Notice2024-28127
Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2025
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
December 2, 2024
Effective
January 1, 2025
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This notice announces a $730.00 calendar year (CY) 2025 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new Medicare practice location. This fee is required with any enrollment application submitted on or after January 1, 2025, and on or before December 31, 2025.
Full Text
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<title>Federal Register, Volume 89 Issue 231 (Monday, December 2, 2024)</title>
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[Federal Register Volume 89, Number 231 (Monday, December 2, 2024)]
[Notices]
[Pages 95215-95217]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-28127]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-6094-N]
RIN 0938-ZB85
Medicare, Medicaid, and Children's Health Insurance Programs;
Provider Enrollment Application Fee Amount for Calendar Year 2025
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Notice.
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SUMMARY: This notice announces a $730.00 calendar year (CY) 2025
application fee for institutional providers that are initially
enrolling in the Medicare or Medicaid program or the Children's Health
Insurance Program (CHIP); revalidating their Medicare, Medicaid, or
CHIP enrollment; or adding a new Medicare practice location. This fee
is required with any enrollment application submitted on or after
January 1, 2025, and on or before December 31, 2025.
DATES: The application fee announced in this notice is effective on
January 1, 2025.
FOR FURTHER INFORMATION CONTACT: Frank Whelan, (410) 786-1302.
SUPPLEMENTARY INFORMATION:
I. Background
In the February 2, 2011 Federal Register (76 FR 5862), we published
a final rule with comment period titled ``Medicare, Medicaid, and
Children's Health Insurance Programs; Additional Screening
Requirements, Application Fees, Temporary Enrollment Moratoria, Payment
Suspensions and Compliance Plans for Providers and Suppliers.'' This
rule finalized, among other things, provisions related to the
submission of application fees as part of the Medicare, Medicaid, and
CHIP provider enrollment processes.
As provided in section 1866(j)(2)(C)(i) of the Social Security Act
(the Act) and in 42 CFR 424.514, ``institutional providers'' that are
initially enrolling in the Medicare or Medicaid programs or CHIP,
revalidating their enrollment, or adding a new Medicare practice
location are required to submit a fee with their enrollment
application. An ``institutional provider'' for purposes of Medicare is
defined at Sec. 424.502 as ``any provider or supplier that submits a
paper Medicare enrollment application using the CMS-855A, CMS-855B (not
including physician and non-physician practitioner organizations), CMS-
855S, or associated internet-based PECOS enrollment application.'' As
we explained in the February 2, 2011 final rule (76 FR 5914), in
addition to the providers and suppliers subject to the application fee
under Medicare, Medicaid-only and CHIP-only institutional providers
would include nursing facilities, intermediate care facilities for
persons with intellectual disabilities (ICF/IID), and psychiatric
residential treatment facilities; they may also include other
institutional provider types designated by a State in accordance with
their approved State plan.
As indicated in Sec. 424.514 and Sec. 455.460, the application
fee is not required for either of the following:
<bullet> A Medicare physician or non-physician practitioner
submitting a CMS-855I.
<bullet> A prospective or revalidating Medicaid or CHIP provider--
++ Who is an individual physician or non-physician practitioner; or
++ That is enrolled as an institutional provider in Title XVIII of
the Act or
[[Page 95216]]
another State's title XIX or XXI plan and has paid the application fee
to a Medicare contractor or another State.
II. Provisions of the Notice
Section 1866(j)(2)(C)(i)(I) of the Act established a $500
application fee for institutional providers in CY 2010. Consistent with
section 1866(j)(2)(C)(i)(II) of the Act, Sec. 424.514(d)(2) states
that for CY 2011 and subsequent years, the preceding year's fee will be
adjusted by the percentage change in the consumer price index (CPI) for
all urban consumers (all items; United States city average, CPI-U) for
the 12-month period ending on June 30 of the previous year.
Consequently, each year since 2011 we have published in the Federal
Register an announcement of the application fee amount for the
forthcoming CY based on this formula. Most recently, in the November 7,
2023 Federal Register (88 FR 76754), we published a notice announcing a
fee amount for the period of January 1, 2024 through December 31, 2024
of $709.00. The $709.00 fee amount for CY 2024 was used to calculate
the fee amount for 2025 as specified in Sec. 424.514(d)(2).
According to Bureau of Labor Statistics (BLS) data, the CPI-U
increase for the period of July 1, 2023 through June 30, 2024 was 3.0
percent. (See <a href="https://www.bls.gov/news.release/archives/cpi_07112024.htm">https://www.bls.gov/news.release/archives/cpi_07112024.htm</a>.) As required by Sec. 424.514(d)(2), the preceding
year's fee of $709 will be adjusted by 3.0 percent. This results in a
CY 2025 application fee amount of $730.27 ($709 x 1.03). As we must
round this to the nearest whole dollar amount, the resultant
application fee amount for CY 2025 is $730.
