[Federal Register Volume 63, Number 203 (Wednesday, October 21, 1998)]
[Notices]
[Pages 56212-56214]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-28161]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-8000-N]
RIN 0938-AJ03
Medicare Program; Part A Premium for 1999 for the Uninsured Aged
and for Certain Disabled Individuals Who Have Exhausted Other
Entitlement
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Notice.
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SUMMARY: This notice announces the hospital insurance premium for
calendar year 1999 under Medicare's hospital insurance program (Part A)
for the uninsured aged and for certain disabled individuals who have
exhausted other entitlement. The monthly Medicare Part A premium for
the 12 months beginning January 1, 1999 for these individuals is $309,
the same as in 1998. The reduced premium for certain other individuals
as described in this notice is $170. Section 1818(d) of the Social
Security Act specifies the method to be used to determine these
amounts.
EFFECTIVE DATE: This notice is effective on January 1, 1999.
FOR FURTHER INFORMATION CONTACT: Clare McFarland, (410) 786-6390.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1818 of the Social Security Act (the Act) provides for
voluntary enrollment in the Medicare hospital insurance program
(Medicare Part A), subject to payment of a monthly premium, of certain
persons aged 65 and older, who are uninsured for social security or
railroad retirement benefits and do not otherwise meet the requirements
for entitlement to Medicare Part A. (Persons insured under the Social
Security or Railroad Retirement Acts need not pay premiums for hospital
insurance.)
Section 1818(d) 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 performed, and related administrative
costs incurred, in the following calendar year with respect to
individuals aged 65 and over who will be entitled to benefits under
Medicare Part A. We must then, during September of each year, determine
the monthly actuarial rate (the per capita amount estimated above
divided by 12) and publish the dollar amount for the monthly premium in
the succeeding calendar year. If the premium is not a multiple of $1,
the premium 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). The 1998 premium under this method was $309 and was effective
January 1, 1998. (See 62 FR 59366, November 3, 1997.)
Section 1818(d)(2) of the Act requires us to determine and publish,
during September of each calendar year, the amount of the monthly
premium for the following calendar year for persons who voluntarily
enroll in Medicare Part A.
Section 1818A of the Act provides for voluntary enrollment in
Medicare Part A, subject to payment of a monthly premium, of certain
disabled individuals who have exhausted other entitlement. These
individuals are those not now entitled but who have been
[[Page 56213]]
entitled under section 226(b) of the Act, who continue to have the
disabling impairment upon which their entitlement was based, and whose
entitlement ended solely because they had earnings that exceeded the
substantial gainful activity amount (as defined in section 223(d)(4) of
the Act).
Section 1818A(d)(2) of the Act specifies that the premium
determined under section 1818(d)(2) of the Act for the aged will also
apply to certain disabled individuals as described above.
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 monthly premium amount for certain voluntary
enrollees. The reduction applies for an individual who is not eligible
for social security or railroad retirement benefits but who--
Has at least 30 quarters of coverage under title II of the
Act;
Is married and has been married for the previous 1-year
period to a person who has at least 30 quarters of coverage;
Had been married for at least 1 year at the time of the
person's death to a person who 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.
For calendar year 1999, section 1818(d)(4)(A) of the Act specifies
that the monthly premium that these individuals will pay for calendar
year 1999 will be equal to the monthly premium for aged voluntary
enrollees reduced by 45 percent.
II. Premium Amount for 1999
Under the authority of sections 1818(d)(2) and 1818A(d)(2) of the
Act, the Secretary has determined that the monthly Medicare Part A
hospital insurance premium for the uninsured aged and for certain
disabled individuals who have exhausted other entitlement for the 12
months beginning January 1, 1999 is $309, the same as in 1998.
The monthly premium for those individuals subject to a 45 percent
reduction in the monthly premium for the 12-month period beginning
January 1, 1999 is $170.
III. Statement of Actuarial Assumptions and Bases Employed in
Determining the Monthly Premium Rate
As discussed in section I of this notice, the monthly Medicare Part
A premium for 1999 is equal to the estimated monthly actuarial rate for
1999 rounded to the nearest multiple of $1. The monthly actuarial rate
is defined to be one-twelfth of the average per capita amount that the
Secretary estimates will be paid from the Federal Hospital Insurance
Trust Fund for services performed and related administrative costs
incurred in 1999 for individuals aged 65 and over who will be entitled
to benefits under the hospital insurance program. Thus, the number of
individuals aged 65 and over who will be entitled to hospital insurance
benefits and the costs incurred on behalf of these beneficiaries must
be projected to determine the premium rate.
