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Notice2022-21090

Medicare Program; Medicare Part B Monthly Actuarial Rates, Premium Rates, and Annual Deductible Beginning January 1, 2023

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Published

September 29, 2022

Effective

January 1, 2023

Issuing agencies

Health and Human Services DepartmentCenters for Medicare & Medicaid Services

Abstract

This notice announces the monthly actuarial rates for aged (age 65 and over) and disabled (under age 65) beneficiaries enrolled in Part B of the Medicare Supplementary Medical Insurance (SMI) program beginning January 1, 2023. In addition, this notice announces the monthly premium for aged and disabled beneficiaries, the deductible for 2023, and the income-related monthly adjustment amounts to be paid by beneficiaries with modified adjusted gross income above certain threshold amounts.

Full Text

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<title>Federal Register, Volume 87 Issue 188 (Thursday, September 29, 2022)</title>
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[Federal Register Volume 87, Number 188 (Thursday, September 29, 2022)]
[Notices]
[Pages 59080-59091]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-21090]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-8082-N]
RIN 0938-AU48

Medicare Program; Medicare Part B Monthly Actuarial Rates,
Premium Rates, and Annual Deductible Beginning January 1, 2023

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

ACTION: Notice.

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SUMMARY: This notice announces the monthly actuarial rates for aged
(age 65 and over) and disabled (under age 65) beneficiaries enrolled in
Part B of the Medicare Supplementary Medical Insurance (SMI) program
beginning January 1, 2023. In addition, this notice announces the
monthly premium for aged and disabled beneficiaries, the deductible for
2023, and the income-related monthly adjustment amounts to be paid by
beneficiaries with modified adjusted gross income above certain
threshold amounts.

DATES: The premium and related amounts announced in this notice are
effective January 1, 2023.

FOR FURTHER INFORMATION CONTACT: M. Kent Clemens, (410) 786-6391.

SUPPLEMENTARY INFORMATION: The monthly actuarial rates for 2023 are
$323.70 for aged enrollees and $357.90 for disabled enrollees. The
standard monthly Part B premium rate for all enrollees for 2023 is
$164.90, which is equal to 50 percent of the monthly actuarial rate for
aged enrollees (or approximately 25 percent of the expected average
total cost of Part B coverage for aged enrollees) plus the $3.00
repayment amount required under current law. (The 2022 standard premium
rate was $170.10, which included the $3.00 repayment amount.) The Part
B deductible for 2023 is $226.00 for all Part B beneficiaries. If a
beneficiary has to pay an income-related monthly adjustment amount,
that individual will have to pay a total monthly premium of about 35,
50, 65, 80, or 85 percent of the total cost of Part B coverage plus a
repayment amount of $4.20, $6.00, $7.80, $9.60, or $10.20,
respectively. Beginning in 2023, certain Medicare enrollees who are 36
months post kidney transplant, and therefore are no longer eligible for
full Medicare coverage, can elect to continue Part B coverage of
immunosuppressive drugs by paying a premium. For 2023, the
immunosuppressive drug premium is $97.10.

I. Background

Part B is the voluntary portion of the Medicare program that pays
all or part of the costs for physicians' services; outpatient hospital
services; certain home health services; services furnished by rural
health clinics, ambulatory surgical centers, and comprehensive
outpatient rehabilitation facilities; and certain other medical and
health services not covered by Medicare Part A, Hospital Insurance.
Medicare Part B is available to individuals who are entitled to
Medicare Part A, as well as to U.S. residents who have attained age 65
and are citizens and to non-citizens who were lawfully admitted for
permanent residence and have resided in the United States for 5
consecutive years. Part B requires enrollment and payment of monthly
premiums, as

[[Page 59081]]

