89998 Federal Register / Vol. 89, No. 220 / Thursday, November 14, 2024 / Notices 

Freedom of Information Office at 

https://www.federalreserve.gov/foia/ 

request.htm. Interested persons may 

express their views in writing on the 

standards enumerated in the BHC Act 

(12 U.S.C. 1842(c)). 

Comments received are subject to 

public disclosure. In general, comments 

received will be made available without 

change and will not be modified to 

remove personal or business 

information including confidential, 

contact, or other identifying 

information. Comments should not 

include any information such as 

confidential information that would not 

be appropriate for public disclosure. 

Comments regarding each of these 

applications must be received at the 

Reserve Bank indicated or the offices of 

the Board of Governors, Ann E. 

Misback, Secretary of the Board, 20th 

Street and Constitution Avenue NW, 

Washington, DC 20551–0001, not later 

than December 16, 2024. 

A. Federal Reserve Bank of Atlanta 

(Erien O. Terry, Assistant Vice 

President) 1000 Peachtree Street NE, 

Atlanta, Georgia 30309. Comments can 

also be sent electronically to 

Applications.Comments@atl.frb.org: 

1. Georgia Banking Company, Inc., 

Atlanta, Georgia; to merge with Primary 

Bancshares Corporation, and thereby 

indirectly acquire Georgia Primary 

Bank, both of Atlanta, Georgia. 

Board of Governors of the Federal Reserve 

System. 

Michele Taylor Fennell, 

Associate Secretary of the Board. 

[FR Doc. 2024–26503 Filed 11–13–24; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8086–N] 

RIN 0938–AV36 

Medicare Program; CY 2025 Inpatient 

Hospital Deductible and Hospital and 

Extended Care Services Coinsurance 

Amounts 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice of 2025 deductible and 

coinsurance amounts. 

SUMMARY: This notice announces the 

inpatient hospital deductible and the 

hospital and extended care services 

coinsurance amounts for services 

furnished in calendar year (CY) 2025 

under Medicare’s Hospital Insurance 

Program (Medicare Part A). The 

Medicare statute specifies the formulae 

used to determine these amounts. For 

CY 2025, the inpatient hospital 

deductible will be $1,676. The daily 

coinsurance amounts for CY 2025 will 

be as follows: $419 for the 61st through 

90th day of hospitalization in a benefit 

period; $838 for lifetime reserve days; 

and $209.50 for the 21st through 100th 

day of extended care services in a 

skilled nursing facility in a benefit 

period. 

DATES: The deductible and coinsurance 

amounts announced in this notice are 

effective on January 1, 2025. 

FOR FURTHER INFORMATION CONTACT: 

Suzanne Codespote, (410) 786–7737 or 

Yaminee Thaker, (410) 786–7921. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1813 of the Social Security 

Act (the Act) provides for an inpatient 

hospital deductible to be subtracted 

from the amount payable by Medicare 

for inpatient hospital services furnished 

to a beneficiary. It also provides for 

certain coinsurance amounts to be 

subtracted from the amounts payable by 

Medicare for inpatient hospital and 

extended care services. Section 

1813(b)(2) of the Act requires the 

Secretary of the Department of Health 

and Human Services (the Secretary) to 

determine and publish each year the 

amount of the inpatient hospital 

deductible and the hospital and 

extended care services coinsurance 

amounts applicable for services 

furnished in the following calendar year 

(CY). 

II. Computing the Inpatient Hospital 

Deductible for CY 2025 

Section 1813(b) of the Act prescribes 

the method for computing the amount of 

the inpatient hospital deductible. The 

inpatient hospital deductible is an 

amount equal to the inpatient hospital 

deductible for the preceding CY, 

adjusted by the Secretary’s best estimate 

of the payment-weighted average of the 

applicable percentage increases (as 

defined in section 1886(b)(3)(B) of the 

Act) used for updating the payment 

rates to hospitals for discharges in the 

fiscal year (FY) that begins on October 

1 of the same preceding CY, and 

adjusted to reflect changes in real casemix. The adjustment to reflect real casemix is determined on the basis of the 

most recent case-mix data available. The 

amount determined under this formula 

is rounded to the nearest multiple of $4 

(or, if midway between two multiples of 

$4, to the next higher multiple of $4). 

