71570 Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 

Publication of this notice is consistent 

with section 1839 of the Act, and we 

believe that any potential delay in the 

effective date of the notice, if such delay 

were required at all, could cause 

unnecessary confusion for both the 

agency and Medicare beneficiaries. 

Chiquita Brooks-LaSure, 

Administrator of the Centers for 

Medicare & Medicaid Services, 

approved this document on October 11, 

2023. 

Dated: October 11, 2023. 

Xavier Becerra, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2023–22823 Filed 10–12–23; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–576 and CMS– 

576A] 

Agency Information Collection 

Activities: Submission for OMB 

Review; 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 

(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 

a second opportunity for public 

comment on the notice. Interested 

persons are invited to send comments 

regarding the burden estimate 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 on the collection(s) of 

information must be received by the 

OMB desk officer by November 16, 

2023. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. 

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 Parham at (410) 786–4669. 

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: Reinstatement with change of a 

previously approved collection; Title of 

Information Collection: Organ 

Procurement Organization (OPO) 

Request for Designation as an OPO, 

Health Insurance Benefits Agreement, 

and Supporting Regulations; Use: We 

are seeking reinstatement of a revised 

version of the CMS–576 form. We are 

also seeking reinstatement for the CMS– 

576A form. The CMS–576 and CMS– 

576A forms have been updated to a 

fillable .pdf format. In addition, 

multiple changes were made to the 

CMS–576 and CMS–576A forms. 

Organizations seeking designation 

from CMS as a qualified and approved 

Organ Procurement Organization (OPO), 

as per §§ 371(a) and 1138 of the Social 

Security Act (‘‘the Act’’) must complete 

and submit the CMS–576 form. After 

designation as an OPO, the organization 

must sign CMS–576A form in order to 

be reimbursed by Medicare for their 

services. The CMS–576A form requires 

the OPO ‘‘to maintain compliance with 

the requirements of titles XVIII and XIX 

of the Act, § 1138 of the Act, applicable 

regulations including the conditions set 

forth in Part 486, subpart G, title 42 of 

the Code of Federal Regulations, those 

conditions of the Organ Procurement 

and Transplantation Network 

established under § 372 of the Public 

Health Service Act that have been 

approved by the Secretary, and to report 

promptly to CMS. Form Number: CMS– 

576 and 576A (OMB Control Number: 

0938–0512); Frequency: Occasionally; 

Affected Public: Private Sector (Business 

or other for-profit and Not-for-profit 

institutions); Number of Respondents: 

16; Total Annual Responses: 16; Total 

Annual Hours: 32. (For policy questions 

regarding this collection contact 

Caroline Gallaher at 410–786–8705.) 

Dated: October 12, 2023. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2023–22892 Filed 10–16–23; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8084–N] 

RIN 0938–AV12 

Medicare Program; CY 2024 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 notice announces the 

monthly premium for uninsured 

enrollees under the Medicare Hospital 

Insurance (Part A) program in calendar 

year 2024. This premium is paid by 

enrollees aged 65 and over who are not 

otherwise eligible for benefits under 

Part A (hereafter known as the 

‘‘uninsured aged’’) and by certain 

individuals with disabilities who have 

exhausted other entitlement. The 

monthly Part A premium for the 12 

months beginning January 1, 2024 for 


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Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 71571 

1Effective on January 1, 2023, the regulatory 

definition of qualified Medicare beneficiaries at 42 

CFR 435.123 has been expanded to include 

additional individuals. These individuals are only 

entitled to limited Medicare coverage under Part B 

for immunosuppressive drugs. Because the new 

individuals are not entitled to Part A, the expansion 

of the QMB definition does not change the analysis 

in this notice. 

these individuals will be $505. The 

premium for certain other individuals as 

described in this notice will be $278. 

DATES: The premium announced in this 

notice is effective on January 1, 2024. 

FOR FURTHER INFORMATION CONTACT: 

Yaminee Thaker, (410) 786–7921. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1818 of the Social Security 

Act (the Act) provides for voluntary 

enrollment in the Medicare Hospital 

Insurance (Part A) program, 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 

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 

Part A.) 

Section 1818A of the Act provides for 

voluntary enrollment in Medicare Part 

A, subject to payment of a monthly 

premium, for certain individuals with 

disabilities 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 

premium-free 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 for the aged, under section 

1818(d) through section 1818(f), will 

also apply to certain individuals with 

disabilities, as described above. 

