[Federal Register Volume 88, Number 199 (Tuesday, October 17, 2023)]
[Notices]
[Pages 71570-71573]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-22848]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-8084-N]
RIN 0938-AV12


Medicare Program; CY 2024 Part A Premiums for the Uninsured Aged 
and for Certain Disabled Individuals Who Have Exhausted Other 
Entitlement

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

ACTION: Notice.

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SUMMARY: This notice announces the monthly premium for uninsured 
enrollees under the Medicare Hospital Insurance (Part A) program in 
calendar year 2024. This premium is paid by enrollees aged 65 and over 
who are not otherwise eligible for benefits under Part A (hereafter 
known as the ``uninsured aged'') and by certain individuals with 
disabilities who have exhausted other entitlement. The monthly Part A 
premium for the 12 months beginning January 1, 2024 for

[[Page 71571]]

these individuals will be $505. The premium for certain other 
individuals as described in this notice will be $278.

DATES: The premium announced in this notice is effective on January 1, 
2024.

FOR FURTHER INFORMATION CONTACT: Yaminee Thaker, (410) 786-7921.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 1818 of the Social Security Act (the Act) provides for 
voluntary enrollment in the Medicare Hospital Insurance (Part A) 
program, subject to payment of a monthly premium, of certain persons 
aged 65 and older who are uninsured under the Old-Age, Survivors, and 
Disability Insurance (OASDI) program or the Railroad Retirement Act and 
do not otherwise meet the requirements for entitlement to Part A. These 
``uninsured aged'' individuals are uninsured under the OASDI program or 
the Railroad Retirement Act because they do not have 40 quarters of 
coverage under Title II of the Act (or are/were not married to someone 
who did). (Persons insured under the OASDI program or the Railroad 
Retirement Act and certain others do not have to pay premiums for Part 
A.)
    Section 1818A of the Act provides for voluntary enrollment in 
Medicare Part A, subject to payment of a monthly premium, for certain 
individuals with disabilities who have exhausted other entitlement. 
These are individuals who were entitled to coverage due to a disabling 
impairment under section 226(b) of the Act but who are no longer 
entitled to disability benefits and premium-free Part A coverage 
because they have gone back to work and their earnings exceed the 
statutorily defined ``substantial gainful activity'' amount (section 
223(d)(4) of the Act).
    Section 1818A(d)(2) of the Act specifies that the provisions 
relating to premiums for the aged, under section 1818(d) through 
section 1818(f), will also apply to certain individuals with 
disabilities, as described above.
    Section 1818(d)(1) of the Act requires us to estimate, on an 
average per capita basis, the amount to be paid from the Federal 
Hospital Insurance Trust Fund for services incurred in the upcoming 
calendar year (CY) (including the associated administrative costs) on 
behalf of individuals aged 65 and over who will be entitled to benefits 
under Part A. We must then determine the monthly actuarial rate for the 
following year (the per capita amount estimated above divided by 12) 
and publish the dollar amount for the monthly premium in the succeeding 
CY. If the premium is not a multiple of $1, it is rounded to the 
nearest multiple of $1 (or, if it is a multiple of 50 cents but not of 
$1, it is rounded to the next highest $1).
    Section 13508 of the Omnibus Budget Reconciliation Act of 1993 
(Pub. L. 103-66) amended section 1818(d) of the Act to provide for a 
reduction in the premium amount for certain voluntary enrollees 
(sections 1818 and 1818A). The reduction applies to an individual who 
is eligible to buy into the Part A program and who, as of the last day 
of the previous month:
     Had at least 30 quarters of coverage under Title II of the 
Act;
     Was married, and had been married for the previous 1-year 
period, to a person who had at least 30 quarters of coverage;
     Had been married to a person for at least 1 year at the 
time of the person's death if, at the time of death, the person had at 
least 30 quarters of coverage; or
     Is divorced from a person who at the time of divorce had 
at least 30 quarters of coverage if the marriage lasted at least 10 
years.
    Section 1818(d)(4)(A) of the Act specifies that the premium that 
these individuals will pay for CY 2024 will be equal to the premium for 
uninsured aged enrollees reduced by 45 percent.
    Section 1818(g) of the Act requires the Secretary of Health and 
Human Services (the Secretary), at the request of a state, to enter 
into a Medicare Part A buy-in agreement with the state to pay Part A 
premiums for Qualified Medicare Beneficiaries (QMBs).\1\ Under the QMB 
eligibility group, state Medicaid agencies must pay the Part A premium 
for those not eligible for premium-free Part A, if those individuals 
meet all of the eligibility requirements for the QMB eligibility group 
under the state's Medicaid state plan. (Entering into a Part A buy-in 
agreement would permit states to avoid any Part A late enrollment 
penalties that individuals may owe and would allow states to enroll 
persons in Part A at any time of the year, without regard to Medicare 
enrollment periods.) Other individuals may be eligible for the 
Qualified Disabled and Working Individuals (QDWIs) eligibility group, 
through which state Medicaid programs provide coverage for the Part A 
premiums for individuals who are eligible to enroll in Part A by virtue 
of section 1818A of the Act and meet certain financial eligibility 
criteria.
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    \1\ Effective on January 1, 2023, the regulatory definition of 
qualified Medicare beneficiaries at 42 CFR 435.123 has been expanded 
to include additional individuals. These individuals are only 
entitled to limited Medicare coverage under Part B for 
immunosuppressive drugs. Because the new individuals are not 
entitled to Part A, the expansion of the QMB definition does not 
change the analysis in this notice.
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II. Monthly Premium Amount for CY 2024

