[Federal Register Volume 74, Number 16 (Tuesday, January 27, 2009)]
[Rules and Regulations]
[Pages 4888-4889]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-1771]



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Part IV





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 447 and 457



Medicaid Program; Premiums and Cost Sharing; Final Rule

  Federal Register / Vol. 74, No. 16 / Tuesday, January 27, 2009 / 
Rules and Regulations  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 447 and 457

[CMS-2244-F2]
RIN 0938-A047


Medicaid Program; Premiums and Cost Sharing

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

ACTION: Final rule; delay of effective date and reopening of comment 
period.

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SUMMARY: In accordance with the memorandum of January 20, 2009, from 
the Assistant to the President and Chief of Staff, entitled 
``Regulatory Review Plan,'' this action temporarily delays for 60 days 
the effective date of the final rule entitled ``Medicaid Program; 
Premiums and Cost Sharing'' (73 FR 71828). The temporary 60-day delay 
in effective date is necessary to give Department officials the 
opportunity for further review and consideration of new regulations. In 
addition, this action reopens the comment period on the policies set 
out in the November 25, 2008 final rule.

DATES: Effective Date. This action is effective January 23, 2009. The 
effective date of the rule amending 42 CFR parts 447 and 457 published 
in the November 25, 2008 Federal Register (73 FR 71828) is delayed 60 
days until March 27, 2009.
    Comment Period. To be assured consideration, comments must be 
received at one of the addresses provided below, no later than 5 p.m. 
on February 26, 2009.

ADDRESSES: In commenting, please refer to file code CMS-2244-F2. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    You may submit comments in one of four ways (please choose only one 
of the ways listed):
    1. Electronically. You may submit electronic comments on this 
regulation to http://www.regulations.gov. Follow the instructions for 
``Comment or Submission'' and enter the filecode to find the document 
accepting comments.
    2. By regular mail. You may mail written comments (one original and 
two copies) to the following address only: Centers for Medicare & 
Medicaid Services, Department of Health and Human Services, Attention: 
CMS-2244-F2, P.O. Box 8010, Baltimore, MD 21244-8010.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments (one 
original and two copies) to the following address only: Centers for 
Medicare & Medicaid Services, Department of Health and Human Services, 
Attention: CMS-2244-F2, Mail Stop C4-26-05, 7500 Security Boulevard, 
Baltimore, MD 21244-8010.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period to either of the following addresses:

a. Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, 
SW., Washington, DC 20201.

    (Because access to the interior of the HHH Building is not readily 
available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
b. 7500 Security Boulevard,
Baltimore, MD 21244-1850.
    If you intend to deliver your comments to the Baltimore address, 
please call telephone number (410) 786-9994 in advance to schedule your 
arrival with one of our staff members.
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.

FOR FURTHER INFORMATION CONTACT: Christine Gerhardt, (410) 786-0693.

SUPPLEMENTARY INFORMATION: 

I. Background

    On November 25, 2008, we published a final rule entitled ``Medicaid 
Program; Premiums and Cost Sharing'' in the Federal Register to 
implement and interpret the provisions of sections 6041, 6042, and 6043 
of the Deficit Reduction Act of 2005 (DRA), and section 405(a)(1) of 
the Tax Relief and Health Care Act of 2006 (TRHCA) (73 FR 71828). The 
DRA was amended by the TRHCA which revised sections 6041, 6042, and 
6043 of the DRA including limitations on cost sharing for individuals 
with family incomes at or below 100 percent of the federal poverty 
line. These sections amended the Social Security Act (the Act) by 
adding a new section 1916A to provide State Medicaid agencies with 
increased flexibility to impose premium and cost sharing requirements 
on certain Medicaid recipients. The DRA provisions also specifically 
address cost sharing for non-preferred drugs and non-emergency care 
furnished in a hospital emergency department.
    The November 25, 2008 final rule integrated into CMS regulations 
the statutory flexibility to impose premiums and cost sharing that was 
added by the DRA. In addition, in the November 25, 2008 final rule, we 
responded to public comments on the February 22, 2008 proposed rule (73 
FR 9727).

II. Provisions of This Action

    This action delays the effective date of the November 25, 2008 
final rule and reopens the comment period on the policies set out in 
the final rule. The effective date of the November 25, 2008 final rule, 
which would have been January 26, 2009, is now March 27, 2009. The 60-
day delay in the effective date is necessary to give the public the 
opportunity to submit additional comments on the policies set forth in 
the November 25, 2008 final rule, and to provide an opportunity for CMS 
to consider all additional public comments.

III. Waiver of Proposed Rulemaking and Delay in Effective Date

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a notice such as this take effect, in accordance with 
section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 
553(b)). We also ordinarily provide a 30-day delay in the effective 
date of the provisions of a notice in accordance with section 553(d) of 
the APA (5 U.S.C. 553(d)). However, we can waive both the notice and 
comment procedure and the 30-day delay in effective date if the 
Secretary finds, for good cause, that it is impracticable, unnecessary 
or contrary to the public interest to follow the notice and comment 
procedure or to comply with the 30-day delay in the effective date, and 
incorporates a statement of the finding and the reasons in the notice.
    This action delays the effective date of the November 25, 2008 
final rule that was promulgated through notice and comment rulemaking. 
A delay in effective date and reopening of the comment period is 
necessary to ensure that we have the opportunity to receive additional 
public comments to fully inform our decisions before the policies 
contained in the final rule become effective. Moreover, we believe it 
would be contrary to the public interest for the November 25, 2008 
final rule to become

[[Page 4889]]

effective until we are certain that all public comments, including any 
additional comments that are submitted in the reopened comment period, 
are considered. To do otherwise could potentially result in uncertainty 
and confusion as to the finality of the final rule. For the reasons 
stated above, we find that both notice and comment and the 30-day delay 
in effective date for this action are unnecessary. Therefore, we find 
there is good cause to waive notice and comment procedures and the 30-
day delay in effective date for this action.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)

    Dated: January 22, 2009.

    Approved:
Charles Johnson,
Acting Secretary.
[FR Doc. E9-1771 Filed 1-23-09; 11:15 am]
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