Federal Register / Vol. 72, No. 193 / Friday, October 5, 2007 / Notices 57039 

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 these changes in the 

Part A premium will be a cost to 

voluntary enrollees (section 1818 and 

section 1818A of the Act) of about $91 

million. Therefore, this notice is not a 

major rule as defined in Title 5, United 

States Code, section 804(2) and is not an 

economically significant rule under 

Executive Order 12866. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and 

government agencies. Most hospitals 

and most other providers and suppliers 

are small entities, either by nonprofit 

status or by having revenues of $6 

million to $29 million in any 1 year. 

Individuals and States are not included 

in the definition of a small entity. We 

have determined that this notice will 

not have a significant economic impact 

on a substantial number of small 

entities. Therefore, we are not preparing 

an analysis for the RFA. 

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 (MSA) 

and has fewer than 100 beds. We have 

determined that this notice will not 

have a significant effect on the 

operations of a substantial number of 

small rural hospitals. Therefore, we are 

not preparing an analysis for section 

1102(b) of the Act. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule that may result in expenditure in 

any 1 year by State, local, or tribal 

governments, in the aggregate, or by the 

private sector, of $120 million. This 

notice has no consequential effect on 

State, local, or tribal governments or on 

the private sector. However, States are 

required to pay the premiums for 

dually-eligible beneficiaries. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it publishes 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 effect on 

State or local governments. 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was reviewed by the Office of 

Management and Budget. 

Authority: Sections 1818(d)(2) and 

1818A(d)(2) of the Social Security Act (42 

U.S.C. 1395i–2(d)(2) and 1395i–2a(d)(2)). 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance) 

Dated: September 26, 2007. 

Kerry Weems, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: September 26, 2007. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. 07–4909 Filed 10–1–07; 11:18 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8033–N] 

RIN 0938–AO68 

Medicare Program; Medicare Part B 

Monthly Actuarial Rates, Premium 

Rate, and Annual Deductible 

Beginning January 1, 2008 

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, 2008. 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 2008 are $192.70 for aged enrollees 

and $209.70 for disabled enrollees. The 

standard monthly Part B premium rate 

for 2008 is $96.40, 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 2007 standard premium 

rate was $93.50.) The Part B deductible 

for 2008 is $135.00 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, by the end of the 3-year 

transition period. However, for 2008, 

the beneficiary is only responsible for 

67 percent of any applicable incomerelated monthly adjustment amount. 

(For 2007, the beneficiary was 

responsible for 33 percent of the 

applicable amount.) 

DATES: Effective Date: January 1, 2008. 

FOR FURTHER INFORMATION CONTACT: 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 provided for 

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 

from the general revenues of the Federal 

Government. 

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 the expected 

average monthly cost of Part B for each 

aged enrollee (age 65 or over) and onehalf the expected average monthly cost 

of Part B for each disabled enrollee 

(under age 65). 

The Part B deductible to be paid by 

enrollees is also announced. Prior to the 

Medicare Prescription Drug, 

Improvement, and Modernization Act of 


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2003 (MMA) (Pub. L. 108–173), the Part 

B deductible was set in statute. After 

setting the 2005 deductible amount at 

$110.00, section 629 of the MMA 

(amending section 1833(b) of the Act) 

requires that the Part B deductible be 

indexed beginning in 2006. The 

inflation factor to be used each year is 

the annual percentage increase in the 

Part B actuarial rate for enrollees age 65 

and over. Specifically, the 2008 Part B 

deductible is calculated by multiplying 

the 2007 deductible by the ratio of the 

2008 aged actuarial rate over the 2007 

aged actuarial rate. The amount 

determined under this formula is then 

rounded to the nearest $1. 

The monthly Part B premium rate to 

be paid by aged and disabled enrollees 

is also announced. (Although the costs 

to the program per disabled enrollee are 

different than for the aged, the statute 

provides that they pay the same 

premium amount.) Beginning with the 

passage of section 203 of the Social 

Security Amendments of 1972 (Pub. L. 

92–603), the premium rate, which was 

determined on a fiscal year basis, was 

limited to the lesser of the actuarial rate 

for aged enrollees, or the current 

monthly premium rate increased by the 

same percentage as the most recent 

general increase in monthly Title II 

social security benefits. 

However, the passage of section 124 

of the Tax Equity and Fiscal 

Responsibility Act of 1982 (TEFRA) 

(Pub. L. 97–248) suspended this 

premium determination process. 

Section 124 of TEFRA changed the 

premium basis to 50 percent of the 

monthly actuarial rate for aged enrollees 

(that is, 25 percent of program costs for 

aged enrollees). Section 606 of the 

Social Security Amendments of 1983 

(Pub. L. 98–21), section 2302 of the 

Deficit Reduction Act of 1984 (DEFRA 

84) (Pub. L. 98–369), section 9313 of the 

Consolidated Omnibus Budget 

Reconciliation Act of 1985 (COBRA 85) 

(Pub. L. 99–272), section 4080 of the 

Omnibus Budget Reconciliation Act of 

1987 (OBRA 87) (Pub. L. 100–203), and 

section 6301 of the Omnibus Budget 

Reconciliation Act of 1989 (OBRA 89) 

(Pub. L. 101–239) extended the 

provision that the premium be based on 

50 percent of the monthly actuarial rate 

for aged enrollees (that is, 25 percent of 

program costs for aged enrollees). This 

extension expired at the end of 1990. 

The premium rate for 1991 through 

1995 was legislated by section 

1839(e)(1)(B) of the Act, as added by 

section 4301 of the Omnibus Budget 

Reconciliation Act of 1990 (OBRA 90) 

(Pub. L. 101–508). In January 1996, the 

premium determination basis would 

have reverted to the method established 

by the 1972 Social Security Act 

Amendments. However, section 13571 

of the Omnibus Budget Reconciliation 

Act of 1993 (OBRA 93) (Pub. L. 103–66) 

changed the premium basis to 50 

percent of the monthly actuarial rate for 

aged enrollees (that is, 25 percent of 

program costs for aged enrollees) for 

1996 through 1998. 