    The monthly premium for the uninsured aged and certain individuals 
with disabilities who have exhausted other entitlement, for the 12 
months beginning January 1, 2024, is $505. The monthly premium for the 
individuals who are eligible under section 1818(d)(4)(B) of the Act, 
and who are therefore subject to the 45-percent reduction in the 
monthly premium, is $278.

III. Monthly Premium Rate Calculation

    As discussed in section I of this notice, the monthly Medicare Part 
A premium is equal to the estimated monthly actuarial rate for CY 2024 
rounded to the nearest multiple of $1 and equals one-twelfth of the 
average per capita amount, which is determined by projecting the number 
of Part A enrollees aged 65 years and over, as well as the benefits and 
administrative costs that will be incurred on their behalf.
    The steps involved in projecting these future costs to the Federal 
Hospital Insurance Trust Fund are as follows:
     Establishing the present cost of services furnished to 
beneficiaries, by type of service, to serve as a projection base;
     Projecting increases in payment amounts for each of the 
service types; and
     Projecting increases in administrative costs.
    We base our projections for CY 2024 on (1) current historical data 
and (2) projection assumptions derived from current law and the 
President's Fiscal Year 2024 Budget.
    For CY 2024, we estimate that 59,121,430 people aged 65 years and 
over will be entitled to (enrolled in) benefits (without premium 
payment) and that they will incur about $358,251 billion in benefits 
and related administrative costs. Thus, the estimated monthly average 
per capita amount is $504.97, and the monthly premium is $505. 
Subsequently, the full monthly premium reduced by 45 percent is $278.

IV. Costs to Beneficiaries

    The CY 2024 premium of $505 is approximately 0.2 percent lower than 
the CY 2023 premium of $506. We estimate that approximately 729,000 
enrollees will voluntarily enroll in Medicare Part A by paying the full 
premium and that over 90 percent of these individuals will have their 
Part A

[[Page 71572]]

premium paid for by states, since they are entitled to Part A and 
enrolled in the QMB program eligibility group. Furthermore, the CY 2024 
reduced premium is the same as for CY 2023, at $278, and we estimate 
that an additional 94,000 enrollees will pay this premium. Therefore, 
for enrollees paying these premiums in CY 2024, we estimate that the 
total aggregate savings, compared with the amount that they paid in CY 
2023, will be about $9 million.

