[Federal Register Volume 67, Number 188 (Friday, September 27, 2002)]
[Rules and Regulations]
[Pages 60993-60997]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-23845]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 408

[CMS-1221-F]
RIN 0938-AK42


Medicare Program; Supplementary Medical Insurance Premium 
Surcharge Agreements

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule.

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SUMMARY: This final rule implements legislation contained in section 
1839(e) of the Social Security Act (the Act). That statute authorizes a 
Medicare premium payment arrangement whereby State and local government 
agencies can enter into an agreement with the Secretary to make 
periodic lump sum payments for the Supplementary Medical Insurance 
(SMI) late enrollment premium surcharge amounts due for a designated 
group of eligible enrollees. Under this rule, we define and set out the 
basic rules for the new SMI premium surcharge billing agreement. In 
order to give States additional time for implementation of the 
provisions of this final rule, we are delaying the rule's effective 
date to six months from the date of its publication in the Federal 
Register.

EFFECTIVE DATE: This final rule is effective March 26, 2003.

FOR FURTHER INFORMATION CONTACT: Sandra Clarke, (410) 786-7451.

SUPPLEMENTARY INFORMATION: 

I. Background

    Section 1839(e) of the Social Security Act (the Act), as amended by 
section 144 of the Social Security Act Amendments of 1994 (Pub. L. 103-
432, October 31, 1994), allows States to enter into agreements with us 
to pay a lump sum for the Part B premium late enrollment surcharge 
amounts due for a designated group of eligible enrollees. Section 4582 
of the Balanced Budget Act of 1997 (Pub. L. 105-33) (BBA) amended the 
Act by adding language that allows local government agencies to also 
pay the surcharge. Under section 4582 of the BBA, any appropriate State 
or local government agency specified by the Secretary may enter into a 
Supplementary Medical Insurance (SMI) premium surcharge agreement.
    This legislation was requested to enable State and local government 
agencies that are no longer offering a health benefits package to their 
retirees to pay the SMI late enrollment premium surcharge on a lump sum 
basis for their retirees who consequently enrolled or reenrolled in the 
Medicare program.
    While covered by the State or local government agency health care 
plans, some retirees, who believed that these health plans would be 
sufficient to cover their health care needs, chose not to enroll in 
Medicare when they first became eligible, or enrolled and subsequently 
canceled their Medicare coverage. In some cases, these retirees were 
subsequently notified by their State or local government retirement 
offices that those agencies would no longer offer a health benefit 
package to their retirees. The agencies recommended that their retirees 
enroll or reenroll in Medicare. When they did so, some retirees learned 
that they would be subject to Medicare's late enrollment premium 
surcharge. Consequently, State and local government retirement offices 
contacted us and requested either a waiver of the surcharge or 
establishment of a special enrollment period for the affected retirees. 
We denied these requests and determined that the affected retirees were 
subject to the late enrollment premium surcharge. This prompted some 
State and local government retirement offices to offer to pay the

[[Page 60994]]

surcharge portion of the Supplemental Medical Insurance premium on 
behalf of their affected retirees. It also prompted a request from a 
local government agency to enter into a special billing and payment 
arrangement with us in order periodically to receive a single bill and 
pay a lump sum for the surcharge amounts due from a specified group of 
its retirees.
    Since there was no law or regulation in place that would have 
allowed us to send a State or local government agency a single bill to 
pay a lump sum for the SMI premium surcharge portion for a group of 
enrollees, we initially denied the request. Subsequently, the Congress 
enacted legislation that allowed States to pay the Secretary, on a 
quarterly or other periodic basis, a lump sum for the total amount of 
the SMI premium surcharges for a group of Medicare enrollees (section 
1839(e) of the Act, section 144 of the Social Security Act Amendments 
(Pub. L. 103-432)). Section 4582 of the BBA subsequently amended 
section 1839(e) of the Act by adding language that would also allow any 
appropriate State or local government agency specified by the Secretary 
to enter into an agreement to pay the SMI premium surcharges on a 
periodic lump sum basis. Because our third party billing system, which 
is used for billing and payment of these surcharge amounts, was 
developed to accommodate monthly billing and payments, all SMI premium 
surcharge amounts will be billed and paid on a monthly basis.
    The election to make lump sum payments of SMI premium surcharges by 
a State or local government agency under an SMI premium surcharge 
agreement is strictly voluntary and is provided as a convenience to the 
State or local government agency.