Section 4571 of the Balanced Budget 

Act of 1997 (BBA) (Pub. L. 105–33) 

permanently extended the provision 

that the premium be based on 50 

percent of the monthly actuarial rate for 

aged enrollees (that is, 25 percent of 

program costs for aged enrollees). 

The BBA included a further provision 

affecting the calculation of the Part B 

actuarial rates and premiums for 1998 

through 2003. Section 4611 of the BBA 

modified the home health benefit 

payable under Part A for individuals 

enrolled in Part B. Under this section, 

beginning in 1998, expenditures for 

home health services not considered 

‘‘post-institutional’’ are payable under 

Part B rather than Part A. However, 

section 4611(e)(1) of the BBA required 

that there be a transition from 1998 

through 2002 for the aggregate amount 

of the expenditures transferred from 

Part A to Part B. Section 4611(e)(2) of 

the BBA also provided a specific yearly 

proportion for the transferred funds. 

The proportions were 1/6 for 1998, 1/3 

for 1999, 1/2 for 2000, 2/3 for 2001, and 

5/6 for 2002. For the purpose of 

determining the correct amount of 

financing from general revenues of the 

Federal Government, it was necessary to 

include only these transitional amounts 

in the monthly actuarial rates for both 

aged and disabled enrollees, rather than 

the total cost of the home health 

services being transferred. 

Section 4611(e)(3) of the BBA also 

specified, for the purpose of 

determining the premium, that the 

monthly actuarial rate for enrollees age 

65 and over be computed as though the 

transition would occur for 1998 through 

2003 and that 1/7 of the cost be 

transferred in 1998, 2/7 in 1999, 3/7 in 

2000, 4/7 in 2001, 5/7 in 2002, and 6/ 

7 in 2003. Therefore, the transition 

period for incorporating this home 

health transfer into the premium was 7 

years while the transition period for 

including these services in the actuarial 

rate was 6 years. 

Section 811 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (Pub. L. 108–

173, also known as the Medicare 

Modernization Act, or MMA), which 

amended section 1839 of the Act, 

requires that, starting on January 1, 

2007, the Part B premium a beneficiary 

pays each month be based on their 

annual income. Specifically, if a 

beneficiary’s ‘‘modified adjusted gross 

income’’ is greater than the legislated 

threshold amounts (for 2008, $82,000 

for a beneficiary filing an individual 

income tax return, and $164,000 for a 

beneficiary filing a joint tax return) the 

beneficiary is responsible for a larger 

portion of the estimated total cost of 

Part B benefit coverage. In addition to 

the standard 25 percent premium, these 

beneficiaries will now have to pay an 

income-related monthly adjustment 

amount. The MMA made no change to 

the actuarial rate calculation, and the 

standard premium, which will continue 

to be paid by beneficiaries whose 

modified adjusted gross income is 

below the applicable thresholds, still 

represents 25 percent of the estimated 

total cost to the program of Part B 

coverage for an aged enrollee. However, 

once the adjustments are fully phased 

in, and depending on income and tax 

filing status, a beneficiary could now be 

responsible for 35, 50, 65, or 80 percent 

of the estimated total cost of Part B 

coverage, rather than 25 percent. The 

end result of the higher premium is that 

the Part B premium subsidy is reduced 

and less general revenue financing is 

required for beneficiaries with higher 

income because they are paying a larger 

share of the total cost with their 

premium. That is, the premium subsidy 

will continue to be approximately 75 

percent for beneficiaries with income 

below the applicable income thresholds, 

but will be reduced for beneficiaries 

with income above these thresholds. 

The MMA specified that there be a 5- 

year transition to full implementation of 

this provision. However, section 5111 of 

the Deficit Reduction Act of 2005 (Pub. 

L. 109–171) (DRA) modified the 

transition to a 3-year period. 

Section 4732(c) of the BBA added 

section 1933(c) of the Act, which 

required the Secretary to allocate money 

from the Part B trust fund to the State 

Medicaid programs for the purpose of 

providing Medicare Part B premium 

assistance from 1998 through 2002 for 

the low-income Medicaid beneficiaries 

who qualify under section 1933 of the 

Act. This allocation, while not a benefit 

expenditure, was an expenditure of the 

trust fund and was included in 

calculating the Part B actuarial rates 

through 2002. For 2003 through 2007, 

the expenditure was made from the trust 

fund because the allocation was 

temporarily extended. However, 

because the extension occurred after the 

financing was determined, the 

allocation was not included in the 

calculation of the financing rates. 

A further provision affecting the 

calculation of the Part B premium is 


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section 1839(f) of the Act, as amended 

by section 211 of the Medicare 

Catastrophic Coverage Act of 1988 

(MCCA 88) (Pub. L. 100–360). (The 

Medicare Catastrophic Coverage Repeal 

Act of 1989 (Pub. L. 101–234) did not 

repeal the revisions to section 1839(f) 

made by MCCA 88.) Section 1839(f) of 

the Act, referred to as the ‘‘holdharmless’’ provision, provides that if an 

individual is entitled to benefits under 

section 202 or 223 of the Act (the OldAge and Survivors Insurance Benefit 

and the Disability Insurance Benefit, 

respectively) and has the Part B 

premiums deducted from these benefit 

payments, the premium increase will be 

reduced, if necessary, to avoid causing 

a decrease in the individual’s net 

monthly payment. This decrease in 

payment occurs if the increase in the 

individual’s social security benefit due 

to the cost-of-living adjustment under 

section 215(i) of the Act is less than the 

increase in the premium. Specifically, 

the reduction in the premium amount 

applies if the individual is entitled to 

benefits under section 202 or 223 of the 

Act for November and December of a 

particular year and the individual’s Part 

B premiums for December and the 

following January are deducted from the 

respective month’s section 202 or 223 

benefits. The ‘‘hold-harmless’’ provision 

does not apply to beneficiaries who are 

required to pay an income-related 

monthly adjustment amount. 

