55096 Federal Register / Vol. 73, No. 186 / Wednesday, September 24, 2008 / Notices 

announces the 2009 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 $85,000 ..................................... Less than or equal to $170,000 ................................... $0.00 $96.40 

Greater than $85,000 and less than or equal to 

$107,000.

Greater than $170,000 and less than or equal to 

$214,000.

38.50 134.90 

Greater than $107,000 and less than or equal to 

$160,000.

Greater than $214,000 and less than or equal to 

$320,000.

96.30 192.70 

Greater than $160,000 and less than or equal to 

$213,000.

Greater than $320,000 and less than or equal to 

$426,000.

154.10 250.50 

Greater than $213,000 ................................................. Greater than $426,000 ................................................. 211.90 308.30 

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. 

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 $85,000 ................................................................................................................................ $0.00 $96.40 

Greater than $85,000 and less than or equal to $128,000 ..................................................................................... 154.10 250.50 

Greater than $128,000 ............................................................................................................................................ 211.90 308.30 

The Part B deductible for calendar 

year 2009 is $135.00. The standard Part 

B premium rate of $96.40 is the same as 

the premium rate for 2008, so there will 

be no additional costs to the 

approximately 42.3 million Part B 

enrollees for 2009. The monthly impact 

on the beneficiaries who are required to 

pay a higher premium for 2009 because 

their incomes exceed specified 

thresholds is $38.50, $96.30, $154.10, or 

$211.90, which is in addition to the 

standard monthly premium. These 

amounts are higher than the 2008 

amounts of $25.80, $64.50, $103.30, and 

$142.00, respectively, which results in 

$770 million in additional costs to the 

approximately 1.7 million Part B 

enrollees who are affected. Therefore, 

this notice is a major rule as defined in 

5 U.S.C. 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 12, 2008. 

Kerry Weems, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. E8–22314 Filed 9–19–08; 9:00 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–8035–N] 

RIN 0938–AP04 

Medicare Program; Part A Premium for 

Calendar Year 2009 for the Uninsured 

Aged and for Certain Disabled 

Individuals Who Have Exhausted Other 

Entitlement 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This annual notice announces 

Medicare’s Hospital Insurance (Part A) 

premium for uninsured enrollees in 

calendar year (CY) 2009. This premium 

is to be paid by enrollees age 65 and 

over who are not otherwise eligible for 

benefits under Medicare Part A 

(hereafter known as the ‘‘uninsured 

aged’’) and by certain disabled 

individuals who have exhausted other 


jlentini on PROD1PC65 with NOTICES
Federal Register / Vol. 73, No. 186 / Wednesday, September 24, 2008 / Notices 55097 

entitlement. The monthly Part A 

premium for the 12 months beginning 

January 1, 2009 for these individuals 

will be $443. The reduced premium for 

certain other individuals as described in 

this notice will be $244. 

DATES: Effective Date: This notice is 

effective on January 1, 2009. 

FOR FURTHER INFORMATION CONTACT: 

Clare McFarland, (410) 786–6390. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Section 1818 of the Social Security 

Act (the Act) provides for voluntary 

enrollment in the Medicare Hospital 

Insurance program (Medicare Part A), 

subject to payment of a monthly 

premium, of certain persons aged 65 

and older who are uninsured under the 

Old-Age, Survivors and Disability 

Insurance (OASDI) program or the 

Railroad Retirement Act and do not 

otherwise meet the requirements for 

entitlement to Medicare Part A. (Persons 

insured under the OASDI program or 

the Railroad Retirement Act and certain 

others do not have to pay premiums for 

Medicare Part A.) 

Section 1818A of the Act provides for 

voluntary enrollment in Medicare Part 

A, subject to payment of a monthly 

premium, of certain disabled 

individuals who have exhausted other 

entitlement. These are individuals who 

were entitled to coverage due to a 

disabling impairment under section 

226(b) of the Act, but are no longer 

entitled to disability benefits and free 

Medicare Part A coverage because they 

have gone back to work and their 

earnings exceed the statutorily defined 

‘‘substantial gainful activity’’ amount 

(section 223(d)(4) of the Act). 

