[Federal Register Volume 76, Number 212 (Wednesday, November 2, 2011)]
[Notices]
[Pages 67743-67745]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-28424]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-6049-N]


Medicare, Medicaid, and Children's Health Insurance Programs; 
Provider Enrollment Application Fee Amount for Calendar Year 2012

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

ACTION: Notice.

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SUMMARY: This notice announces the $523 calendar year (CY) 2012

[[Page 67744]]

application fee for institutional providers that are initially 
enrolling in the Medicare or Medicaid programs or Children's Health 
Insurance Program (CHIP); revalidating their Medicare, Medicaid or CHIP 
enrollment; or adding a new Medicare practice location. This fee is 
required with any enrollment application submitted on or after January 
1, 2012 and on or before December 31, 2012.

DATES: Effective Date: This notice is effective on December 2, 2011.

FOR FURTHER INFORMATION CONTACT: Frank Whelan, (410) 786-1302 for 
Medicare enrollment issues. Claudia Simonson, (312) 353-2115 for 
Medicaid and CHIP enrollment issues.

SUPPLEMENTARY INFORMATION: 

I. Background

    In the February 2, 2011 Federal Register (76 FR 5862), we published 
a final rule with comment period entitled: ``Medicare, Medicaid, and 
Children's Health Insurance Programs; Additional Screening 
Requirements, Application Fees, Temporary Enrollment Moratoria, Payment 
Suspensions and Compliance Plans for Providers and Suppliers.'' This 
rule finalized, among other things, provisions related to the 
submission of application fees as part of the Medicare, Medicaid, and 
Children's Health Insurance Program (CHIP) provider enrollment 
processes. Specifically, and as indicated in 42 CFR 424.514, 
``institutional providers'' that are initially enrolling in the 
Medicare, Medicaid or CHIP program, revalidating their enrollment or 
adding a new Medicare practice location, are required to submit a fee 
with an enrollment application submitted on or after March 25, 2011. An 
``institutional provider'' is defined at 42 CFR 424.502 as--

Any provider or supplier that submits a paper Medicare enrollment 
application using the CMS-855A, CMS-855B (not including physician 
and non-physician practitioner organizations), CMS-855S or 
associated Internet-based PECOS enrollment application.

    As indicated in 42 CFR 424.514 and 455.460, the application fee is 
not required for either of the following:
     A Medicare physician or non-physician practitioner 
submitting a CMS-855I.
     A prospective or re-enrolling Medicaid or CHIP provider--
    ++ Who is an individual physician or non-physician practitioner; or
    ++ That is enrolled in Title XVIII of the Act or another State's 
title XIX or XXI plan and has paid the application fee to a Medicare 
contractor or another State.
    In the March 23, 2011 Federal Register (76 FR 16422), we published 
a notice announcing--
     A $505 calendar year (CY) 2011 application fee for 
institutional providers that are initially enrolling in the Medicare, 
Medicaid, or CHIP program; revalidating their enrollment; or adding a 
new Medicare practice location;
     That institutional providers are required to submit the 
$505 fee with enrollment applications submitted on or after March 25, 
2011 and on or before December 31, 2011; and
     That prospective or re-enrolling Medicaid or CHIP 
providers must submit the application fee unless: (1) The provider is 
an individual physician or non-physician practitioner; or (2) the 
provider is enrolled in Title XVIII of the Act or another State's title 
XIX or XXI plan and has paid the application fee to a Medicare 
contractor or another State.

II. Provisions of the Notice

A. Current Fee Amount

    As noted in section I. of this notice, the fee amount for the 
period of March 25, 2011 through December 31, 2011 is $505. This figure 
was calculated as follows:
     Section 1866(j)(2)(C)(i)(I) of the Social Security Act 
(the Act) established a $500 application fee for institutional 
providers in CY 2010.
     Consistent with section 1866(j)(2)(C)(i)(II) of the Act, 
42 CFR 424.514(d)(2) states that for CY 2011 and subsequent years, the 
fee will be adjusted by the percentage change in the consumer price 
index (CPI) for all urban consumers (all items; United States city 
average) for the 12-month period ending with June of the previous year.
     The CPI increase for CY 2011, which was calculated to be 
1.0 percent, was based on data obtained from the Bureau of Labor 
Statistics. This resulted in an application fee for CY 2011 of $505 (or 
$500 x 1.01). For more detailed information on the CPI and the 
calculation of the application fee, see the February 2, 2011 final rule 
with comment period (76 FR 5955) and the March 23, 2011 notice (76 FR 
16423).

B. Fee Amount for Calendar Year 2012

    The CPI increase for the period of July 2010 through June 2011 was 
3.54 percent, based on data obtained from the Bureau of Labor 
Statistics. (This percentage is higher than the 2.0 percent CPI 
increase that we estimated for CY 2012 in the February 2, 2011 final 
rule with comment period (76 FR 5955).) This results in a projected 
application fee amount for the period of January 1, 2012 through 
December 31, 2012 of $522.87 (or $505 x 1.0354). However, in the 
preamble to the February 2, 2011 final rule with comment period (76 FR 
5907), we stated that ``(t)o ease the administration of the fee, if the 
adjustment sets the fee at an uneven dollar amount, we will round the 
fee to the nearest whole dollar amount.'' Therefore, the projected 
application fee amount for CY 2012 will be rounded to the ``nearest 
whole dollar amount,'' which is $523.00. This represents an $8.00 
difference from the $515 fee that we had originally projected for CY 
2012.

III. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35). However, it 
does reference previously approved information collections. As stated 
in section I. of this notice, the forms CMS-855A, CMS-855B, and CMS-
855I are approved under OMB control number 0938-0685; the CMS-855S is 
approved under OMB control number 0938-1056.

IV. Regulatory Impact Statement

    We have examined the impact of this notice as required by Executive 
Order 12866 on Regulatory Planning and Review (September 30, 1993), 
Executive Order 13563 on Improving Regulation and Regulatory Review 
(February 2, 2011), 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 
Orders 12866 and 13563 direct 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 explained in this section of 
the notice (section IV), we estimate that the total cost of the 
increase in the application fee will not exceed $100 million. This 
notice therefore does not reach the $100 million economic threshold and 
is not considered a major rule.

[[Page 67745]]

    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 small governmental 
jurisdictions. Most hospitals and most other providers and suppliers 
are small entities, either by nonprofit status or by having revenues of 
$7.0 million to $34.5 million in any 1 year. Individuals and States are 
not included in the definition of a small entity. As we stated in the 
RIA for the February 2, 2011 final rule with comment period (76 FR 
5952) and the regulatory impact statement of the March 23, 2011 notice 
(76 FR 16423), we do not believe that the application fee will have a 
significant impact on small entities.
    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 for Medicare payment regulations and has fewer than 
100 beds. We are not preparing an analysis for section 1102(b) of the 
Act because we have determined that this notice would not have a 
significant impact on the operations of a substantial number of small 
rural hospitals.
    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 2011, that 
threshold is approximately $136 million. This notice does not mandate 
such expenditures by States and local governments.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule that imposes 
substantial direct requirement costs on State and local governments, 
preempts State law, or otherwise has Federalism implications. Since 
this notice does not impose substantial direct costs on State or local 
governments, the requirements of Executive Order 13132 are not 
applicable.
    The costs associated with this notice involve the increase in the 
application fee that certain providers and suppliers must pay in CY 
2012. In the RIA for the February 2, 2011 final rule with comment 
period (76 FR 5955 through 5958), we estimated the total amount of 
application fees for CYs 2011 through 2015. For 2012, and based on a 
$515 application fee, we projected in Tables 11 and 12 (76 FR 5955 and 
5956) a total cost in fees of $71,803,875 for Medicare institutional 
providers (or 139,425 providers x $515). In the February 2, 2011 final 
rule with comment period (76 FR 5957 and 5958), we estimated the total 
cost in CY 2012 for Medicaid providers to be $12,944,010 (or 25,134 
providers x $515), as indicated in Tables 13 and 14.
    We are retaining the figure of 25,134 Medicaid providers for 
purposes of this notice. However, we are changing the Medicare provider 
estimate based on our plan to revalidate all Medicare providers and 
suppliers- even if the revalidation is considered ``off-cycle'' per 42 
CFR 424.515(e).

1. Medicare

    For purposes of this notice only, we estimate that approximately 
840,000 Medicare providers and suppliers will be subject to 
revalidation in CY 2012. Of this total, we believe that roughly 80 
percent will be exempt from the application fee requirement because the 
provider or supplier: (1) Is of a type (for example, a physician) that 
is exempt from the requirement, or (2) qualifies for a hardship 
exception under 42 CFR 424.514(c). This leaves 168,000 revalidating 
providers and suppliers that will have to pay the fee.
    In the February 2, 2011 final rule with comment period (76 FR 
5955), we estimated that 31,200 newly-enrolling institutional providers 
would be subject to the application fee in CY 2012. We stand by this 
projection for purposes of this notice. Using a figure of 199,200 
providers and suppliers (168,000 + 31,200), we estimate an increase in 
the cost of the Medicare application fee requirement in CY 2012 of 
$1,593,600 (or 199,200 x $8.00).

2. Medicaid and CHIP

    In the February 2, 2011 final rule with comment period (76 FR 5957 
and 5958), we estimated that 25,134 (8,438 newly enrolling + 16,696 re-
enrolling) Medicaid and CHIP providers would be subject to an 
application fee in CY 2012. This results in an increase in the cost of 
the Medicaid and CHIP application fee requirement in CY 2012 of 
$201,072 (or 25,134 x $8.00).

3. Total

    Based on the foregoing, we estimate the total increase in the cost 
of the application fee requirement for Medicare, Medicaid, and CHIP 
providers and suppliers in CY 2012 to be $1,794,672.
    In accordance with the provisions of Executive Order 12866, this 
notice was not reviewed by the Office of Management and Budget.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program; No. 93.773 Medicare--Hospital Insurance Program; 
and No. 93.774, Medicare--Supplementary Medical Insurance Program)

    Dated: September 30, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2011-28424 Filed 11-1-11; 8:45 am]
BILLING CODE 4120-01-P