[Federal Register Volume 88, Number 214 (Tuesday, November 7, 2023)]
[Notices]
[Pages 76754-76756]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-24607]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-6093-N]
RIN 0938-ZB79


Medicare, Medicaid, and Children's Health Insurance Programs; 
Provider Enrollment Application Fee Amount for Calendar Year 2024

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces a $709.00 calendar year (CY) 2024 
application fee for institutional providers that are initially 
enrolling in the Medicare or Medicaid program or the Children's Health 
Insurance Program (CHIP); revalidating their Medicare, Medicaid, or 
CHIP enrollment; or adding a new Medicare practice location. This fee 
is required with any enrollment application submitted on or after 
January 1, 2024 and on or before December 31, 2024.

[[Page 76755]]


DATES: The application fee announced in this notice is effective on 
January 1, 2024.

FOR FURTHER INFORMATION CONTACT: Frank Whelan, (410) 786-1302.

SUPPLEMENTARY INFORMATION: 

I. Background

    In the February 2, 2011 Federal Register (76 FR 5862), we published 
a final rule with comment period titled ``Medicare, Medicaid, and 
Children's Health Insurance Programs; Additional Screening 
Requirements, Application Fees, Temporary Enrollment Moratoria, Payment 
Suspensions and Compliance Plans for Providers and Suppliers.'' This 
rule finalized, among other things, provisions related to the 
submission of application fees as part of the Medicare, Medicaid, and 
CHIP provider enrollment processes. As provided in section 
1866(j)(2)(C)(i) of the Social Security Act (the Act) and in 42 CFR 
424.514, ``institutional providers'' that are initially enrolling in 
the Medicare or Medicaid programs or CHIP, revalidating their 
enrollment, or adding a new Medicare practice location are required to 
submit a fee with their enrollment application. An ``institutional 
provider'' for purposes of Medicare is defined at Sec.  424.502 as 
``any provider or supplier that submits a paper Medicare enrollment 
application using the CMS-855A, CMS-855B (not including physician and 
non-physician practitioner organizations), CMS-855S, or associated 
internet-based PECOS enrollment application.'' As we explained in the 
February 2, 2011 final rule (76 FR 5914), in addition to the providers 
and suppliers subject to the application fee under Medicare, Medicaid-
only and CHIP-only institutional providers would include nursing 
facilities, intermediate care facilities for persons with intellectual 
disabilities (ICF/IID), and psychiatric residential treatment 
facilities; they may also include other institutional provider types 
designated by a state in accordance with their approved state plan.
    As indicated in Sec.  424.514 and Sec.  455.460, the application 
fee is not required for either of the following:
    <bullet> A Medicare physician or non-physician practitioner 
submitting a CMS-855I.
    <bullet> A prospective or revalidating Medicaid or CHIP provider--
    ++ Who is an individual physician or non-physician practitioner; or
    ++ That is enrolled as an institutional provider in Title XVIII of 
the Act or another state's Title XIX or XXI plan and has paid the 
application fee to a Medicare contractor or another state.

II. Provisions of the Notice

    Section 1866(j)(2)(C)(i)(I) of the Act established a $500 
application fee for institutional providers in CY 2010. Consistent with 
section 1866(j)(2)(C)(i)(II) of the Act, Sec.  424.514(d)(2) states 
that for CY 2011 and subsequent years, the preceding year's fee will be 
adjusted by the percentage change in the consumer price index (CPI) for 
all urban consumers (all items; United States city average, CPI-U) for 
the 12-month period ending on June 30 of the previous year. 
Consequently, each year since 2011 we have published in the Federal 
Register an announcement of the application fee amount for the 
forthcoming CY based on this formula. Most recently, in the December 5, 
2022 Federal Register (87 FR 74422), we published a notice announcing a 
fee amount for the period of January 1, 2023 through December 31, 2023 
of $688.00. The $688.00 fee amount for CY 2023 will be used to 
calculate the fee amount for 2024 as specified in Sec.  424.514(d)(2).
    According to Bureau of Labor Statistics (BLS) data, the CPI-U 
increase for the period of July 1, 2022 through June 30, 2023 was 3.0 
percent. As required by Sec.  424.514(d)(2), the preceding year's fee 
of $688 will be adjusted by 3.0 percent. This results in a CY 2024 
application fee amount of $708.64 ($688 x 1.03). As we must round this 
to the nearest whole dollar amount, the resultant application fee 
amount for CY 2024 is $709.00.

