential conflict of 

interest issue. 

To verify AOA’s continued 

compliance with the provisions of this 

final notice, we will conduct a followup corporate onsite visit within 1 year 

of the date of publication of this notice. 

B. Term of Approval 

Based on the review and observations 

described in section III of this final 

notice, we have determined that the 

AOA’s requirements for ASCs meet or 

exceed our requirements. Therefore, we 

approve AOA as a national accreditation 

organization for ASCs that request 

participation in the Medicare program, 

effective October 23, 2009 through 

October 23, 2013. 

V. 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). 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: September 10, 2009. 

Charlene Frizzera, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. E9–22956 Filed 9–24–09; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–4141–N] 

Medicare Program; Medicare Appeals; 

Adjustment to the Amount in 

Controversy Threshold Amounts for 

Calendar Year 2010 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

annual adjustment in the amount in 

controversy (AIC) threshold amounts for 

Administrative Law Judge (ALJ) 

hearings and judicial review under the 

Medicare appeals process. The 

adjustment to the AIC threshold 

amounts will be effective for requests 

for ALJ hearings and judicial review 

filed on or after January 1, 2010. The 

2010 AIC threshold amounts are $130 

for ALJ hearings and $1,260 for judicial 

review. 

DATES: Effective Date: This notice is 

effective on January 1, 2010. 

FOR FURTHER INFORMATION CONTACT: Liz 

Hosna, (410) 786–4993. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1869(b)(1)(E) of the Social 

Security Act (the Act), as amended by 

section 521 of the Medicare, Medicaid, 

and SCHIP Benefits Improvement and 

Protection Act of 2000 (BIPA), 

established AIC threshold amounts for 

ALJ hearing requests and judicial review 

at $100 and $1000, respectively, for 

Medicare Part A and Part B appeals. 

Section 940 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003, amended 

section 1869(b)(1)(E) of the Act to 

require the AIC threshold amounts for 

ALJ hearings and judicial review to be 

adjusted annually. The AIC threshold 

amounts are to be adjusted, as of 

January 2005, by the percentage increase 

in the medical care component of the 

consumer price index for all urban 

consumers (U.S. city average) for July 

2003 to July of the year preceding the 

year involved and rounded to the 

nearest multiple of $10. Section 

940(b)(2) of the MMA provided 

conforming amendments to apply the 

AIC adjustment requirement to 

Medicare Part C (Medicare Advantage 

‘‘MA’’) appeals and certain health 

maintenance organization and 

competitive health plan appeals. Health 

care prepayment plans are also subject 

to MA appeals rules, including the AIC 

adjustment requirement. Section 101 of 

the MMA provides for the application of 

the AIC adjustment requirement to 

Medicare Part D appeals. 

A. Medicare Part A and Part B Appeals 

The statutory formula for the annual 

adjustment to the AIC threshold 

amounts for ALJ hearings and judicial 

review of Medicare Part A and Part B 

appeals, set forth at section 

1869(b)(1)(E) of the Act, is included in 

the applicable implementing 

regulations, 42 CFR part 405, subpart I, 

at § 405.1006(b). The regulations require 

the Secretary of the Department of 

Health and Human Services (the 

Secretary) to publish changes to the AIC 

threshold amounts in the Federal 

Register (§ 405.1006(b)(2)). In order to 

be entitled to a hearing before an ALJ, 

a party to a proceeding must meet the 

AIC requirements at § 405.1006(b). 

Similarly, a party must meet the AIC 

requirements at § 405.1006(c) at the time 

judicial review is requested for the court 

to have jurisdiction over the appeal 

(§ 405.1136(a)). 

B. Medicare Part C (Medicare 

Advantage) Appeals 

Section 940(b)(2) of the MMA applies 

the AIC adjustment requirement to Part 

C (MA) appeals by amending section 

1852(g)(5) of the Act. The implementing 

regulations for Medicare Part C appeals 

are found at 42 CFR part 422, subpart 

M. Specifically, § 422.600 and § 422.612 

discuss the AIC threshold amounts for 

ALJ hearings and judicial review. 

Section 422.600 grants any party to 

the reconsideration, except the MA 

organization, who is dissatisfied with 

the reconsideration determination, a 

right to an ALJ hearing as long as the 

amount remaining in controversy after 

reconsideration meets the threshold 

requirement established annually by the 

Secretary. Section 422.612 states that 

any party, including the MA 

organization, may request judicial 

review if, in part, the amount in 

controversy meets the threshold 

requirement established annually by the 

Secretary. 


jlentini on DSKJ8SOYB1PROD with NOTICES
Federal Register / Vol. 74, No. 185 / Friday, September 25, 2009 / Notices 48977 

C. Health Maintenance Organizations, 

Competitive Medical Plans, and Health 

Care Prepayment Plans 

Section 1876(c)(5)(B) of the Act states 

that the annual adjustment to the 

amount in controversy dollar amounts 

set forth in section 1869(b)(1)(E) of the 

Act applies to certain beneficiary 

appeals within the context of health 

maintenance organizations and 

competitive medical plans. The 

applicable implementing regulations for 

Medicare Part C appeals are set forth in 

42 CFR part 422, subpart M, and as 

discussed above, apply to these appeals. 

