55086 Federal Register / Vol. 73, No. 186 / Wednesday, September 24, 2008 / Notices 

Agenda items for these meetings are 

subject to change as priorities dictate. 

Dated: September 15, 2008. 

Carolyn M. Clancy, 

Director. 

[FR Doc. E8–22132 Filed 9–23–08; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

Board of Scientific Counselors, 

National Center for Environmental 

Health/Agency for Toxic Substances 

and Disease Registry (BSC, NCEH/ 

ATSDR) 

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

the Federal Advisory Committee Act 

(Pub. L. 92–463), CDC announces the 

following meetings for the 

aforementioned committee: 

Times and Dates: 8:30 a.m.–4:30 p.m., 

November 6, 2008. 8:30 a.m.–12:00 p.m., 

November 7, 2008. 

Place: Marriott Century Center Hotel, 2000 

Century Boulevard, Chamblee, Georgia 

30341. 

Status: Open to the public, limited only by 

the space available. The meeting room 

accommodates approximately 75 people. 

Purpose: The Secretary, Department of 

Health and Human Services (HHS) and by 

delegation, the Director, CDC, and 

Administrator, NCEH/ATSDR, are authorized 

under Section 301 (42 U.S.C. 241) and 

Section 311 (42 U.S.C. 243) of the Public 

Health Service Act, as amended, to: (1) 

Conduct, encourage, cooperate with, and 

assist other appropriate public authorities, 

scientific institutions, and scientists in the 

conduct of research, investigations, 

experiments, demonstrations, and studies 

relating to the causes, diagnosis, treatment, 

control, and prevention of physical and 

mental diseases and other impairments; (2) 

assist states and their political subdivisions 

in the prevention of infectious diseases and 

other preventable conditions and in the 

promotion of health and well being; and (3) 

train state and local personnel in health 

work. The BSC, NCEH/ATSDR provides 

advice and guidance to the Secretary, HHS; 

the Director, CDC; the Administrator, 

ATSDR; and the Director, NCEH/ATSDR, 

regarding program goals, objectives, 

strategies, and priorities in fulfillment of the 

agency’s mission to protect and promote 

people’s health. The board provides advice 

and guidance that will assist NCEH/ATSDR 

in ensuring scientific quality, timeliness, 

utility, and dissemination of results. The 

board also provides guidance to help NCEH/ 

ATSDR work more efficiently and effectively 

with its various constituents and to fulfill its 

mission in protecting America’s health. 

Matters To Be Discussed: An update on 

NCEH/ATSDR’s Office of the Director; 

updates on NCEH/ATSDR work on 

Formaldehyde and FEMA Trailers; 

discussion of the findings on the BSC 

Program Peer Review of NCEH/ATSDR’s 

internal clearance and external peer review 

processes and policies; a presentation of the 

response to the Preparedness and Emergency 

Response Peer Review Report from the Office 

of Terrorism Preparedness and Emergency 

Response; updates on public health issues: 

selenium poisoning associated with an overthe-counter dietary supplement; exercising 

the response capability of CDC and the 

Laboratory Response Network to test 10,000 

clinical samples for nerve agent exposure; 

and vapor intrusion activities at hazardous 

waste sites. 

Agenda items are tentative and subject to 

change. 

Contact Person for More Information: 

Sandra Malcom, Committee Management 

Specialist, NCEH/ATSDR, 4770 Buford 

Highway, Mail Stop F–61, Chamblee, Georgia 

30345; Telephone (770) 488–0575, Fax (770) 

488–3377; E-mail: smalcom@cdc.gov. The 

deadline for notification of attendance is 

October 31, 2008. 

The Director, Management Analysis and 

Services Office, has been delegated the 

authority to sign Federal Register notices 

pertaining to announcements of meetings and 

other committee management activities for 

both CDC and the Agency for Toxic 

Substances and Disease Registry. 

Dated: September 16, 2008. 

Elaine L. Baker, 

Director, Management Analysis and Services 

Office, Centers for Disease Control and 

Prevention. 

[FR Doc. E8–22346 Filed 9–23–08; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

Safety and Occupational Health Study 

Section (SOHSS), National Institute for 

Occupational Safety and Health 

(NIOSH) 

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

the Federal Advisory Committee Act 

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

Control and Prevention (CDC) 

announces the following meetings for 

the aforementioned committee: 

Times and Dates: 8 a.m.–5 p.m., October 

14, 2008 (Closed). 8 a.m.–5 p.m., October 15, 

2008 (Closed). 

Place: Embassy Suites Hotel, 1900 

Diagonal Road, Alexandria, Virginia 22314, 

Telephone (703) 684–5900, Fax (703)684– 

1403. 

