Federal Register / Vol. 88, No. 188 / Friday, September 29, 2023 / Notices 67297 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–4202–N] 

Medicare Program; Medicare Appeals; 

Adjustment to the Amount in 

Controversy Threshold Amounts for 

Calendar Year 2024 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), Department 

of Health and Human Services (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, 2024. The 

calendar year 2024 AIC threshold 

amounts are $180 for ALJ hearings and 

$1,840 for judicial review. 

DATES: This annual adjustment takes 

effect on January 1, 2024. 

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) established the 

amount in controversy (AIC) threshold 

amounts for Administrative Law Judge 

(ALJ) hearings and judicial review at 

$100 and $1,000, respectively, for 

Medicare Part A and Part B appeals. 

Additionally, section 1869(b)(1)(E) of 

the Act provides that beginning in 

January 2005, the AIC threshold 

amounts are to be adjusted annually 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 preceding the year involved and 

rounded to the nearest multiple of $10. 

Sections 1852(g)(5) and 1876(c)(5)(B) of 

the Act 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, 

pursuant to 42 CFR 417.840. Section 

1860D—4(h)(1) of the Act, provides that 

a Medicare Part D plan sponsor shall 

meet the requirements of paragraphs (4) 

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

with respect to benefits, including 

appeals and 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 405.1006(b) and (c). 

The regulations at § 405.1006(b)(2) 

require the Secretary of Health and 

Human Services (the Secretary) to 

publish changes to the AIC threshold 

amounts in the Federal Register. 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/MA Appeals 

Section 1852(g)(5) of the Act applies 

the AIC adjustment requirement to 

Medicare Part C appeals. The 

implementing regulations for Medicare 

Part C appeals are found at 42 CFR 422, 

subpart M. Specifically, sections 

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, in 

part, that any party, including the MA 

organization, may request judicial 

review if the AIC meets the threshold 

requirement established annually by the 

Secretary. 

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 AIC 

dollar amounts set forth in section 

1869(b)(1)(E)(iii) 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 422, subpart M 

and apply to these appeals in 

accordance with 42 CFR 417.600(b). The 

Medicare Part C appeals rules also apply 

to health care prepayment plan appeals 

in accordance with 42 CFR 417.840. 

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 1860D–4(h)(1) of 

the Act regarding Part D appeals 

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. The implementing 

regulations for Medicare Part D appeals 

can be found at 42 CFR 423, subparts M 

and U. More specifically, § 423.2006 of 

the Part D appeals rules discusses the 

AIC threshold amounts for ALJ hearings 

and judicial review. Sections 423.2002 

and 423.2006 grant 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, and other requirements set 

forth in § 423.2002. Sections 423.2006 

and 423.2136 allow a Part D enrollee to 

request judicial review of an ALJ or 

Medicare Appeals Council decision if 

the AIC meets the threshold amount 

established annually by the Secretary, 

and other requirements are met as set 

forth in these provisions. 

II. Provisions of the Notice—Annual 

AIC Adjustments 

A. AIC Adjustment Formula and AIC 

Adjustments 

Section 1869(b)(1)(E)(iii) of the Act 

requires that the AIC threshold amounts 

be adjusted annually, beginning in 

January 2005, by the percentage increase 

in the medical care component of the 

CPI 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. 

B. Calendar Year 2024 

The AIC threshold amount for ALJ 

hearings will remain at $180 and the 

AIC threshold amount for judicial 

review will decrease from $1,850 for CY 

2023 to $1,840 for CY 2024. These 

amounts are based on the 83.702 

percent change in the medical care 

component of the CPI, which was at 

297.600 in July 2003 and rose to 546.678 

in July 2023. The AIC threshold amount 

for ALJ hearings changes to $183.70 

based on the 83.702 percent increase 

over the initial threshold amount of 


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67298 Federal Register / Vol. 88, No. 188 / Friday, September 29, 2023 / Notices 

$100 established in 2003. In accordance 

with section 1869(b)(1)(E)(iii) of the Act, 

the adjusted threshold amounts are 

rounded to the nearest multiple of $10. 

Therefore, the CY 2024 AIC threshold 

amount for ALJ hearings is $180.00. The 

AIC threshold amount for judicial 

review changes to $1,837.02 based on 

the 83.702 percent increase over the 

initial threshold amount of $1,000. This 

amount was rounded to the nearest 

multiple of $10, resulting in the CY 

2024 AIC threshold amount of $1,840.00 

for judicial review. 