The principal steps involved in projecting the future costs of the
hospital insurance program are (a) establishing the present cost of
services furnished to beneficiaries, by type of service, to serve as a
projection base; (b) projecting increases in payment amounts for each
of the various service types; and (c) projecting increases in
administrative costs. Establishing historical Medicare Part A
enrollment and projecting future enrollment, by type of beneficiary, is
part of this process.
We have completed all of the above steps, basing our projections
for 1999 on (a) current historical data and (b) projection assumptions
under current law from the Midsession Review of the President's Fiscal
Year 1999 Budget. It is estimated that in calendar year 1999, 33.415
million people aged 65 and over will be entitled to Medicare Part A
benefits (without premium payment), and that these individuals will, in
1999, incur $124.033 billion of benefits for services performed and
related administrative costs. Thus, the estimated monthly average per
capita amount is $309.32 and the monthly premium is $309. The monthly
premium for those individuals eligible to pay this premium reduced by
45 percent is $170.
IV. Costs to Beneficiaries
The 1999 Medicare Part A premium is equal to the $309 monthly
premium amount for the 12-month period beginning January 1, 1998.
We estimate that there will be, in calendar year 1999,
approximately 351,000 enrollees who do not otherwise meet the
requirements for entitlement, and will voluntarily enroll in Medicare
Part A by paying the full premium. We estimate an additional 9,000
enrollees will be paying the reduced premium. Since the premium amount
for calendar year 1999 is unchanged from calendar year 1998, there is
neither cost nor savings to these voluntary enrollees.
V. Waiver of Notice of Proposed Rulemaking
The Medicare statute, as discussed previously, requires publication
of the Medicare Part A hospital insurance premium for the upcoming
calendar year during September of each year. The amounts are determined
according to the statute. As has been our custom, we use general
notices, rather than formal notice and comment rulemaking procedures,
to make the announcements. In doing so, we acknowledge that, under the
Administrative Procedure Act, interpretive rules, general statements of
policy, and rules of agency organization, procedure, or practice are
excepted from the requirements of notice and comment rulemaking.
We considered publishing a proposed notice to provide a period for
public comment. However, we may waive that procedure if we find good
cause that prior notice and comment are impracticable, unnecessary, or
contrary to the public interest. We find that the procedure for notice
and comment is unnecessary because the formula used to calculate the
Part A hospital insurance premium is statutorily directed, and we can
exercise no discretion in following that formula. Moreover, the statute
established the time period for which the premium will apply and
delaying publication of the premium amount would be contrary to the
public interest. Therefore, we find good cause to waive publication of
a proposed notice and solicitation of public comments.
VI. Regulatory Impact Statement
We have examined the impacts of this notice as required by
Executive Order 12866 and the Regulatory Flexibility Act (RFA) (Pub. L.
96-354). Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, when regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects; distributive impacts; and equity). The RFA requires agencies
to analyze options for regulatory relief for small businesses. For
purposes of the RFA, States and individuals are not considered small
entities.
Also, section 1102(b) of the Act requires the Secretary to prepare
a regulatory impact analysis for any notice that may have a significant
impact on the operations of a substantial number of small rural
hospitals. Such an analysis must conform to the provisions of section
604 of the RFA.
[[Page 56214]]
For purposes of section 1102(b) of the Act, we consider a small rural
hospital as a hospital that is located outside of a Metropolitan
Statistical Area and has fewer than 50 beds.
This notice merely announces that the monthly Medicare Part A
hospital insurance premium for the uninsured aged and for certain
disabled individuals who have exhausted other entitlement for the 12
months beginning January 1, 1999 is $309. It also announces that the
premium for certain other individuals subject to a reduction in the
monthly premium is $170. There is neither cost nor savings as a result
of this notice because the premium amount for calendar year 1999 is
unchanged from calendar year 1998. Therefore, this notice is not a
major rule as defined in Title 5, United States Code, section 804(2)
and is not an economically significant rule under Executive Order
12866.
Therefore, we have determined, and the Secretary certifies, that
this notice will not result in a significant impact on a substantial
number of small entities and will not have a significant effect on the
operations of a substantial number of small rural hospitals. Therefore,
we are not preparing analyses for either the RFA or section 1102(b) of
the Act.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
Authority: Sections 1818(d)(2) and 1818A(d)(2) of the Social
Security Act (42 U.S.C. 1395i-2(d)(2) and 1395i-2a(d)(2)).
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance)
Dated: September 28, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
Dated: October 8, 1998.
Donna E. Shalala,
Secretary.
[FR Doc. 98-28161 Filed 10-16-98; 9:34 am]
BILLING CODE 4120-01-P