A check for benefits under section 202 

or 223 of the Act is received in the 

month following the month for which 

the benefits are due. The Part B 

premium that is deducted from a 

particular check is the Part B payment 

for the month in which the check is 

received. Therefore, a benefit check for 

November is not received until 

December, but has December’s Part B 

premium deducted from it. 

Generally, if a beneficiary qualifies for 

hold-harmless protection, that is, if the 

beneficiary was in current payment 

status for November and December of 

the previous year, the reduced premium 

for the individual for that January and 

for each of the succeeding 11 months for 

which he or she is entitled to benefits, 

under section 202 or 203 of the Act, is 

the greater of the following—

• The monthly premium for January 

reduced as necessary to make the 

December monthly benefits, after the 

deduction of the Part B premium for 

January, at least equal to the preceding 

November’s monthly benefits, after the 

deduction of the Part B premium for 

December; or 

• The monthly premium for that 

individual for that December. 

In determining the premium 

limitations under section 1839(f) of the 

Act, the monthly benefits to which an 

individual is entitled under section 202 

or 223 of the Act do not include 

retroactive adjustments or payments and 

deductions on account of work. Also, 

once the monthly premium amount is 

established under section 1839(f) of the 

Act, it will not be changed during the 

year even if there are retroactive 

adjustments or payments and 

deductions on account of work that 

apply to the individual’s monthly 

benefits. 

Individuals who have enrolled in Part 

B late or who have re-enrolled after the 

termination of a coverage period are 

subject to an increased premium under 

section 1839(b) of the Act. The increase 

is a percentage of the premium and is 

based on the new premium rate before 

any reductions under section 1839(f) of 

the Act are made. 

II. Provisions of the Notice 

A. Notice of Medicare Part B Monthly 

Actuarial Rates, Monthly Premium 

Rates, and Annual Deductible 

The Medicare Part B monthly 

actuarial rates applicable for 2008 are 

$192.70 for enrollees age 65 and over 

and $209.70 for disabled enrollees 

under age 65. Section II.B. of this notice 

below, presents the actuarial 

assumptions and bases from which 

these rates are derived. The Part B 

standard monthly premium rate for 

2008 is $96.40. The Part B annual 

deductible for 2008 is $135.00. Listed 

below are the 2008 Part B monthly 

premium rates to be paid by 

beneficiaries who file an individual tax 

return (including those who are single, 

head of household, qualifying 

widow(er) with dependent child, or 

married filing separately who lived 

apart from their spouse for the entire 

taxable year), or a joint tax return. 

Beneficiaries who file an individual tax return 

with income: Beneficiaries who file a joint tax return with income: 

Income-related 

monthly adjustment 

amount 

Total monthly 

premium 

amount 

Less than or equal to $82,000 ..................................... Less than or equal to $164,000 ................................... $0.00 $96.40 

Greater than $82,000 and less than or equal to 

$102,000.

Greater than $164,000 and less than or equal to 

$204,000.

25.80 122.20 

Greater than $102,000 and less than or equal to 

$153,000.

Greater than $204,000 and less than or equal to 

$306,000.

64.50 160.90 

Greater than $153,000 and less than or equal to 

$205,000.

Greater than $306,000 and less than or equal to 

$410,000.

103.30 199.70 

Greater than $205,000 ................................................. Greater than $410,000 ................................................. 142.00 238.40 

In addition, the monthly premium 

rates to be paid by beneficiaries who are 

married and lived with their spouse at 

any time during the taxable year, but file 

a separate tax return from their spouse, 

are listed below. 

Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax 

return from their spouse: 

Income-related 

monthly adjustment 

amount 

Total monthly 

premium 

amount 

Less than or equal to $82,000 ................................................................................................................................ $0.00 $96.40 

Greater than $82,000 and less than or equal to $123,000 ..................................................................................... 103.30 199.70 

Greater than $123,000 ............................................................................................................................................ 142.00 238.40 


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The Part B annual deductible for 2008 

is $135.00 for all beneficiaries. 

B. Statement of Actuarial Assumptions 

and Bases Employed in Determining the 

Monthly Actuarial Rates and the 

Monthly Premium Rate for Part B 

Beginning January 2008 

1. Actuarial Status of the Part B Account 

in the Supplementary Medical 

Insurance Trust Fund 

Under the statute, the starting point 

for determining the standard monthly 

premium is the amount that would be 

necessary to finance Part B on an 

incurred basis. This is the amount of 

income that would be sufficient to pay 

for services furnished during that year 

(including associated administrative 

costs) even though payment for some of 

these services will not be made until 

after the close of the year. The portion 

of income required to cover benefits not 

paid until after the close of the year is 

added to the trust fund and used when 

needed. 

The premium rates are established 

prospectively and are, therefore, subject 

to projection error. Additionally, 

legislation enacted after the financing 

was established, but effective for the 

period in which the financing is set, 

may affect program costs. As a result, 

the income to the program may not 

equal incurred costs. Therefore, trust 

fund assets must be maintained at a 

level that is adequate to cover an 

appropriate degree of variation between 

actual and projected costs, and the 

amount of incurred, but unpaid, 

expenses. Numerous factors determine 

what level of assets is appropriate to 

cover variation between actual and 

projected costs. The three most 

important of these factors are: (1) The 

difference from prior years between the 

actual performance of the program and 

estimates made at the time financing 

was established; (2) the likelihood and 

potential magnitude of expenditure 

changes resulting from enactment of 

legislation affecting Part B costs in a 

year subsequent to the establishment of 

financing for that year, and (3) the 

expected relationship between incurred 

and cash expenditures. These factors are 

analyzed on an ongoing basis, as the 

trends can vary over time. 