Section 1818(d)(1) 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 

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, it 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 (sections 1818 and 1818A). 

The reduction applies to an individual 

who is eligible to buy into the 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 who at 

the time of divorce had at least 30 

quarters of coverage if the marriage 

lasted at least 10 years. 

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

specifies that the premium that these 

individuals will pay for CY 2024 will be 

equal to the premium for uninsured 

aged enrollees reduced by 45 percent. 

Section 1818(g) of the Act requires the 

Secretary of Health and Human Services 

(the Secretary), at the request of a state, 

to enter into a Medicare Part A buy-in 

agreement with the state to pay Part A 

premiums for Qualified Medicare 

Beneficiaries (QMBs).1 Under the QMB 

eligibility group, state Medicaid 

agencies must pay the Part A premium 

for those not eligible for premium-free 

Part A, if those individuals meet all of 

the eligibility requirements for the QMB 

eligibility group under the state’s 

Medicaid state plan. (Entering into a 

Part A buy-in agreement would permit 

states to avoid any Part A late 

enrollment penalties that individuals 

may owe and would allow states to 

enroll persons in Part A at any time of 

the year, without regard to Medicare 

enrollment periods.) Other individuals 

may be eligible for the Qualified 

Disabled and Working Individuals 

(QDWIs) eligibility group, through 

which state Medicaid programs provide 

coverage for the Part A premiums for 

individuals who are eligible to enroll in 

Part A by virtue of section 1818A of the 

Act and meet certain financial eligibility 

criteria. 

II. Monthly Premium Amount for CY 

2024 

The monthly premium for the 

uninsured aged and certain individuals 

with disabilities who have exhausted 

other entitlement, for the 12 months 

beginning January 1, 2024, is $505. The 

monthly premium for the individuals 

who are eligible under section 

1818(d)(4)(B) of the Act, and who are 

therefore subject to the 45-percent 

reduction in the monthly premium, is 

$278. 

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 2024 

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 as follows: 

• 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 2024 

on (1) current historical data and (2) 

projection assumptions derived from 

current law and the President’s Fiscal 

Year 2024 Budget. 

For CY 2024, we estimate that 

59,121,430 people aged 65 years and 

over will be entitled to (enrolled in) 

benefits (without premium payment) 

and that they will incur about $358,251 

billion in benefits and related 

administrative costs. Thus, the 

estimated monthly average per capita 

amount is $504.97, and the monthly 

premium is $505. Subsequently, the full 

monthly premium reduced by 45 

percent is $278. 

IV. Costs to Beneficiaries 

The CY 2024 premium of $505 is 

approximately 0.2 percent lower than 

the CY 2023 premium of $506. We 

estimate that approximately 729,000 

enrollees will voluntarily enroll in 

Medicare Part A by paying the full 

premium and that over 90 percent of 

these individuals will have their Part A 


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71572 Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 

premium paid for by states, since they 

are entitled to Part A and enrolled in the 

QMB program eligibility group. 

Furthermore, the CY 2024 reduced 

premium is the same as for CY 2023, at 

$278, and we estimate that an additional 

94,000 enrollees will pay this premium. 

Therefore, for enrollees paying these 

premiums in CY 2024, we estimate that 

the total aggregate savings, compared 

with the amount that they paid in CY 

2023, will be about $9 million. 

V. Waiver of Proposed Rulemaking 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register and invite public comment 

prior to a rule taking effect in 

accordance with section 1871 of the Act 

and section 553(b) of the Administrative 

Procedure Act (APA). Section 1871(a)(2) 

of the Act provides that no rule, 

requirement, or other statement of 

policy (other than a national coverage 

determination) that establishes or 

changes a substantive legal standard 

governing the scope of benefits, the 

payment for services, or the eligibility of 

individuals, entities, or organizations to 

furnish or receive services or benefits 

under Medicare shall take effect unless 

it is promulgated through notice and 

comment rulemaking. Unless there is a 

statutory exception, section 1871(b)(1) 

of the Act generally requires the 

Secretary to provide for notice of a 

proposed rule in the Federal Register 

and provide a period of not less than 60 

days for public comment before 

establishing or changing a substantive 

legal standard regarding the matters 

enumerated by the statute. Similarly, 

under 5 U.S.C. 553(b) of the APA, the 

agency is required to publish a notice of 

proposed rulemaking in the Federal 

Register before a substantive rule takes 

effect. Section 553(d) of the APA and 

section 1871(e)(1)(B)(i) of the Act 

usually require a 30-day delay in 

effective date after issuance or 

publication of a rule, subject to 

exceptions. Sections 553(b)(B) and 

553(d)(3) of the APA provide for 

exceptions from the advance notice and 

comment requirement and the delay in 

effective date requirements. Sections 

1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the 

Act also provide exceptions from the 

notice and 60-day comment period and 

the 30-day delay in effective date. 

