Federal Register / Vol. 73, No. 188 / Friday, September 26, 2008 / Notices 55847 

Reports Clearance Office on (410) 786– 

1326. 

In commenting on the proposed 

information collections please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways November 25, 2008: 

1. Electronically. You may submit 

your comments electronically to http:// 

www.regulations.gov. Follow the 

instructions for ‘‘Comment or 

Submission’’ or ‘‘More Search Options’’ 

to find the information collection 

document(s) accepting comments. 

2. By regular mail. You may mail 

written comments to the following 

address: CMS, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attention: Document Identifier/OMB 

Control Number lllll, Room C4– 

26–05, 7500 Security Boulevard, 

Baltimore, Maryland 21244–1850. 

Dated: September 18, 2008. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E8–22584 Filed 9–25–08; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–4136–N] 

Medicare Program; Medicare Appeals; 

Adjustment to the Amount in 

Controversy Threshold Amounts for 

Calendar Year 2009 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

annual adjustment in the amount in 

controversy (AIC) threshold amounts for 

Administrative Law Judge (ALJ) 

hearings and judicial review under the 

Medicare appeals process. The 

adjustment to the AIC threshold 

amounts will be effective for requests 

for ALJ hearings and judicial review 

filed on or after January 1, 2009. The 

2009 AIC threshold amounts are $120 

for ALJ hearings and $1,220 for judicial 

review. 

DATES: Effective Date: This notice is 

effective on January 1, 2009. 

FOR FURTHER INFORMATION CONTACT: Liz 

Hosna, (410) 786–4993. 

SUPPLEMENTARY INFORMATION: 

I. Background 

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

Security Act (the Act), as amended by 

section 521 of the Medicare, Medicaid, 

and SCHIP Benefits Improvement and 

Protection Act of 2000 (BIPA), 

established the AIC threshold amounts 

for ALJ hearing requests and judicial 

review at $100 and $1000, respectively, 

for Medicare Part A and Part B appeals. 

Section 940 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA), 

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

Act to require the AIC threshold 

amounts for ALJ hearings and judicial 

review to be adjusted annually. The AIC 

threshold amounts are to be adjusted, as 

of January 2005, by the percentage 

increase in the medical care component 

of the consumer price index for all 

urban consumers (U.S. city average) for 

July 2003 to July of the year preceding 

the year involved and rounded to the 

nearest multiple of $10. Section 

940(b)(2) of the MMA provided 

conforming amendments to apply the 

AIC adjustment requirement to 

Medicare Part C (Medicare Advantage 

‘‘MA’’) appeals and certain health 

maintenance organization and 

competitive health plan appeals. Health 

care prepayment plans are also subject 

to MA appeals rules, including the AIC 

adjustment requirement. Section 101 of 

the MMA provides for the application of 

the AIC adjustment requirement to 

Medicare Part D appeals. 

A. Medicare Part A and Part B Appeals 

The statutory formula for the annual 

adjustment to the AIC threshold 

amounts for ALJ hearings and judicial 

review of Medicare Part A and Part B 

appeals, set forth at section 

1869(b)(1)(E) of the Act, is included in 

the applicable implementing 

regulations, 42 CFR Part 405, Subpart I, 

at § 405.1006(b). The regulations require 

the Secretary of the Department of 

Health and Human Services (the 

Secretary) to publish changes to the AIC 

threshold amounts in the Federal 

Register (§ 405.1006(b)(2)). In order to 

be entitled to a hearing before an ALJ, 

a party to a proceeding must meet the 

AIC requirements at § 405.1006(b). 

Similarly, a party must meet the AIC 

requirement at § 405.1006(c) at the time 

judicial review is requested for the court 

to have jurisdiction over the appeal 

(§ 405.1136(a)). 

B. Medicare Part C (Medicare 

Advantage) Appeals 

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

the AIC adjustment requirement to Part 

C (MA) appeals by amending section 

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

regulations for Medicare Part C appeals 

are found at 42 CFR Part 422, Subpart 

M. Specifically, § 422.600 and § 422.612 

discuss the AIC threshold amounts for 

ALJ hearings and judicial review. 

