Federal Register / Vol. 75, No. 185 / Friday, September 24, 2010 / Notices 58407 

participate in a meeting. If you do not 

pass the connection test, perform the 

suggested actions and run the test again. 

2. Joining the Meeting 

Registrants will receive an e-mail 

invitation with meeting access 

information prior to meeting. When the 

meeting date and time arrive, click on 

the link or enter the URL into your Web 

browser. The meeting login screen 

appears. Select ‘‘Enter as a Guest,’’ type 

in your first and last name, and click 

‘‘Enter Room.’’ The meeting launches in 

your browser. 

To access the audio portion of the 

meeting please dial 1–888–469–0694 

and enter passcode 1995616. If you 

should have difficulties accessing the 

meeting please contact Syreeta Jones via 

phone at 1–301–577–0244 ext. 4900 or 

via e-mail at sjones@blseamon.com. 

Authority: Sec. 222 of the Public Health 

Service Act (42 U.S.C. 217a) and sec. 10(a) 

of Pub. L. 92–463 (5 U.S.C. App. 2, sec. 10(a) 

and 41 CFR 102–3). 

(Catalog of Federal Domestic Assistance 

Program No. 93.733, Medicare—Hospital 

Insurance Program; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: September 9, 2010. 

Donald M. Berwick, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2010–23312 Filed 9–23–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–4143–N] 

Medicare Program; Medicare Appeals; 

Adjustment to the Amount in 

Controversy Threshold Amounts for 

Calendar Year 2011 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), 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, 2011. The 

2011 AIC threshold amounts are $130 

for ALJ hearings and $1,300 for judicial 

review. 

DATES: Effective Date: This notice is 

effective on January 1, 2011. 

FOR FURTHER INFORMATION CONTACT: Liz 

Hosna (Katherine.Hosna@cms.hhs.gov), 

(410) 786–4993. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1869(b)(1)(E) of the Social 

Security Act (the Act), as amended by 

section 521 of the Medicare, Medicaid, 

and SCHIP Benefits Improvement and 

Protection Act of 2000 (BIPA), 

established the AIC threshold amounts 

for ALJ hearing requests and judicial 

review at $100 and $1,000, respectively, 

for Medicare Part A and Part B appeals. 

Section 940 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA), 

amended section 1869(b)(1)(E) of the 

Act to require the AIC threshold 

amounts for ALJ hearings and judicial 

review to be adjusted annually. The AIC 

threshold amounts are to be adjusted, as 

of January 2005, by the percentage 

increase in the medical care component 

of the consumer price index 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. Section 

940(b)(2) of the MMA provided 

conforming amendments to 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. Section 101 of 

the MMA provides for 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 Part 405, Subpart I, 

at § 405.1006(b). The regulations require 

the Secretary of the Department of 

Health and Human Services (the 

Secretary) to publish changes to the AIC 

threshold amounts in the Federal 

Register (§ 405.1006(b)(2)). 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 (Medicare 

Advantage) Appeals 

Section 940(b)(2) of the MMA applies 

the AIC adjustment requirement to Part 

C (MA) appeals by amending section 

1852(g)(5) of the Act. The implementing 

regulations for Medicare Part C appeals 

are found at 42 CFR Part 422, Subpart 

M. Specifically, § 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 that 

any party, including the MA 

organization, may request judicial 

review if, in part, 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) 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 and Subpart U. The 

regulations impart at § 423.562(c) that, 


srobinson on DSKHWCL6B1PROD with NOTICES
58408 Federal Register / Vol. 75, No. 185 / Friday, September 24, 2010 / Notices 

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, 

§ 423.1970 and § 423.1976 of the Part D 

appeals rules discuss the AIC threshold 

amounts for ALJ hearings and judicial 

review. Section 423.1970(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. Sections 423.1976(a) and (b) 

allow a Part D enrollee to request 

judicial review of an ALJ or MAC 

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 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 2011 