Section 553(b)(B) of the APA and 

section 1871(b)(2)(C) of the Act 

expressly authorize an agency to 

dispense with notice and comment 

rulemaking for good cause if the agency 

makes a finding that notice and 

comment procedures are impracticable, 

unnecessary, or contrary to the public 

interest. 

The annual Medicare Part A premium 

announcement set forth in this notice 

does not establish or change a 

substantive legal standard regarding the 

matters enumerated by the statute or 

constitute a substantive rule that would 

be subject to the notice requirements in 

section 553(b) of the APA. However, to 

the extent that an opportunity for public 

notice and comment could be construed 

as required for this notice, we find good 

cause to waive this requirement. 

Section 1818(d) of the Act requires 

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 CY 

(including the associated administrative 

costs) on behalf of individuals aged 65 

and over who will be entitled to benefits 

under Part A. Further, the statute 

requires that the agency determine the 

applicable premium amount for each CY 

in accordance with the statutory 

formula. In this notice, we are simply 

notifying the public of the changes to 

the Part A premiums for CY 2024. We 

have calculated the Part A premiums as 

directed by the statute, which 

establishes both when the premium 

amounts must be published and what 

information must be factored by the 

Secretary into these amounts; we do not 

have any discretion in that regard. We 

find notice and comment procedures to 

be unnecessary for this notice, and we 

find good cause to waive such 

procedures under section 553(b)(B) of 

the APA and section 1871(b)(2)(C) of the 

Act, if such procedures may be 

construed to be required at all. Through 

this notice, we are simply notifying the 

public of the updates to the Part A 

premiums, in accordance with the 

statute, for CY 2024. As such, we also 

note that even if notice and comment 

procedures were required for this 

notice, for the reasons stated above we 

would find good cause to waive the 

delay in effective date of the notice, as 

additional delay would be contrary to 

the public interest under section 

1871(e)(1)(B)(ii) of the Act. Publication 

of this notice is consistent with section 

1818(d) of the Act, and we believe that 

any potential delay in the effective date 

of the notice, if such delay were 

required at all, could cause unnecessary 

confusion for both the agency and 

Medicare beneficiaries. 

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 (44 

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

VII. Regulatory Impact Analysis 

Although this notice does not 

constitute a substantive rule, we 

nevertheless prepared this Regulatory 

Impact Analysis section in the interest 

of ensuring that the impacts of this 

notice are fully understood. 

A. Statement of Need 

This notice announces the CY 2024 

Medicare Part A premiums for the 

uninsured aged and for certain disabled 

individuals who have exhausted other 

entitlement, as required by sections 

1818 and 1818A of the Act. It also 

responds to section 1818(d) of the Act, 

which requires the Secretary to provide 

for publication of these amounts in the 

Federal Register during the September 

that precedes the start of each CY. As 

this statutory provision prescribes a 

detailed methodology for calculating 

these amounts, we do not have the 

discretion to adopt an alternative 

approach on these issues. 

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); Executive Order 14094 entitled 

‘‘Modernizing Regulatory Review’’ 

(April 6, 2023); 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. 804(2)). 

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). Executive Order 14094, 

‘‘Modernizing Regulatory Review,’’ 

amends section 3(f)(1) of Executive 

Order 12866 (Regulatory Planning and 

Review). The amended section 3(f) of 

Executive Order 12866 defines a 

‘‘significant regulatory action’’ as an 

action that is likely to result in a rule 

(1) having an annual effect on the 

economy of $200 million or more in any 


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Federal Register / Vol. 88, No. 199 / Tuesday, October 17, 2023 / Notices 71573 

1 year (adjusted every 3 years by the 

Administrator of the Office of 

Information and Regulatory Affairs 

(OIRA) for changes in gross domestic 

product) or adversely affecting in a 

material way the economy, a sector of 

the economy, productivity, competition, 

jobs, the environment, public health or 

safety, or State, local, territorial, or tribal 

governments or communities; (2) 

creating a serious inconsistency or 

otherwise interfering with an action 

taken or planned by another agency; (3) 

materially altering the budgetary 

impacts of entitlement grants, user fees, 

or loan programs or the rights and 

obligations of recipients thereof; or (4) 

raising legal or policy issues, for which 

centralized review would meaningfully 

further the President’s priorities or the 

principles set forth in this Executive 

order, as specifically authorized in a 

timely manner by the Administrator of 

OIRA in each case. 