C. Summary Table of Adjustments in 

the AIC Threshold Amounts 

In the following table we list the CYs 

2020 through 2024 threshold amounts. 

CY 2020 CY 2021 CY 2022 CY 2023 CY 2024 

ALJ Hearing ......................................................................... $170 $180 $180 $180 $180 

Judicial Review .................................................................... 1,670 1,760 1,760 1,850 1,840 

III. Collection of Information 

Requirements 

This document announces the annual 

adjustment in the AIC threshold 

amounts. It does not impose any 

‘‘collection of information’’ 

requirements as defined under 5 CFR 

1320.3(c). Consequently, the notice is 

not subject to the requirements of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 3501 et seq.). 

The Administrator of the Centers for 

Medicare & Medicaid Services (CMS), 

Chiquita Brooks-LaSure, having 

reviewed and approved this document, 

authorizes Vanessa Garcia, who is the 

Federal Register Liaison, to 

electronically sign this document for 

purposes of publication in the Federal 

Register. 

Vanessa Garcia, 

Federal Register Liaison, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2023–21500 Filed 9–28–23; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10718, CMS– 

10142 and CMS–10540] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, Health and Human 

Services (HHS). 

ACTION: Notice. 

SUMMARY: The Centers for Medicare & 

Medicaid Services (CMS) is announcing 

an opportunity for the public to 

comment on CMS’ intention to collect 

information from the public. Under the 

Paperwork Reduction Act of 1995 (the 

PRA), federal agencies are required to 

publish notice in the Federal Register 

concerning each proposed collection of 

information (including each proposed 

extension or reinstatement of an existing 

collection of information) and to allow 

60 days for public comment on the 

proposed action. Interested persons are 

invited to send comments regarding our 

burden estimates or any other aspect of 

this collection of information, including 

the necessity and utility of the proposed 

information collection for the proper 

performance of the agency’s functions, 

the accuracy of the estimated burden, 

ways to enhance the quality, utility, and 

clarity of the information to be 

collected, and the use of automated 

collection techniques or other forms of 

information technology to minimize the 

information collection burden. 

DATES: Comments must be received by 

November 28, 2023. 

ADDRESSES: When commenting, please 

reference the document identifier or 

OMB control number. To be assured 

consideration, comments and 

recommendations must be submitted in 

any one of the following ways: 

1. Electronically. You may send your 

comments electronically to http://

www.regulations.gov. Follow the 

instructions for ‘‘Comment or 

Submission’’ or ‘‘More Search Options’’ 

to find the information collection 

document(s) that are accepting 

comments. 

2. By regular mail. You may mail 

written comments to the following 

address: CMS, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attention: Document Identifier/OMB 

Control Number:ll Room C4–26–05, 

7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

To obtain copies of a supporting 

statement and any related forms for the 

proposed collection(s) summarized in 

this notice, please access the CMS PRA 

website by copying and pasting the 

following web address into your web 

browser: https://www.cms.gov/ 

Regulations-and-Guidance/Legislation/

PaperworkReductionActof1995/PRAListing. 

FOR FURTHER INFORMATION CONTACT: 

William N. Parham at (410) 786–4669. 

SUPPLEMENTARY INFORMATION: 

Contents 

This notice sets out a summary of the 

use and burden associated with the 

following information collections. More 

detailed information can be found in 

each collection’s supporting statement 

and associated materials (see 

ADDRESSES). 

CMS–10718 Model Medicare 

Advantage and Medicare Prescription 

Drug Plan Individual Enrollment 

Request Form 

CMS–10142 Bid Pricing Tool (BPT) for 

Medicare Advantage (MA) Plans and 

Prescription Drug Plans (PDP) 

CMS–10540 Quality Improvement 

Strategy Implementation Plan, 

Progress Report, and Modification 

Summary Supplement Forms 

Under the 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 

requires federal agencies to publish a 

60-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. 

Information Collection 

1. Type of Information Collection 

Request: Revision with change to the 

currently approved collection; Title of 

Information Collection: Model Medicare 

Advantage and Medicare Prescription 

Drug Plan Individual Enrollment 

Request Form; Use: The enrollment 

form is considered a ‘‘model’’ under 

Medicare regulations at §§ 422.2262 and 

423.2262, for purposes of 


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