Under section 1886(b)(3)(B)(i)(XX) of 

the Act, the percentage increase used to 

update the payment rates for FY 2025 

for hospitals paid under the inpatient 

prospective payment system (IPPS) is 

the IPPS operating market basket 

percentage increase, otherwise known 

as the IPPS market basket update, 

reduced by an adjustment based on 

changes in the economy-wide 

productivity (productivity adjustment) 

(see section 1886(b)(3)(B)(xi)(II) of the 

Act). Under section 1886(b)(3)(B)(viii) of 

the Act, for FY 2025, the applicable 

percentage increase for hospitals that do 

not submit quality data as specified by 

the Secretary is reduced by one quarter 

of the market basket update. We are 

estimating that after accounting for 

those hospitals receiving the lower 

market basket update in the paymentweighted average update, the calculated 

deductible will not be affected, since the 

majority of hospitals submit quality data 

and receive the full market basket 

update. Section 1886(b)(3)(B)(ix) of the 

Act requires that any hospital that is not 

a meaningful electronic health record 

(EHR) user (as defined in section 

1886(n)(3) of the Act) will have threequarters of the market basket update 

reduced by 100 percent for FY 2017 and 

each subsequent FY. We are estimating 

that after accounting for these hospitals 

receiving the lower market basket 

update, the calculated deductible will 

not be affected, since the majority of 

hospitals are meaningful EHR users and 

are expected to receive the full market 

basket update. 

Under section 1886 of the Act, the 

percentage increase used to update the 

payment rates (or target amounts, as 

applicable) for FY 2025 for hospitals 

excluded from the inpatient prospective 

payment system is as follows: 

• The percentage increase for long 

term care hospitals (LTCH) is the LTCH 

market basket percentage increase 

reduced by the productivity adjustment 

(see section 1886(m)(3)(A) of the Act). In 

addition, these hospitals may also be 

impacted by the quality reporting 

adjustments and the site-neutral 

payment rates (see sections 1886(m)(5) 

and 1886(m)(6) of the Act). 

• The percentage increase for 

inpatient rehabilitation facilities (IRF) is 

the IRF market basket percentage 

increase reduced by the productivity 

adjustment in accordance with section 

1886(j)(3)(C)(ii)(I) of the Act. In 

addition, these hospitals may also be 

impacted by the quality reporting 

adjustments (see section 1886(j)(7) of 

the Act). 

• The percentage increase used to 

update the payment rate for inpatient 

psychiatric facilities (IPF) is the IPF 


ddrumheller on DSK120RN23PROD with NOTICES1
Federal Register / Vol. 89, No. 220 / Thursday, November 14, 2024 / Notices 89999 

market basket percentage increase 

reduced by the productivity adjustment 

(see section 1886(s)(2)(A)(i) of the Act). 

In addition, these hospitals may also be 

impacted by the quality reporting 

adjustments (see section 1886(s)(4) of 

the Act). 

• The percentage increase used to 

update the target amounts for other 

types of hospitals that are excluded 

from the inpatient prospective payment 

system and that are paid on a reasonable 

cost basis, subject to a rate-of-increase 

ceiling, is the IPPS operating market 

basket percentage increase, which is 

described at section 

1886(b)(3)(B)(ii)(VIII) of the Act and 42 

CFR 413.40(c)(3). These other types of 

hospitals include cancer hospitals, 

children’s hospitals, extended 

neoplastic disease care hospitals, and 

hospitals located outside the 50 states, 

the District of Columbia, and Puerto 

Rico. 

The IPPS operating market basket 

percentage increase for FY 2025 is 3.4 

percent and the productivity adjustment 

is 0.5 percentage point, as announced in 

the final rule that appeared in the 

Federal Register on August 28, 2024 

entitled, ‘‘Medicare and Medicaid 

Programs and the Children’s Health 

Insurance Program; Hospital Inpatient 

Prospective Payment Systems for Acute 

Care Hospitals and the Long-Term Care 

Hospital Prospective Payment System 

and Policy Changes and Fiscal Year 

2025 Rates; Quality Programs 

Requirements; and Other Policy 

Changes’’ (89 FR 68986). Therefore, the 

percentage increase for hospitals paid 

under the inpatient prospective 

payment system that submit quality data 

and are meaningful EHR users is 2.9 

percent (that is, the FY 2025 IPPS 

operating market basket update of 3.4 

percent less the productivity adjustment 

of 0.5 percentage point). The average 

payment percentage increase for 

hospitals excluded from the inpatient 

prospective payment system is 3.05 

percent. This average includes long term 

care hospitals, inpatient rehabilitation 

facilities, inpatient psychiatric facilities 

and other hospitals excluded from the 

inpatient prospective payment system. 

Weighting these percentages in 

accordance with payment volume, our 

best estimate of the payment-weighted 

average of the increases in the payment 

rates for FY 2025 is 2.92 percent. 

To develop the adjustment to reflect 

changes in real case-mix, we first 

calculated an average case-mix for each 

hospital that reflects the relative 

costliness of that hospital’s mix of cases 

compared to those of other hospitals. 

