61312 Federal Register / Vol. 79, No. 197 / Friday, October 10, 2014 / Notices 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). A regulatory impact analysis 

(RIA) must be prepared for major 

notices with economically significant 

effects ($100 million or more in any 1 

year). As stated in section IV of this 

notice, we estimate that the total 

increase in costs to beneficiaries 

associated with this notice is about 

$1,120 million due to: (1) the increase 

in the deductible and coinsurance 

amounts, and (2) the increase in the 

number of deductibles and daily 

coinsurance amounts paid. As a result, 

this notice is economically significant 

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

12866 and thus, is a major action under 

the Congressional Review Act. In 

accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

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 

nonprofit status or by having revenues 

of less than $7.5 million to $38.5 

million in any 1 year (for details, see the 

Small Business Administration’s Web 

site at http://www.sba.gov/sites/default/ 

files/files/Size_Standards_Table.pdf). 

Individuals and states are not included 

in the definition of a small entity. As 

discussed above, this annual notice 

announces the inpatient hospital 

deductible and the hospital and 

extended care services coinsurance 

amounts for services furnished in CY 

2015 under Medicare’s Hospital 

Insurance Program (Medicare Part A). 

As a result, we are not preparing an 

analysis for the RFA because the 

Secretary has determined that this 

notice will not have a significant 

economic impact on a substantial 

number of small entities. 

In addition, section 1102(b) of the 

Social Security 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. As discussed above, we are not 

preparing an analysis for section 1102(b) 

of the Act because the Secretary has 

determined that this notice will 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 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. 

For 2014, that threshold accounting for 

inflation is approximately $141 million. 

This notice does not impose mandates 

that will have a consequential effect of 

$141 million or more on state, local, or 

tribal governments or on the private 

sector. 

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 any 

costs on state or local governments, 

preempt state law, or have Federalism 

implications, the requirements of 

Executive Order 13132 are not 

applicable. 

Dated: September 12, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Dated: September 26, 2014. 

Sylvia M. Burwell, 

Secretary. 

[FR Doc. 2014–24257 Filed 10–9–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8057–N] 

RIN 0938–AR96 

Medicare Program; CY 2015 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 annual notice announces 

Medicare’s Hospital Insurance (Part A) 

premium for uninsured enrollees in 

calendar year (CY) 2015. This premium 

is paid by enrollees age 65 and over who 

are not otherwise eligible for benefits 

under Medicare Part A (hereafter known 

as the ‘‘uninsured aged’’) and by certain 

disabled individuals who have 

exhausted other entitlement. The 

monthly Part A premium for the 12 

months beginning January 1, 2015, for 

these individuals will be $407. The 

premium for certain other individuals as 

described in this notice will be $224. 

DATES: Effective Date: This notice is 

effective on January 1, 2015. 

FOR FURTHER INFORMATION CONTACT: 

Clare McFarland, (410) 786–6390. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1818 of the Social Security 

Act (the Act) provides for voluntary 

enrollment in the Medicare Hospital 

Insurance Program (Medicare Part A), 

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 Medicare 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 

Medicare Part A.) 

Section 1818A of the Act provides for 

voluntary enrollment in Medicare Part 

A, subject to payment of a monthly 

premium for certain disabled 

individuals 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 free 

Medicare 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 under section 1818(d) 

through section 1818(f) of the Act for 

the aged will also apply to certain 

disabled individuals as described above. 

Section 1818(d) 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 

mstockstill on DSK4VPTVN1PROD with NOTICES

Federal Register / Vol. 79, No. 197 / Friday, October 10, 2014 / Notices 61313 

who will be entitled to benefits under 

Medicare 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, 

the premium 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 (section 1818 and section 

1818A of the Act). The reduction 

applies to an individual who is eligible 

to buy into the Medicare 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 and had 

been married to the person for at least 

10 years at the time of the divorce if, at 

the time of the divorce, the person had 

at least 30 quarters of coverage. 

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

specifies that the premium that these 

individuals will pay for CY 2015 will be 

equal to the premium for uninsured 

aged enrollees reduced by 45 percent. 