Status: This meeting will be closed to the 

public in accordance with provisions set 

forth in Section 552b(c)(4) and (6), Title 5 

U.S.C., and the Determination of the Director, 

Management Analysis and Services Office, 

Centers for Disease Control and Prevention, 

pursuant to Section 10(d) Public Law 92–463. 

Purpose: The Safety and Occupational 

Health Study Section will review, discuss, 

and evaluate grant application(s) received in 

response to the Institute’s standard grants 

review and funding cycles pertaining to 

research issues in occupational safety and 

health, and allied areas. 

It is the intent of NIOSH to support broadbased research endeavors in keeping with the 

Institute’s program goals. This will lead to 

improved understanding and appreciation for 

the magnitude of the aggregate health burden 

associated with occupational injuries and 

illnesses, as well as to support more focused 

research projects, which will lead to 

improvements in the delivery of occupational 

safety and health services, and the 

prevention of work-related injury and illness. 

It is anticipated that research funded will 

promote these program goals. 

Matters To Be Discussed: The meeting will 

convene to address matters related to the 

conduct of study section business and for the 

study section to consider safety and 

occupational health-related grant 

applications. 

Agenda items are subject to change as 

priorities dictate. 

Contact Person for More Information: Price 

Connor, Ph.D., NIOSH Health Scientist, 1600 

Clifton Road, NE., Mailstop E–20, Atlanta, 

Georgia 30333, Telephone (404)498–2511, 

Fax (404)498–2571. 

The Director, Management Analysis and 

Services Office, has been delegated the 

authority to sign Federal Register notices 

pertaining to announcements of meetings and 

other committee management activities for 

both CDC and the Agency for Toxic 

Substances and Disease Registry. 

Dated: September 16, 2008. 

Elaine L. Baker, 

Director, Management Analysis and Services 

Office, Centers for Disease Control and 

Prevention. 

[FR Doc. E8–22344 Filed 9–23–08; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8034–N] 

RIN 0938–AP03 

Medicare Program; Inpatient Hospital 

Deductible and Hospital and Extended 

Care Services Coinsurance Amounts 

for Calendar Year 2009 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

inpatient hospital deductible and the 

hospital and extended care services 

coinsurance amounts for services 

furnished in calendar year (CY) 2009 

under Medicare’s Hospital Insurance 


jlentini on PROD1PC65 with NOTICES
Federal Register / Vol. 73, No. 186 / Wednesday, September 24, 2008 / Notices 55087 

program (Medicare Part A). The 

Medicare statute specifies the formulae 

used to determine these amounts. For 

CY 2009, the inpatient hospital 

deductible will be $1068. The daily 

coinsurance amounts for CY 2009 will 

be: (a) $267 for the 61st through 90th 

day of hospitalization in a benefit 

period; (b) $534 for lifetime reserve 

days; and (c) $133.50 for the 21st 

through 100th day of extended care 

services in a skilled nursing facility in 

a benefit period. 

DATES: Effective Date: This notice is 

effective on January 1, 2009. 

FOR FURTHER INFORMATION CONTACT: 

Clare McFarland, (410) 786–6390 for 

general information. Gregory J. Savord, 

(410) 786–1521 for case-mix analysis. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1813 of the Social Security 

Act (the Act) provides for an inpatient 

hospital deductible to be subtracted 

from the amount payable by Medicare 

for inpatient hospital services furnished 

to a beneficiary. It also provides for 

certain coinsurance amounts to be 

subtracted from the amounts payable by 

Medicare for inpatient hospital and 

extended care services. Section 

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

determine and publish each year the 

amount of the inpatient hospital 

deductible and the hospital and 

extended care services coinsurance 

amounts applicable for services 

furnished in the following CY. 

II. Computing the Inpatient Hospital 

Deductible for CY 2009 

Section 1813(b) of the Act prescribes 

the method for computing the amount of 

the inpatient hospital deductible. The 

inpatient hospital deductible is an 

amount equal to the inpatient hospital 

deductible for the preceding CY, 

adjusted by our best estimate of the 

payment-weighted average of the 

applicable percentage increases (as 

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

Act) used for updating the payment 

rates to hospitals for discharges in the 

fiscal year (FY) that begins on October 

1 of the same preceding CY, and 

adjusted to reflect real case-mix. The 

adjustment to reflect real case-mix is 

determined on the basis of the most 

recent case-mix data available. The 

amount determined under this formula 

is rounded to the nearest multiple of $4 

(or, if midway between two multiples of 

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

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

Act, the percentage increase used to 

update the payment rates for FY 2009 

for hospitals paid under the inpatient 

prospective payment system is the 

market basket percentage increase, 

otherwise known as the market basket 

update. Under section 1886(b)(3)(B)(viii) 

of the Act, hospitals will receive the full 

market basket update only if they 

submit quality data as specified by the 

Secretary. The market basket update for 

hospitals that do not submit this data is 

reduced by 2.0 percentage points. We 

are estimating that after accounting for 

those hospitals receiving the lower 

market basket update in the paymentweighted average update, the calculated 

deductible will remain the same. 

