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
48978 Federal Register / Vol. 74, No. 185 / Friday, September 25, 2009 / Notices 

November 18, 2009 from 7:30 a.m. until 

4:30 p.m., Eastern Standard Time (EST). 

Deadline for Submission of Written 

Comments: Written comments must be 

received at the address specified in the 

ADDRESSES section of this notice by 5 

p.m., Eastern Daylight Time (EDT) on 

October 19, 2009. Once submitted all 

comments are final. 

Deadlines for Speaker Registration 

and Presentation Materials: The 

deadline to register to be a speaker and 

to submit powerpoint presentation 

materials and writings that will be used 

in support of an oral presentation, is 5 

p.m., EDT on Monday, October 19, 

2009. Speakers may register by phone or 

via e-mail by contacting the person 

listed in the FOR FURTHER INFORMATION

CONTACT section of this notice. 

Presentation materials must be received 

at the address specified in the 

ADDRESSES section of this notice. 

Deadline for All Other Attendees 

Registration: Individuals may register by 

phone or via e-mail by contacting the 

person listed in the FOR FURTHER

INFORMATION CONTACT section of this 

notice by 5 p.m., EDT on Wednesday, 

November 11, 2009. 

Deadline for Submitting a Request for 

Special Accommodations: Persons 

attending the meeting who are hearing 

or visually impaired, or have a 

condition that requires special 

assistance or accommodations, are 

asked to contact the Executive Secretary 

as specified in the FOR FURTHER

INFORMATION CONTACT section of this 

notice no later than 5 p.m., EDT Friday, 

November 6, 2009. 

ADDRESSES: Meeting Location: The 

meeting will be held in the main 

auditorium of the Centers for Medicare 

& Medicaid Services, 7500 Security 

Boulevard, Baltimore, MD 21244. 

Submission of Presentations and 

Comments: Presentation materials and 

written comments that will be presented 

at the meeting must be submitted via email to 

MedCACpresentations@cms.hhs.gov or 

by regular mail to the contact listed in 

the FOR FURTHER INFORMATION CONTACT

section of this notice by the date 

specified in the DATES section of this 

notice. 

FOR FURTHER INFORMATION CONTACT: 

Maria Ellis, Executive Secretary for 

MEDCAC, Centers for Medicare & 

Medicaid Services, Office of Clinical 

Standards and Quality, Coverage and 

Analysis Group, C1–09–06, 7500 

Security Boulevard, Baltimore, MD 

21244 or contact Ms. Ellis by phone 

(410–786–0309) or via e-mail at 

Maria.Ellis@cms.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background 

MEDCAC, formerly known as the 

Medicare Coverage Advisory Committee 

(MCAC), provides advice and 

recommendations to CMS regarding 

clinical issues. (For more information 

on MCAC, see the December 14, 1998 

Federal Register (63 FR 68780.)) This 

notice announces the November 18, 

2009, public meeting of the Committee. 

During this meeting, the Committee will 

discuss the quality of evidence 

surrounding the diagnosis and treatment 

of secondary lymphedema. Background 

information about this topic, including 

panel materials, is available at http:// 

www.cms.hhs.gov/coverage. We 

encourage the participation of 

appropriate organizations with expertise 

in the diagnosis and treatment of 

secondary lymphedema. 

II. Meeting Format 

This meeting is open to the public. 

The Committee will hear oral 

presentations from the public for 

approximately 45 minutes. The 

Committee may limit the number and 

duration of oral presentations to the 

time available. Your comments should 

focus on issues specific to the list of 

topics that we have proposed to the 

Committee. The list of research topics to 

be discussed at the meeting will be 

available on the following Web site 

prior to the meeting: http:// 

www.cms.hhs.gov/mcd/ 

index_list.asp?list_type=mcac. We 

require that you declare at the meeting 

whether you have any financial 

involvement with manufacturers (or 

their competitors) of any items or 

services being discussed. 

The Committee will deliberate openly 

on the topics under consideration. 

Interested persons may observe the 

deliberations, but the Committee will 

not hear further comments during this 

time except at the request of the 

chairperson. The Committee will also 

allow a 15-minute unscheduled open 

public session for any attendee to 

address issues specific to the topics 

under consideration. At the conclusion 

of the day, the members will vote and 

the Committee will make its 

recommendation(s) to CMS. 

III. Registration Instructions 

CMS’ Coverage and Analysis Group is 

coordinating meeting registration. While 

there is no registration fee, individuals 

must register to attend. You may register 

by contacting the person listed in the 

FOR FURTHER INFORMATION CONTACT

section of this notice by the deadline 

listed in the DATES section of this notice. 

Please provide your full name (as it 

appears on your state-issued driver’s 

license), address, organization, 

telephone, fax number(s), and e-mail 

address. You will receive a registration 

confirmation with instructions for your 

arrival at the CMS complex or you will 

be notified the seating capacity has been 

reached. 

IV. Security, Building, and Parking 

Guidelines 

This meeting will be held in a Federal 

government building; therefore, Federal 

security measures are applicable. We 

recommend that confirmed registrants 

arrive reasonably early, but no earlier 

than 45 minutes prior to the start of the 

meeting, to allow additional time to 

clear security. Security measures 

include the following: 

• Presentation of government-issued 

photographic identification to the 

Federal Protective Service or Guard 

Service personnel. 

• Inspection of vehicle’s interior and 

exterior (this includes engine and trunk 

inspection) at the entrance to the 

grounds. Parking permits and 

instructions will be issued after the 

vehicle inspection. 

• Inspection, via metal detector or 

other applicable means, of all persons 

entering the building. We note that all 

items brought into CMS, whether 

personal or for the purpose of 

presentation or to support a 

presentation, are subject to inspection. 

We cannot assume responsibility for 

coordinating the receipt, transfer, 

transport, storage, set-up, safety, or 

timely arrival of any personal 

belongings or items used for 

presentation or to support a 

presentation. 

Note: Individuals who are not registered in 

advance will not be permitted to enter the 

building and will be unable to attend the 

meeting. The public may not enter the 

building earlier than 45 minutes prior to the 

convening of the meeting. All visitors must 

be escorted in areas other than the lower and 

first floor levels in the Central Building. 

Authority: 5 U.S.C. App. 2, section 10(a). 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: September 21, 2009. 

Barry M. Straube, 

Chief Medical Officer and Director, Office 

of Clinical Standards and Quality, Centers 

for Medicare & Medicaid Services. 

[FR Doc. E9–23255 Filed 9–24–09; 8:45 am] 

BILLING CODE 4120–01–P 


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