Section 1818A(d)(2) of the Act 

specifies that the provisions relating to 

premiums under section 1818(d) 

through section 1818(f) of the Act for 

the aged will also apply to certain 

disabled individuals as described above. 

Section 1818(d) of the Act requires us 

to estimate, on an average per capita 

basis, the amount to be paid from the 

Federal Hospital Insurance Trust Fund 

for services incurred in the following 

calendar year (CY) (including the 

associated administrative costs) on 

behalf of individuals aged 65 and over 

who will be entitled to benefits under 

Medicare Part A. We must then 

determine, during September of each 

year, the monthly actuarial rate for the 

following year (the per capita amount 

estimated above divided by 12) and 

publish the dollar amount for the 

monthly premium in the succeeding CY. 

If the premium is not a multiple of $1, 

the premium is rounded to the nearest 

multiple of $1 (or, if it is a multiple of 

50 cents but not of $1, it is rounded to 

the next highest $1). 

Section 13508 of the Omnibus Budget 

Reconciliation Act of 1993 (Pub. L. 103– 

66) amended section 1818(d) of the Act 

to provide for a reduction in the 

premium amount for certain voluntary 

enrollees (section 1818 and section 

1818A of the Act). The reduction 

applies to an individual who is eligible 

to buy into the Medicare Part A program 

and who, as of the last day of the 

previous month— 

• Had at least 30 quarters of coverage 

under title II of the Act; 

• Was married, and had been married 

for the previous 1-year period, to a 

person who had at least 30 quarters of 

coverage; 

• Had been married to a person for at 

least 1 year at the time of the person’s 

death if, at the time of death, the person 

had at least 30 quarters of coverage; or 

• Is divorced from a person and had 

been married to the person for at least 

10 years at the time of the divorce if, at 

the time of the divorce, the person had 

at least 30 quarters of coverage. 

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

specifies that the premium that these 

individuals will pay for CY 2009 will be 

equal to the premium for uninsured 

aged enrollees reduced by 45 percent. 

II. Monthly Premium Amount for CY 

2009 

The monthly premium for the 

uninsured aged and certain disabled 

individuals who have exhausted other 

entitlement for the 12 months beginning 

January 1, 2009, is $443. 

The monthly premium for those 

individuals subject to the 45 percent 

reduction in the monthly premium is 

$244. 

III. Monthly Premium Rate Calculation 

As discussed in section I of this 

notice, the monthly Medicare Part A 

premium is equal to the estimated 

monthly actuarial rate for CY 2009 

rounded to the nearest multiple of $1 

and equals one-twelfth of the average 

per capita amount, which is determined 

by projecting the number of Part A 

enrollees aged 65 years and over as well 

as the benefits and administrative costs 

that will be incurred on their behalf. 

The steps involved in projecting these 

future costs to the Federal Hospital 

Insurance Trust Fund are: 

• Establishing the present cost of 

services furnished to beneficiaries, by 

type of service, to serve as a projection 

base; 

• Projecting increases in payment 

amounts for each of the service types; 

and 

• Projecting increases in 

administrative costs. 

We base our projections for CY 2009 

on: (1) Current historical data; and (2) 

projection assumptions derived from 

current law and the Mid-Session Review 

of the President’s Fiscal Year 2009 

Budget. 

We estimate that in CY 2009, 

37,402,000 people aged 65 years and 

over will be entitled to benefits (without 

premium payment) and that they will 

incur about $198.827 billion in benefits 

and related administrative costs. Thus, 

the estimated monthly average per 

capita amount is $443.00 and the 

monthly premium is $443. The full 

monthly premium reduced by 45 

percent is $244. 

IV. Costs to Beneficiaries 

The CY 2009 premium of $443 is 

approximately 5 percent higher than the 

CY 2008 premium of $423. 

We estimate that approximately 

588,000 enrollees will voluntarily enroll 

in Medicare Part A by paying the full 

premium. We estimate an additional 

10,000 enrollees will pay the reduced 

premium. We estimate that the aggregate 

cost to enrollees paying these premiums 

will be about $142 million in CY 2009 

over the amount that they paid in CY 

2008. 

