[Federal Register Volume 80, Number 232 (Thursday, December 3, 2015)]
[Notices]
[Pages 75680-75681]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-30686]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-6066-N]
Medicare, Medicaid, and Children's Health Insurance Programs;
Provider Enrollment Application Fee Amount for Calendar Year 2016
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice announces a $554.00 calendar year (CY) 2016
application fee for institutional providers that are initially
enrolling in the Medicare or Medicaid program or the 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, 2016 and on or before December 31, 2016.
DATES: This notice is effective on January 1, 2016.
FOR FURTHER INFORMATION CONTACT: Frank Whelan, (410) 786-1302.
SUPPLEMENTARY INFORMATION:
I. Background
In the February 2, 2011 Federal Register (76 FR 5862), we published
a final rule with comment period titled ``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
CHIP provider enrollment processes. As provided in section
1866(j)(2)(C)(i) of the Social Security Act (the Act) (as amended by
section 6401 of the Affordable Care Act) and in 42 CFR 424.514,
``institutional providers'' that are initially enrolling in the
Medicare or Medicaid programs or CHIP, revalidating their enrollment,
or adding a new Medicare practice location are required to submit a fee
with their enrollment application. An ``institutional provider'' for
purposes of Medicare is defined at Sec. 424.502 as ``(a)ny 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 we explained in the February 2, 2011
final rule (76 FR 5914), in addition to the providers and suppliers
subject to the application fee under Medicare, Medicaid-only, and CHIP-
only institutional providers would include nursing facilities,
intermediate care facilities for persons with intellectual disabilities
(ICF/IID), psychiatric residential treatment facilities, and may
include other institutional provider types designated by a state in
accordance with their approved state plan.
As indicated in Sec. Sec. 424.514 and Sec. 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 revalidating 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.
II. Provisions of the Notice
A. CY 2015 Fee Amount
In the December 5, 2014 Federal Register (79 FR 72183), we
published a notice announcing a fee amount for the period of January 1,
2015 through December 31, 2015 of $553.00. This figure was calculated
as follows:
Section 1866(j)(2)(C)(i)(I) of 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,
Sec. 424.514(d)(2) states that for CY 2011 and subsequent years, the
preceding year's fee will be adjusted by the percentage change in the
consumer price index (CPI) for all urban consumers (all items; United
States city average, CPI-U) for the 12-month period ending on June 30
of the previous year.
The CPI-U increase for CY 2011 was 1.0 percent, based on
data obtained from the Bureau of Labor Statistics (BLS). This resulted
in an application fee amount for CY 2011 of $505 (or $500 x 1.01).
The CPI-U increase for the period of July 1, 2010 through
June 30, 2011 was 3.54 percent, based on BLS data. This resulted in an
application fee amount for CY 2012 of $522.87 (or $505 x 1.0354). In
the aforementioned February 2, 2011 final rule, we stated that if the
adjustment sets the fee at an uneven dollar amount, we would round the
fee to the nearest whole dollar amount. Accordingly, the application
fee amount for CY 2012 was rounded to the nearest whole dollar amount,
or $523.00.
The CPI-U increase for the period of July 1, 2011 through
June 30, 2012 was 1.664 percent, based on BLS data. This resulted in an
application fee amount for CY 2013 of $531.70 ($523 x 1.01664).
Rounding this figure to the nearest whole dollar amount resulted in a
CY 2013 application fee amount of $532.00.
The CPI-U increase for the period of July 1, 2012 through
June 30, 2013 was 1.8 percent, based on BLS data. This resulted in an
application fee amount for CY 2014 of $541.576 ($532 x 1.018). Rounding
this figure to the nearest whole dollar amount resulted in a CY 2014
application fee amount of $542.00.
The CPI-U increase for the period of July 1, 2013 through
June 30, 2014 was 2.1 percent, based on BLS data. This resulted in an
application fee amount for CY 2015 of $553.382 ($542 x 1.021). Rounding
this figure to the nearest whole dollar amount resulted in a CY 2015
application fee amount of $553.00.
B. CY 2016 Fee Amount
Using BLS data, the CPI-U increase for the period of July 1, 2014
through June 30, 2015 was 0.2 percent. This results in a CY 2016
application fee amount of $554.106 ($553 x 1.002). As we must round
this to the nearest whole dollar amount, the resultant application fee
amount for CY 2016 is $554.00.
III. Collection of Information Requirements
This document does not impose information collection requirements,
that is, reporting, recordkeeping, or third-party disclosure
requirements. Consequently, there is no need for review by the Office
of Management and Budget under the authority of the Paperwork Reduction
Act of 1995. However, it does reference previously approved information
collections. The forms CMS-855A, CMS-855B, and CMS-855I are approved
under OMB
[[Page 75681]]
control number 0938-0685; the CMS-855S is approved under OMB control
number 0938-1056.
IV. Regulatory Impact Statement
A. Background
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
(January 18, 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, we estimate that the total
cost of the increase in the application fee will not exceed $100
million. Therefore, this notice does not reach the $100 million
economic threshold and is not considered a major notice.
B. Costs
The costs associated with this notice involve the increase in the
application fee amount that certain providers and suppliers must pay in
CY 2016.
1. Estimates of Number of Affected Institutional Providers in December
5, 2014 Fee Notice
In the December 5, 2014 application fee notice, we estimated that
based on CMS statistics--
10,000 newly enrolling Medicare institutional providers
would be subject to and pay an application fee in CY 2015.
35,000 revalidating Medicare institutional providers would
be subject to and pay an application fee in CY 2015.
8,438 newly enrolling Medicaid and CHIP providers would be
subject to and pay an application fee in CY 2015.
19,421 revalidating Medicaid and CHIP providers would be
subject to and pay an application fee in CY 2015.
2. CY 2016 Estimates
a. Medicare
Based on CMS data, we estimate that in CY 2016 approximately--
10,000 newly enrolling institutional providers will be
subject to and pay an application fee; and
45,000 revalidating institutional providers will be
subject to and pay an application fee.
Using a figure of 55,000 (10,000 newly enrolling + 45,000
revalidating) institutional providers, we estimate an increase in the
cost of the Medicare application fee requirement in CY 2016 of
$5,585,000 (or (10,000 additional newly enrolling or revalidating
institutional providers x $554) + (45,000 x $1.00) from our CY 2015
projections and as previously described.
b. Medicaid and CHIP
Based on CMS and state statistics, we estimate that approximately
30,000 (9,000 newly enrolling + 21,000 revalidating) Medicaid and CHIP
institutional providers will be subject to an application fee in CY
2016. Using this figure, we project an increase in the cost of the
Medicaid and CHIP application fee requirement in CY 2016 of $1,213,973
(or ((562 additional newly enrolling institutional providers + 1,579
additional revalidating institutional providers, or 2,141 total
additional institutional providers) x $554) + 27,859 x $1.00) from our
CY 2015 projections and as previously described.
c. 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 2016 to be $6,798,973 ($5,585,000 +
$1,213,973) from our CY 2015 projections.
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
less than $7.5 million to $38.5 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), 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, and the Secretary certifies, 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 2015, that
threshold is approximately $144 million. The Agency has determined that
there will be minimal impact from the costs of this notice, as the
threshold is not met under the UMRA.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a proposed rule (and subsequent
final rule) that imposes substantial direct requirement costs on state
and local governments, preempts state law, or otherwise has federalism
implications. Since this notice does not impose substantial direct
costs on state or local governments, the requirements of Executive
Order 13132 are not applicable.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
Dated: November 14, 2015.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2015-30686 Filed 12-2-15; 8:45 am]
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