[Federal Register Volume 64, Number 204 (Friday, October 22, 1999)]
[Notices]
[Pages 57105-57110]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-27627]



[[Page 57105]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-8006-N]
RIN 0938-AJ80


Medicare Program; Monthly Actuarial Rates and Monthly 
Supplementary Medical Insurance Premium Rate Beginning January 1, 2000

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice.

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SUMMARY: In accordance with section 1839 of the Social Security Act, 
this notice announces the monthly actuarial rates for aged (age 65 or 
over) and disabled (under age 65) enrollees in the Medicare 
Supplementary Medical Insurance (SMI) program for 2000. It also 
announces the monthly SMI premium rate to be paid by all enrollees 
during 2000. The monthly actuarial rates for 2000 are $91.90 for aged 
enrollees and $121.10 for disabled enrollees. The monthly SMI premium 
rate for 2000 is $45.50. (The 1999 premium rate was also $45.50). The 
2000 Part B premium is not equal to 50 percent of the monthly actuarial 
rate because of the differential between the amount of home health that 
is transferred into Part B in 2000 (three-sixths) and the amount in 
Part B that is included in the premium calculation (three-sevenths). 
Included in the monthly premium rate is $2.87 for home health services 
being transferred into Part B.

EFFECTIVE DATE: January 1, 2000.

FOR FURTHER INFORMATION CONTACT: Carter S. Warfield, (410) 786-6396.

SUPPLEMENTARY INFORMATION:

I. Background

    The Medicare Supplementary Medical Insurance (SMI) program is the 
voluntary Medicare Part B program that pays all or part of the costs 
for physicians' services, outpatient hospital services, 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 hospital 
insurance (HI) (Medicare Part A). The SMI program is available to 
individuals who are entitled to HI and to U.S. residents who have 
attained age 65 and are citizens, or aliens who were lawfully admitted 
for permanent residence and have resided in the United States for 5 
consecutive years. This program requires enrollment and payment of 
monthly premiums, as provided 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 Health and Human Services is required by section 
1839 of the Social Security Act (the Act) to issue two annual notices 
relating to the SMI program.
    One notice announces two amounts that, according to actuarial 
estimates, will equal respectively, one-half the expected average 
monthly cost of SMI for each aged enrollee (age 65 or over) and one-
half the expected average monthly cost of SMI for each disabled 
enrollee (under age 65) during the year beginning the following 
January. These amounts are called ``monthly actuarial rates.''
    The second notice announces the monthly SMI premium rate to be paid 
by aged and disabled enrollees for the year beginning the following 
January. (Although the costs to the program per disabled enrollee are 
different than for the aged, the law provides that they pay the same 
premium amount.) Beginning with the passage of section 203 of the 
Social Security Amendments of 1972 (Public Law 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) (Public Law 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 (Public Law 98-21), section 
2302 of the Deficit Reduction Act of 1984 (DRA 1984) (Public Law 98-
369), section 9313 of the Consolidated Omnibus Budget Reconciliation 
Act of 1985 (COBRA 1985) (Public Law 99-272), section 4080 of the 
Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) (Public Law 100-
203), and section 6301 of the Omnibus Budget Reconciliation Act of 1989 
(OBRA 1989) (Public Law 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 1990) (Public Law 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 1993) (Public Law 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 1997) (Public 
Law 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).
    BBA 1997 included a further provision affecting the calculation of 
the SMI actuarial rates and premiums for 1998 though 2003. Section 4611 
of BBA 1997 modified the home health benefit payable under the HI 
program for individuals enrolled in the SMI program. In doing so, 
expenditures for home health services not considered ``post-
institutional'' will be payable under the SMI program rather than the 
HI program beginning in 1998. However, section 4611(e)(1) of BBA 1997 
requires that there be a transition from 1998 through 2002 for the 
aggregate amount of the expenditures transferred from the HI program to 
the SMI program. Section 4611(e)(2) also provides a specific yearly 
proportion for the transferred funds. The proportions are \1/6\ for 
1998, \1/3\ for 1999, \1/2\ for 2000, \4/6\ for 2001, and \5/6\ for 
2002. For purposes of determining the correct amount of financing from 
general revenues of the Federal government, it is 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. Accordingly, the actuarial rates 
shown in this announcement reflect the net transitional cost only.
    Section 4611(e)(3) of BBA 1997 also specifies, for the purposes of 
determining the premium, that the monthly actuarial rate for enrollees 
age 65 and over shall be computed as though the transition would occur 
for 1998 through 2003 and that \1/7\ of the cost would 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 is 7

