[Federal Register Volume 77, Number 11 (Wednesday, January 18, 2012)]
[Rules and Regulations]
[Pages 2446-2448]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-827]
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SOCIAL SECURITY ADMINISTRATION
20 CFR Part 418
[Docket No. SSA-2010-0033]
RIN 0960-AH24
Amendments to Regulations Regarding Eligibility for a Medicare
Prescription Drug Subsidy
AGENCY: Social Security Administration.
ACTION: Final rule.
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SUMMARY: This final rule adopts, without change, the interim final rule
with request for comments we published in the Federal Register on
December 29, 2010. The interim final rule incorporated changes to the
Medicare prescription drug coverage low-income subsidy (Extra Help)
program made by the Patient Protection and Affordable Care Act
(Affordable Care Act) enacted in March 2010. Under our interpretation
of section 3304 of the Affordable Care Act, if the death of a
beneficiary's spouse would decrease or eliminate the subsidy provided
by the Extra Help program, we will extend the effective period of
eligibility for the most recent determination or redetermination until
one year after the month following the month we are notified of the
death of the spouse. The effective date of this provision was January
1, 2011. We also revised our regulations to incorporate changes made by
the Medicare Improvements for Patients and Providers Act of 2008
(MIPPA) which affect the way we account for income and resources when
determining eligibility for the Extra Help program. The statute
provides that we no longer count the value of any life insurance policy
as a resource for Extra Help effective on and after January 1, 2010. As
of that date, we also no longer count as income the help a beneficiary
receives when someone else provides food and shelter, or pays household
bills for food, mortgage, rent, electricity, water, property taxes, or
heating fuel or gas. These revisions updated our rules to reflect these
statutory changes.
DATES: The interim final rule with request for comments published on
December 29, 2010, is confirmed as final effective January 18, 2012.
FOR FURTHER INFORMATION CONTACT: Craig Streett, Office of Income
Security Programs, Social Security Administration, 2-R-24 Operations
Building, 6401 Security Boulevard, Baltimore, MD 21235-6401, (410) 965-
9793. For information on eligibility or filing for benefits, call our
national toll-free number, 1-(800) 772-1213 or TTY 1-(800) 325-0778, or
visit our Internet site, Social Security Online, at http://www.socialsecurity.gov.
SUPPLEMENTARY INFORMATION:
Background
This final rule adopts, without change, the interim final rule with
request for comments we published in the Federal Register on December
29, 2010, at 75 FR 81843. The interim final rule changed the way we
account for income and resources when determining eligibility for the
subsidy provided by the Extra Help program, and removed certain items
from those we will count as income and resources. In addition, the
interim final rule extended the effective date of a determination or
redetermination of an Extra Help subsidy when there is a death of a
spouse.
Medicare prescription drug coverage is a voluntary program that
covers various prescription drugs. The regulations and requirements for
the program are codified in 42 CFR part 423. The Centers for Medicare &
Medicaid Services (CMS) promulgates rules and regulations concerning
the Medicare program. Anyone who meets the requirements listed in 42
CFR 423.30(a) can enroll in Medicare prescription drug coverage.
Medicare prescription drug coverage beneficiaries are generally
responsible for deductibles, cost-sharing, and monthly
[[Page 2447]]
premiums towards the cost of covered prescriptions.
Beneficiaries with Medicare prescription drug coverage who have
limited income and resources may qualify for Extra Help with their
monthly premiums, deductibles, and cost-sharing for Medicare
prescription drug coverage. To qualify for Extra Help, a Medicare
beneficiary must reside in one of the fifty states or the District of
Columbia and must have resources and income within specific limits.
Congress enacted MIPPA in July of 2008.\1\ Section 116 of MIPPA
exempts certain items from income and resources determinations of Extra
Help eligibility on or after January 1, 2010. We apply these exemptions
to applications filed and redeterminations initiated on or after
January 1, 2010. The items exempted under section 116 are the value of
life insurance and in-kind support and maintenance.
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\1\ Medicare Improvements for Patients and Providers Act of
2008, Public Law 110-275, 122 Stat. 2494 (2008).
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To implement these requirements of MIPPA, we issued guidance in
August 2009 and discontinued counting these exempted items for
applications and redeterminations in accordance with the requirements
of the statute. Accordingly, we no longer count as income the help a
beneficiary receives when someone else provides food and shelter, or
pays for food, mortgage, rent, heating fuel, gas, electricity, water,
or property taxes. To reflect these statutory exemptions, we revised
sections 418.3335(b) and 418.3350 and deleted section 418.3345 of our
regulations in the interim final rule that we published in December
2010.
In March 2010, Congress passed the Affordable Care Act, which
extends the effective date of a determination or redetermination of an
Extra Help subsidy due to the death of a spouse.\2\ In our previous
rules, any adjustment in the amount of Extra Help the beneficiary
receives was effective the month after the month in which we are
notified of the death of a spouse. In some cases, the death of a spouse
would result in a decrease in the amount of Extra Help or loss of Extra
Help eligibility for the beneficiary.
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\2\ The Patient Protection and Affordable Care Act, Public Law
111-148 Sec. 3304.
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Effective January 1, 2011, if the death of the spouse would
decrease or eliminate the subsidy provided by the Extra Help program,
we extend the effective period for a determination or redetermination
until one year after the date on which it would otherwise cease to be
effective--that is, the month after the month we are notified of the
death of the spouse. In order to reflect the changes made by the
Affordable Care Act, we revised sections 418.3120 and 418.3123 of our
regulations.