described in 42 CFR part 407, subpart B, and part 408, respectively.
The premiums paid by (or on behalf of) all enrollees fund approximately
one-fourth of the total incurred costs, and transfers from the general
fund of the Treasury pay approximately three-fourths of these costs.
The Secretary of the Department of Health and Human Services (the
Secretary) is required by section 1839 of the Social Security Act (the
Act) to announce the Part B monthly actuarial rates for aged and
disabled beneficiaries as well as the monthly Part B premium. The Part
B annual deductible, income-related monthly adjustment amounts, and the
immunosuppressive drug premium are included because their
determinations are directly linked to the aged actuarial rate.
The monthly actuarial rates for aged and disabled enrollees are
used to determine the correct amount of general revenue financing per
beneficiary each month. These amounts, according to actuarial
estimates, will equal, respectively, one-half of the expected average
monthly cost of Part B for each aged enrollee (age 65 or over) and one-
half of the expected average monthly cost of Part B for each disabled
enrollee (under age 65).
The Part B deductible to be paid by enrollees is also announced.
Prior to the Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 (MMA) (Pub. L. 108-173), the Part B deductible was set in
statute. After setting the 2005 deductible amount at $110.00, section
629 of the MMA (amending section 1833(b) of the Act) required that the
Part B deductible be indexed beginning in 2006. The inflation factor to
be used each year is the annual percentage increase in the Part B
actuarial rate for enrollees age 65 and over. Specifically, the 2023
Part B deductible is calculated by multiplying the 2022 deductible by
the ratio of the 2023 aged actuarial rate to the 2022 aged actuarial
rate. The amount determined under this formula is then rounded to the
nearest $1.00.
The monthly Part B premium rate to be paid by aged and disabled
enrollees is also announced. (Although the costs to the program per
disabled enrollee are different than for the aged, the statute provides
that the two groups pay the same premium amount.) Beginning with the
passage of section 203 of the Social Security Amendments of 1972 (Pub.
L. 92-603), the premium rate, which was determined on a fiscal-year
basis, was limited to the lesser of the actuarial rate for aged
enrollees, or the current monthly premium rate increased by the same
percentage as the most recent general increase in monthly Title II
Social Security benefits.
However, the passage of section 124 of the Tax Equity and Fiscal
Responsibility Act of 1982 (TEFRA) (Pub. L. 97-248) suspended this
premium determination process. Section 124 of TEFRA changed the premium
basis to 50 percent of the monthly actuarial rate for aged enrollees
(that is, 25 percent of program costs for aged enrollees). Section 606
of the Social Security Amendments of 1983 (Pub. L. 98-21), section 2302
of the Deficit Reduction Act of 1984 (DEFRA 84) (Pub. L. 98-369),
section 9313 of the Consolidated Omnibus Budget Reconciliation Act of
1985 (COBRA 85) (Pub. L. 99-272), section 4080 of the Omnibus Budget
Reconciliation Act of 1987 (OBRA 87) (Pub. L. 100-203), and section
6301 of the Omnibus Budget Reconciliation Act of 1989 (OBRA 89) (Pub.
L. 101-239) extended the provision that the premium be based on 50
percent of the monthly actuarial rate for aged enrollees (that is, 25
percent of program costs for aged enrollees). This extension expired at
the end of 1990.
The premium rate for 1991 through 1995 was legislated by section
1839(e)(1)(B) of the Act, as added by section 4301 of the Omnibus
Budget Reconciliation Act of 1990 (OBRA 90) (Pub. L. 101-508). In
January 1996, the premium determination basis would have reverted to
the method established by the 1972 Social Security Act Amendments.
However, section 13571 of the Omnibus Budget Reconciliation Act of 1993
(OBRA 93) (Pub. L. 103-66) changed the premium basis to 50 percent of
the monthly actuarial rate for aged enrollees (that is, 25 percent of
program costs for aged enrollees) for 1996 through 1998.
Section 4571 of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105-
33) permanently extended the provision that the premium be based on 50
percent of the monthly actuarial rate for aged enrollees (that is, 25
percent of program costs for aged enrollees).
The BBA included a further provision affecting the calculation of
the Part B actuarial rates and premiums for 1998 through 2003. Section
4611 of the BBA modified the home health benefit payable under Part A
for individuals enrolled in Part B. Under this section, beginning in
1998, expenditures for home health services not considered ``post-
institutional'' are payable under Part B rather than Part A. However,
section 4611(e)(1) of the BBA required that there be a transition from
1998 through 2002 for the aggregate amount of the expenditures
transferred from Part A to Part B. Section 4611(e)(2) of the BBA also
provided a specific yearly proportion for the transferred funds. The
proportions were one-sixth for 1998, one-third for 1999, one-half for
2000, two-thirds for 2001, and five-sixths for 2002. For the purpose of
determining the correct amount of financing from general revenues of
the Federal Government, it was necessary to include only these
transitional amounts in the monthly actuarial rates for both aged and
disabled enrollees, rather than the total cost of the home health
services being transferred.
Section 4611(e)(3) of the BBA also specified, for the purpose of
determining the premium, that the monthly actuarial rate for enrollees
age 65 and over be computed as though the transition would occur for
1998 through 2003 and that one-seventh of the cost be transferred in
1998, two-sevenths in 1999, three-sevenths in 2000, four-sevenths in
2001, five-sevenths in 2002, and six-sevenths in 2003. Therefore, the
transition period for incorporating this home health transfer into the
premium was 7 years while the transition period for including these
services in the actuarial rate was 6 years.
Section 811 of the MMA, which amended section 1839 of the Act,
requires that, starting on January 1, 2007, the Part B premium a
beneficiary pays each month be based on that individual's annual
income. (The MMA specified that there be a 5-year transition period to
reach full implementation of this provision. However, section 5111 of
the Deficit Reduction Act of 2005 (DRA) (Pub. L. 109-171) modified the
transition to a 3-year period, which ended in 2009.) Specifically, if a
beneficiary's modified adjusted gross income is greater than the
legislated threshold amounts (for 2023, $97,000 for a beneficiary
filing an individual income tax return and $194,000 for a beneficiary
filing a joint tax return), the beneficiary is responsible for a larger
portion of the estimated total cost of Part B benefit coverage. In
addition to the standard 25-percent premium, these beneficiaries now
have to pay an income-related monthly adjustment amount. The MMA made
no change to the actuarial rate calculation, and the standard premium,
which will continue to be paid by beneficiaries whose modified adjusted
gross income is below the applicable thresholds, still represents 25
percent of the estimated total cost to the program of Part B coverage
for an aged enrollee. However, depending on income and tax filing
status, a beneficiary can now be responsible for 35, 50, 65, 80, or 85
percent of the estimated total cost of Part B coverage, rather than 25
percent.

[[Page 59082]]