We then computed the change in 

average case-mix for hospitals paid 

under the Medicare inpatient 

prospective payment system in FY 2024 

compared to FY 2023. (We excluded 

from this calculation hospitals whose 

payments are not based on the inpatient 

prospective payment system because 

their payments are based on alternate 

prospective payment systems or 

reasonable costs.) We used Medicare 

bills from prospective payment 

hospitals that we received as of July 

2024. These bills represent a total of 

about 5.8 million Medicare discharges 

for FY 2024 and provide the most recent 

case-mix data available at this time. 

Based on these bills, the change in 

average case-mix in FY 2024 is ¥0.3 

percent. Based on these bills and past 

experience, we expect the overall FY 

2024 case mix change to be ¥0.3 

percent as the year progresses and more 

FY 2024 data become available. 

Section 1813(b) of the Act requires 

that the inpatient hospital deductible be 

adjusted only by that portion of the case 

mix change that is determined to be 

real. Real case-mix is that portion of 

case-mix that is due to changes in the 

mix of cases and not due to coding 

optimization. COVID–19 has 

complicated the determination of real 

case-mix changes over the last few 

years, since these cases typically had 

higher-weighted Medicare Severity 

Diagnosis Related Groups, which 

resulted in an increase in real case-mix. 

However, the number of COVID–19 

cases and the severity of these cases is 

lower in 2024, compared to the last 

several years, and resulted in a decrease 

in case-mix of ¥0.3 percent. We are 

assuming that this decrease in case-mix 

is real and not a result of coding 

optimization. 

Thus, the estimate of the paymentweighted average of the applicable 

percentage increases used for updating 

the payment rates is 2.92 percent, and 

the real case-mix adjustment factor for 

the deductible is ¥0.3 percent. 

Therefore, using the statutory formula as 

stated in section 1813(b) of the Act, we 

calculate the inpatient hospital 

deductible for services furnished in CY 

2025 to be $1,676. This deductible 

amount is determined by multiplying 

$1,632 (the inpatient hospital 

deductible for CY 2024 (88 FR 59035)) 

by the payment-weighted average 

increase in the payment rates of 1.0292 

multiplied by the decrease in real casemix of 0.997, which equals $1,674.62 

and is rounded to $1,676 (based on 

rounding to the nearest multiple of 4). 

III. Computing the Inpatient Hospital 

and Extended Care Services 

Coinsurance Amounts for CY 2025 

The coinsurance amounts provided 

for in section 1813 of the Act are 

defined as fixed percentages of the 

inpatient hospital deductible for 

services furnished in the same CY. The 

increase in the deductible generates 

increases in the coinsurance amounts. 

For inpatient hospital and extended care 

services furnished in CY 2025, in 

accordance with the fixed percentages 

defined in the law, the daily 

coinsurance for the 61st through 90th 

day of hospitalization in a benefit 

period will be $419 (one-fourth of the 

inpatient hospital deductible as stated 

in section 1813(a)(1)(A) of the Act); the 

daily coinsurance for lifetime reserve 

days will be $838 (one-half of the 

inpatient hospital deductible as stated 

in section 1813(a)(1)(B) of the Act); and 

the daily coinsurance for the 21st 

through 100th day of extended care 

services in a skilled nursing facility 

(SNF) in a benefit period will be 

$209.50 (one-eighth of the inpatient 

hospital deductible as stated in section 

1813(a)(3) of the Act). 

IV. Cost to Medicare Beneficiaries 

Table 1 summarizes the deductible 

and coinsurance amounts for CYs 2024 

and 2025, as well as the number of each 

that is estimated to be paid. 

TABLE 1—MEDICARE PART A DEDUCTIBLE AND COINSURANCE AMOUNTS FOR CYS 2024 AND 2025 

Type of cost sharing 

Value Number paid 

(in millions) 

2024 2025 2024 2025 

Inpatient hospital deductible ................................................................................................................ $1,632 $1,676 5.00 4.91 

Daily coinsurance for 61st–90th day ................................................................................................... 408 419 1.23 1.21 

Daily coinsurance for lifetime reserve days ........................................................................................ 816 838 0.62 0.61 

SNF coinsurance ................................................................................................................................. 204.00 209.50 24.66 24.46 


ddrumheller on DSK120RN23PROD with NOTICES1
90000 Federal Register / Vol. 89, No. 220 / Thursday, November 14, 2024 / Notices 

The estimated total increase in costs 

to beneficiaries is about $170 million 

(rounded to the nearest $10 million) due 

to: (1) the increase in the deductible and 

coinsurance amounts; and (2) the 

change in the number of deductibles 

and daily coinsurance amounts paid. 

We determine the increase in cost to 

beneficiaries by calculating the 

difference between the 2024 and 2025 

deductible and coinsurance amounts 

multiplied by the estimated change in 

the number of deductible and 

coinsurance amounts paid. 