II. Provisions of the Proposed Regulations

    The proposed rule that we published in the Federal Register on 
October 26, 2001 (66 FR 54186) would implement section 1839(e) of the 
Act, section 144 of the Social Security Act Amendments of 1994 (Pub. L. 
103-432), and section 4582 of the BBA. We proposed to make the 
following changes in 42 CFR part 408:
    We would add a new subpart H to the regulations in part 408 
(Premiums for Supplementary Medical Insurance). The new subpart would 
be entitled ``Supplementary Medical Insurance Premium Surcharge 
Agreements''.
    Within the subpart, we would add a section that would contain the 
authority for allowing States and local government agencies to enter 
into an agreement with us to pay, on a periodic basis, a lump sum for 
the total amount of the SMI premium surcharges for a group of eligible 
Medicare enrollees.
    Since there are no existing regulations that prescribe the basic 
rules for making periodic lump sum payments of the SMI premium 
surcharge under a special billing arrangement, we would add sections 
entitled ``Definitions'' Conditions for participation'', ``Application 
procedures'', ``Billing and payment procedures'', and ``Termination of 
SMI premium surcharge agreements''. In the ``Definitions'' section, we 
would define SMI premium surcharge and SMI premium surcharge agreement. 
SMI premium surcharge would be defined as the amount that the standard 
monthly SMI premium would be increased for late enrollment and for 
reenrollment as specified in Sec. Sec.  408.22 through 408.25. SMI 
premium surcharge agreement would be defined as an agreement entered 
into between a State or local government agency and us whereby the 
State or local government agency would agree to periodically pay a lump 
sum for the premium surcharge amounts due from a specified group of 
eligible enrollees.
    The ``Conditions for participation'' section would identify 
individuals who could be included under an SMI premium surcharge 
agreement, identify individuals excluded from coverage under an 
agreement, and require the State or local government agency to secure 
the written consent of each enrollee covered under the agreement. This 
section would also state that as a condition for participation the 
State or local government agency would be required to establish an 
automated data exchange with us to electronically transmit addition, 
removal, and change records and make all monthly SMI premium surcharge 
payments via electronic funds transfer.
    We would identify eligible individuals as those who, at the time 
they are added under the premium surcharge agreement, are enrolled 
under Medicare Part B (SMI) and are responsible for paying the SMI base 
premiums and surcharges either through direct remittance or benefit 
withholding. Eligible individuals may also be those who receive a 
Railroad Retirement Board or Civil Service annuity and are having the 
SMI premium and surcharge withheld.
    We would identify individuals excluded from coverage under an SMI 
premium surcharge agreement as those who are not enrolled in SMI, those 
whose SMI premiums are being paid by a State Welfare Agency under a 
State buy-in agreement, or those whose SMI premiums and surcharges are 
being paid under a group billing agreement.
    In the ``Application procedures'' section, we described how the 
State or local government agency may contact its CMS regional office 
(RO), obtain an application, and return it for approval.
    The ``Billing and payment'' section would state that the State or 
local government agency must pay the SMI premium surcharge for each 
eligible enrollee who is included in the agreement for the time period 
beginning with the month the enrollee is added and continuing through 
the month the State or local government agency notifies us that it is 
necessary to remove the enrollee, the month the enrollee's Part B 
coverage terminates, or the month of the enrollee's death, whichever 
comes first.
    In the ``Termination of SMI premium surcharge agreement'' section, 
we proposed that a State or local government agency may voluntarily 
terminate an SMI premium surcharge agreement by notifying us, in 
writing, at least 30 days before the termination date.
    We also proposed that we may terminate an SMI premium surcharge 
agreement with 30 days notice if the State or local government agency 
fails to comply with the terms of the agreement, is delinquent in 
payment 60 days or more, three times in any calendar year, or fails to 
comply with prescribed regulations or instructions. We proposed that we 
may terminate the agreement at any time if we find that the State or 
local government agency is not acting in the best interest of the 
enrollees, or us, or for any other reason. If an agreement is 
terminated by us, the State or local government agency must wait 3 
years from the effective date of the termination before it can request 
to enter into another agreement.