II. Monthly Premium Amount for CY 

2015 

The monthly premium for the 

uninsured aged and certain disabled 

individuals who have exhausted other 

entitlement for the 12 months beginning 

January 1, 2015, is $407. 

The monthly premium for the 

individuals eligible under Section 

1818(d)(4)(B) of the Act, and therefore, 

subject to the 45 percent reduction in 

the monthly premium, is $224. 

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 2015 

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: 

• 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 2015 

on—(1) current historical data; and (2) 

projection assumptions derived from 

current law and the Mid-Session Review 

of the President’s Fiscal Year 2015 

Budget. 

We estimate that in CY 2015, 

45,458,424 people aged 65 years and 

over will be entitled to benefits (without 

premium payment) and that they will 

incur about $221.762 billion in benefits 

and related administrative costs. Thus, 

the estimated monthly average per 

capita amount is $406.53 and the 

monthly premium is $407. 

Subsequently, the full monthly 

premium reduced by 45 percent is $224. 

IV. Costs to Beneficiaries 

The CY 2015 premium of $407 is 

approximately 4.46 percent lower than 

the CY 2014 premium of $426. We 

estimate that approximately 644,000 

enrollees will voluntarily enroll in 

Medicare Part A, by paying the full 

premium. Furthermore, the CY 2015 

reduced premium of $224 is 

approximately 4.27 percent lower than 

the CY 2014 premium of $234. We 

estimate an additional 58,000 enrollees 

will pay the reduced premium. 

Therefore, we estimate that the total 

aggregate savings to enrollees paying 

these premiums in CY 2015, compared 

to the amount that they paid in CY 

2014, will be about $154 million. 

V. Waiver of Proposed Notice and 

Comment Period 

We use general notices, rather than 

notice and comment rulemaking 

procedures, to make announcements 

such as this premium notice. In doing 

so, we acknowledge that, under the 

Administrative Procedure Act (APA), 

interpretive rules, general statements of 

policy, and rules of agency organization, 

procedure, or practice are excepted from 

the requirements of notice and comment 

rulemaking. The agency may also waive 

notice and comment if there is ‘‘good 

cause,’’ as defined by the statute. We 

considered publishing a proposed 

notice to provide a period for public 

comment. However, under the APA, we 

may waive that procedure if we find 

good cause that prior notice and 

comment are impracticable, 

unnecessary, or contrary to the public 

interest. 

We are not using notice and comment 

rulemaking in this notification of 

Medicare Part A premiums for CY 2015 

as that procedure is unnecessary 

because of the lack of discretion in the 

statutory formula that is used to 

calculate the premium and the solely 

ministerial function that this notice 

serves. The APA permits agencies to 

waive notice and comment rulemaking 

when notice and public comment 

thereon are unnecessary. On this basis, 

we waive publication of a proposed 

notice and a solicitation of public 

comments. 

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. 

VII. Regulatory Impact Analysis 

A. Statement of Need 

Section 1818(d) of the Act requires 

the Secretary of the Department of 

Health and Human Services (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 calendar year 

(CY) (including the associated 

administrative costs) on behalf of 

individuals aged 65 and over who will 

be entitled to benefits under Medicare 

Part A. 

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), 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., Part I, Ch. 8). 

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 

mstockstill on DSK4VPTVN1PROD with NOTICES

61314 Federal Register / Vol. 79, No. 197 / Friday, October 10, 2014 / Notices 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). A regulatory impact analysis 

(RIA) must be prepared for major 

notices with economically significant 

effects ($100 million or more in any 1 

year). As stated in section IV of this 

notice, we estimate that the overall 

effect of the changes in the Part A 

premium will be a savings to voluntary 

enrollees (section 1818 and section 

1818A of the Act) of about $154 million. 

As a result, this notice is economically 

significant under section 3(f)(1) of 

Executive Order 12866 and thus, a 

major action under the Congressional 

Review Act. In accordance with the 

provisions of Executive Order 12866, 

this notice was reviewed by the Office 

of Management and Budget. 

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 

nonprofit status or by having revenues 

of less than $7.5 million to $38.5 

million in any 1 year (for details, see the 

Small Business Administration’s Web 

site at http://www.sba.gov/sites/default/ 

files/files/Size_Standards_Table.pdf). 