[[Page 57106]]

years while the transition period for including these services in the 
actuarial rate is 6 years. As a result, the premium rate for this year 
and each of the next 3 years, through 2003, will be less than 50 
percent of the actuarial rate for aged enrollees announced by the 
Secretary.
    New section 1933(c) of the Act, as added by section 4732(c) of BBA 
1997, requires the Secretary to allocate money from the SMI trust fund 
to the State Medicaid programs for the purpose of providing Medicare 
Part B premium assistance from 1998 through 2002 for the section 1933 
qualifying low-income Medicaid beneficiaries. This allocation, while 
not being a benefit expenditure, will be an expenditure of the trust 
fund and has been included in calculating the SMI actuarial rates for 
this year. The allocation will be included in calculating the SMI 
actuarial rates through 2002.
    As determined according to section 1839(a)(3) of the Act and 
section 4611(e)(3) of BBA 1997, the premium rate for 2000 is $45.50. 
Included in the premium rate is $2.87 for home health services being 
transferred into Part B.
    A further provision affecting the calculation of the SMI premium is 
section 1839(f) of the Act, as amended by section 211 of the Medicare 
Catastrophic Coverage Act of 1988 (Public Law 100-360). (The Medicare 
Catastrophic Coverage Repeal Act of 1989 (Public Law 101-234) did not 
repeal the revisions to section 1839(f) made by Public Law 100-360.) 
Section 1839(f) provides that if an individual is entitled to benefits 
under section 202 or 223 of the Act (the Old-Age and Survivors 
Insurance Benefit and the Disability Insurance Benefit, respectively) 
and has the SMI premiums deducted from these benefit payments, the 
premium increase will be reduced to avoid causing a decrease in the 
individual's net monthly payment. This 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 SMI premiums for December and the following January are 
deducted from the respective month's section 202 or 223 benefits.
    A check for benefits under section 202 or 223 is received in the 
month following the month for which the benefits are due. The SMI 
premium that is deducted from a particular check is the SMI payment for 
the month in which the check is received. Therefore, a benefit check 
for November is not received until December, but has the December's SMI 
premium deducted from it. This change, in effect, perpetuates former 
amendments that prohibited SMI premium increases from reducing an 
individual's benefits in years in which the dollar amount of the 
individual's cost-of-living increase in benefits was not at least as 
great as the dollar amount of the individual's SMI premium increase.
    Generally, if a beneficiary qualifies for this protection that is, 
the beneficiary must have been in current payment status for November 
and December of the previous year, the reduced premium for the 
individual for that January and 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:
    (1) The monthly premium for January reduced as necessary to make 
the December monthly benefits, after the deduction of the SMI premium 
for January, at least equal to the preceding November's monthly 
benefits, after the deduction of the SMI premium for December; or
    (2) 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 do not include retroactive adjustments or payments 
and deductions on account of work. Also, once the monthly premium 
amount has been 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 the SMI program late or have 
reenrolled 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) are made.

II. Notice of Monthly Actuarial Rates and Monthly Premium Rate

    The monthly actuarial rates applicable for 2000 are $91.90 for 
enrollees age 65 and over, and $121.10 for disabled enrollees under age 
65. Section III of this notice gives the actuarial assumptions and 
bases from which these rates are derived. The monthly premium rate will 
be $45.50 during 2000, the same as the 1999 premium rate. Included in 
the monthly premium rate is $2.87 for home health services being 
transferred into Part B.

III. Statement of Actuarial Assumptions and Bases Employed in 
Determining the Monthly Actuarial Rates and the Monthly Premium 
Rate for the Supplementary Medical Insurance Program Beginning 
January 2000

A. Actuarial Status of the Supplementary Medical Insurance Trust Fund

    Under the law, the starting point for determining the monthly 
premium is the amount that would be necessary to finance the SMI 
program 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 rates are established prospectively and are, therefore, subject 
to projection error. Additionally, legislation enacted after the 
financing has been established, but effective for the period in which 
the financing has been set, may affect program costs. As a result, the 
income to the program may not equal incurred costs. Therefore, trust 
fund assets should be maintained at a level that is adequate to cover a 
moderate degree of variation between actual and projected costs, and 
the amount of incurred, but unpaid expenses. An appropriate level for 
assets to cover a moderate degree of variation between actual and 
projected costs depends on numerous factors. The 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, and (2) the expected relationship between 
incurred and cash expenditures. Ongoing analysis is made of both 
factors as the trends vary over time.
    Table 1 summarizes the estimated actuarial status of the trust fund 
as of the end of the financing period for 1998 and 1999.