III. Analysis and Responses to Public Comments

    In response to the publication of the proposed rule on October 26, 
2001 (66 FR 54186), we did not receive any public comments.

IV. Provisions of the Final Rule

    With the exception of changes to proposed Sec.  408.210(b); the 
addition of a six-month delay in the rule's effective date, to allow 
additional time for States and local governments to implement the 
provisions of this rule; and a change of the grace period for payment 
from 25 to 10 days (Sec.  408.207(b)), we are adopting the provisions 
of the proposed rule published on October 26, 2001 (66 FR

[[Page 60995]]

54186) as the provisions of this final rule.
    In proposed Sec.  408.210(b)(2), we subsequently decided that we 
may terminate the agreement with a State or local government agency 
with 30 days advance notice if the State or local government agency's 
payments are delinquent 30 days or more, rather than if the payments 
are delinquent 60 days or more, three times in any calendar year. This 
change was made because the proposed rule would have allowed a State or 
local government agency to be delinquent in its payments for almost 
one-half of a year before any corrective action was taken. Upon further 
reflection, we decided that this was too much time and that it would 
not be in the best interests of the State or local government agency, 
the beneficiaries, or us to allow the delinquent state to continue for 
so long a time. This section was also renumbered to become Sec.  
408.210(b)(1).
    In proposed Sec.  408.210(b)(1), we have added language in this 
final rule to clarify that we may terminate the agreement with a State 
or local government agency at any time if we find that it is not acting 
in the best interest of the enrollees, or us, or for any other reason 
other than delinquent payments or failure to comply with the terms of 
the agreement or procedures promulgated by us. This section was 
renumbered to become Sec.  408.210(b)(3).
    In Sec.  408.27(b)(2), we are revising the grace period to 10 days 
from the 25 days suggested in the proposed rule because we believe that 
the 10-day period allows ample opportunity for States and local 
agencies to send us their payments and more accurately reflects typical 
business practices.
    We are retaining all other language of the proposed regulation 
because we did not receive any public comments.

V. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995 (PRA 1995), we are 
required to provide 60 days notice in the Federal Register and solicit 
public comment before a collection of information requirement is 
submitted to the Office of Management and Budget (OMB) for review and 
approval. In order to fairly evaluate whether an information collection 
should be approved by OMB, section 3506(c)(2)(A) of the PRA 1995 
requires that we solicit comment on the following issues:
    [sbull] The need for the information collection and its usefulness 
in carrying out the proper functions of our agency.
    [sbull] The accuracy of our estimate of the information collection 
burden.
    [sbull] The quality, utility, and clarity of the information to be 
collected.
    [sbull] The minimization of the information collection burden on 
the affected public, including automated collection techniques.

Section 408.202 Conditions for Participation

    In the October 26, 2001 proposed rule (66 FR 54186), under this 
section, a State or local government retirement agency would secure 
from each Medicare enrollee for whom the surcharge will be paid a 
written, signed, statement that would authorize us to send billing 
notices directly to the State or local government agency and to release 
any information required under the SMI premium surcharge agreement. As 
stated in the proposed rule, the burden associated with this 
requirement is the time and effort for the enrollee to sign the 
required authorization statement. We estimated that for the two States 
affected by this requirement, each State will obtain an average of 
1,175 authorizations. Since this requirement will be standardized and 
incorporated into the enrollment process, we anticipated that it would 
take each enrollee 5 minutes to provide the necessary authorization. 
Therefore, in the proposed rule we projected that the total burden 
associated with this requirement is 196 hours (5 minutes x 1,175 
enrollees x 2 retirement agencies = 196 total hours).
    This section also requires that the State or local government 
agency maintain the authorization statement for each enrollee in its 
files as long as the enrollee is covered by the agreement.
    Lastly, this section requires a State or local government agency to 
certify to us, in writing, that an authorization statement is on file 
for each enrollee covered under the SMI premium surcharge agreement. 
Only one certification is necessary for the entire group of covered 
enrollees. Given that this requirement affects only two entities, it is 
not subject to the PRA under 5 CFR 1320.3(c).