III. Collection of Information Requirements
This document does not impose information collection requirements
(that is, reporting, recordkeeping, or third-party disclosure
requirements). Accordingly, there is no need for review by the Office
of Management and Budget under the authority of the Paperwork Reduction
Act of 1995. However, it does reference previously approved information
collections. The CMS-855A, CMS-855B, CMS-855I, and CMS-855S
applications are approved under, respectively, OMB control numbers
0938-0685, 0938-1377, 0938-1355, and 0938-1056.
IV. Regulatory Impact Statement
A. Overall Impact
We have examined the impacts of this notice as required by
Executive Order 12866 on Regulatory Planning and Review (September 30,
1993), Executive Order 13563 on Improving Regulation and Regulatory
Review (January 18, 2011), Executive Order 14094 titled ``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). The
Executive Order 14094 titled ``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 (notice) that may: (1) have an annual effect on the economy
of $200 million or more in any 1 year, (adjusted every 3 years by the
Administrator of OMB's Office of Information and Regulatory Affairs
(OIRA) for changes in gross domestic product); or adversely affect 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) create a
serious inconsistency or otherwise interfere with an action taken or
planned by another agency; (3) materially alter the budgetary impacts
of entitlement grants, user fees, or loan programs or the rights and
obligations of recipients thereof; or (4) raise 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 OIRA in each case.
A regulatory impact analysis (RIA) must be prepared for notices
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, OIRA has determined that this
rulemaking is not significant per section 3(f)(1) as measured by the
$200 million or more in any 1 year.
As explained in this section of the notice, we estimate that the
total cost of the increase in the application fee will not exceed $200
million. Therefore, this notice does not reach the $200 million
economic threshold and is not considered a significant notice.
B. Cost
The costs associated with this notice involve the increase in the
application fee amount that certain providers and suppliers must pay in
CY 2025. The CY 2025 cost estimates are as follows:
1. Medicare
Based on CMS data, we estimate that in CY 2025 approximately--
<bullet> 13,151 newly enrolling institutional providers will be
subject to and pay an application fee; and
<bullet> 37,224 revalidating institutional providers will be
subject to and pay an application fee.
Using a figure of 50,375 (13,151 newly enrolling + 37,224
revalidating) institutional providers, we estimate an increase in the
cost of the Medicare application fee requirement in CY 2025 of
$1,057,875 (or 50,375 x $21 (or $730 minus $709)) from our CY 2024
projections.
2. Medicaid and CHIP
Based on CMS and State statistics, we estimate that approximately
30,000 (9,000 newly enrolling + 21,000 revalidating) Medicaid and CHIP
institutional providers will be subject to an application fee in CY
2025. Using this figure, we project an increase in the cost of the
Medicaid and CHIP application fee requirement in CY 2025 of $630,000
(or 30,000 x $21 (or $730 minus $709)) from our CY 2024 projections.
3. Total
Based on the foregoing, we estimate the total increase in the cost
of the application fee requirement for Medicare, Medicaid, and CHIP
providers and suppliers in CY 2025 to be $1,687,875 ($1,057,875 +
$630,000) from our CY 2024 projections.
We do not anticipate any negative impact on equity from the
increase in the application fee amount, which we calculated in
accordance with the requirements specified in statute and regulation.
Prior application fee increases have had no such discernable effect,
and we reiterate that the fee requirement does not apply to individual
physicians and non-physician practitioners completing the CMS-855I, who
represent the overwhelming preponderance of the more than 2 million
Medicare-enrolled providers and suppliers.
[[Page 95217]]
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and small governmental
jurisdictions. Most hospitals and most other providers and suppliers
are small entities, either by nonprofit status or by having revenues of
less than $9 million to $47 million in any 1 year. Individuals and
States are not included in the definition of a small entity. As we
stated in the RIA for the February 2, 2011 final rule (76 FR 5952), we
do not believe that the application fee will have a significant impact
on small entities.
In addition, section 1102(b) of the Act requires us to prepare an
RIA if a rule (notice) 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. 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.
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 2024, that
threshold is approximately $183 million. This notice would not impose a
mandate that will result in the expenditure by State, local, and Tribal
governments, in the aggregate, or by the private sector, of more than
$183 million in any 1 year.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a proposed rule (and subsequent
final rule) (in this case a notice) that imposes substantial direct
requirement costs on State and local governments, preempts State law,
or otherwise has federalism implications. Since this notice does not
impose substantial direct costs on State or local governments, the
requirements of Executive Order 13132 are not applicable.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
The Administrator of the Centers for Medicare & Medicaid Services
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this
document, authorizes Chyana Woodyard, who is the Federal Register
Liaison, to electronically sign this document for purposes of
publication in the Federal Register.
Chyana Woodyard,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2024-28127 Filed 11-29-24; 8:45 am]
BILLING CODE 4120-01-P
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</html>Indexed from Federal Register on December 2, 2024.
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