Under section 1886(b)(3)(B)(ii) of the 

Act, the percentage increase used to 

update the payment rates for FY 2009 

for hospitals excluded from the 

prospective payment system is the 

market basket percentage increase, 

defined according to section 

1886(b)(3)(B)(iii) of the Act. 

The market basket percentage increase 

for 2009 is 3.6 percent, as announced in 

the final rule published in the Federal 

Register entitled, ‘‘Medicare Program; 

Changes to the Hospital Inpatient 

Prospective Payment Systems and Fiscal 

Year 2009 Rates’’ (73 FR 48434, August 

19, 2008). Therefore, the percentage 

increase for hospitals paid under the 

prospective payment system is 3.6 

percent. The average payment 

percentage increase for hospitals 

excluded from the prospective payment 

system is 3.5 percent. Weighting these 

percentages in accordance with 

payment volume, our best estimate of 

the payment-weighted average of the 

increases in the payment rates for FY 

2009 is 3.6 percent. 

To develop the adjustment for real 

case-mix, we first calculated for each 

hospital an average case-mix that 

reflects the relative costliness of that 

hospital’s mix of cases compared to 

those of other hospitals. We then 

computed the change in average casemix for hospitals paid under the 

Medicare prospective payment system 

in FY 2008 compared to FY 2007. (We 

excluded from this calculation hospitals 

excluded from the prospective payment 

system because their payments are 

based on reasonable costs.) We used 

Medicare bills from prospective 

payment hospitals that we received as of 

July 2008. These bills represent a total 

of about 8.9 million Medicare 

discharges for FY 2008 and provide the 

most recent case-mix data available at 

this time. Based on these bills, the 

change in average case-mix in FY 2008 

is 1.55 percent. Based on these bills and 

past experience, we expect the overall 

case mix change to be 1.75 percent as 

the year progresses and more FY 2008 

data become available. 

Section 1813 of the Act requires that 

the inpatient hospital deductible be 

adjusted only by that portion of the 

case-mix change that is determined to 

be real. In the FY 2008 IPPS final rule 

with comment period, we indicated that 

we believe the adoption of the MS– 

DRGs had the potential to lead to 

increases in aggregate payments without 

a corresponding increase in actual 

patient severity of illness due to the 

incentives for improved documentation 

and coding. In that final rule, we 

estimated that changes in coding or 

classification that do not reflect real 

change in case-mix would be 1.2 

percent for FY 2008. Therefore, since we 

are expecting overall case mix to 

increase by 1.75 percent and 1.2 percent 

of that to be caused by coding changes, 

real case mix changes resulted in an 

increase of 0.55 percent for FY 2008. 

Thus, the estimate of the paymentweighted average of the applicable 

percentage increases used for updating 

the payment rates is 3.6 percent, and the 

real case-mix adjustment factor for the 

deductible is 0.55 percent. Therefore, 

under the statutory formula, the 

inpatient hospital deductible for 

services furnished in CY 2009 is $1068. 

This deductible amount is determined 

by multiplying $1024 (the inpatient 

hospital deductible for CY 2008) by the 

payment-weighted average increase in 

the payment rates of 1.036 multiplied by 

the increase in real case-mix of 1.0055, 

which equals $1066.70 and is rounded 

to $1068. 

III. Computing the Inpatient Hospital 

and Extended Care Services 

Coinsurance Amounts for CY 2009 

The coinsurance amounts provided 

for in section 1813 of the Act are 

defined as fixed percentages of the 

inpatient hospital deductible for 

services furnished in the same CY. 