[[Page 57107]]



   Table 1.--Estimated Actuarial Status of the Supplementary Medical Insurance Trust Fund as of the End of the
                                                Financing Period
                                            [In billions of dollars]
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                                                                                                    Assets less
                     Financing period ending                          Assets        Liabilities     liabilities
----------------------------------------------------------------------------------------------------------------
Dec. 31, 1998...................................................          46,212           8,842          37,369
Dec. 31, 1999...................................................          43,715           3,190          40,525
----------------------------------------------------------------------------------------------------------------

B. Monthly Actuarial Rate for Enrollees Age 65 and Older

    The monthly actuarial rate for enrollees age 65 and older is one-
half of the monthly projected cost of benefits, the Medicaid transfer 
(for 1998 through 2002), and administrative expenses for each enrollee 
age 65 and older, adjusted to allow for interest earnings on assets in 
the trust fund and a contingency margin. The contingency margin is an 
amount appropriate to provide for a moderate degree of variation 
between actual and projected costs and to amortize any surplus or 
unfunded liabilities. As noted in section I. of this announcement, 
section 4611(e)(2) of BBA 1997 requires that only \1/2\ of the cost of 
the home health services being transferred be included in the actuarial 
rate for 2000, rather than the full cost of such benefits.
    The monthly actuarial rate for enrollees age 65 and older for 2000 
is determined by first establishing per-enrollee cost by type of 
service from program data through 1998 and then projecting these costs 
for subsequent years. The projection factors used are shown in Table 2. 
The projected values for financing periods from January 1, 1997 through 
December 31, 2000, are shown in Table 3.
    The projected monthly rate required to pay for one-half of the 
total of benefits, the transfer to Medicaid, and administrative costs 
for enrollees age 65 and over for 2000 is $106.25. Included in the 
total of $106.25 is $10.56 for home health services and $23.52 for 
managed care services. The amount of $10.56 for home health services 
includes (1) the full cost of fee-for-service home health services 
being transferred from the HI program as a result of BBA 1997 as if the 
transition did not apply ($10.20) as well as (2) the cost of furnishing 
all home health services to those individuals enrolled in SMI only 
($0.36). The amount of $23.52 for managed care services includes (1) 
The full cost of managed care home health services being transferred 
from the HI program as a result of BBA 1997 as if the transition did 
not apply ($3.18) as well as (2) the cost of furnishing all other SMI 
services to those individuals enrolled in managed care plans ($20.34). 
Since section 4611(e)(2) of BBA 1997 requires that only \1/2\ of the 
cost for those services being transferred be included in the actuarial 
rate for 2000, the monthly actuarial rate provides for an adjustment of 
-$6.69, representing \1/2\ of the full cost of such services. The 
monthly actuarial rate of $91.90 also provides an adjustment of -$3.77 
for interest earnings and -$3.89 for a contingency margin. Based on 
current estimates, it appears that the assets are more than sufficient 
to cover the amount of incurred but unpaid expenses and to provide for 
a moderate degree of variation between actual and projected costs. 
Thus, a negative contingency margin is needed to reduce assets to a 
more appropriate level.