Table 1 summarizes the estimated 

actuarial status of the trust fund as of 

the end of the financing period for 2006 

and 2007. 

TABLE 1.—ESTIMATED ACTUARIAL STATUS OF THE PART B ACCOUNT IN THE SUPPLEMENTARY MEDICAL INSURANCE

TRUST FUND AS OF THE END OF THE FINANCING PERIOD

Financing period ending Assets 

(millions) 

Liabilities 

(millions) 

Assets less 

liabilities 

(millions) 

Dec. 31, 2006 .............................................................................................................................. $32,325 $10,929 $21,396 

Dec. 31, 2007 .............................................................................................................................. 39,469 9,470 29,999 

2. Monthly Actuarial Rate for Enrollees 

Age 65 and Older 

The monthly actuarial rate for 

enrollees age65 and older is one-half of 

the sum of monthly amounts for: (1) The 

projected cost of benefits; and (2) 

administrative expenses for each 

enrollee age 65 and older, after 

adjustments to this sum to allow for 

interest earnings on assets in the trust 

fund and an adequate contingency 

margin. The contingency margin is an 

amount appropriate to provide for 

possible variation between actual and 

projected costs and to amortize any 

surplus assets or unfunded liabilities. 

The monthly actuarial rate for 

enrollees age 65 and older for 2008 is 

determined by first establishing perenrollee cost by type of service from 

program data through 2006 and then 

projecting these costs for subsequent 

years. The projection factors used for 

financing periods from January 1, 2005 

through December 31, 2008 are shown 

in Table 2. 

As indicated in Table 3, the projected 

monthly rate required to pay for onehalf of the total of benefits and 

administrative costs for enrollees age 65 

and over for 2008 is $183.25. The 

monthly actuarial rate of $192.70 also 

provides an adjustment of ¥$2.40 for 

interest earnings and $11.85 for a 

contingency margin. Based on current 

estimates, the assets are not sufficient to 

cover the amount of incurred, but 

unpaid, expenses and to provide for a 

significant degree of variation between 

actual and projected costs. Thus, a 

positive contingency margin is needed 

to increase assets to a more appropriate 

level. 

The size of the contingency margin for 

2008 is affected by several factors. First, 

a significant portion of the assets of the 

Part B account in the SMI trust fund was 

drawn down in 2003 and 2004 as a 

result of faster-than-expected 

expenditure growth, along with the 

enactment of the Consolidated 

Appropriations Resolution (Pub. L. 108–

7) in February 2003 and the Medicare 

Modernization Act in December 2003. 

Each of these two legislative packages 

was enacted after the establishment of 

the Part B premium (for 2003 and 2004, 

respectively). Because each Act raised 

Part B expenditures subsequent to the 

setting of the premium, total Part B 

revenues from premiums and general 

fund transfers were inadequate to cover 

total costs. As a consequence, the assets 

of the Part B account in the 

Supplementary Medical Insurance trust 

fund were drawn on to cover the 

shortfall. Due to continuing faster-thanexpected growth in Part B expenditures, 

only a minimal increase in assets 

occurred in 2005, despite a large 

increase in the 2005 Part B premium 

that was intended to partially replenish 

the assets in the Part B account. In 2006 

and 2007, the Part B expenditures were 

again higher in each year than expected 

when the Part B financing was 

determined as a result of the enactment 

of legislation after the financing was set 

(specifically, the Deficit Reduction Act 

of 2005 and the Tax Relief and Health 

Care Act of 2006). Therefore, while the 

Part B assets increased in 2006 and 

2007, the asset level remains lower than 

intended for contingency purposes. 

In addition, the likelihood and 

magnitude of possible differences 

between actual and estimated Part B 

expenditures have increased 

significantly. Under current law, the 

cumulative actual level of physician 

(and physician-related) Part B 

expenditures is substantially in excess 

of the ‘‘allowable’’ level provided by the 

Sustainable Growth Rate (SGR) 

provisions. As a result, current law 

mandates a reduction in Medicare 

payment rates for physicians of 

approximately 10 percent for 2008 and 

another 5 percent per year for roughly 

another 10 years. As noted above, 

Congress has acted repeatedly in recent 

years to prevent such fee reductions 

from occurring, and is very likely to 

continue to do so for 2008 and 

subsequent years. Because of this 

continuing possibility, and the 

significant increase in Part B 

expenditures that results when Congress 


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overrides the statutory provisions that 

otherwise mandate decreases in 

physician fees, it is appropriate to 

maintain a somewhat larger Part B 

contingency reserve than would 

otherwise be necessary. 

The traditional goal for the Part B 

reserve has been that assets minus 

liabilities at the end of a year should 

represent between 15 and 20 percent of 

the following year’s total incurred 

expenditures. Within this range, 17 

percent has been the normal target. In 

view of the strong likelihood of actual 

expenditures exceeding estimated 

levels, due to the enactment of 

legislation after the financing has been 

set for a given year, a contingency 

reserve ratio of about 20 percent of the 

following year’s expenditures would 

better ensure that the assets of the Part 

B account can adequately cover the cost 

of incurred-but-not-reported benefits 

together with variations between actual 

and estimated cost levels. 

The final factor affecting the 

contingency margin in the 2008 aged 

actuarial rate is the correction of an 

accounting error. Beginning in May 

2005, expenditures for certain Part A 

hospice benefits were inadvertently 

drawn from the Part B account of the 

SMI trust fund, rather than from the 

Hospital Insurance (HI) trust fund. 