Section 408.205 Application Procedures

    In the October 26, 2001 proposed rule (66 FR 54186), under this 
section, a State interested in entering into an agreement would return 
to the CMS Regional Office (RO) two completed copies of the application 
materials.
    As stated in the proposed rule, we estimate that two States/
agencies will apply for an agreement. Thus, this requirement is not 
subject to the PRA in accordance with 5 CFR 1320.3(c).

Section 408.207 Billing and Payment Procedures

    In the proposed rule, under paragraph (a) of this section, the 
State or local government agency must transmit electronically an input 
file to us containing addition and removal records at least once each 
calendar month, but may transmit this information as often as once a 
day.
    Under paragraph (d) of this section, if a State or local government 
agency disagrees with the amount assessed in a billing statement or 
interest charge, it must notify us as required under this section. 
Given that this activity is conducted as part of an administrative 
action, audit, and/or investigation, this requirement is exempt from 
the PRA under 5 CFR 1320.4.

Section 408.210 Termination of SMI Premium Surcharge Agreement

    In the October 26, 2001 proposed rule (66 FR 54186), under 
paragraph (a), if the State or local government agency voluntarily 
terminates its agreement with us, it must notify us, in writing, at 
least 30 days before the effective date of the termination.
    As stated in the proposed rule, we estimate that two States/
agencies will be subject to the provisions of this section. Thus, this 
requirement is not subject to the PRA in accordance with 5 CFR 
1320.3(c).
    The total burden associated with this rule is 196 annual hours.
    We have submitted a copy of this final rule to OMB for its review 
of the information collection requirement in Sec.  408.202. These 
requirements are not effective until they have been approved by the 
OMB.

VI. Regulatory Impact Statement

A. Overall Impact

    We have examined the impacts of this final rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review) 
and the Regulatory Flexibility Act (RFA) (September 19, 1980, 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). A regulatory impact 
analysis (RIA) must be prepared for major rules with economically 
significant effects ($100 million or more annually). This is not a 
major rule. It has no significant economic impact, on either costs or 
savings, because either

[[Page 60996]]

the enrollee or the State or local government agency would remit the 
same amount to us whether or not there is an SMI premium surcharge 
agreement in effect. The only difference is that under this rule, the 
State or local government agency is allowed to voluntarily elect to 
remit SMI premium surcharge amounts in a lump sum payment on behalf of 
eligible Medicare enrollees.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and government agencies. 
Most hospitals and most other providers and suppliers are small 
entities, either by nonprofit status or by having revenues of $5 
million or less annually. Individuals and States are not included in 
the definition of small entities. Therefore, we have determined, and we 
certify, that this final regulation does not result in a significant 
impact on a substantial number of small entities.
    In addition, section 1102(b) of the Social Security Act (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 located outside of a 
Metropolitan Statistical Area with fewer than 100 beds. This rule has 
no impact on any small rural hospitals. Therefore, we have determined, 
and we certify, that this final regulation does not have a significant 
effect on the operations of a substantial number of small rural 
hospitals.

B. The Unfunded Mandates Act

    Section 202 of the Unfunded Mandates Reform Act of 1995 (UMRA, Pub. 
L. 104-4) requires that agencies assess anticipated costs and benefits 
before issuing any rule that may result in an annual expenditure by 
State, local, or tribal governments, in the aggregate, or by the 
private sector, of $110 million. This rule has no effect on the annual 
expenditures of any State, local, or tribal government, or the private 
sector. Participation in an SMI premium surcharge agreement is strictly 
voluntary and does not change the total amount of SMI premium 
surcharges paid by a State or local government agency. Therefore, we 
have determined, and we certify, that this final regulation does not 
result in an annual expenditure by State, local, or tribal governments, 
in the aggregate, or by the private sector, of $110 million.