C. Monthly Actuarial Rate for Disabled Enrollees

    Disabled enrollees are those persons enrolled in SMI because of 
entitlement (before age 65) to disability benefits for more than 24 
months or because of entitlement to Medicare under the end-stage renal 
disease program. Projected monthly costs for disabled enrollees (other 
than those suffering from end-stage renal disease) are prepared in a 
fashion parallel to the projection for the aged using appropriate 
actuarial assumptions (see Table 2). Costs for the end-stage renal 
disease program are projected differently because of the different 
nature of services offered by the program. The combined results for all 
disabled enrollees are shown in Table 4.
    The projected monthly rate required to pay for one-half of the 
total of benefits, the transfer to Medicaid, and administrative costs 
for disabled enrollees for 2000 is $120.56. Included in the total of 
$120.56 is $7.71 for home health services and $12.00 for managed care 
services. The amount of $7.71 is the full cost of the home health 
services being transferred from the HI program as a result of BBA 1997 
as if the transition did not apply. The amount of $12.00 for managed 
care services includes (1) the full cost of managed care home health 
services being transferred from the HI program as a result of BBA 1997 
as if the transition did not apply ($1.31) as well as (2) the cost of 
furnishing all other SMI services to those individuals enrolled in 
managed care plans ($10.69). The monthly actuarial rate provides for an 
adjustment of -$4.51, representing \1/2\ of the full cost of such 
services. Since section 4611(e)(2) of BBA 1997 requires that only \1/2\ 
of the cost for those services being transferred be included in the 
actuarial rate for 2000, the monthly actuarial rate of $121.10 also 
provides an adjustment of $0.98 for interest earnings and $4.07 for a 
contingency margin. Based on current estimates, it appears that the 
assets are not sufficient to cover the amount of incurred but unpaid 
expenses and to provide for a moderate degree of variation between 
actual and projected costs. Thus, a positive contingency margin is 
needed to increase assets to a more appropriate level.

D. 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 is, 
therefore, more optimistic than the current estimate. The other set 
represents increases that are higher and is therefore, more pessimistic 
than the current version. The values for the alternative assumptions 
were determined from a statistical analysis of the historical variation 
in the respective increase factors.
    Table 5 indicates that, under the assumptions used in preparing 
this report, the monthly actuarial rates would result in an excess of 
assets over liabilities of $37,932 billion by the end of December 2000. 
This amounts to 39.7 percent of the estimated total incurred 
expenditures for the following year. Assumptions that are somewhat more 
pessimistic (and therefore, test the adequacy of the assets to 
accommodate projection errors) produce a surplus of $28,019 billion by 
the end of December 2000, which amounts to 25.9 percent of the 
estimated total incurred expenditures for the following year.

[[Page 57108]]

Under fairly optimistic assumptions, the monthly actuarial rates would 
result in a surplus of $47,863 billion by the end of December 2000, 
which amounts to 57.6 percent of the estimated total incurred 
expenditures for the following year.

E. Premium Rate

    As determined by with section 1839(a)(3) of the Act and section 
4611(e)(3) of BBA 1997, the monthly premium rate for 2000, for both 
aged and disabled enrollee, is $45.50.

                                    Table 2.--Projection Factors\1\ 12-Month Periods Ending December 31 of 1997-2000
                                                                      [In percent]
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                                     Physicians' services    Durable                 Other                    Home                   Other
           Calendar year           ------------------------  medical    Carrier     carrier    Outpatient    Health    Hospital  intermediary   Managed
                                     Fees \2\    Residual   equipment   lab \4\     services    hospital     agency    lab \7\   services \8\     care
---------------------------------------------------\3\--------------------------------\5\---------------------\6\---------------------------------------
Aged:
    1997..........................        0.6         3.1        12.0       -5.3        15.0          8.0        3.3        7.0         13.1        -0.9
    1998..........................        3.5         0.8        -2.7      -10.7        10.1         -0.1  \9\ 3617.        2.7         -4.6        21.6
                                                                                                                   6
    1999..........................        2.3         2.1         5.6        0.6         7.7          1.0      -19.7        5.4         -9.5         3.0
    2000..........................        5.5         1.6         6.5        1.4         7.5          4.3        4.0        4.2          1.8         5.3
Disabled:
    1997..........................        0.6         2.2         4.8       -2.9        11.7          7.6        0.0        0.0         25.2       -11.8
    1998..........................        3.5         0.6         1.6       -0.9         7.9         -2.4        (9)       -1.9         -4.5        11.5
    1999..........................        2.3         2.0         5.5        1.0         6.5          2.6      -16.5        4.9         -7.4         0.2
    2000..........................        5.5         1.6         6.4        1.3         7.1          4.9        3.4        4.2          0.3        4.2
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All values for services other than managed care are per fee-for-service enrollee. Managed care values are per managed care enrollee.
\2\ As 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 physicians office or an independent lab.
\5\ Includes ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc.
\6\ From July 1, 1981 to December 31, 1997, home health agency services have been provided by the SMI program only for those SMI enrollees not entitled
  to HI. Otherwise these services were provided by the HI program. Since all SMI disabled enrollees are entitled to HI, their coverage of these services
  has been provided by the HI program during this period.
\7\ Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
\8\ Includes services furnished in rehabilitation and psychiatric hospitals, dialysis facilities, rural health clinics, federally qualified health
  centers, etc.
\9\ Effective January 1, 1998, the coverage of home health agency services not considered ``post-institutional'' for those individuals entitled to HI
  and enrolled in SMI will be transferred from the HI program to the SMI program. As a result, as of January 1, 1998, there will be a large increase in
  SMI expenditures for these services for the aged enrollees, and SMI coverage for these services will resume for disabled enrollees.