Correction of this error will result in 

adjustments to the HI and SMI trust 

funds to account for the misallocated 

hospice expenditures during fiscal years 

2005 through 2007. As a result of this 

error, Part B outlays had been overstated 

in 2005 through 2007; Part B benefit 

costs estimated for 2008 are lower than 

previously projected, and Part B assets 

available for contingency purposes will 

be greater. Both factors serve to reduce 

the level of assets needed to serve as an 

adequate contingency reserve. In 

addition, the lower expected amount of 

Part B outlays in 2008 reduces the 

premium increase that, together with 

matching general fund transfers, is 

needed to finance Part B benefits and 

administrative expenses. This error has 

no impact on the 2008 Part A premium. 

The actuarial rate of $192.70 per 

month for aged beneficiaries, as 

announced in this notice for 2008, 

reflects the combined net effect of the 

factors described above and the 

projection assumptions listed in Table 

2. 

3. Monthly Actuarial Rate for Disabled 

Enrollees 

Disabled enrollees are those persons 

under age 65 who are enrolled in Part 

B because of entitlement to Social 

Security disability benefits for more 

than 24 months or because of 

entitlement to Medicare under the endstage renal disease (ESRD) program. 

Projected monthly costs for disabled 

enrollees (other than those with ESRD) 

are prepared in a fashion parallel to the 

projection for the aged using 

appropriate actuarial assumptions (see 

Table 2). Costs for the ESRD program are 

projected differently because of the 

different nature of services offered by 

the program. 

As shown in Table 4, the projected 

monthly rate required to pay for onehalf of the total of benefits and 

administrative costs for disabled 

enrollees for 2008 is $213.50. The 

monthly actuarial rate of $209.70 also 

provides an adjustment of -$3.83 for 

interest earnings and $0.03 for a 

contingency margin, reflecting the same 

factors described above for the aged 

actuarial rate. Based on current 

estimates, the assets associated with the 

disabled Medicare beneficiaries are 

sufficient to cover the amount of 

incurred, but unpaid, expenses and to 

provide for a significant degree of 

variation between actual and projected 

costs. Thus, a near-zero contingency 

margin is sufficient to maintain assets at 

an appropriate level. 

The actuarial rate of $209.70 per 

month for disabled beneficiaries, as 

announced in this notice for 2008, 

reflects the combined net effect of the 

factors described above for aged 

beneficiaries and the projection 

assumptions listed in table 2. 

4. Sensitivity Testing 

Several factors contribute to 

uncertainty about future trends in 

medical care costs. It is appropriate to 

test the adequacy of the rates using 

alternative assumptions. The results of 

those assumptions are shown in Table 5. 

One set represents increases that are 

lower and, therefore, more optimistic 

than the current estimate. The other set 

represents increases that are higher and, 

therefore, more pessimistic than the 

current estimate. The values for the 

alternative assumptions were 

determined from a statistical analysis of 

the historical variation in the respective 

increase factors. 

As indicated in Table 5, the monthly 

actuarial rates would result in an excess 

of assets over liabilities of $41,627 

million by the end of December 2008—

(1) Under the assumptions used in 

preparing this report; and (2) with the 

Part B account of the SMI trust fund 

fully reimbursed for the cost of Part A 

hospice benefits inadvertently drawn 

from the Part B account. This amounts 

to 20.8 percent of the estimated total 

incurred expenditures for the following 

year. 

Assumptions that are somewhat more 

pessimistic (and that therefore test the 

adequacy of the assets to accommodate 

projection errors) produce a surplus of 

$27,532 million by the end of December 

2008, which amounts to 12.4 percent of 

the estimated total incurred 

expenditures for the following year. 

Under fairly optimistic assumptions, the 

monthly actuarial rates would result in 

a surplus of $53,492 million by the end 

of December 2008, or 29.6 percent of the 

estimated total incurred expenditures 

for the following year. 

The above analysis indicates that the 

premium and general revenue financing 

established for 2008, together with 

existing Part B account assets (including 

the restoration of assets inadvertently 

drawn from the Part B account to pay 

the cost of Part A hospice benefits), 

would be adequate to cover estimated 

Part B costs for 2008 under current law, 

even if actual costs prove to be 

somewhat greater than expected. 

5. Premium Rates and Deductible 

As determined pursuant to section 

1839 of the Act, listed below are the 

2008 Part B monthly premium rates to 

be paid by beneficiaries who file an 

individual tax return (including those 

who are single, head of household, 

qualifying widow(er) with dependent 

child, or married filing separately who 

lived apart from their spouse for the 

entire taxable year), or a joint tax return. 

Beneficiaries who file an individual tax return 

with income: Beneficiaries who file a joint tax return with income: 

Income-related 

monthly adjustment 

amount 

Total monthly 

premium 

amount 

Less than or equal to $82,000 ..................................... Less than or equal to $164,000 ................................... $0.00 $96.40 

Greater than $82,000 and less than or equal to 

$102,000.

Greater than $164,000 and less than or equal to 

$204,000.

25.80 122.20 

Greater than $102,000 and less than or equal to 

$153,000.

Greater than $204,000 and less than or equal to 

$306,000.

64.50 160.90 


yshivers on PROD1PC62 with NOTICES
57044 Federal Register / Vol. 72, No. 193 / Friday, October 5, 2007 / Notices 

Beneficiaries who file an individual tax return 

with income: Beneficiaries who file a joint tax return with income: 

Income-related 

monthly adjustment 

amount 

Total monthly 

premium 

amount 

Greater than $153,000 and less than or equal to 

$205,000.

Greater than $306,000 and less than or equal to 

$410,000.