Section 422.600 grants any party to 

the reconsideration, except the MA 

organization, a right to an ALJ hearing 

as long as the amount remaining in 

controversy after reconsideration meets 

the threshold requirement established 

annually by the Secretary. Section 

422.612 states that any party, including 

the MA organization, may request 

judicial review if the amount in 

controversy meets the threshold 

requirement established annually by the 

Secretary. 

C. Health Maintenance Organizations, 

Competitive Medical Plans, and Health 

Care Prepayment Plans 

Section 1876(c)(5)(B) of the Act states 

that the annual adjustment to the AIC 

dollar amounts set forth in section 

1869(b)(1)(E) of the Act applies to 

certain beneficiary appeals within the 

context of health maintenance 

organizations and competitive medical 

plans. The applicable implementing 

regulations for Medicare Part C appeals 

are set forth in 42 CFR Part 422, Subpart 

M, and as discussed above, apply to 

these appeals. The Medicare Part C 

appeals rules also apply to health care 

prepayment plan appeals. 

D. Medicare Part D (Prescription Drug 

Plan) Appeals 

The annually adjusted AIC threshold 

amounts for ALJ hearings and judicial 

review that apply to Medicare Parts A, 

B, and C appeals also apply to Medicare 

Part D appeals. Section 101 of the MMA 

added section 1860D–4(h)(1) of the Act 

regarding Part D appeals. This statutory 

provision requires a prescription drug 

plan sponsor to meet the requirements 

set forth in sections 1852(g)(4) and (g)(5) 

of the Act, in a similar manner as MA 

organizations. As noted above, the 

annually adjusted AIC threshold 

requirement was added to section 

1852(g)(5) of the Act by section 

940(b)(2)(A) of the MMA. The 

implementing regulations for Medicare 

Part D appeals can be found at 42 CFR 

Part 423, Subpart M. The regulations 

impart at § 423.562(c) that unless the 

Part D appeals rules provide otherwise, 

the Part C appeals rules (including the 

annually adjusted AIC threshold 

amount) apply to Part D appeals to the 

extent they are appropriate. More 

specifically, § 423.610 and § 423.630 of 

the Part D appeals rules discuss the AIC 

threshold amounts for ALJ hearings and 

judicial review. Section 423.610(a) 


jlentini on PROD1PC65 with NOTICES
55848 Federal Register / Vol. 73, No. 188 / Friday, September 26, 2008 / Notices 

grants a Part D enrollee, who is 

dissatisfied with the Independent 

Review Entity (IRE) reconsideration 

determination, a right to an ALJ hearing 

if the amount remaining in controversy 

after the IRE reconsideration meets the 

threshold amount established annually 

by the Secretary. Section 423.630(a) 

allows a Part D enrollee to request 

judicial review of an ALJ’s decision if 

the AIC meets the threshold amount 

established annually by the Secretary. 

II. Annual AIC Adjustments 

A. AIC Adjustment Formula and AIC 

Adjustments 

As previously noted, section 940 of 

the MMA requires that the AIC 

threshold amounts be adjusted 

annually, beginning in January of 2005, 

by the percentage increase in the 

medical care component of the 

consumer price index (CPI) for all urban 

consumers (U.S. city average) for July 

2003 to the July of the preceding year 

involved and rounded to the nearest 

multiple of $10. 

B. Calendar Year 2009 

The AIC threshold amount for ALJ 

hearing requests will be $120 and the 

AIC threshold amount for judicial 

review will be $1,220 for the 2009 

calendar year. These new amounts are 

based on the 22.3 percent increase in 

the medical care component of the CPI 

from July of 2003 to July of 2008. The 

CPI level was at 297.6 in July of 2003 

and rose to 363.96 in July of 2008. This 

change accounted for the 22.3 percent 

increase. The AIC threshold amount for 

ALJ hearing requests changes to $122.30 

based on the 22.3 percent increase. In 

accordance with section 940 of the 

MMA, this amount is rounded to the 

nearest multiple of $10. Therefore, the 

2009 AIC threshold amount for ALJ 

hearings is $120. The AIC threshold 

amount for judicial review changes to 

$1,223.00 based on the 22.3 percent 

increase. This amount was rounded to 

the nearest multiple of $10, resulting in 

a 2009 AIC threshold amount of $1,220. 

