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[Federal Register Volume 89, Number 231 (Monday, December 2, 2024)]
[Notices]
[Pages 95215-95217]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-28127]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-6094-N]
RIN 0938-ZB85

Medicare, Medicaid, and Children's Health Insurance Programs; 
Provider Enrollment Application Fee Amount for Calendar Year 2025

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (HHS).

ACTION: Notice.

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SUMMARY: This notice announces a $730.00 calendar year (CY) 2025 
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, 2025, and on or before December 31, 2025.

DATES: The application fee announced in this notice is effective on 
January 1, 2025.

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:
     A Medicare physician or non-physician practitioner 
submitting a CMS-855I.
     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

[[Page 95216]]

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 November 7, 
2023 Federal Register (88 FR 76754), we published a notice announcing a 
fee amount for the period of January 1, 2024 through December 31, 2024 
of $709.00. The $709.00 fee amount for CY 2024 was used to calculate 
the fee amount for 2025 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, 2023 through June 30, 2024 was 3.0 
percent. (See https://www.bls.gov/news.release/archives/cpi_07112024.htm.) As required by Sec.  424.514(d)(2), the preceding 
year's fee of $709 will be adjusted by 3.0 percent. This results in a 
CY 2025 application fee amount of $730.27 ($709 x 1.03). As we must 
round this to the nearest whole dollar amount, the resultant 
application fee amount for CY 2025 is $730.

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. Overall Impact

    We have examined the impacts 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), Executive Order 14094 titled ``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). 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 (notice) that may: (1) have an annual effect on the economy 
of $200 million or more in any 1 year, (adjusted every 3 years by the 
Administrator of OMB's 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 interfere 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.
    A regulatory impact analysis (RIA) must be prepared for notices 
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, OIRA has determined that this 
rulemaking is not significant per section 3(f)(1) as measured by the 
$200 million or more in any 1 year.
    As explained in this section of the notice, we estimate that the 
total cost of the increase in the application fee will not exceed $200 
million. Therefore, this notice does not reach the $200 million 
economic threshold and is not considered a significant notice.

B. Cost

    The costs associated with this notice involve the increase in the 
application fee amount that certain providers and suppliers must pay in 
CY 2025. The CY 2025 cost estimates are as follows:
1. Medicare
    Based on CMS data, we estimate that in CY 2025 approximately--
     13,151 newly enrolling institutional providers will be 
subject to and pay an application fee; and
     37,224 revalidating institutional providers will be 
subject to and pay an application fee.
    Using a figure of 50,375 (13,151 newly enrolling + 37,224 
revalidating) institutional providers, we estimate an increase in the 
cost of the Medicare application fee requirement in CY 2025 of 
$1,057,875 (or 50,375 x $21 (or $730 minus $709)) from our CY 2024 
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 
2025. Using this figure, we project an increase in the cost of the 
Medicaid and CHIP application fee requirement in CY 2025 of $630,000 
(or 30,000 x $21 (or $730 minus $709)) from our CY 2024 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 2025 to be $1,687,875 ($1,057,875 + 
$630,000) from our CY 2024 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.

[[Page 95217]]

    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 an 
RIA if a rule (notice) 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. 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.
    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.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) (in this case a notice) 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. 2024-28127 Filed 11-29-24; 8:45 am]
BILLING CODE 4120-01-P
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