Section 402 of the Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) (Pub. L. 114-10) modified the income thresholds beginning in
2018, and section 53114 of the Bipartisan Budget Act of 2018 (BBA of
2018) (Pub. L. 115-123) further modified the income thresholds
beginning in 2019. For years beginning in 2019, the BBA of 2018
established a new income threshold. If a beneficiary's modified
adjusted gross income is greater than or equal to $500,000 for a
beneficiary filing an individual income tax return and $750,000 for a
beneficiary filing a joint tax return, the beneficiary is responsible
for 85 percent of the estimated total cost of Part B coverage. The BBA
of 2018 specified that these new income threshold levels be inflation-
adjusted beginning in 2028. The end result of the higher premium is
that the Part B premium subsidy is reduced, and less general revenue
financing is required, for beneficiaries with higher income because
they are paying a larger share of the total cost with their premium.
That is, the premium subsidy continues to be approximately 75 percent
for beneficiaries with income below the applicable income thresholds,
but it will be reduced for beneficiaries with income above these
thresholds.
The Consolidated Appropriations Act, 2021 (Pub. L. 116-260)
established a new basis for Medicare Part B eligibility for post-
kidney-transplant immunosuppressive drug coverage only. Medicare
eligibility due solely to end-stage renal disease generally ends 36
months after a successful kidney transplant. Beginning in 2023, post-
kidney-transplant individuals without certain types of insurance
coverage can elect to remain enrolled in Part B and receive coverage of
immunosuppressive drugs only. The premium for this continuation of
coverage is 15 percent of a different aged actuarial rate, which is
equal to 100 percent of costs for aged enrollees (rather than the
standard aged actuarial rate, which is equal to one-half of the costs
for aged enrollees). Enrollees paying the immunosuppressive premium are
not subject to the late enrollment penalty and the $3.00 repayment
amounts, but they are subject to the hold-harmless provision (described
later) and the income-related monthly adjustment amounts. The law
requires transfers equal to the reduction in aggregate premiums payable
that results from enrollees with coverage only for immunosuppressive
drugs paying the immunosuppressive drug Part B premium rather than the
standard Part B premium. These transfers are to be treated as premiums
payable for general revenue matching purposes.
Section 4732(c) of the BBA added section 1933(c) of the Act, which
required the Secretary to allocate money from the Part B trust fund to
the State Medicaid programs for the purpose of providing Medicare Part
B premium assistance from 1998 through 2002 for the low-income Medicaid
beneficiaries who qualify under section 1933 of the Act. This
allocation, while not a benefit expenditure, was an expenditure of the
trust fund and was included in calculating the Part B actuarial rates
through 2002. For 2003 through 2015, the expenditure was made from the
trust fund because the allocation was temporarily extended. However,
because the extension occurred after the financing was determined, the
allocation was not included in the calculation of the financing rates
for these years. Section 211 of MACRA permanently extended this
expenditure, which is included in the calculation of the Part B
actuarial rates for 2016 and subsequent years.
Another provision affecting the calculation of the Part B premium
is section 1839(f) of the Act, as amended by section 211 of the
Medicare Catastrophic Coverage Act of 1988 (MCCA 88) (Pub. L. 100-360).
(The Medicare Catastrophic Coverage Repeal Act of 1989 (Pub. L. 101-
234) did not repeal the revisions to section 1839(f) of the Act made by
MCCA 88.) Section 1839(f) of the Act, referred to as the ``hold-
harmless'' provision, provides that, if an individual is entitled to
benefits under section 202 or 223 of the Act (the Old-Age and Survivors
Insurance Benefit and the Disability Insurance Benefit, respectively)
and has the Part B premium deducted from these benefit payments, the
premium increase will be reduced, if necessary, to avoid causing a
decrease in the individual's net monthly payment. This decrease in
payment occurs if the increase in the individual's Social Security
benefit due to the cost-of-living adjustment under section 215(i) of
the Act is less than the increase in the premium. Specifically, the
reduction in the premium amount applies if the individual is entitled
to benefits under section 202 or 223 of the Act for November and
December of a particular year and the individual's Part B premiums for
December and the following January are deducted from the respective
month's section 202 or 223 benefits. The hold-harmless provision does
not apply to beneficiaries who are required to pay an income-related
monthly adjustment amount.
A check for benefits under section 202 or 223 of the Act is
received in the month following the month for which the benefits are
due. The Part B premium that is deducted from a particular check is the
Part B payment for the month in which the check is received. Therefore,
a benefit check for November is not received until December, but
December's Part B premium has been deducted from it.
Generally, if a beneficiary qualifies for hold-harmless protection,
the reduced premium for the individual for that January and for each of
the succeeding 11 months is the greater of either--
<bullet> The monthly premium for January reduced as necessary to
make the December monthly benefits, after the deduction of the Part B
premium for January, at least equal to the preceding November's monthly
benefits, after the deduction of the Part B premium for December; or
<bullet> The monthly premium for that individual for that December.
In determining the premium limitations under section 1839(f) of the
Act, the monthly benefits to which an individual is entitled under
section 202 or 223 of the Act do not include retroactive adjustments or
payments and deductions on account of work. Also, once the monthly
premium amount is established under section 1839(f) of the Act, it will
not be changed during the year even if there are retroactive
adjustments or payments and deductions on account of work that apply to
the individual's monthly benefits.
Individuals who have enrolled in Part B late or who have re-
enrolled after the termination of a coverage period are subject to an
increased premium under section 1839(b) of the Act. The increase is a
percentage of the premium and is based on the new premium rate before
any reductions under section 1839(f) of the Act are made.
Section 1839 of the Act, as amended by section 601(a) of the
Bipartisan Budget Act of 2015 (Pub. L. 114-74), specified that the 2016
actuarial rate for enrollees age 65 and older be determined as if the
hold-harmless provision did not apply. The premium revenue that was
lost by using the resulting lower premium (excluding the forgone
income-related premium revenue) was replaced by a transfer of general
revenue from the Treasury, which will be repaid over time to the
general fund.
Similarly, section 1839 of the Act, as amended by section 2401 of
the Continuing Appropriations Act, 2021 and Other Extensions Act (Pub.
L. 116-159), specified that the 2021 actuarial rate for enrollees age
65 and older be determined as the sum of the 2020

[[Page 59083]]

actuarial rate for enrollees age 65 and older and one-fourth of the
difference between the 2020 actuarial rate and the preliminary 2021
actuarial rate (as determined by the Secretary) for such enrollees. The
premium revenue lost by using the resulting lower premium (excluding
the forgone income-related premium revenue) was replaced by a transfer
of general revenue from the Treasury, which will be repaid over time.
Starting in 2016, in order to repay the balance due (which includes
the transfer amounts and the forgone income-related premium revenue
from the Bipartisan Budget Act of 2015 and the Continuing
Appropriations Act, 2021 and Other Extensions Act), the Part B premium
otherwise determined will be increased by $3.00. These repayment
amounts will be added to the Part B premium otherwise determined each
year and will be paid back to the general fund of the Treasury, and
they will continue until the balance due is paid back.
High-income enrollees pay the $3.00 repayment amount plus an
additional $1.20, $3.00, $4.80, $6.60, or $7.20 in repayment as part of
the income-related monthly adjustment amount (IRMAA) premium dollars,
which reduce (dollar for dollar) the amount of general revenue received
by Part B from the general fund of the Treasury. Because of this
general revenue offset, the repayment IRMAA premium dollars are not
included in the direct repayments made to the general fund of the
Treasury from Part B in order to avoid a double repayment. (Only the
$3.00 monthly repayment amounts are included in the direct repayments.)
These repayment amounts will continue until the balance due is
zero. (In the final year of the repayment, the additional amounts may
be modified to avoid an overpayment.) The repayment amounts (excluding
those for high-income enrollees) are subject to the hold-harmless
provision. The original balance due was $9,066,409,000, consisting of
$1,625,761,000 in forgone income-related premium revenue plus a
transfer amount of $7,440,648,000 from the provisions of the Bipartisan
Budget Act of 2015. The increase in the balance due in 2021 was
$8,799,829,000, consisting of $946,046,000 in forgone income-related
premium income plus a transfer amount of $7,853,783,000 from the
provisions of the Continuing Appropriations Act, 2021 and Other
Extensions Act. An estimated $10,948,663,000 will have been collected
for repayment to the general fund by the end of 2022.