The AIC threshold amount for ALJ 

hearing requests will remain at $130 

and the AIC threshold amount for 

judicial review will rise to $1,300 for 

the 2011 calendar year. These updated 

amounts are based on the 30.34 percent 

increase in the medical care component 

of the CPI from July of 2003 to July of 

2010. The CPI level was at 297.6 in July 

of 2003 and rose to 387.898 in July of 

2010. This change accounted for the 

30.34 percent increase. The AIC 

threshold amount for ALJ hearing 

requests changes to $130.34 based on 

the 30.34 percent increase. In 

accordance with section 940 of the 

MMA, this amount is rounded to the 

nearest multiple of $10. Therefore, the 

2011 AIC threshold amount for ALJ 

hearings is $130. The AIC threshold 

amount for judicial review changes to 

$1,303.42 based on the 30.34 percent 

increase. This amount was rounded to 

the nearest multiple of $10, resulting in 

a 2011 AIC threshold amount of $1,300. 

C. Summary Table of Adjustments in 

the AIC Threshold Amounts 

In Table 1 below, we list the (CY) 

2005 through 2011 threshold amounts. 

TABLE 1—AMOUNT-IN-CONTROVERSY THRESHOLD AMOUNTS

CY 2005 CY 2006 CY 2007 CY 2008 CY 2009 CY 2010 CY 2011 

ALJ Hearing ......................................................................... $100 $110 $110 $120 $120 $130 $130 

Judicial Review .................................................................... 1,050 1,090 1,130 1,180 1,220 1,260 1,300 

* CY—Calendar Year. 

III. Collection of Information 

Requirements 

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 2, 2010. 

Donald M. Berwick, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2010–23584 Filed 9–23–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

Subcommittee on Procedures Review, 

Advisory Board on Radiation and 

Worker Health (ABRWH), National 

Institute for Occupational Safety and 

Health (NIOSH) 

In accordance with section 10(a)(2) of 

the Federal Advisory Committee Act 

(Pub. L. 92–463), the Centers for Disease 

Control and Prevention (CDC), 

announces the following meeting of the 

aforementioned subcommittee: 

Time and Date: 9 a.m.–5 p.m., 

October 13, 2010. 

Place: Cincinnati Airport Marriott, 

2395 Progress Drive, Hebron, Kentucky 

41018. Telephone (859) 334–4611, Fax 

(859) 334–4619. 

Status: Open to the public, but 

without a public comment period. To 

access by conference call, dial the 

following information: (866) 659–0537, 

Participant Pass Code 9933701. 

Background: The ABRWH was 

established under the Energy Employees 

Occupational Illness Compensation 

Program Act of 2000 to advise the 

President on a variety of policy and 

technical functions required to 

implement and effectively manage the 

compensation program. Key functions of 

the ABRWH include providing advice 

on the development of probability of 

causation guidelines that have been 

promulgated by the Department of 

Health and Human Services (HHS) as a 

final rule; advice on methods of dose 

reconstruction which have also been 

promulgated by HHS as a final rule; 

advice on the scientific validity and 

quality of dose estimation and 

reconstruction efforts being performed 

for purposes of the compensation 

program; and advice on petitions to add 

classes of workers to the Special 

Exposure Cohort (SEC). 

In December 2000, the President 

delegated responsibility for funding, 

staffing, and operating the ABRWH to 

HHS, which subsequently delegated this 

authority to CDC. NIOSH implements 

this responsibility for CDC. The charter 

was issued on August 3, 2001, renewed 

at appropriate intervals, and will expire 

on August 3, 2011. 

Purpose: The ABRWH is charged with 

(a) providing advice to the Secretary, 

HHS, on the development of guidelines 

under Executive Order 13179; (b) 

providing advice to the Secretary, HHS, 

on the scientific validity and quality of 

dose reconstruction efforts performed 

for this program; and (c) upon request 

by the Secretary, HHS, advising the 

Secretary on whether there is a class of 

employees at any Department of Energy 

facility who were exposed to radiation 


srobinson on DSKHWCL6B1PROD with NOTICES