Thus, the increase in the deductible 

generates increases in the coinsurance 

amounts. For inpatient hospital and 

extended care services furnished in CY 

2009, in accordance with the fixed 

percentages defined in the law, the daily 

coinsurance for the 61st through 90th 

day of hospitalization in a benefit 

period will be $267 (one-fourth of the 

inpatient hospital deductible); the daily 

coinsurance for lifetime reserve days 

will be $534 (one-half of the inpatient 

hospital deductible); and the daily 

coinsurance for the 21st through 100th 

day of extended care services in a 

skilled nursing facility in a benefit 

period will be $133.50 (one-eighth of 

the inpatient hospital deductible). 


jlentini on PROD1PC65 with NOTICES
55088 Federal Register / Vol. 73, No. 186 / Wednesday, September 24, 2008 / Notices 

IV. Cost to Medicare Beneficiaries 

Table 1 summarizes the deductible 

and coinsurance amounts for CYs 2008 

and 2009, as well as the number of each 

that is estimated to be paid. 

TABLE 1—PART A DEDUCTIBLE AND COINSURANCE AMOUNTS FOR CALENDAR YEARS 2008 AND 2009 

Type of cost sharing 

Value Number paid 

(in millions) 

2008 2009 2008 2009 

Inpatient hospital deductible ............................................................................ $1024 $1068 8.54 8.53 

Daily coinsurance for 61st–90th day ............................................................... 256 267 2.22 2.22 

Daily coinsurance for lifetime reserve days ..................................................... 512 534 1.06 1.06 

SNF coinsurance ............................................................................................. 128 133.50 39.66 40.05 

The estimated total increase in costs 

to beneficiaries is about $680 million 

(rounded to the nearest $10 million) due 

to: (1) The increase in the deductible 

and coinsurance amounts; and (2) the 

change in the number of deductibles 

and daily coinsurance amounts paid. 

V. Waiver of Proposed Notice and 

Comment Period 

The Medicare statute, as discussed 

previously, requires publication of the 

Medicare Part A inpatient hospital 

deductible and the hospital and 

extended care services coinsurance 

amounts for services for each CY. The 

amounts are determined according to 

the statute. As has been our custom, we 

use general notices, rather than notice 

and comment rulemaking procedures, to 

make the announcements. 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. 

We considered publishing a proposed 

notice to provide a period for public 

comment. However, 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 find that the 

procedure for notice and comment is 

unnecessary because the formulae used 

to calculate the inpatient hospital 

deductible and hospital and extended 

care services coinsurance amounts are 

statutorily directed, and we can exercise 

no discretion in following the formulae. 

Moreover, the statute establishes the 

time period for which the deductible 

and coinsurance amounts will apply 

and delaying publication would be 

contrary to the public interest. 

Therefore, we find good cause to waive 

publication of a proposed notice and 

solicitation of public comments. 

VI. Collection of Information 

Requirements 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

VII. Regulatory Impact Statement 

We have examined the impact of this 

rule as required by Executive Order 

12866 on regulatory planning and 

review (September 30 1993), as further 

amended, 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 Order 12866 (as amended 

by Executive Orders 13258 and 13422) 

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). A regulatory impact analysis 

(RIA) must be prepared for major rules 

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 $680 million due to: (1) 

The increase in the deductible and 

coinsurance amounts and (2) the change 

in the number of deductibles and daily 

coinsurance amounts paid. 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. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses, 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 

government agencies. Most hospitals 

and most other providers and suppliers 

are small entities, either by nonprofit 

status or by having revenues of $6.5 

million to $31.5 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 and has 

fewer than 100 beds. Therefore, the 

Secretary has determined that this 

notice will not have a significant impact 

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 (UMRA) 

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 2008, that 

threshold is approximately $130 

million. This notice has no 

consequential effect on State, local, or 

tribal governments or on the private 

sector. However, States may be required 

to pay the deductibles and coinsurance 

for dually-eligible beneficiaries. 


jlentini on PROD1PC65 with NOTICES
Federal Register / Vol. 73, No. 186 / Wednesday, September 24, 2008 / Notices 55089 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

This notice will not have a substantial 

effect on State or local governments. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance) 

Dated: August 28, 2008. 

Kerry Weems, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: September 5, 2008. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. E8–22310 Filed 9–19–08; 9:00 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8036–N] 

RIN 0938–APOO 

Medicare Program; Medicare Part B 

Monthly Actuarial Rates, Premium 

Rate, and Annual Deductible 

Beginning January 1, 2009 

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, 2009. 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 2009 are $192.70 for aged enrollees 

and $224.20 for disabled enrollees. The 

standard monthly Part B premium rate 

for 2009 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 2008 standard premium 

rate was also $96.40.) The Part B 

deductible for 2009 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. 

DATES: Effective Date: January 1, 2009. 

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 

by payments from the Supplementary 

Medical Insurance Fund. 

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 

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 2009 Part B 

deductible is calculated by multiplying 

the 2008 deductible by the ratio of the 

2009 aged actuarial rate over the 2008 

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 


jlentini on PROD1PC65 with NOTICES