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 inpatient hospital 

deductible and the hospital and 

extended care services coinsurance 

amounts 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 which 

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 1813(b)(2) of the Act requires 

publication of the inpatient hospital 

deductible and the hospital and 

extended care services coinsurance 

amounts between September 1 and 

September 15 of the year preceding the 

year to which they will apply. Further, 

the statute requires that the agency 

determine and publish the inpatient 

hospital deductible and hospital and 

extended care services coinsurance 

amounts for each CY in accordance with 

the statutory formulae, and we are 

simply notifying the public of the 

changes to the deductible and 

coinsurance amounts for CY 2025. We 

have calculated the inpatient hospital 

deductible and hospital and extended 

care services coinsurance amounts as 

directed by the statute; the statute 

establishes both when the deductible 

and coinsurance amounts must be 

published and the information that the 

Secretary must factor into the 

deductible and coinsurance amounts, so 

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 inpatient 

hospital deductible and the hospital and 

extended care services coinsurance 

amounts, in accordance with the statute, 

for CY 2025. 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 1813(b)(2) 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 both for 

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 significant regulatory action 

(defined below), we nevertheless 

prepared this Regulatory Impact 

Analysis (RIA) section in the interest of 

ensuring that the impacts of this notice 

are fully understood. 

A. Statement of Need 

This notice announces the Medicare 

Part A inpatient hospital deductible and 

associated coinsurance amounts for 

hospital and extended care services 

applicable for care provided in CY 2025, 

as required by section 1813 of the Act. 

It also responds to section 1813(b)(2) of 

the Act, which requires the Secretary to 

provide for publication of these 

amounts in the Federal Register 

between September 1 and September 15 

of the year preceding the year to which 

they will apply. 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 titled 

‘‘Modernizing Regulatory Review’’ 

(April 6, 2024), 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, 


ddrumheller on DSK120RN23PROD with NOTICES1
Federal Register / Vol. 89, No. 220 / Thursday, November 14, 2024 / Notices 90001 

environmental, public health and safety 

effects, distributive impacts, and 

equity). The Executive Order 14094, 

titled ‘‘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 

that may: (1) have an annual effect on 

the economy of $200 million or more 

(adjusted every 3 years by the 

Administrator of the Office of 

Information and Regulatory Affairs 

(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) create 

a serious inconsistency or otherwise 

interfering with an action taken or 

planned by another agency; (3) 

materially alter 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 OIRA in each case. 

An RIA must be prepared for rules 

that are likely to result in a significant 

regulatory action(s) as set forth in 

section 3(f)(1) of Executive Order 12866 

($200 million or more in any 1 year). 

Based on our estimates, OIRA has 

determined that this notice is not 

significant per section 3(f)(1) of E.O. 

12866 as measured by the $200 million 

or more impact in any 1 year. 

In accordance with the Congressional 

Review Act, OIRA has determined that 

this notice meets the criteria set forth in 

5 U.S.C. 804(2). Accordingly, we have 

prepared an RIA that to the best of our 

ability presents the costs and benefits of 

this notice. 

As stated in section IV. of this notice, 

we estimate that the total increase in 

costs to beneficiaries is about $170 

million due to: (1) the increase in the 

deductible and coinsurance amounts; 

and (2) the change in the number of 

deductibles and daily coinsurance 

amounts paid. 

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 table 2, we 

have prepared an accounting statement 

showing the estimated total increase in 

costs to beneficiaries of about $170 

million. As stated in section IV. of this 

notice, we determined the increase in 

cost to beneficiaries by calculating the 

difference between the 2024 and 2025 

deductible and coinsurance amounts 

multiplied by the estimated change in 

the number of deductible and 

coinsurance amounts paid. 

TABLE 2—ESTIMATED TRANSFERS FOR

CY 2025 DEDUCTIBLE AND COINSURANCE AMOUNTS

Category Transfers Period 

covered 

Annualized 

Monetized 

Transfers.

$170 million ..... 2025 

From Whom to 

Whom.

Beneficiaries to 

Providers.

................

D. Regulatory Flexibility Act 

The 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 deductible and 

coinsurance amounts for CY 2025 and 

will have an impact on the 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 an 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 deductible and 

coinsurance amounts for CY 2025 and 

will have an impact on the 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 2024, that threshold is approximately 

$183 million. This notice would not 

impose a mandate that will result in the 

expenditure by state, local, and Tribal 

governments, in the aggregate, or by the 

private sector, of more than $183 

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 notice is subject to the 

Congressional Review Act and has been 

transmitted to the Congress and the 

Government Accountability Office’s 

Comptroller General for review. 

Chiquita Brooks-LaSure, 

Administrator of the Centers for 

Medicare & Medicaid Services, 

approved this document on October 31, 

2024. 

Xavier Becerra, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2024–26472 Filed 11–8–24; 4:15 pm] 

BILLING CODE 4120–01–P 


ddrumheller on DSK120RN23PROD with NOTICES1