II. Provisions of the Notice

A. Notice of Medicare Part B Monthly Actuarial Rates, Monthly Premium
Rates, and Annual Deductible

The Medicare Part B monthly actuarial rates applicable for 2023 are
$323.70 for enrollees age 65 and over and $357.90 for disabled
enrollees under age 65. In section II.B. of this notice, we present the
actuarial assumptions and bases from which these rates are derived. The
Part B standard monthly premium rate for all enrollees for 2023 is
$164.90. The Part B immunosuppressive drug premium is $97.10.
The following are the 2023 Part B monthly premium rates to be paid
by (or on behalf of) beneficiaries with full Part B coverage who file
either individual tax returns (and are single individuals, heads of
households, qualifying widows or widowers with dependent children, or
married individuals filing separately who lived apart from their
spouses for the entire taxable year) or joint tax returns.

Full Part B Coverage
----------------------------------------------------------------------------------------------------------------
Beneficiaries who file joint
Beneficiaries who file individual tax tax returns with modified Income-related Total monthly
returns with modified adjusted gross adjusted gross income: monthly adjustment premium amount
income: amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $97,000............. Less than or equal to $0.00 $164.90
$194,000.
Greater than $97,000 and less than or Greater than $194,000 and 65.90 230.80
equal to $123,000. less than or equal to
$246,000.
Greater than $123,000 and less than or Greater than $246,000 and 164.80 329.70
equal to $153,000. less than or equal to
$306,000.
Greater than $153,000 and less than or Greater than $306,000 and 263.70 428.60
equal to $183,000. less than or equal to
$366,000.
Greater than $183,000 and less than Greater than $366,000 and 362.60 527.50
$500,000. less than $750,000.
Greater than or equal to $500,000......... Greater than or equal to 395.60 560.50
$750,000.
----------------------------------------------------------------------------------------------------------------

For beneficiaries with immunosuppressive drug only Part B coverage,
who file either individual tax returns (and are single individuals,
heads of households, qualifying widows or widowers with dependent
children, or married individuals filing separately who lived apart from
their spouses for the entire taxable year) or joint tax returns, the
2023 Part B monthly premium rates are as follows:

Part B Immunosuppressive Drug Coverage Only
----------------------------------------------------------------------------------------------------------------
Beneficiaries who file joint
Beneficiaries who file individual tax tax returns with modified Income-related Total monthly
returns with modified adjusted gross adjusted gross income: monthly adjustment premium amount
income: amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $97,000............. Less than or equal to $0.00 $97.10
$194,000.
Greater than $97,000 and less than or Greater than $194,000 and 64.70 161.80
equal to $123,000. less than or equal to
$246,000.
Greater than $123,000 and less than or Greater than $246,000 and 161.80 258.90
equal to $153,000. less than or equal to
$306,000.
Greater than $153,000 and less than or Greater than $306,000 and 258.90 356.00
equal to $183,000. less than or equal to
$366,000.
Greater than $183,000 and less than Greater than $366,000 and 356.00 453.10
$500,000. less than $750,000.
Greater than or equal to $500,000......... Greater than or equal to 388.40 485.50
$750,000.
----------------------------------------------------------------------------------------------------------------

In addition, the monthly premium rates to be paid by (or on behalf
of) beneficiaries with full Part B coverage who are married and lived
with their spouses at any time during the taxable year, but who file
separate tax returns from their spouses, are as follows:

[[Page 59084]]

Full Part B Coverage
------------------------------------------------------------------------
Beneficiaries who are married
and lived with their spouses at
any time during the year, but Income-related Total monthly
who file separate tax returns monthly adjustment premium amount
from their spouses, with amount
modified adjusted gross income:
------------------------------------------------------------------------
Less than or equal to $97,000... $0.00 $164.90
Greater than $97,000 and less 362.60 527.50
than $403,000..................
Greater than or equal to 395.60 560.50
$403,000.......................
------------------------------------------------------------------------

The monthly premium rates to be paid by (or on behalf of)
beneficiaries with immunosuppressive drug only Part B coverage who are
married and lived with their spouses at any time during the taxable
year, but who file separate tax returns from their spouses, are as
follows:

Part B Immunosuppressive Drug Coverage Only
------------------------------------------------------------------------
Beneficiaries who are married
and lived with their spouses at
any time during the year, but Income-related Total monthly
who file separate tax returns monthly adjustment premium amount
from their spouses, with amount
modified adjusted gross income:
------------------------------------------------------------------------
Less than or equal to $97,000... $0.00 $97.10
Greater than $97,000 and less 356.00 453.10
than $403,000..................
Greater than or equal to 388.40 485.50
$403,000.......................
------------------------------------------------------------------------

The Part B annual deductible for 2023 is $226.00 for all
beneficiaries.

B. Statement of Actuarial Assumptions and Bases Employed in Determining
the Monthly Actuarial Rates and the Monthly Premium Rate for Part B
Beginning January 2023

The actuarial assumptions and bases used to determine the monthly
actuarial rates and the monthly premium rates for Part B are
established by the Centers for Medicare & Medicaid Services' Office of
the Actuary. The estimates underlying these determinations are prepared
by actuaries meeting the qualification standards and following the
actuarial standards of practice established by the Actuarial Standards
Board.
1. Actuarial Status of the Part B Account in the Supplementary Medical
Insurance Trust Fund
Under section 1839 of the Act, the starting point for determining
the standard monthly premium is the amount that would be necessary to
finance Part B on an incurred basis. This is the amount of income that
would be sufficient to pay for services furnished during that year
(including associated administrative costs) even though payment for
some of these services will not be made until after the close of the
year. The portion of income required to cover benefits not paid until
after the close of the year is added to the trust fund and used when
needed.
Because the premium rates are established prospectively, they are
subject to projection error. Additionally, legislation enacted after
the financing was established, but effective for the period in which
the financing is set, may affect program costs. As a result, the income
to the program may not equal incurred costs. Trust fund assets must
therefore be maintained at a level that is adequate to cover an
appropriate degree of variation between actual and projected costs, and
the amount of incurred, but unpaid, expenses. Numerous factors
determine what level of assets is appropriate to cover variation
between actual and projected costs. For 2023, the four most important
of these factors are (1) the impact of the COVID-19 pandemic on program
spending; (2) the difference from prior years between the actual
performance of the program and estimates made at the time financing was
established; (3) the likelihood and potential magnitude of expenditure
changes resulting from enactment of legislation affecting Part B costs
in a year subsequent to the establishment of financing for that year;
and (4) the expected relationship between incurred and cash
expenditures. The impact of the pandemic on program spending brings a
higher-than-usual degree of uncertainty to projected costs for the 2023
Part B financing. The other three factors are analyzed on an ongoing
basis, as the trends can vary over time.
Table 1 summarizes the estimated actuarial status of the trust fund
as of the end of the financing period for 2021 and 2022.