103.30 199.70 

Greater than $205,000 ................................................. Greater than $410,000 ................................................. 142.00 238.40 

In addition, the monthly premium 

rates to be paid by beneficiaries who are 

married and lived with their spouse at 

any time during the taxable year, but file 

a separate tax return from their spouse, 

are listed below. 

Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax 

return from their spouse: 

Income-related 

monthly adjustment 

amount 

Total monthly 

premium 

amount 

Less than or equal to $82,000 ................................................................................................................................ $0.00 $96.40 

Greater than $82,000 and less than or equal to $123,000 ..................................................................................... 103.30 199.70 

Greater than $123,000 ............................................................................................................................................ 142.00 238.40 

TABLE 2.—PROJECTION FACTORS1 12-MONTH PERIODS ENDING DECEMBER 31 OF 2005–2008 

[In percent] 

Calendar year 

Physicians’ services Durable 

medical 

equipment 

Carrier 

lab 4

Other carrier services 5

Outpatient 

hospital 

Home 

health 

agency 

Hospital 

Lab 6

Other 

intermediary 

services 7

Managed 

care Fees 2 Residual 3

Aged: 

2005 ............................... 2.1 3.4 1.6 6.6 3.4 8.4 16.2 3.5 13.6 9.8 

2006 ............................... 0.2 4.7 6.8 7.9 5.8 4.6 6.3 4.8 5.2 13.5 

2007 ............................... ¥1.4 4.7 4.4 7.9 9.7 2.8 8.9 3.1 ¥3.7 3.5 

2008 ............................... 10.1 7.7 4.6 5.5 12.7 10.0 7.4 3.4 ¥2.6 6.4 

Disabled: 

2005 ............................... 2.1 2.8 1.9 7.9 8.5 6.2 17.3 5.5 11.6 2.3 

2006 ............................... 0.2 0.9 5.1 7.1 ¥5.7 2.0 5.9 3.5 7.4 8.9 

2007 ............................... ¥1.4 2.6 3.7 12.3 1.6 3.3 8.5 ¥1.0 ¥18.4 3.4 

2008 ............................... ¥10.1 7.7 4.9 5.4 11.6 9.9 8.1 3.4 ¥3.2 7.8 

1All values for services other than managed care are per fee-for-service enrollee. Managed care values are per managed care enrollee. 2As recognized for payment under the program. 

3 Increase in the number of services received per enrollee and greater relative use of more expensive services. 

4 Includes services paid under the lab fee schedule furnished in the physician’s office or an independent lab. 5 Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc. 6 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital. 

7 Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitation and psychiatric hospitals, etc. 

TABLE 3.—DERIVATION OF MONTHLY ACTUARIAL RATE FOR ENROLLEES AGE 65 AND OVER FOR FINANCING PERIODS

ENDING DECEMBER 31, 2005 THROUGH DECEMBER 31, 2008 

Financing periods 

CY 2005 CY 2006 CY 2007 CY 2008 

Covered services (at level recognized): 

Physician fee schedule ............................................................................. 79.51 79.96 79.06 75.12 

Durable medical equipment ...................................................................... 9.68 9.92 9.92 10.19 

Carrier lab 1 ............................................................................................... 3.63 3.75 3.88 4.02 

Other carrier services 2 ............................................................................. 19.38 19.68 20.67 22.86 

Outpatient hospital .................................................................................... 28.23 28.31 27.88 30.11 

Home health ............................................................................................. 7.64 7.79 8.13 8.57 

Hospital lab 3 ............................................................................................. 2.79 2.80 2.77 2.81 

Other intermediary services 4 ................................................................... 12.32 12.44 11.47 10.97 

Miscellaneous intermediary 5 .................................................................... 2.25 5.63 4.42 1.34 

Managed care ........................................................................................... 26.12 36.06 43.86 49.56 

Total services .................................................................................... 191.56 206.34 212.07 215.55 

Cost-sharing: 

Deductible ................................................................................................. ¥4.48 ¥5.05 ¥5.33 ¥5.50 

Coinsurance .............................................................................................. ¥31.81 ¥31.18 ¥29.97 ¥29.51 

Total benefits ..................................................................................... 155.27 170.12 176.76 180.54 

Administrative expenses .................................................................................. 3.39 3.37 3.03 2.71 

Incurred expenditures ...................................................................................... 158.66 173.48 179.79 183.25 

Value of interest ............................................................................................... ¥1.27 ¥1.52 ¥1.70 ¥2.40 


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Federal Register / Vol. 72, No. 193 / Friday, October 5, 2007 / Notices 57045 

TABLE 3.—DERIVATION OF MONTHLY ACTUARIAL RATE FOR ENROLLEES AGE 65 AND OVER FOR FINANCING PERIODS

ENDING DECEMBER 31, 2005 THROUGH DECEMBER 31, 2008—Continued 

Financing periods 

CY 2005 CY 2006 CY 2007 CY 2008 

Contingency margin for projection error and to amortize the surplus or deficit ................................................................................................................. ¥0.98 4.94 8.91 11.85 

Monthly actuarial rate ............................................................................... 156.40 176.90 187.00 192.70 

1 Includes services paid under the lab fee schedule furnished in the physician’s office or an independent lab. 2 Includes physician-administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc. 3 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital. 

4 Includes services furnished in dialysis facilities, rural health clinics, Federally qualified health centers, rehabilitation and psychiatric hospitals, 

etc. 5 Represents intermediary Part B expenditures reported on a cash basis that have not yet been reconciled with corresponding incurred benefit 

costs. 