A regulatory impact analysis (RIA) 

must be prepared for major rules with 

significant regulatory action/s and/or 

with significant effects as per section 

3(f)(1) of Executive Order 12866 ($200 

million or more in any 1 year). Based on 

our estimates, OMB’s Office of 

Information and Regulatory Affairs has 

determined that this rulemaking is not 

significant and not major under Subtitle 

E of the Small Business Regulatory 

Enforcement Fairness Act of 1996 (also 

known as the Congressional Review 

Act). 

As stated in section IV of this notice, 

we estimate that the overall effect of the 

changes in the Medicare Part A 

premium will be a savings to voluntary 

enrollees (sections 1818 and 1818A of 

the Act) of about $9 million. 

C. Accounting Statement and Table 

As required by OMB Circular A–4 

(available at https://

www.whitehouse.gov/wp-content/ 

uploads/legacy_drupal_files/omb/ 

circulars/A4/a-4.pdf), in the Table 

below we have prepared an accounting 

statement showing the total aggregate 

savings to enrollees paying premiums in 

CY 2024, compared with the amount 

that they paid in CY 2023. The amount 

of savings will be about $9 million. As 

stated in section IV of this notice, the 

CY 2024 premium of $505 is 

approximately 0.2 percent lower than 

the CY 2023 premium of $506. We 

estimate that approximately 729,000 

enrollees will voluntarily enroll in 

Medicare Part A by paying the full 

premium and that over 90 percent of 

these individuals will have their Part A 

premium paid for by states, since they 

are enrolled in the QMB eligibility 

group. Furthermore, the CY 2024 

reduced premium of $278 is the same as 

for CY 2023. 

TABLE—ESTIMATED TRANSFERS FOR

CY 2024 MEDICARE PART A PREMIUMS

Category Transfers 

Annualized Monetized 

Transfers.

¥$9 million. 

From Whom to Whom Beneficiaries to Federal Government. 

D. Regulatory Flexibility Act 

The Regulatory Flexibility Act (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 being nonprofit 

organizations or by meeting the Small 

Business Administration’s definition of 

a small business (having revenues of 

less than $9.0 million to $47 million in 

any 1 year). Individuals and states are 

not included in the definition of a small 

entity. This annual notice announces 

the Medicare Part A premiums for CY 

2024 and will have an impact on certain 

Medicare beneficiaries. As a result, we 

are not preparing an analysis for the 

RFA because the Secretary has certified 

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 RIA 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. This annual notice announces the 

Medicare Part A premiums for CY 2024 

and will have an impact on certain 

Medicare beneficiaries. As a result, we 

are not preparing an analysis for section 

1102(b) of the Act because the Secretary 

has certified that this notice will not 

have a significant impact on the 

operations of a substantial number of 

small rural hospitals. 

E. Unfunded Mandates Reform Act 

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 2023, that threshold is approximately 

$177 million. This notice would not 

impose a mandate that will result in 

expenditures by state, local, and Tribal 

Governments, in the aggregate, or by the 

private sector, of more than $177 

million in any 1 year. 

F. Federalism 

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. 

This notice will not have a substantial 

direct effect on state or local 

governments, preempt state law, or 

otherwise have Federalism implications. 

G. Congressional Review 

This final regulation is subject to the 

Congressional Review Act provisions of 

the Small Business Regulatory 

Enforcement Fairness Act of 1996 (5 

U.S.C. 801 et seq.) and has been 

transmitted to the Congress and the 

Comptroller General for review. 

Chiquita Brooks-LaSure, 

Administrator of the Centers for 

Medicare & Medicaid Services, 

approved this document on October 11, 

2023. 

Xavier Becerra, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2023–22848 Filed 10–12–23; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10450, CMS– 

10383, and CMS–10466] 

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 


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