Individuals and states are not 

included in the definition of a small 

entity. As discussed above, this annual 

notice announces Medicare’s Hospital 

Insurance (Part A) premium for 

uninsured enrollees in calendar year 

(CY) 2015. As a result, we are not 

preparing an analysis for the RFA 

because the Secretary has determined 

that this notice will not have a 

significant economic impact on a 

substantial number of small entities. 

In addition, section 1102(b) of the 

Social Security 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. As discussed above, we are not 

preparing an analysis for section 1102(b) 

of the Act, because the Secretary has 

determined that this notice will 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 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 2014, that threshold is approximately 

$141 million. This notice does not 

impose mandates that will have a 

consequential effect of $141 million or 

more on state, local, or tribal 

governments or on the private sector. 

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 any 

costs on state or local governments, the 

requirements of Executive Order 13132 

are not applicable. 

Dated: September 12, 2014. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Dated: September 26, 2014. 

Sylvia M. Burwell, 

Secretary. 

[FR Doc. 2014–24250 Filed 10–9–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8058–N] 

RIN 0938–AS34 

Medicare Program; Medicare Part B 

Monthly Actuarial Rates, Premium 

Rate, and Annual Deductible 

Beginning January 1, 2015 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

monthly actuarial rates for aged (age 65 

and over) and disabled (under age 65) 

beneficiaries enrolled in Part B of the 

Medicare Supplementary Medical 

Insurance (SMI) program beginning 

January 1, 2015. In addition, this notice 

announces the monthly premium for 

aged and disabled beneficiaries as well 

as the income-related monthly 

adjustment amounts to be paid by 

beneficiaries with modified adjusted 

gross income above certain threshold 

amounts. The monthly actuarial rates 

for 2015 are $209.80 for aged enrollees 

and $254.80 for disabled enrollees. The 

standard monthly Part B premium rate 

for all enrollees for 2015 is $104.90, 

which is equal to 50 percent of the 

monthly actuarial rate for aged enrollees 

or approximately 25 percent of the 

expected average total cost of Part B 

coverage for aged enrollees. (The 2014 

standard premium rate was $104.90.) 

The Part B deductible for 2015 is 

$147.00 for all Part B beneficiaries. If a 

beneficiary has to pay an income-related 

monthly adjustment, they may have to 

pay a total monthly premium of about 

35, 50, 65, or 80 percent of the total cost 

of Part B coverage. 

DATES: Effective Date: January 1, 2015. 

FOR FURTHER INFORMATION: M. Kent 

Clemens, (410) 786–6391. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Part B is the voluntary portion of the 

Medicare program that pays all or part 

of the costs for physicians’ services, 

outpatient hospital services, certain 

home health services, services furnished 

by rural health clinics, ambulatory 

surgical centers, comprehensive 

outpatient rehabilitation facilities, and 

certain other medical and health 

services not covered by Medicare Part 

A, Hospital Insurance. Medicare Part B 

is available to individuals who are 

entitled to Medicare Part A, as well as 

to U.S. residents who have attained age 

65 and are citizens, and aliens who were 

lawfully admitted for permanent 

residence and have resided in the 

United States for 5 consecutive years. 

Part B requires enrollment and payment 

of monthly premiums, as described in 

42 CFR part 407, subpart B, and part 

408, respectively. The difference 

between the premiums paid by all 

enrollees and total incurred costs is met 

by transfers from the general fund of the 

Treasury. 

The Secretary of the Department of 

Health and Human Services (the 

Secretary) is required by section 1839 of 

the Social Security Act (the Act) to 

announce the Part B monthly actuarial 

rates for aged and disabled beneficiaries 

as well as the monthly Part B premium. 

The Part B annual deductible is 

included because its determination is 

directly linked to the aged actuarial rate. 

The monthly actuarial rates for aged 

and disabled enrollees are used to 

determine the correct amount of general 

revenue financing per beneficiary each 

month. These amounts, according to 

actuarial estimates, will equal, 

respectively, one-half of the expected 

average monthly cost of Part B for each 

mstockstill on DSK4VPTVN1PROD with NOTICES