Table 1--Estimated Actuarial Status of the Part B Account in the Supplementary Medical Insurance Trust Fund as
of the End of the Financing Period
----------------------------------------------------------------------------------------------------------------
Assets less
Financing period ending Assets (in Liabilities \1\ liabilities \1\
millions) (in millions) (in millions)
----------------------------------------------------------------------------------------------------------------
December 31, 2021................................... $163,333 $32,618 $130,716
December 31, 2022................................... 192,097 35,045 157,052
----------------------------------------------------------------------------------------------------------------
\1\ These amounts include only items incurred but not paid. They do not include the amounts that are to be paid
back to the general fund of the Treasury over time as specified by section 1839 of the Act as amended by
section 601(a) of the Bipartisan Budget Act of 2015 and further amended by section 2401 of the Continuing
Appropriations Act, 2021 and Other Extensions Act, nor do they include the Accelerated and Advance Payments
Program amounts that are to be repaid by providers and returned to the general fund of the Treasury.

[[Page 59085]]

2. Monthly Actuarial Rate for Enrollees Age 65 and Older
The monthly actuarial rate for enrollees age 65 and older is one-
half of the sum of monthly amounts for (1) the projected cost of
benefits and (2) administrative expenses for each enrollee age 65 and
older, after adjustments to this sum to allow for interest earnings on
assets in the trust fund and an adequate contingency margin. The
contingency margin is an amount appropriate to provide for possible
variation between actual and projected costs and to amortize any
surplus assets or unfunded liabilities.
The monthly actuarial rate for enrollees age 65 and older for 2023
is determined by first establishing per enrollee costs by type of
service from program data through 2021 and then projecting these costs
for subsequent years. The projection factors used for financing periods
from January 1, 2020 through December 31, 2023 are shown in Table 2.
As indicated in Table 3, the projected per enrollee amount required
to pay for one-half of the total of benefits and administrative costs
for enrollees age 65 and over for 2023 is $332.59. Based on current
estimates, the assets at the end of 2022 are sufficient to cover the
amount of incurred, but unpaid, expenses, to provide for substantial
variation between actual and projected costs, and to accommodate the
unusually high degree of uncertainty regarding program costs due to the
COVID-19 pandemic. Thus, a negative contingency margin can be included
to decrease assets to a more appropriate level. The monthly actuarial
rate of $323.70 provides an adjustment of -$5.96 for a contingency
margin and -$2.93 for interest earnings.
The contingency margin for 2023 is affected by several factors. In
order to take into account the uncertainty and potential impact of the
COVID-19 pandemic, assumptions were developed for testing and treatment
for COVID-19, utilization of non-COVID-related care, potential costs
for COVID-19 vaccines, and possible paths of the pandemic. The Part B
projected program costs were developed based on these assumptions and
were included in the margin development.
In addition, starting in 2011, manufacturers and importers of
brand-name prescription drugs pay a fee that is allocated to the Part B
account of the SMI trust fund. For 2023, the total of these brand-name
drug fees is estimated to be $2.8 billion. The contingency margin for
2023 has been reduced to account for this additional revenue.
The traditional goal for the Part B reserve has been that assets
minus liabilities at the end of a year should represent between 15 and
20 percent of the following year's total incurred expenditures. To
accomplish this goal, a 17-percent reserve ratio, which is a fully
adequate contingency reserve level, has been the normal target used to
calculate the Part B premium. At the end of 2022, the reserve ratio is
expected to be well above 20 percent. The financing rates for 2023 are
set to use excess reserves to reduce the 2023 premium and to move the
reserve ratio towards the normal target range. The actuarial rate of
$323.70 per month for aged beneficiaries, as announced in this notice
for 2023, reflects the combined effect of the factors and legislation
previously described and the projected assumptions listed in Table 2.
3. Monthly Actuarial Rate for Disabled Enrollees
Disabled enrollees are those persons under age 65 who are enrolled
in Part B because of entitlement to Social Security disability benefits
for more than 24 months or because of entitlement to Medicare under the
end-stage renal disease (ESRD) program. Projected monthly costs for
disabled enrollees (other than those with ESRD) are prepared in a
manner parallel to the projection for the aged using appropriate
actuarial assumptions (see Table 2). Costs for the ESRD program are
projected differently because of the different nature of services
offered by the program.
As shown in Table 4, the projected per enrollee amount required to
pay for one-half of the total of benefits and administrative costs for
disabled enrollees for 2023 is $410.24. The monthly actuarial rate of
$357.90 also provides an adjustment of -$3.59 for interest earnings and
-$48.75 for a contingency margin, reflecting the same factors and
legislation described previously for the aged actuarial rate at
magnitudes applicable to the disabled rate determination. Based on
current estimates, the assets associated with the disabled Medicare
beneficiaries at the end of 2022 are sufficient to cover the amount of
incurred, but unpaid, expenses and to provide for a significant degree
of variation between actual and projected costs.
The actuarial rate of $357.90 per month for disabled beneficiaries,
as announced in this notice for 2023, reflects the combined net effect
of the factors and legislation described previously for aged
beneficiaries and the projection assumptions listed in Table 2.
4. Sensitivity Testing
Several factors contribute to uncertainty about future trends in
medical care costs. It is appropriate to test the adequacy of the rates
using alternative cost growth rate assumptions, the results of which
are shown in Table 5. One set represents increases that are higher and,
therefore, more pessimistic than the current estimate, and the other
set represents increases that are lower and, therefore, more optimistic
than the current estimate. The values for the alternative assumptions
were determined from a statistical analysis of the historical variation
in the respective increase factors. The historical variation may not be
representative of the current level of uncertainty due to the COVID-19
pandemic.
As indicated in Table 5, the monthly actuarial rates would result
in an excess of assets over liabilities of $144,015 million by the end
of December 2023 under the cost growth rate assumptions shown in Table
2 and under the assumption that the provisions of current law are fully
implemented. This result amounts to 26.3 percent of the estimated total
incurred expenditures for the following year.
Assumptions that are somewhat more pessimistic (and that therefore
test the adequacy of the assets to accommodate projection errors)
produce a surplus of $88,664 million by the end of December 2023 under
current law, which amounts to 14.5 percent of the estimated total
incurred expenditures for the following year. Under fairly optimistic
assumptions, the monthly actuarial rates would result in a surplus of
$230,559 million by the end of December 2023, or 47.6 percent of the
estimated total incurred expenditures for the following year.
The sensitivity analysis indicates that, in a typical year, the
premium and general revenue financing established for 2023, together
with existing Part B account assets, would be adequate to cover
estimated Part B costs for 2023 under current law, should actual costs
prove to be somewhat greater than expected. However, the current level
of uncertainty due to the pandemic may differ from the historical
variation included in this analysis.
5. Premium Rates and Deductible
As determined in accordance with section 1839 of the Act, the
following are the 2023 Part B monthly premium rates to be paid by (or
on behalf of) beneficiaries with full Part B coverage who file either
individual tax returns (and are single individuals, heads of