C. Federalism

    We have reviewed this final rule under the threshold criteria of 
Executive Order 13132, Federalism, and we have determined that it does 
not significantly affect the rights, roles, and responsibilities of 
States. This rule is in response to a specific request from a State/
local government and is an example of regulatory flexibility and 
cooperation with States. Also, in order to give States additional time 
to implement the rule's provisions, we have delayed the effective date 
of the rule to six months from the date of publication in the Federal 
Register.
    In accordance with the provisions of Executive Order 12866, this 
final rule was reviewed by the Office of Management and Budget. This 
final rule is not a major rule as defined at 5 U.S.C. 804(2).

List of Subjects in 42 CFR Part 408

    Medicare.
    Accordingly, the Centers for Medicare & Medicaid Services amends 42 
CFR chapter IV, part 408 as follows:

PART 408--PREMIUMS FOR SUPPLEMENTAL MEDICAL INSURANCE

    1. The authority citation for part 408 continues to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

    2. Add a new subpart H, consisting of Sec. Sec.  408.200 through 
408.210, to part 408, to read as follows:

Subpart H--Supplementary Medical Insurance Premium Surcharge 
Agreements

Sec.
408.200 Statutory basis.
408.201 Definitions.
408.202 Conditions for participation.
408.205 Application procedures.
408.207 Billing and payment procedures.
408.210 Termination of SMI premium surcharge agreement.

Subpart H--Supplementary Medical Insurance Premium Surcharge 
Agreements


Sec.  408.200  Statutory basis.

    This subpart implements provisions of section 1839(e) of the Social 
Security Act that allow State or local government agencies to enter 
into an agreement with the Secretary to pay, on a quarterly or other 
periodic basis, a lump sum for the total of the SMI premium late 
enrollment surcharge amounts due for a group of eligible enrollees.


Sec.  408.201  Definitions.

    For purposes of this subpart, the following definitions apply:
    SMI premium surcharge means the amount that the standard monthly 
SMI premium is increased for late enrollment or for reenrollment as 
specified in Sec. Sec.  408.22 through 408.25.
    SMI premium surcharge agreement means a written arrangement between 
the Secretary and a State or local government agency to pay, on a 
quarterly, monthly, or other periodic basis, a lump sum for the SMI 
premium surcharge amounts due for a designated group of eligible 
enrollees.


Sec.  408.202  Conditions for participation.

    (a) A State or local government agency may apply to CMS to enter 
into an SMI premium surcharge agreement if the following conditions are 
met:
    (1) Each individual designated for coverage under the premium 
surcharge agreement must be enrolled in Medicare Part B at the time the 
individual is added to the premium surcharge account.
    (2) Each enrollee designated for coverage under the agreement must, 
at the time the individual is added to the premium surcharge account, 
be responsible for paying the base premium and surcharge through direct 
remittance or benefit withholding from Social Security or Railroad 
Retirement benefits or a Civil Service annuity.
    (3) Each enrollee designated for coverage under the agreement must, 
at the time the individual is added to the premium surcharge account, 
not have premiums paid by a State Welfare Agency under a State buy-in 
agreement as described in Sec.  407.40 of this chapter or under a group 
billing arrangement as described in Sec.  408.80.
    (b) The State or local government agency must secure from each 
enrollee a signed, written statement authorizing CMS to send billing 
notices directly to the State or local government agency, and to 
release to the State or local government agency information required 
under the SMI premium surcharge agreement.
    (c) The authorization statement for each enrollee must be retained 
in the State or local government agency files for as long as the 
enrollee is covered by the agreement. These authorization statements 
need not be forwarded to CMS.
    (d) The State or local government agency must certify to CMS, in 
writing, that an authorization statement is on file for each enrollee 
covered under the SMI

[[Page 60997]]

premium surcharge agreement. Only one certification is necessary for 
the entire group of covered enrollees.
    (e) A State or local government agency must establish an automated 
data exchange with CMS using the Third Party Premium Collection System, 
in order to transmit electronically an input file that will be used to 
add or remove enrollees from the billing system.


Sec.  408.205  Application procedures.

    (a) A State or local government agency must contact its CMS 
regional office (RO) to request application materials.
    (b) If interested in entering into an agreement, the State or local 
government agency must return to the RO two copies of the completed 
application materials.
    (c) CMS reviews the application materials, and, when they are 
approved, notifies the State or local government agency, and the RO.