TABLE 4.—DERIVATION OF MONTHLY ACTUARIAL RATE FOR DISABLED ENROLLEES FINANCING PERIODS ENDING

DECEMBER 31, 2005 THROUGH DECEMBER 31, 2008 

Financing periods 

CY 2005 CY 2006 CY 2007 CY 2008 

Covered services (at level recognized): 

Physician fee schedule ............................................................................. 81.05 80.70 80.26 77.02 

Durable medical equipment ...................................................................... 16.73 17.25 17.58 18.29 

Carrier lab 1 ............................................................................................... 4.43 4.70 5.14 5.37 

Other carrier services 2 ............................................................................. 24.32 22.92 23.11 25.59 

Outpatient hospital .................................................................................... 37.51 37.98 38.53 42.01 

Home health ............................................................................................. 6.25 6.50 6.91 7.42 

Hospital lab 3 ............................................................................................. 4.28 4.33 4.26 4.37 

Other intermediary services 4 ................................................................... 39.06 39.48 37.29 35.49 

Miscellaneous intermediary 5 .................................................................... 2.59 6.22 5.00 1.57 

Managed care ........................................................................................... 12.45 16.80 20.69 23.74 

Total services .................................................................................... 228.68 236.88 238.77 240.87 

Cost-sharing: 

Deductible ................................................................................................. ¥4.17 ¥4.71 ¥4.98 ¥5.14 

Coinsurance .............................................................................................. ¥45.63 ¥44.37 ¥33.98 ¥25.33 

Total benefits ..................................................................................... 178.87 187.80 199.80 210.39 

Administrative expenses .................................................................................. 3.78 3.56 3.24 3.11 

Incurred expenditures ............................................................................... 182.66 191.36 203.04 213.50

Value of interest ............................................................................................... ¥2.33 ¥3.53 ¥3.74 ¥3.83 

Contingency margin for projection error and to amortize the surplus or deficit ................................................................................................................. 11.47 15.87 ¥2.00 0.03 

Monthly actuarial rate ............................................................................... $191.80 $203.70 $197.30 $209.70 

1 Includes services paid under the lab fee schedule furnished in the physician’s office or an independent lab. 2 Includes physician¥administered drugs, ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc. 3 Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital. 

4 Includes services furnished in dialysis facilities, rural health clinics, Federally qualified health centers, rehabilitation and psychiatric hospitals, 

etc. 5 Represents intermediary Part B expenditures reported on a cash basis that have not yet been reconciled with corresponding incurred benefit 

costs. 

TABLE 5.—ACTUARIAL STATUS OF THE PART B ACCOUNT IN THE SMI TRUST FUND UNDER THREE SETS OF

ASSUMPTIONS FOR FINANCING PERIODS THROUGH DECEMBER 31, 2008 

As of December 31 

2006 2007 2008 

This projection: 

Actuarial status (in millions): 

Assets ............................................................................................................................ 32,325 39,469 51,547 

Liabilities ........................................................................................................................ 10,929 9,470 9,920 

Assets less liabilities .............................................................................................. 21,396 29,999 41,627 

Ratio (in percent) 1 ................................................................................................................ 11.9 16.0 20.8 


yshivers on PROD1PC62 with NOTICES
57046 Federal Register / Vol. 72, No. 193 / Friday, October 5, 2007 / Notices 

TABLE 5.—ACTUARIAL STATUS OF THE PART B ACCOUNT IN THE SMI TRUST FUND UNDER THREE SETS OF

ASSUMPTIONS FOR FINANCING PERIODS THROUGH DECEMBER 31, 2008—Continued 

As of December 31 

2006 2007 2008 

Low cost projection: 

Actuarial status (in millions): 

Assets ............................................................................................................................ 32,325 39,488 62,911 

Liabilities ........................................................................................................................ 10,929 8,687 9,419 

Assets less liabilities .............................................................................................. 21,396 30,761 53,492 

Ratio (in percent) 1 ................................................................................................................ 12.5 17.7 29.6 

High cost projection: 

Actuarial status (in millions): 

Assets ............................................................................................................................ 32,325 39,448 38,098 

Liabilities ........................................................................................................................ 10,929 10,267 10,566 

Assets less liabilities .............................................................................................. 21,396 29,181 27,532 

Ratio (in percent) 1 ................................................................................................................ 11.4 14.5 12.4 

1 Ratio of assets less liabilities at the end of the year to the total incurred expenditures during the following year, expressed as a percent. 

III. Regulatory Impact Analysis 

We have examined the impact of this 

notice as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review) and the 

Regulatory Flexibility Act (RFA) 

(September 19, 1980, Pub. L. 96–354). 

Executive Order 12866 directs 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 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 $6 million to $29 million in any 1 

year. 

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 and has 

fewer than 100 beds. We have 

determined that this notice will not 

have a significant effect on a substantial 

number of small entities or on the 

operations of a substantial number of 

small rural hospitals. Therefore, we are 

not preparing analyses for either the 

RFA or section 1102(b) of the Act. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule that may result in expenditure in 

any 1 year by State, local, or tribal 

governments, in the aggregate, or by the 

private sector, of $110 million. This 

notice has no consequential effect on 

State, local, or tribal governments. We 

believe the private sector costs of this 

notice fall below this threshold as well. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it publishes a proposed 

rule (and subsequent final rule) that 

imposes substantial direct compliance 

costs on State and local governments, 

preempts State law, or otherwise has 

Federalism implications. We have 

determined that this notice does not 

significantly affect the rights, roles, and 

responsibilities of States. 

This notice announces that the 

monthly actuarial rates applicable for 

2008 are $192.70 for enrollees age 65 

and over and $209.70 for disabled 

enrollees under age 65. It also 

announces the 2008 monthly Part B 

premium rates to be paid by 

beneficiaries who file an individual tax 

return (including those who are single, 

head of household, qualifying 

widow(er) with a dependent child, or 

married filing separately who lived 

apart from their spouse for the entire 

taxable year), or a joint tax return. 