[[Page 59086]]

households, qualifying widows or widowers with dependent children, or
married individuals filing separately who lived apart from their
spouses for the entire taxable year) or joint tax returns.

For beneficiaries with immunosuppressive drug only Part B coverage
who file either individual tax returns (and are single individuals,
heads of households, qualifying widows or widowers with dependent
children, or married individuals filing separately who lived apart from
their spouses for the entire taxable year) or joint tax returns, the
2023 Part B monthly premium rates are shown below.

The Part B annual deductible for 2023 is $226.00 for all
beneficiaries.

[[Page 59087]]

Table 2--Projection Factors \1\
12-Month Periods Ending December 31 of 2020-2023
[In percent]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Physician Durable Physician- Other Home Other
Calendar year fee medical Practitioner administered practitioner Outpatient health Hospital institutional Managed
schedule equipment lab \2\ drugs services \3\ hospital agency lab \4\ services \5\ care
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Aged:
2020.................................................... -11.3 2.3 8.8 4.2 -0.5 -5.9 -2.2 10.7 -5.2 6.9
2021.................................................... 18.6 5.6 20.2 10.9 5.1 20.3 3.7 16.3 5.8 1.3
2022.................................................... 2.1 4.7 -6.9 12.4 4.8 11.5 5.3 -5.3 7.0 6.5
2023.................................................... 1.0 11.4 -2.6 10.4 6.4 12.3 26.9 -8.8 7.3 6.3
Disabled:
2020.................................................... -8.5 -0.8 -7.0 8.8 8.4 -7.7 10.5 9.7 -4.8 7.8
2021.................................................... 13.1 3.6 22.4 16.8 0.2 11.5 6.6 20.4 12.9 1.6
2022.................................................... -0.9 3.7 -8.6 13.8 0.6 8.6 6.3 -5.4 7.0 7.7
2023.................................................... 1.3 11.9 -2.6 10.8 6.8 13.3 31.3 -8.8 7.7 6.4
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ All values for services other than managed care are per fee-for-service enrollee. Managed care values are per managed care enrollee.
\2\ Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab.
\3\ Includes ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs, supplies, etc.
\4\ Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
\5\ Includes services furnished in dialysis facilities, rural health clinics, federally qualified health centers, rehabilitation and psychiatric hospitals, etc.

Table 3--Derivation of Monthly Actuarial Rate for Enrollees Age 65 and Over for Financing Periods Ending
December 31, 2020 Through December 31, 2023
----------------------------------------------------------------------------------------------------------------
CY 2020 CY 2021 CY 2022 CY 2023
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
Physician fee schedule.................................. $62.05 $69.45 $67.26 $65.53
Durable medical equipment............................... 6.16 6.15 6.11 6.56
Practitioner lab \1\.................................... 4.54 5.15 4.55 4.27
Physician-administered drugs............................ 17.33 18.16 19.37 20.69
Other practitioner services \2\......................... 8.85 8.78 8.73 8.95
Outpatient hospital..................................... 45.57 51.78 54.76 59.29
Home health agency...................................... 8.12 7.95 7.94 9.71
Hospital lab \3\........................................ 2.16 2.37 2.13 1.87
Other institutional services \4\........................ 17.36 17.34 17.59 18.19
Managed care............................................ 128.46 139.51 157.29 173.27
---------------------------------------------------
Total services...................................... 300.61 326.65 345.73 368.33
----------------------------------------------------------------------------------------------------------------
Cost sharing:
Deductible.............................................. -7.56 -7.77 -8.90 -8.65
Coinsurance............................................. -24.88 -27.68 -25.53 -24.52
Sequestration of benefits................................... -1.79 0.00 -3.89 -6.70
---------------------------------------------------
Total benefits.......................................... 266.38 291.20 307.40 328.46
Administrative expenses..................................... 4.52 4.74 4.43 4.13
Incurred expenditures....................................... 270.90 295.94 311.83 332.59
Value of interest........................................... -1.33 -1.93 -2.45 -2.93
Contingency margin for projection error and to amortize the 13.63 -3.01 24.82 -5.96
surplus or deficit.........................................
---------------------------------------------------
Monthly actuarial rate.................................. $283.20 $291.00 $334.20 $323.70
----------------------------------------------------------------------------------------------------------------
\1\ Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab.
\2\ Includes ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs,
supplies, etc.
\3\ Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
\4\ Includes services furnished in dialysis facilities, rural health clinics, federally qualified health
centers, rehabilitation and psychiatric hospitals, etc.