 Table 3.--Derivation of Monthly Actuarial Rate for Enrollees Age 65 and Over Financing Periods Ending December
                                       31, 1997 Through December 31, 2000
----------------------------------------------------------------------------------------------------------------
                                                                               Financing periods
                                                             ---------------------------------------------------
                                                                CY 1997      CY 1998      CY 1999      CY 2000
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
    Physician Fee Schedule..................................       $48.63       $49.06       $50.54       $52.87
    Durable Medical Equipment...............................         5.84         5.50         5.71         5.94
    Carrier Lab \1\.........................................         2.64         2.28         2.26         2.24
    Other Carrier Services \2\..............................         7.93         8.44         8.95         9.40
    Outpatient Hospital.....................................        19.17        18.52        18.42        18.76
    Home health.............................................         0.34    \5\ 12.64    \5\ 10.15    \5\ 10.56
    Hospital Lab \3\........................................         1.58         1.57         1.63         1.66
    Other Intermediary Services \4\.........................         7.30         6.74         6.00         5.97
    Managed Care............................................        13.01    \6\ 18.57    \6\ 20.43    \6\ 23.52
                                                             ---------------------------------------------------
        Total services......................................       106.44       123.32       124.09       130.90
Cost-sharing:
    Deductible..............................................        -3.80        -3.82        -3.84        -3.85
    Coinsurance.............................................       -21.55       -22.11       -22.45       -22.79
                                                             ---------------------------------------------------
Total benefits..............................................        81.09        97.39        97.81       104.27
Transfer to Medicaid........................................         0.00     \7\ 0.08     \7\ 0.09     \7\ 0.11
Administrative expenses.....................................         1.52         1.65         1.84         1.87
                                                             ---------------------------------------------------
Incurred expenditures.......................................        82.61        99.13        99.74       106.25
Value of interest...........................................        -3.11        -3.49        -3.97        -3.77
Adjustment for home health agency services transferred from          0.00   \8\ -12.77    \8\ -8.31    \8\ -6.69
 HI.........................................................
Contingency margin for projection error and to amortize the          8.11         5.03         4.84        -3.89
 surplus or deficit.........................................
                                                             ---------------------------------------------------
Monthly actuarial rate......................................       $87.60       $87.90       $92.30      $91.90
----------------------------------------------------------------------------------------------------------------
\1\ Includes services paid under the lab fee schedule furnished in the physicians office or an independent lab.
\2\ Includes 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.

[[Page 57109]]

 
\4\ Includes services furnished in rehabilitation and psychiatric hospitals, dialysis facilities, rural health
  clinics, federally qualified health centers, etc.
\5\ This amount includes the full cost of the fee-for-service home health services being transferred from the HI
  program as a result of BBA 1997 as if the transition did not apply, as well as the cost of furnishing all home
  health services to those individuals enrolled in SMI only.
\6\ This amount includes the full cost of the managed care home health services being transferred from the HI
  program as a result of BBA 1997 as if the transition did not apply, as well as the cost of furnishing all
  other SMI services to individuals enrolled in group practice prepayment plans.
\7\ Section 1933(c)(2) of the Act, as added by section 4732 of BBA 1997, allocates an amount to be
  transferred from the SMI trust fund to the state Medicaid programs. This transfer is for the purpose of paying
  the SMI premiums for certain low-income beneficiaries. It is not a benefit expenditure but is used in
  determining the SMI actuarial rates since it is an expenditure of the trust fund.
\8\ Section 4611 of BBA 1997 specifies that expenditures for home health services not considered ``post-
  institutional'' will be payable under the SMI program rather than the HI program beginning in 1998. However,
  section 4611(e)(1) requires there be a transition from 1998 through 2002 for the aggregate amount of the
  expenditures transferred from the HI program to the SMI program. For 1998 the amount transferred is \1/6\ of
  the full cost for such services, and for 1999, \1/3\, and for 2000, \1/2\. Therefore, the adjustment for 1998
  represents \5/6\ of the full cost, and for 1999, \2/3\, and for 2000, \1/2\. This amount adjusts the actuarial
  rate to reflect the correct amount attributable to home health services.