C. Summary Table of Adjustments in 

the AIC Threshold Amounts 

In Table 1 below, we list the Calendar 

Year 2005 through 2009 threshold 

amounts. 

TABLE 1—AMOUNT-IN-CONTROVERSY THRESHOLD AMOUNTS

CY 2005 CY 2006 CY 2007 CY 2008 CY 2009 

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

Judicial Review .................................................................... 1050 1090 1130 1180 1,220 

Key: CY = Calendar Year. 

III. Collection of Information 

Requirements (If Applicable) 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program; No. 93.773 Medicare—Hospital 

Insurance Program; and No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: September 12, 2008. 

Kerry Weems, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. E8–22589 Filed 9–25–08; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3203–N] 

Medicare Program; Meeting of the 

Medicare Evidence Development and 

Coverage Advisory Committee— 

November 19, 2008 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice of meeting. 

SUMMARY: This notice announces that a 

public meeting of the Medicare 

Evidence Development & Coverage 

Advisory Committee (MEDCAC) 

(‘‘Committee’’) will be held on 

Wednesday, November 19, 2008. The 

Committee generally provides advice 

and recommendations concerning the 

adequacy of scientific evidence needed 

to determine whether certain medical 

items and services can be covered under 

the Medicare statute. This meeting will 

focus on the use of computed 

tomography colonography (CTC), also 

referred to as virtual colonoscopy, as a 

cancer screening test for average risk 

individuals (See section 1861(pp) of the 

Social Security Act (42 U.S.C. section 

1395x(pp))). The meeting will discuss 

the various kinds of evidence that are 

useful to support requests for Medicare 

coverage in this field. This meeting is 

open to the public in accordance with 

the Federal Advisory Committee Act (5 

U.S.C. App. 2, section 10(a)). 

DATES: Meeting date: The public 

meeting will be held on Wednesday, 

November 19, 2008 from 7:30 a.m. until 

4:30 p.m., e.s.t. 

Deadline for Submission of Written 

Comments: Written comments must be 

received at the address specified in the 

ADDRESSES section of this notice by 5 

p.m., e.s.t on October 20, 2008. Once 

submitted comments are final. 

Deadlines for Speaker Registration 

and Presentation Materials: The 

deadline to register to be a speaker and 

to submit powerpoint presentation 

materials and writings that will be used 

in support of an oral presentation, is 5 

p.m., d.s.t. on Monday, October 20, 

2008. Speakers may register by phone or 

via e-mail by contacting the person 

listed in the FOR FURTHER INFORMATION

CONTACT section of this notice. 

Presentation materials must be received 

at the address specified in the 

ADDRESSES section of this notice. 

Deadline for All Other Attendees 

Registration: Individuals may register by 

phone or via e-mail by contacting the 

person listed in the FOR FURTHER

INFORMATION CONTACT section of this 

notice by 5 p.m., e.s.t. on Wednesday, 

November 12, 2008. 

Deadline for Submitting a Request for 

Special Accommodations: Persons 

attending the meeting who are hearing 

or visually impaired, or have a 

condition that requires special 

assistance or accommodations, are 

asked to contact the Executive Secretary 

as specified in the FOR FURTHER

INFORMATION CONTACT section of this 

notice no later than 5 p.m., e.s.t. Friday, 

November 7, 2008. 

ADDRESSES: Meeting Location: The 

meeting will be held in the main 

auditorium of the Centers for Medicare 

& Medicaid Services, 7500 Security 

Blvd., Baltimore, MD 21244. 

Submission of Presentations and 

Comments: Presentation materials and 

written comments that will be presented 

at the meeting must be submitted via eVerDate Aug<31>2005 18:07 Sep 25, 2008 Jkt 214001 PO 00000 Frm 00038 Fmt 4703 Sfmt 4703 E:\FR\FM\26SEN1.SGM 26SEN1

jlentini on PROD1PC65 with NOTICES