V. Waiver of Proposed Rulemaking

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register and invite public comment prior to a rule taking 
effect in accordance with section 1871 of the Act and section 553(b) of 
the Administrative Procedure Act (APA). Section 1871(a)(2) of the Act 
provides that no rule, requirement, or other statement of policy (other 
than a national coverage determination) that establishes or changes a 
substantive legal standard governing the scope of benefits, the payment 
for services, or the eligibility of individuals, entities, or 
organizations to furnish or receive services or benefits under Medicare 
shall take effect unless it is promulgated through notice and comment 
rulemaking. Unless there is a statutory exception, section 1871(b)(1) 
of the Act generally requires the Secretary to provide for notice of a 
proposed rule in the Federal Register and provide a period of not less 
than 60 days for public comment before establishing or changing a 
substantive legal standard regarding the matters enumerated by the 
statute. Similarly, under 5 U.S.C. 553(b) of the APA, the agency is 
required to publish a notice of proposed rulemaking in the Federal 
Register before a substantive rule takes effect. Section 553(d) of the 
APA and section 1871(e)(1)(B)(i) of the Act usually require a 30-day 
delay in effective date after issuance or publication of a rule, 
subject to exceptions. Sections 553(b)(B) and 553(d)(3) of the APA 
provide for exceptions from the advance notice and comment requirement 
and the delay in effective date requirements. Sections 1871(b)(2)(C) 
and 1871(e)(1)(B)(ii) of the Act also provide exceptions from the 
notice and 60-day comment period and the 30-day delay in effective 
date. Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act 
expressly authorize an agency to dispense with notice and comment 
rulemaking for good cause if the agency makes a finding that notice and 
comment procedures are impracticable, unnecessary, or contrary to the 
public interest.
    The annual Medicare Part A premium announcement set forth in this 
notice does not establish or change a substantive legal standard 
regarding the matters enumerated by the statute or constitute a 
substantive rule that would be subject to the notice requirements in 
section 553(b) of the APA. However, to the extent that an opportunity 
for public notice and comment could be construed as required for this 
notice, we find good cause to waive this requirement.
    Section 1818(d) of the Act requires the Secretary, during September 
of each year, to determine and publish the amount to be paid, on an 
average per capita basis, from the Federal Hospital Insurance Trust 
Fund for services incurred in the impending CY (including the 
associated administrative costs) on behalf of individuals aged 65 and 
over who will be entitled to benefits under Part A. Further, the 
statute requires that the agency determine the applicable premium 
amount for each CY in accordance with the statutory formula. In this 
notice, we are simply notifying the public of the changes to the Part A 
premiums for CY 2024. We have calculated the Part A premiums as 
directed by the statute, which establishes both when the premium 
amounts must be published and what information must be factored by the 
Secretary into these amounts; we do not have any discretion in that 
regard. We find notice and comment procedures to be unnecessary for 
this notice, and we find good cause to waive such procedures under 
section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act, if 
such procedures may be construed to be required at all. Through this 
notice, we are simply notifying the public of the updates to the Part A 
premiums, in accordance with the statute, for CY 2024. As such, we also 
note that even if notice and comment procedures were required for this 
notice, for the reasons stated above we would find good cause to waive 
the delay in effective date of the notice, as additional delay would be 
contrary to the public interest under section 1871(e)(1)(B)(ii) of the 
Act. Publication of this notice is consistent with section 1818(d) of 
the Act, and we believe that any potential delay in the effective date 
of the notice, if such delay were required at all, could cause 
unnecessary confusion for both the agency and Medicare beneficiaries.

VI. 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 (44 U.S.C. 3501 et seq.).

VII. Regulatory Impact Analysis

    Although this notice does not constitute a substantive rule, we 
nevertheless prepared this Regulatory Impact Analysis section in the 
interest of ensuring that the impacts of this notice are fully 
understood.

A. Statement of Need

    This notice announces the CY 2024 Medicare Part A premiums for the 
uninsured aged and for certain disabled individuals who have exhausted 
other entitlement, as required by sections 1818 and 1818A of the Act. 
It also responds to section 1818(d) of the Act, which requires the 
Secretary to provide for publication of these amounts in the Federal 
Register during the September that precedes the start of each CY. As 
this statutory provision prescribes a detailed methodology for 
calculating these amounts, we do not have the discretion to adopt an 
alternative approach on these issues.

B. Overall Impact

    We have examined the impacts of this rule 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); Executive Order 14094 entitled ``Modernizing 
Regulatory Review'' (April 6, 2023); 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). 
Executive Order 14094, ``Modernizing Regulatory Review,'' amends 
section 3(f)(1) of Executive Order 12866 (Regulatory Planning and 
Review). The amended section 3(f) of Executive Order 12866 defines a 
``significant regulatory action'' as an action that is likely to result 
in a rule (1) having an annual effect on the economy of $200 million or 
more in any

[[Page 71573]]