V. Waiver of Proposed Notice and 

Comment Period 

We are not using notice and comment 

rulemaking in this notification of 

Medicare Part A premiums for CY 2009, 

as that procedure is unnecessary 

because of the lack of discretion in the 

statutory formula that is used to 

calculate the premium and the solely 

ministerial function that this notice 

serves. The Administrative Procedure 

Act (APA) permits agencies to waive 

notice and comment rulemaking when 

notice and public comment thereon are 

unnecessary. On this basis, we waive 

publication of a proposed notice and a 

solicitation of public comments. 

VI. 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) 


jlentini on PROD1PC65 with NOTICES
55098 Federal Register / Vol. 73, No. 186 / Wednesday, September 24, 2008 / Notices 

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 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 $142 million. 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 are required to 

pay the premiums for dually-eligible 

beneficiaries. 

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. E8–22312 Filed 9–19–08; 9:00 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Notice of Public Comment on Section 

635 [42 U.S.C. 9801]—The 2007 Head 

Start School Readiness Act, SubSection 649(k)(1)(A–D)—‘‘Indian Head 

Start Study’’ 

AGENCY: Office of Head Start (OHS), 

Administration for Children and 

Families (ACF), HHS. 

ACTION: Notice of Public Comment on 

Section 635 [42 U.S.C. 9801]—The 2007 

Head Start School Readiness Act, SubSection 649(k)(1)(A–D)—‘‘Indian Head 

Start Study’’. 

SUMMARY: The following Notice of 

Public Comment is in response to 

section 649(k) Sub-Section (3) of the 

2007 Head Start School Readiness Act 

that requires the Secretary no later than 

9 months after the effective date of this 

Sub-Section, publish in the Federal 

Register a plan of how the Secretary 

will carry out section 649 Sub-Section 

(k) Sub-Paragraph (1) and shall provide 

a period for public comment. 

DATES: To ensure consideration, written 

comments must be submitted on or 

before 60 days after this notice is 

published. 

To Comment on This Document, or 

for Further Information Contact: Anne 

Bergan, Office of Planning, Research 

and Evaluation, Administration for 

Children and Families, 370 L’Enfant 

Promenade, SW., Washington, DC 

20447, 202–546–4273, 

abergan@acf.hhs.gov. 

SUPPLEMENTARY INFORMATION: Pursuant 

to the Improving Head Start for School 

Readiness Act of 2007, Public Law 110– 

134, Section 635 [42 U.S.C. 9801]—SubSection 649(k)(1)(A–D), notice is hereby 

given of a plan to conduct a set of 

studies designed to focus on the 

American Indian and Alaska Native (AI/ 

AN) Head Start-eligible population. 

There are two requirements addressed 

in this notice: (1) A plan for a set of 

studies that will focus on the American 

Indian and Alaska Native Head Starteligible population related to the 

following areas: Curriculum 

development, availability and need for 

services, appropriate research 

methodologies and measures, and best 

practices for teaching and educating 

American Indian and Alaska Native 

Head Start Children, and (2) a plan to 

accurately determine the number of 

children nationwide who are eligible to 

participate in Indian Head Start 

programs each year and to document 

how many of these children are 

receiving Head Start services each year. 

Consultation and Collaboration 

For the purposes of responding to the 

requirements in the legislation related to 

consultation and collaboration, ACF 

conferred with the National Indian Head 

Start Directors Association (NIHSDA), 

the AI/AN Head Start Collaboration 

Director, AI/AN Head Start Program 

Directors, staff from the U.S. 

Department of Education, the Bureau of 

Indian Affairs, the Indian Health 

Service, the U.S. Census Bureau, the 

Annie E. Casey Foundation, the 

American Indian and Alaska Native 

Head Start Research Center at the 

University of Colorado—Denver, Dr. C. 

Matthew Snipp of Stanford University, 

Dr. Angela Willeto of Northern Arizona 

University and participants at the Tribal 

consultation sessions held in Denver, 

Colorado; Kansas City, Kansas; Seattle, 

Washington; and Phoenix, Arizona. 

Section I. A Plan for Carrying Out 

Section 649 Subsection (k) Paragraph 

(1) Subparagraph (A) 

To address the first requirement, to 

undertake a study or set of studies, the 

Administration for Children and 

Families (ACF) intends to build upon 

previous and current efforts to develop 

a viable research and evaluation agenda 


jlentini on PROD1PC65 with NOTICES