Table 4.--Derivation of Monthly Actuarial Rate for Disabled Enrollees Financing Periods Ending December 31, 1997
                                            Through December 31, 2000
----------------------------------------------------------------------------------------------------------------
                                                                               Financing periods
                                                             ---------------------------------------------------
                                                                CY 1997      CY 1998      CY 1999      CY 2000
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
    Physician Fee Schedule..................................       $50.67       $51.37       $53.58       $56.87
    Durable Medical Equipment...............................         8.97         8.93         9.34         9.83
    Carrier Lab \1\.........................................         3.23         2.73         2.68         2.70
    Other Carrier Services \2\..............................         9.35         9.65        10.26        10.94
    Outpatient Hospital.....................................        24.78        23.65        23.81        24.59
    Home health.............................................         0.00     \5\ 8.93     \5\ 7.46     \5\ 7.71
    Hospital Lab \3\........................................         2.74         2.55         2.66         2.76
    Other Intermediary Services \4\.........................        30.70        27.88        28.25        28.72
    Managed Care............................................         6.88     \6\ 9.51    \6\ 10.30    \6\ 12.00
                                                             ---------------------------------------------------
        Total services......................................       137.31       145.20       148.36       156.13
Cost-sharing:
    Deductible..............................................        -3.43        -3.46         3.47        -3.48
    Coinsurance.............................................        31.86       -32.42       -33.44       -34.31
                                                             ---------------------------------------------------
Total benefits..............................................       102.02       109.32       111.44       118.34
Transfer to Medicaid........................................         0.00     \7\ 0.08     \7\ 0.09     \7\ 0.10
Administrative expenses.....................................         1.91         1.95         2.15         2.12
                                                             ---------------------------------------------------
Incurred expenditures.......................................       103.93       111.35       113.69       120.56
Value of interest...........................................        -0.61        -0.11         0.75         0.98
Adjustment for home health agency services transferred from          0.00     \8\-8.49     \8\-5.72     \8\-4.51
 HI.........................................................
Contingency margin for projection error and to amortize the          7.08        -5.66        -5.71         4.07
 surplus or deficit.........................................
                                                             ---------------------------------------------------
Monthly actuarial rate......................................      $110.40       $97.10      $103.00     $121.10
----------------------------------------------------------------------------------------------------------------
\1\ Includes services paid under the lab fee schedule furnished in the physicians office or an independent lab.
\2\ Includes 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 rehabilitation and psychiatric hospitals, dialysis facilities, rural health
  clinics, federally qualified health centers, etc.
\5\ This amount includes the full cost of the fee-for-service home health services being transferred from the HI
  program as a result of BBA 1997 as if the transition did not apply.
\6\ This amount includes the full cost of the managed care home health services being transferred from the HI
  program as a result of BBA 1997 as if the transition did not apply, as well as the cost of furnishing all
  other SMI services to individuals enrolled in group practice prepayment plans.
\7\ Section 1933(c)(2) of the Act, as added by section 4732 of BBA 1997, allocates an amount to be
  transferred from the SMI trust fund to the state Medicaid programs. This transfer is for the purpose of paying
  the SMI premiums for certain low-income beneficiaries. It is not a benefit expenditure but is used in
  determining the SMI actuarial rates since it is an expenditure of the trust fund.
\8\ Section 4611 of BBA 1997 specifies that expenditures for home health services not considered ``post-
  institutional'' will be payable under the SMI program rather than the HI program beginning in 1998. However,
  section 4611(e)(1) requires there be a transition from 1998 through 2002 for the aggregate amount of the
  expenditures transferred from the HI program to the SMI program. For 1998 the amount transferred is \1/6\ of
  the full cost for such services, and for 1999, \1/3\, and for 2000, \1/2\. Therefore, the adjustment for 1998
  represents \5/6\ of the full cost, and for 1999, \2/3\, and for 2000, \1/2\. This amount adjusts the actuarial
  rate to reflect the correct amount attributable to home health services.