1 year (adjusted every 3 years by the Administrator of the Office of 
Information and Regulatory Affairs (OIRA) for changes in gross domestic 
product) or adversely affecting in a material way the economy, a sector 
of the economy, productivity, competition, jobs, the environment, 
public health or safety, or State, local, territorial, or tribal 
governments or communities; (2) creating a serious inconsistency or 
otherwise interfering with an action taken or planned by another 
agency; (3) materially altering the budgetary impacts of entitlement 
grants, user fees, or loan programs or the rights and obligations of 
recipients thereof; or (4) raising legal or policy issues, for which 
centralized review would meaningfully further the President's 
priorities or the principles set forth in this Executive order, as 
specifically authorized in a timely manner by the Administrator of OIRA 
in each case.
    A regulatory impact analysis (RIA) must be prepared for major rules 
with significant regulatory action/s and/or with significant effects as 
per section 3(f)(1) of Executive Order 12866 ($200 million or more in 
any 1 year). Based on our estimates, OMB's Office of Information and 
Regulatory Affairs has determined that this rulemaking is not 
significant and not major under Subtitle E of the Small Business 
Regulatory Enforcement Fairness Act of 1996 (also known as the 
Congressional Review Act).
    As stated in section IV of this notice, we estimate that the 
overall effect of the changes in the Medicare Part A premium will be a 
savings to voluntary enrollees (sections 1818 and 1818A of the Act) of 
about $9 million.

C. Accounting Statement and Table

    As required by OMB Circular A-4 (available at https://www.whitehouse.gov/wp-content/uploads/legacy_drupal_files/omb/circulars/A4/a-4.pdf), in the Table below we have prepared an 
accounting statement showing the total aggregate savings to enrollees 
paying premiums in CY 2024, compared with the amount that they paid in 
CY 2023. The amount of savings will be about $9 million. As stated in 
section IV of this notice, the CY 2024 premium of $505 is approximately 
0.2 percent lower than the CY 2023 premium of $506. We estimate that 
approximately 729,000 enrollees will voluntarily enroll in Medicare 
Part A by paying the full premium and that over 90 percent of these 
individuals will have their Part A premium paid for by states, since 
they are enrolled in the QMB eligibility group. Furthermore, the CY 
2024 reduced premium of $278 is the same as for CY 2023.

     Table--Estimated Transfers for CY 2024 Medicare Part A Premiums
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                 Category                             Transfers
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Annualized Monetized Transfers............  -$9 million.
From Whom to Whom.........................  Beneficiaries to Federal
                                             Government.
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D. Regulatory Flexibility Act

    The Regulatory Flexibility Act (RFA) requires agencies to analyze 
options for regulatory relief of small entities if a rule has a 
significant impact on a substantial number of small entities. 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 being 
nonprofit organizations or by meeting the Small Business 
Administration's definition of a small business (having revenues of 
less than $9.0 million to $47 million in any 1 year). Individuals and 
states are not included in the definition of a small entity. This 
annual notice announces the Medicare Part A premiums for CY 2024 and 
will have an impact on certain Medicare beneficiaries. As a result, we 
are not preparing an analysis for the RFA because the Secretary has 
certified that this notice will not have a significant economic impact 
on a substantial number of small entities.
    In addition, section 1102(b) of the Act requires us to prepare a 
RIA 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 and has fewer 
than 100 beds. This annual notice announces the Medicare Part A 
premiums for CY 2024 and will have an impact on certain Medicare 
beneficiaries. As a result, we are not preparing an analysis for 
section 1102(b) of the Act because the Secretary has certified that 
this notice will not have a significant impact on the operations of a 
substantial number of small rural hospitals.

E. Unfunded Mandates Reform Act

    Section 202 of the Unfunded Mandates Reform Act of 1995 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 2023, that 
threshold is approximately $177 million. This notice would not impose a 
mandate that will result in expenditures by state, local, and Tribal 
Governments, in the aggregate, or by the private sector, of more than 
$177 million in any 1 year.

F. Federalism

    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. This notice will not have a substantial direct effect on 
state or local governments, preempt state law, or otherwise have 
Federalism implications.

G. Congressional Review

    This final regulation is subject to the Congressional Review Act 
provisions of the Small Business Regulatory Enforcement Fairness Act of 
1996 (5 U.S.C. 801 et seq.) and has been transmitted to the Congress 
and the Comptroller General for review.
    Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & 
Medicaid Services, approved this document on October 11, 2023.

Xavier Becerra,
Secretary, Department of Health and Human Services.
[FR Doc. 2023-22848 Filed 10-12-23; 4:15 pm]
BILLING CODE 4120-01-P