III. Collection of Information Requirements

    This document does not impose information collection requirements 
(that is, reporting, recordkeeping, or third-party disclosure 
requirements). Accordingly, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995. However, it does reference previously approved information 
collections. The CMS-855A, CMS-855B, CMS-855I, and CMS-855S 
applications are approved under, respectively, OMB control numbers 
0938-0685, 0938-1377, 0938-1355, and 0938-1056.

IV. Regulatory Impact Statement

A. Background and Review Requirements

    We have examined the impact of this notice 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 Act, section 202 of the 
Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104-4), 
and Executive Order 13132 on Federalism (August 4, 1999).
    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). The 
Executive Order 14094 entitled ``Modernizing Regulatory Review'' 
(hereinafter, the Modernizing E.O.) 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 1 year (adjusted 
every 3 years by the Administrator of OIRA for changes in gross 
domestic product), or adversely affect 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) raise 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) ($200 million or more in any 1 year). Accordingly, 
we have prepared a Regulatory Impact Analysis that to the best of our 
ability presents the costs and benefits of the rulemaking. Based on our 
estimates, OMB's Office of Information and Regulatory Affairs has 
determined that this notice is ``not significant'' and ``not major''.

B. Costs

    The costs associated with this notice involve the increase in the 
application fee amount that certain providers and suppliers must pay in 
CY 2024. The CY 2024 cost estimates are as follows:

[[Page 76756]]

1. Medicare
    Based on CMS data, we estimate that in CY 2024 approximately--
    <bullet> 14,232 newly enrolling institutional providers will be 
subject to and pay an application fee; and
    <bullet> 36,142 revalidating institutional providers will be 
subject to and pay an application fee.
    Using a figure of 50,374 (14,232 newly enrolling + 36,142 
revalidating) institutional providers, we estimate an increase in the 
cost of the Medicare application fee requirement in CY 2024 of 
$1,057,854 (or 50,374 x $21 (or $709 minus $688)) from our CY 2023 
projections.
2. Medicaid and CHIP
    Based on CMS and state statistics, we estimate that approximately 
30,000 (9,000 newly enrolling + 21,000 revalidating) Medicaid and CHIP 
institutional providers will be subject to an application fee in CY 
2024. Using this figure, we project an increase in the cost of the 
Medicaid and CHIP application fee requirement in CY 2024 of $630,000 
(or 30,000 x $21 (or $709 minus $688)) from our CY 2023 projections.
3. Total
    Based on the foregoing, we estimate the total increase in the cost 
of the application fee requirement for Medicare, Medicaid, and CHIP 
providers and suppliers in CY 2024 to be $1,687,854 ($1,057,854 + 
$630,000) from our CY 2023 projections.
    We do not anticipate any negative impact on equity from the 
increase in the application fee amount, which we calculated in 
accordance with the requirements specified in statute and regulation. 
Prior application fee increases have had no such discernable effect, 
and we reiterate that the fee requirement does not apply to individual 
physicians and non-physician practitioners completing the CMS-855I, who 
represent the overwhelming preponderance of the more than 2 million 
Medicare-enrolled providers and suppliers.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. 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 $9 million to $47 million in any 1 year. Individuals and 
states are not included in the definition of a small entity. As we 
stated in the RIA for the February 2, 2011 final rule (76 FR 5952), we 
do not believe that the application fee will have a significant impact 
on small entities.
    In addition, section 1102(b) of the 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. We are not preparing an analysis for section 1102(b) of the 
Act because we have determined, and the Secretary certifies, that this 
notice would 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 (UMRA) 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 was approximately $198million. The Agency has determined that 
there will be minimal impact from the costs of this notice, as the 
threshold is not met under the UMRA.
    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 substantial direct 
costs on state or local governments, the requirements of Executive 
Order 13132 are not applicable.
    In accordance with the provisions of Executive Order 12866, this 
notice was reviewed by the Office of Management and Budget.
    The Administrator of the Centers for Medicare & Medicaid Services 
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this 
document, authorizes Chyana Woodyard, who is the Federal Register 
Liaison, to electronically sign this document for purposes of 
publication in the Federal Register.

Chyana Woodyard,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2023-24607 Filed 11-6-23; 8:45 am]
BILLING CODE 4120-01-P