Sec.  408.207  Billing and payment procedures.

    (a) Adding and removing enrollees. The State or local government 
agency must transmit an input file containing addition and removal 
records electronically to CMS as follows:
    (1) Input files must be transmitted at least once each calendar 
month, but may be transmitted as often as once a day.
    (2) CMS will not add or remove enrollees retroactively, except for 
removals upon the death of an enrollee.
    (3) The State or local government agency must pay the SMI premium 
surcharge for each eligible enrollee who is included in the agreement 
for the time period beginning with the month the enrollee is added and 
continuing through the month the State or local government agency 
informs CMS that the enrollee is to be removed, the month the 
enrollee's Part B coverage terminates, or the month of the enrollee's 
death, whichever comes first.
    (b) Payment and grace period. Payment must be made to CMS as 
follows:
    (1) Payment to CMS must be received by CMS by the first day of each 
month.
    (2) There is a 10-day grace period for receipt of payment.
    (3) Payment must be made to CMS via electronic funds transfer.
    (c) Late payment penalties. CMS may assess interest for any payment 
it does not receive by the first day of the month as follows:
    (1) Interest will be assessed at the SMI trust fund rate as 
computed for new investments in accordance with section 1841(c) of the 
Act.
    (2) Interest will be waived if the full payment is received by the 
10th day of the month in which it is due.
    (3) Interest will be calculated and assessed in 30-day increments.
    (4) Interest will be assessed on the balance of the amount billed 
that remains unpaid at the expiration of the grace period and unpaid 
balances from prior periods.
    (5) Interest will continue to accrue on unpaid amounts until the 
balance is paid in full.
    (d) Disagreement over billing amounts or interest. If the State or 
local government agency disagrees with the amount assessed in a billing 
statement or interest charge, it must notify CMS as follows:
    (1) The State or local government agency must provide evidence 
suitable to CMS to substantiate its claim.
    (2) The State or local government agency must continue to make full 
payment while CMS evaluates the evidence provided.
    (3) Credit for payment amounts or interest that CMS determines to 
be due to the State or local government agency will be reflected as an 
adjustment in subsequent bills, effective on the date the corrected 
amount would have been due.


Sec.  408.210  Termination of SMI premium surcharge agreement.

    (a) Termination by the State or local government agency. The State 
or local government agency may voluntarily terminate its agreement with 
CMS as follows:
    (1) The State or local government agency must notify CMS, in 
writing, at least 30 days before the effective date of the termination.
    (2) The State or local government agency must pay any unpaid 
premium surcharge amounts and interest due within 30 days after the 
effective date of the termination.
    (3) Interest will continue to accrue until all amounts due are paid 
in full.
    (b) Termination by CMS. CMS may terminate the agreement with a 
State or local government agency as follows:
    (1) If a State or local government agency's payments are delinquent 
30 days or more, CMS may terminate the agreement with 30 days advance 
notice.
    (2) If the State or local government agency fails to comply with 
the terms of the agreement or procedures promulgated by CMS, CMS may 
terminate the agreement with 30 days advance notice.
    (3) If CMS finds that the State or local government agency is not 
acting in the best interest of the enrollees, or CMS, or for any reason 
other than those in paragraphs (b)(1) and (b)(2) of this section, CMS 
may terminate the agreement at any time.
    (4) The State or local government agency must pay all outstanding 
premium surcharge and any interest amounts due within 30 days after the 
effective date of the termination.
    (5) Interest will continue to accrue until all amounts due are paid 
in full.
    (6) After the agreement is terminated, CMS will resume collection 
of the premium surcharge from the enrollees covered under the 
terminated agreement.
    (7) If an agreement is terminated by CMS, the State or local 
government agency must wait 3 years from the effective date of the 
termination before it can request to enter into another SMI premium 
surcharge agreement.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)


    Dated: April 18, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.

    Dated: June 13, 2002.
Tommy G. Thompson,
Secretary.
[FR Doc. 02-23845 Filed 9-26-02; 8:45 am]
BILLING CODE 4120-01-P