Prior to the publication of our interim rule, our regulations at
418.3350(b) stated that we did not count as income the unearned income
described in sections 416.1124(b), (c)(1) through (c)(12), and (c)(14)
through (c)(21). Those rules omitted a reference to paragraph
416.1124(c)(22) that we added after the publication of section 418.3350
in December 2005. We updated the reference in section 418.3350 to
correct this omission. This was a technical change only and did not
affect the substance of our rules.
Public Comments
On December 29, 2010, we published an interim final rule with
request for comments in the Federal Register at 75 FR 81843 and
provided a sixty-day comment period. We received five comments. We
carefully considered the concerns expressed in these comments but did
not make any changes to the final rule.
We summarized the commenters' views and responded to the
significant issues raised that are within the scope of the interim
final rule.
Comment: A commenter expressed gratitude for the cessation of
counting as income the help low-income subsidy recipients receive when
someone else pays household bills.
Response: We appreciate the comment and value the public's input on
regulatory changes. Changes in the Medicare Improvements for Patients
and Providers Act of 2008 have made it easier for people to qualify for
Extra Help with their Medicare prescription drug plan costs.
Comment: An organization expressed support for our efforts to
expand eligibility for low-income subsidy and would like the expansion
efforts to go further. The organization believes it would be
appropriate to eliminate the asset test (resource limits) for Extra
Help with Medicare prescription drug plan costs. The organization
stated that the Extra Help asset test is highly restrictive, preventing
millions of low-income Part D enrollees from benefiting from Extra
Help, and unnecessarily complicates the application process,
potentially discouraging qualified enrollees from applying to the
program. The organization also stated that an asset test is
inappropriate for Medicare beneficiaries, as Americans should be
encouraged to save for retirement.
Response: We cannot adopt this comment because the resources
eligibility standards for the Extra Help program are statutory.
Elimination or adjustment to statutory requirements is beyond the scope
of these regulations.
Comment: An organization expressed concern about contacting the
surviving spouse of a low-income subsidy eligible couple when we
determine that we will defer the redetermination for one year. The
organization believes this correspondence may cause unnecessary anxiety
to the widow/widower.
Response: We are unable to adopt this suggestion. The death of a
spouse is a subsidy-changing event (SCE). We send a redetermination
form whenever an SCE report is received as required in 20 CFR
418.3120(b)(1). We use the information to determine if the event will
affect the Extra Help subsidy. In some cases, contact with the widow/
widower will result in an increase in the Extra Help subsidy. If the
subsidy decreases, we will extend the effective period of the
determination or redetermination for at least one year from the
spouse's death.
Comment: An organization believes that we should provide a more
comprehensive definition of ``in-kind support and maintenance'' in 20
CFR 418.3335, either by providing examples or referencing the
appropriate link.
Response: We cannot adopt this comment at this time because it is
not within the scope of the present regulatory change, which is based
on statutory changes. However, we agree that a more comprehensive
definition of ``in-kind support and maintenance'' may be appropriate in
20 CFR 418.3335(b). We will consider publishing a separate Notice of
Proposed Rulemaking to add a sentence to the end of Sec. 418.3335(b)
explaining that ''Shelter includes room, rent, mortgage payments, real
property taxes, heating fuel, gas, electricity, water, sewerage, and
garbage collection services.''
Comment: An organization asked us to consider clarifying that life
insurance refers to the cash surrender value of the life insurance that
is under 20 CFR 418.3425.
Response: We are unable to adopt this suggestion because the
statutory exclusion is not limited to the cash surrender value of life
insurance. ``No part of the value of any life insurance policy shall be
taken into account'' in determining the resources of an individual and
the eligible spouse of the individual.\3\
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\3\ Medicare Improvements for Patients and Providers Act of
2008, Public Law 110-275, 122 Stat. 2494 (2008).
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[[Page 2448]]
Accordingly, the interim final rule remains unchanged and we are
adopting it as final.
Regulatory Procedures
Executive Order 12866 as Supplemented by Executive Order 13563
We consulted with the Office of Management and Budget (OMB) and
determined that this final rule meets the criteria for a significant
regulatory action under Executive Order 12866 as supplemented by
Executive Order 13563. Thus, OMB reviewed the final rule.
Regulatory Flexibility Act
We certify that these final rules will not have a significant
economic impact on a substantial number of small entities, because they
affect individuals only. Therefore, a regulatory flexibility analysis
is not required under the Regulatory Flexibility Act, as amended.
Paperwork Reduction Act
These rules do not create any new or affect any existing
collections and, therefore, do not require Office of Management and
Budget approval under the Paperwork Reduction Act.
(Catalog of Federal Domestic Assistance Program Nos. 93.770,
Medicare Prescription Drug Coverage; 96.002 Social Security--
Retirement Insurance.)
List of Subjects in 20 CFR Part 418
Administrative practice and procedure, Aged, Blind, Disability
benefits, Public assistance programs, Reporting and recordkeeping
requirements, Supplemental Security Income (SSI), Medicare subsidies.
Michael J. Astrue,
Commissioner of Social Security.
Accordingly, the interim rule amending 20 CFR chapter III, part
418, subpart D that was published at 75 FR 81843 on December 29, 2010,
is adopted as a final rule without change.
[FR Doc. 2012-827 Filed 1-17-12; 8:45 am]
BILLING CODE 4191-02-P