Table 4--Derivation of Monthly Actuarial Rate for Disabled Enrollees for Financing Periods Ending December 31,
2020 Through December 31, 2023
----------------------------------------------------------------------------------------------------------------
CY 2020 CY 2021 CY 2022 CY 2023
----------------------------------------------------------------------------------------------------------------
Covered services (at level recognized):
Physician fee schedule...................... $62.28 $63.52 $57.34 $53.19
Durable medical equipment................... 10.97 10.24 9.61 9.78
Practitioner lab \1\........................ 5.35 5.88 4.86 4.32
Physician-administered drugs................ 15.53 16.28 16.74 16.88
Other practitioner services \2\............. 12.39 11.16 10.23 10.00
Outpatient hospital......................... 55.57 56.30 55.41 57.16
Home health agency.......................... 6.84 6.38 6.23 7.51
Hospital lab \3\............................ 2.53 2.73 2.34 1.95
Other institutional services \4\............ 48.96 41.29 39.95 40.03

[[Page 59088]]

Managed care................................ 149.93 178.13 212.60 244.15
---------------------------------------------------------------
Total services.......................... 370.35 391.91 415.31 444.97
----------------------------------------------------------------------------------------------------------------
Cost sharing:
Deductible.................................. -7.11 -7.30 -8.36 -8.14
Coinsurance................................. -36.24 -35.19 -29.48 -26.22
Sequestration of benefits....................... -2.18 0.00 -4.72 -8.21
---------------------------------------------------------------
Total benefits.............................. 324.82 349.42 372.75 402.41
Administrative expenses......................... 5.43 5.69 8.06 7.82
Incurred expenditures........................... 330.25 355.10 380.81 410.24
Value of interest............................... -1.65 -2.52 -3.53 -3.59
Contingency margin for projection error and to 15.00 -2.68 -8.38 -48.75
amortize the surplus or deficit................
---------------------------------------------------------------
Monthly actuarial rate...................... $343.60 $349.90 $368.90 $357.90
----------------------------------------------------------------------------------------------------------------
\1\ Includes services paid under the lab fee schedule furnished in the physician's office or an independent lab.
\2\ Includes ambulatory surgical center facility costs, ambulance services, parenteral and enteral drug costs,
supplies, etc.
\3\ Includes services paid under the lab fee schedule furnished in the outpatient department of a hospital.
\4\ Includes services furnished in dialysis facilities, rural health clinics, federally qualified health
centers, rehabilitation and psychiatric hospitals, etc.

Table 5--Actuarial Status of the Part B Account in the SMI Trust Fund Under Three Sets of Assumptions for
Financing Periods Through December 31, 2023
----------------------------------------------------------------------------------------------------------------
As of December 31, 2021 2022 2023
----------------------------------------------------------------------------------------------------------------
Actuarial status (in millions):
Assets...................................................... $163,333 $192,097 $180,801
Liabilities................................................. $32,618 $35,045 $36,786
-----------------------------------------------
Assets less liabilities..................................... $130,716 $157,052 $144,015
Ratio \1\................................................... 28.6% 31.4% 26.3%
----------------------------------------------------------------------------------------------------------------
Low-cost projection:
Actuarial status (in millions):
Assets...................................................... $163,333 $215,623 $265,236
Liabilities................................................. $32,618 $32,430 $34,676
-----------------------------------------------
Assets less liabilities..................................... $130,716 $183,202 $230,559
Ratio \1\................................................... 30.3% 40.5% 47.6%
----------------------------------------------------------------------------------------------------------------
High-cost projection:
Actuarial status (in millions):
Assets...................................................... $163,333 $168,397 $127,706
Liabilities................................................. $32,618 $37,678 $39,042
Assets less liabilities..................................... $130,716 $130,718 $88,664
-----------------------------------------------
Ratio \1\................................................... 27.1% 23.8% 14.5%
----------------------------------------------------------------------------------------------------------------
\1\ Ratio of assets less liabilities at the end of the year to the total incurred expenditures during the
following year, expressed as a percent.

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

IV. Regulatory Impact Analysis

A. Statement of Need

This notice announces the monthly actuarial rates and premium
rates, as required by section 1839(a) of the Act, and the annual
deductible, as required by section 1833(b) of the Act, for
beneficiaries enrolled in Part B of the Medicare Supplementary Medical
Insurance (SMI) program beginning January 1, 2023. It also responds to
section 1839(a)(1) 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 calendar year. As section
1839 of the Act 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 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,

[[Page 59089]]

2011), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub.
L. 96-354), section 1102(b) of the 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). Section
3(f) of Executive Order 12866 defines a ``significant regulatory
action'' as an action that is likely to result in a notice/rule: (1)
having an annual effect on the economy of $100 million or more in any
one year, or adversely and materially affecting a sector of the
economy, productivity, competition, jobs, the environment, public
health or safety, or State, local or tribal governments or communities
(also referred to as ``economically significant''); (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 novel
legal or policy issues arising out of legal mandates, the President's
priorities, or the principles set forth in the Executive Order.
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 or
other regulatory documents with economically significant effects ($100
million or more in any one year). Based on our estimates, OMB's Office
of Information and Regulatory Affairs has determined this rulemaking is
``economically significant'' as measured by the $100 million threshold.
The 2023 standard Part B premium of $164.90 is $5.20 lower than the
2022 premium of $170.10. We estimate that the total premium decrease,
for the approximately 60 million Part B enrollees in 2023, will be -
$3.8 billion, which is an annual effect on the economy of $100 million
or more. As a result, this notice is economically significant under
section 3(f)(1) of Executive Order 12866 and is a major action as
defined under the Congressional Review Act (5 U.S.C. 804(2)).

C. Detailed Economic Analysis

As discussed earlier, this notice announces that the monthly
actuarial rates applicable for 2023 are $323.70 for enrollees age 65
and over and $357.90 for disabled enrollees under age 65. It also
announces the 2023 monthly Part B premium rates to be paid by (or on
behalf of) beneficiaries with full Part B coverage who file either
individual tax returns (and are single individuals, heads of
households, qualifying widows or widowers with dependent children, or
married individuals filing separately who lived apart from their
spouses for the entire taxable year) or joint tax returns.