The Medicare Part C appeals rules also 

apply to health care prepayment plan 

appeals. 

D. Medicare Part D (Prescription Drug 

Plan) Appeals 

The annually adjusted AIC threshold 

amounts for ALJ hearings and judicial 

review that apply to Medicare Parts A, 

B, and C appeals also apply to Medicare 

Part D appeals. Section 101 of the MMA 

added section 1860D–4(h)(1) of the Act 

regarding Part D appeals. This statutory 

provision requires a prescription drug 

plan sponsor to meet the requirements 

set forth in sections 1852(g)(4) and (g)(5) 

of the Act, in a similar manner as MA 

organizations. As noted above, the 

annually adjusted AIC threshold 

requirement was added to section 

1852(g)(5) of the Act by section 

940(b)(2)(A) of the MMA. The 

implementing regulations for Medicare 

Part D appeals can be found at 42 CFR 

part 423, subpart M. The regulations 

impart at § 423.562(c) that, unless the 

Part D appeals rules provide otherwise, 

the Part C appeals rules (including the 

annually adjusted AIC threshold 

amount) apply to Part D appeals to the 

extent they are appropriate. More 

specifically, § 423.610 and § 423.630 of 

the Part D appeals rules discuss the AIC 

threshold amounts for ALJ hearings and 

judicial review. Section 423.610(a) 

grants a Part D enrollee, who is 

dissatisfied with the Independent 

Review Entity (IRE) reconsideration 

determination, a right to an ALJ hearing 

if the amount remaining in controversy 

after the IRE reconsideration meets the 

threshold amount established annually 

by the Secretary. Section 423.630(a) 

allows a Part D enrollee to request 

judicial review of an ALJ’s decision if, 

in part, the AIC meets the threshold 

amount established annually by the 

Secretary. 

II. Annual AIC Adjustments 

A. AIC Adjustment Formula and AIC 

Adjustments 

As previously noted, section 940 of 

the MMA requires that the AIC 

threshold amounts be adjusted 

annually, beginning in January of 2005, 

by the percentage increase in the 

medical care component of the 

consumer price index (CPI) for all urban 

consumers (U.S. city average) for July 

2003 to the July of the preceding year 

involved and rounded to the nearest 

multiple of $10. 

B. Calendar Year 2010 

The AIC threshold amount for ALJ 

hearing requests will rise to $130 and 

the AIC threshold amount for judicial 

review will rise to $1,260 for the 2010 

calendar year. These new amounts are 

based on the 26.3 percent increase in 

the medical care component of the CPI 

from July of 2003 to July of 2009. The 

CPI level was at 297.6 in July of 2003 

and rose to 375.739 in July of 2009. This 

change accounted for the 26.3 percent 

increase. The AIC threshold amount for 

ALJ hearing requests changes to $126.26 

based on the 26.3 percent increase. In 

accordance with section 940 of the 

MMA, this amount is rounded to the 

nearest multiple of $10. Therefore, the 

2010 AIC threshold amount for ALJ 

hearings is $130. The AIC threshold 

amount for judicial review changes to 

$1,262.56 based on the 26.3 percent 

increase. This amount was rounded to 

the nearest multiple of $10, resulting in 

a 2010 AIC threshold amount of $1,260. 

C. Summary Table of Adjustments in 

the AIC Threshold Amounts 

In Table 1 below, we list the (CY) 

2005 through 2010 threshold amounts. 

TABLE 1—AMOUNT-IN-CONTROVERSY THRESHOLD AMOUNTS

CY 2005 CY 2006 CY 2007 CY 2008 CY 2009 CY 2010 

ALJ Hearing ............................................. $100 $110 $110 $120 $120 $130 

Judicial Review ........................................ $1050 $1090 $1130 $1180 $1,220 $1,260 

*CY—Calendar Year. 

III. Collection of Information 

Requirements (If Applicable) 

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). 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program; No. 93.773 Medicare—Hospital 

Insurance Program; and No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: September 1, 2009. 

Charlene Frizzera, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. E9–22955 Filed 9–24–09; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3215–N] 

Medicare Program; Meeting of the 

Medicare Evidence Development and 

Coverage Advisory Committee— 

November 18, 2009 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice of meeting. 

SUMMARY: This notice announces that a 

public meeting of the Medicare 

Evidence Development & Coverage 

Advisory Committee (MEDCAC) 

(‘‘Committee’’) will be held on 

Wednesday, November 18, 2009. The 

Committee generally provides advice 

and recommendations concerning the 

adequacy of scientific evidence needed 

to determine whether certain medical 

items and services can be covered under 

the Medicare statute. This meeting will 

focus on the quality of evidence 

surrounding the diagnosis and treatment 

of secondary lymphedema. This meeting 

is open to the public in accordance with 

the Federal Advisory Committee Act (5 

U.S.C. App. 2, section 10(a)). 

DATES: Meeting date: The public 

meeting will be held on Wednesday, 


jlentini on DSKJ8SOYB1PROD with NOTICES