Beneficiaries who file an individual tax return 

with income: Beneficiaries who file a joint tax return with income: 

Income-related 

monthly 

adjustment 

amount 

Total monthly 

premium 

amount 

Less than or equal to $82,000 ..................................... Less than or equal to $164,000 ................................... $0.00 $96.40 

Greater than $82,000 and less than or equal to 

$102,000.

Greater than $164,000 and less than or equal to 

$204,000.

25.80 122.20 

Greater than $102,000 and less than or equal to 

$153,000.

Greater than $204,000 and less than or equal to 

$306,000.

64.50 160.90 

Greater than $153,000 and less than or equal to 

$205,000.

Greater than $306,000 and less than or equal to 

$410,000.

103.30 199.70 

Greater than $205,000. Greater than $410,000. 142.00 238.40 

In addition, the monthly premium 

rates to be paid by beneficiaries who are 

married and lived with their spouse at 

any time during the taxable year, but file 

a separate tax return from their spouse, 

are also announced and listed below. 


yshivers on PROD1PC62 with NOTICES
Federal Register / Vol. 72, No. 193 / Friday, October 5, 2007 / Notices 57047 

Beneficiaries who are married and lived with their spouse at any time during the year, but file a separate tax 

return from their spouse: 

Income-related 

monthly 

adjustment 

amount 

Total monthly 

premium 

amount 

Less than or equal to $82,000 ................................................................................................................................ $0.00 $96.40 

Greater than $82,000 and less than or equal to $123,000 ..................................................................................... 103.30 199.70 

Greater than $123,000 ............................................................................................................................................ 142.00 238.40 

The Part B deductible for calendar 

year 2008 is $135.00. The standard Part 

B premium rate of $96.40 is 3.1 percent 

higher than the $93.50 premium rate for 

2007. We estimate that this increase will 

cost approximately 41.5 million Part B 

enrollees about $1.4 billion for 2008. 

The monthly impact on the beneficiaries 

who are required to pay a higher 

premium for 2008 because their 

incomes exceed specified thresholds is 

$25.80, $64.50, $103.30, or $142.00, 

which is in addition to the standard 

monthly premium. Therefore, this 

notice is a major rule as defined in Title 

5, United States Code, section 804(2) 

and is an economically significant rule 

under Executive Order 12866. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

IV. Waiver of Proposed Notice 

The Medicare statute requires the 

publication of the monthly actuarial 

rates and the Part B premium amounts 

in September. We ordinarily use general 

notices, rather than notice and comment 

rulemaking procedures, to make such 

announcements. In doing so, we note 

that, under the Administrative 

Procedure Act, interpretive rules, 

general statements of policy, and rules 

of agency organization, procedure, or 

practice are excepted from the 

requirements of notice and comment 

rulemaking. 

We considered publishing a proposed 

notice to provide a period for public 

comment. However, we may waive that 

procedure if we find, for good cause, 

that prior notice and comment are 

impracticable, unnecessary, or contrary 

to the public interest. We find that the 

procedure for notice and comment is 

unnecessary because the formulas used 

to calculate the Part B premiums are 

statutorily directed, and we can exercise 

no discretion in applying those 

formulas. Moreover, the statute 

establishes the time period for which 

the premium rates will apply, and 

delaying publication of the Part B 

premium rate such that it would not be 

published before that time would be 

contrary to the public interest. 

Therefore, we find good cause to waive 

publication of a proposed notice and 

solicitation of public comments. 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: September 26, 2007. 

Kerry Weems, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Approved: September 26, 2007. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. 07–4910 Filed 10–1–07; 11:18 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Proposed Project 

Title: Supporting Healthy Marriage 

(SHM) Demonstration and Evaluation 

Project: 12-month Follow-up and 

Implementation Research Data 

Collection. 

OMB No.: New Collection. 

The Administration for Children and 

Families (ACF), U.S. Department of 

Health and Human Services, is 

conducting a demonstration and 

evaluation called the Supporting 

Healthy Marriage (SHM) project. SHM is 

a test of marriage education 

demonstration programs in eight 

separate locations that will aim to enroll 

up to 1,000 couples per location, up to 

500 couples participating in SHM 

programs and 500 control group 

couples. 

SHM is designed to inform program 

operators and policymakers of the most 

effective ways to help low-income 

married couples strengthen and 

maintain healthy marriages. In 

particular, the project will measure the 

effectiveness of marriage education 

programs by randomly assigning eligible 

volunteer couples to SHM program 

groups and control groups. 

This data collection request includes 

three components. First, a survey will 

be administered to couples 12 months 

after they are enrolled in the program. 

The survey is designed to assess the 

effects of the SHM program on marital 

status and stability, quality of 

relationship with spouse, marital 

expectations and ideals, marital 

satisfaction, participation in services, 

parenting outcomes, child outcomes, 

parental well-being, employment, 

income, material hardship, and social 

support characteristics of study 

participants assigned to both the 

program and control groups. Second, 

survey data will be complemented by 

videotaped observations of couple, coparenting, and parent-child interactions 

with a subset of intact and separated 

couples at the 12-month follow-up. 

Third, qualitative data will be collected 

through a process and implementation 

study in each of the eight SHM 

demonstration programs across the 

country. 

These data will complement the 

information gathered by the SHM 

baseline data collection (OMB Control 

No. 0970–0299). The information 

collected at the 12-month follow-up will 

allow the research team to examine the 

effects of SHM services on outcomes of 

interest and to identify mechanisms that 

might account for these effects. The 

process and implementation research 

will consist of a qualitative component 

that will help ACF to better understand 

the results from the impact analysis as 

well as how to replicate programs that 

prove to be successful. 

Respondents: Low-income married 

couples with children. 


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