  Table 5.--Actuarial Status of the SMI Trust Fund Under Three Sets of
       Assumptions for Financing Periods Through December 31, 2000
------------------------------------------------------------------------
        As of December 31              1998         1999         2000
------------------------------------------------------------------------
This Projection:
    Actuarial Status (in
     millions):
    Assets.......................      $46,212      $43,715      $38,886
    Liabilities..................        8,842        3,190          954
                                  --------------------------------------
    Assets Less Liabilities......      $37,369      $40,525      $37,932

[[Page 57110]]

 
    Ratio (in percent) \1\.......         45.1         44.6         39.7
Low Cost Projection:
    Actuarial Status (in
     millions):
    Assets.......................      $46,212      $50,051      $48,512
    Liabilities..................        8,842        2,486          666
                                  --------------------------------------
    Assets Less Liabilities......      $37,369      $47,565      $47,863
    Ratio (in percent) \1\.......         49.3         58.8         57.6
High Cost Projection:
    Actuarial Status (in
     millions):
    Assets.......................      $46,212      $37,379      $29,260
    Liabilities..................        8,842        3,894        1,241
                                  --------------------------------------
    Assets Less Liabilities......      $37,369      $33,485      $28,019
    Ratio (in percent) \1\.......         41.6         33.2        25.9
------------------------------------------------------------------------
\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.

IV. Regulatory Impact Analysis

    We have examined the impacts of this notice as required by 
Executive Order 12866 and the Regulatory Flexibility Act (RFA) (Public 
Law 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 for small businesses. For 
purposes of the RFA, States and individuals are not considered small 
entities.
    Also, section 1102(b) of the Act requires the Secretary to prepare 
a regulatory impact analysis for any notice that may have a significant 
impact on the operations of a substantial number of small rural 
hospitals. Such an analysis must conform to the provisions of section 
604 of the RFA. For purposes of section 1102(b) of the Act, we consider 
a small rural hospital as a hospital that is located outside of a 
Metropolitan Statistical Area and has fewer than 50 beds. We have 
determined that this notice will not have a significant effect on a 
substantial number of small entities nor on the operations of a 
substantial number of small rural hospitals. Therefore, we are not 
preparing an analysis for either the RFA or section 1102(b) of the Act.
    This notice announces that the monthly actuarial rates applicable 
for 2000 are $91.90 for enrollees age 65 and over, and $121.10 for 
disabled enrollees under age 65. It also announces that the monthly SMI 
premium rate for calendar year 2000 is $45.50. The SMI premium rate of 
$45.50 for 2000 is the same as the premium rate for 1999. As a result, 
there is no additional cost to the approximately 37 million SMI 
enrollees for 2000. 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.
    In accordance with the provisions of Executive Order 12866, this 
notice was reviewed by the Office of Management and Budget. We have 
reviewed this notice under the threshold criteria of Executive Order 
13132 of August 4, 1999, Federalism, published in the Federal Register 
on August 10, 1999 (64 FR 43255). The Executive Order is effective 
November 2, 1999, which is 90 days after the date of this Order. We 
have determined that the notice does not significantly affect the 
rights, roles, and responsibilities of States.

V. Waiver of Notice of Proposed Rulemaking

    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 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 formula used to calculate the 
SMI premium is statutorily directed, and we can exercise no discretion 
in following that formula. Moreover, the statute establishes the time 
period for which the premium rates will apply, and delaying publication 
of the SMI premium rate would be contrary to the public interest. 
Therefore, we find good cause to waive publication of a proposed notice 
and solicitation of public comments.

(Section 1839 of the Social Security Act; 42 U.S.C. 1395r)

(Catalog of Federal Domestic Assistance Program No. 93.774, 
Medicare--Supplementary Medical Insurance)

    Dated: October 13, 1999.
Michael M. Hash,
Deputy Administrator, Health Care Financing Administration.
    Dated: October 18, 1999.
Donna E. Shalala,
Secretary.
[FR Doc. 99-27627 Filed 10-19-99; 11:35 am]
BILLING CODE 4120-01-P