Full Part B Coverage
----------------------------------------------------------------------------------------------------------------
Beneficiaries who file joint
Beneficiaries who file individual tax tax returns with modified Income- related Total monthly
returns with modified adjusted gross adjusted gross income: monthly premium amount
income: adjustment amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $97,000............. Less than or equal to $0.00 $164.90
$194,000.
Greater than $97,000 and less than or Greater than $194,000 and 65.90 230.80
equal to $123,000. less than or equal to
$246,000.
Greater than $123,000 and less than or Greater than $246,000 and 164.80 329.70
equal to $153,000. less than or equal to
$306,000.
Greater than $153,000 and less than or Greater than $306,000 and 263.70 428.60
equal to $183,000. less than or equal to
$366,000.
Greater than $183,000 and less than Greater than $366,000 and 362.60 527.50
$500,000. less than $750,000.
Greater than or equal to $500,000......... Greater than or equal to 395.60 560.50
$750,000.
----------------------------------------------------------------------------------------------------------------

Part B Immunosuppressive Drug Coverage Only
----------------------------------------------------------------------------------------------------------------
Beneficiaries who file joint
Beneficiaries who file individual tax tax returns with modified Income- related Total monthly
returns with modified adjusted gross adjusted gross income: monthly premium amount
income: adjustment amount
----------------------------------------------------------------------------------------------------------------
Less than or equal to $97,000............. Less than or equal to $0.00 $97.10
$194,000.
Greater than $97,000 and less than or Greater than $194,000 and 64.70 161.80
equal to $123,000. less than or equal to
$246,000.
Greater than $123,000 and less than or Greater than $246,000 and 161.80 258.90
equal to $153,000. less than or equal to
$306,000.
Greater than $153,000 and less than or Greater than $306,000 and 258.90 356.00
equal to $183,000. less than or equal to
$366,000.
Greater than $183,000 and less than Greater than $366,000 and 356.00 453.10
$500,000. less than $750,000.
Greater than or equal to $500,000......... Greater than or equal to 388.40 485.50
$750,000.
----------------------------------------------------------------------------------------------------------------

[[Page 59090]]

D. Accounting Statement and Table

As required by OMB Circular A-4 (available at <a href="http://www.whitehouse.gov/sites/whitehouse.gov/files/omb/circulars/A4/a-4.pdf">www.whitehouse.gov/sites/whitehouse.gov/files/omb/circulars/A4/a-4.pdf</a>), in Table 6 we
have prepared an accounting statement showing the estimated aggregate
Part B premium increase for all enrollees in 2023.

Table 6--Accounting Statement: The Estimated Aggregate Part B Premium
Increase for All Enrollees for 2023
------------------------------------------------------------------------
Estimated Aggregate Part B Premium Increase for All Enrollees for 2023
-------------------------------------------------------------------------
Category
------------------------------------------------------------------------
Annualized Monetized Transfers......... -$3.8 billion.
From Whom to Whom?..................... Beneficiaries to Federal
Government.
------------------------------------------------------------------------

E. Regulatory Flexibility Act (RFA)

The RFA requires agencies to analyze options for regulatory relief
of small businesses, if a rule or other regulatory document 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. Individuals and
States are not included in the definition of a small entity. This
notice announces the monthly actuarial rates for aged (age 65 and over)
and disabled (under 65) beneficiaries enrolled in Part B of the
Medicare SMI program beginning January 1, 2023. Also, this notice
announces the monthly premium for aged and disabled beneficiaries as
well as the income-related monthly adjustment amounts to be paid by
beneficiaries with modified adjusted gross income above certain
threshold amounts. As a result, we are not preparing an analysis for
the RFA because the Secretary has determined 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
regulatory impact analysis if a rule or other regulatory document 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. As we
discussed previously, we are not preparing an analysis for section
1102(b) of the Act because the Secretary has determined that this
notice will not have a significant effect on 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 one year of
$100 million in 1995 dollars, updated annually for inflation. In 2022,
that threshold is approximately $165 million. Part B enrollees who are
also enrolled in Medicaid have their monthly Part B premiums paid by
Medicaid. The cost to each State Medicaid program from the 2023 premium
decrease is estimated to be less than the threshold. This notice does
not impose mandates that will have a consequential effect of the
threshold amount or more on State, local, or tribal governments or on
the private sector.
Executive Order 13132 establishes certain requirements that an
agency must meet when it publishes a proposed rule or other regulatory
document (and subsequent final rule or other regulatory document) that
imposes substantial direct compliance costs on State and local
governments, preempts State law, or otherwise has Federalism
implications. We have determined that this notice does not
significantly affect the rights, roles, and responsibilities of States.
Accordingly, the requirements of Executive Order 13132 do not apply to
this notice.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.

V. Waiver of Proposed Rulemaking

We ordinarily publish a notice of proposed rulemaking in the
Federal

[[Page 59091]]

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 of the Department of Health
and Human Services (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 updated amounts for the Part B monthly actuarial rates
for aged and disabled beneficiaries, the Part B premium, and the Part B
deductible set forth in this notice do 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 1839 of the Act requires the Secretary to determine the
monthly actuarial rates for aged and disabled beneficiaries, as well as
the monthly Part B premium (including the income-related monthly
adjustment amounts to be paid by beneficiaries with modified adjusted
gross income above certain threshold amounts), for each calendar year
in accordance with the statutory formulae, in September preceding the
year to which they will apply. Further, the statute requires that the
agency promulgate the Part B premium amount, in September preceding the
year to which it will apply, and include a public statement setting
forth the actuarial assumptions and bases employed by the Secretary in
arriving at the amount of an adequate actuarial rate for enrollees age
65 and older. We include the Part B annual deductible, which is
established in accordance with a specific formula described in section
1833(b) of the Act, because the determination of the amount is directly
linked to the rate of increase in actuarial rate under section
1839(a)(1) of the Act. We have calculated the monthly actuarial rates
for aged and disabled beneficiaries, the Part B deductible, and the
monthly Part B premium as directed by the statute; since the statute
establishes both when the monthly actuarial rates for aged and disabled
beneficiaries and the monthly Part B premium must be published and the
information that the Secretary must factor into those 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 monthly actuarial rates for aged and
disabled beneficiaries and the Part B deductible, as well as the
monthly Part B premium amounts and the income-related monthly
adjustment amounts to be paid by certain beneficiaries, in accordance
with the statute, for CY 2023. As such, we also note that even if
notice and comment procedures were required for this notice, we would
find good cause, for the previously stated reason, 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 1839 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.
Chiquita Brooks-LaSure, Administrator of the Centers for Medicare &
Medicaid Services, approved this document on September 23, 2022.

Dated: September 23, 2022.
Xavier Becerra,
Secretary, Department of Health and Human Services.
[FR Doc. 2022-21090 Filed 9-27-22; 8:45 am]
BILLING CODE 4120-01-P

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