[Federal Register Volume 78, Number 181 (Wednesday, September 18, 2013)]
[Rules and Regulations]
[Pages 57257-57260]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-22445]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 418

[Docket No. SSA-2012-0011]
RIN 0960-AH47


Medicare Determinations and Income-Related Monthly Adjustment 
Amounts to Medicare Part B Premiums; Conforming Changes to Regulations

AGENCY: Social Security Administration.

ACTION: Interim final rule with request for comments.

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SUMMARY: We are modifying our regulations regarding Medicare Part B 
income-related monthly adjustment amounts (IRMAA) in order to conform 
to changes made to the Social Security Act (Act) by the Affordable Care 
Act. This rule freezes the modified adjusted gross income threshold and 
ranges from 2011 through 2019 and removes the requirement that 
beneficiaries consent to our release of Internal Revenue Service (IRS) 
information to the U.S. Department of Health and Human Services (HHS) 
for the purpose of adjudicating any appeal of an IRMAA to the Part B 
premium subsidy. We are also removing provisions that phased in IRMAA 
between 2007 and 2009 and updating a citation to reflect the transfer 
of authority for hearing appeals under Title XVIII of the Act from the 
Social Security Administration to HHS.

DATES: Effective Date: This interim final rule will be effective 
September 18, 2013.
    Comment Date: To ensure that your comments are considered, we must 
receive them no later than November 18, 2013.

ADDRESSES: You may submit comments by any one of three methods--
Internet, fax, or mail. Do not submit the same comments multiple times 
or by more than one method. Regardless of which method you choose, 
please state that your comments refer to Docket No. SSA-2012-0011 so 
that we may associate your comments with the correct regulation.
    Caution: You should be careful to include in your comments only 
information that you wish to make publicly available. We strongly urge 
you not to include in your comments any personal information such as 
Social Security numbers or medical information.
    1. Internet: We strongly recommend that you submit your comments 
via the Internet. Please visit the Federal eRulemaking portal at http://www.regulations.gov. Use the Search function to find docket number 
SSA-2012-0011. The system will issue a tracking number to confirm your 
submission. You will not be able to view your comment immediately 
because we must post each comment manually. It may take up to a week 
for your comment to be viewable.
    2. Fax: Fax comments to (410) 966-2830.
    3. Mail: Mail your comments to the Office of Regulations, Social 
Security Administration, 107 Altmeyer Building, 6401 Security 
Boulevard, Baltimore, Maryland 21235-6401.
    Comments are available for public viewing on the Federal 
eRulemaking portal at http://www.regulations.gov or in person, during 
regular business hours, by arranging with the contact person identified 
below.

FOR FURTHER INFORMATION CONTACT: Craig Streett, Office of Income 
Security Programs, Social Security Administration, 2-R-24 Robert M. 
Ball Federal 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

    Medicare Part B is a voluntary medical insurance program that 
provides coverage for services such as physician's care, diagnostic 
services, and medical supplies. A beneficiary enrolled in Medicare Part 
B pays monthly premiums, deductibles, and co-insurance associated with 
covered services. The Centers for Medicare & Medicaid Services (CMS) 
issues rules and regulations about the Medicare program, including the 
standard monthly premium. We determine and

[[Page 57258]]

deduct the amount of certain Medicare Part B premiums from 
beneficiaries' Social Security benefits and make rules and regulations 
necessary to carry out these functions.
    The Federal Government subsidizes the cost of Medicare Part B 
coverage. However, beneficiaries with modified adjusted gross incomes 
(MAGI) above a specified threshold must pay a higher percentage of the 
average cost of coverage than those with MAGI below the threshold.\1\ 
We refer to this subsidy reduction as an IRMAA.
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    \1\ MAGI is defined in 42 U.S.C. 1395r(i)(4). The threshold 
amount is defined in 42 U.S.C. 1395r(i)(2).
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    CMS determines and publishes the annual MAGI threshold and ranges. 
The IRS provides us with beneficiaries' MAGI information for the 
applicable tax year. We use this information to determine IRMAAs using 
the CMS-determined annual MAGI threshold.
    In March 2010, Congress passed the Affordable Care Act.\2\ The 
Affordable Care Act temporarily freezes the MAGI threshold above which 
beneficiaries must pay a higher percentage of the costs of their 
coverage. As a result, we are updating our regulations to reflect this 
change.
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    \2\ Public Law 111-148.
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    Section 3402 of the Affordable Care Act temporarily set aside the 
annual inflation adjustment used to set the MAGI threshold and ranges 
for purposes of determining IRMAAs. From January 1, 2011 through 
December 31, 2019, the dollar amounts used for 2010 are the threshold 
and ranges used to determine if an IRMAA will apply. During this 
period, the threshold is $170,000 for beneficiaries who file their 
Federal income taxes as married filing jointly and $85,000 for 
beneficiaries who file their Federal income taxes with any other filing 
status.\3\ After 2019, these thresholds will resume adjustment for 
inflation as required by section 1839(i)(5) of the Act.
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    \3\ 74 FR 54571, 54573 (2009).
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Regulatory Changes

    We revised sections 418.1105, What is the threshold?, 418.1115, 
What are the modified adjusted gross income ranges?, and 418.1120, How 
do we determine your income-related monthly adjustment amount?, to 
reflect the new threshold and ranges established by the Affordable Care 
Act.
    We removed section 418.1130 as well as language from sections 
418.1001(b), 418.1101(c), 418.1125(b), and 418.1230(a) that described 
how we phased in the IRMAA. When Congress created the IRMAA, it 
provided for a gradual phase-in of the subsidy reduction. We completed 
the phase-in in 2009. Therefore, section 418.1130 and the phase-in 
language used in the revised sections are no longer necessary.
    We deleted from section 418.1350 the requirement that an individual 
provide consent for us to release relevant tax return information to 
HHS' Office of Medicare Hearings and Appeals or Medicare Appeals 
Council for the purposes of adjudicating any appeal of the amount of an 
IRMAA to the Part B premium subsidy. The Affordable Care Act removed 
this requirement by amending section 6103(l)(20) of the Internal 
Revenue Code to provide that we may disclose return information to 
officers and employees of the Department of HHS to the extent necessary 
to resolve administrative appeals of premium subsidy adjustments or 
increased premiums.\4\
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    \4\ Public Law 111-148, sec. 3308(b)(2)(C)(iv).
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    We also updated 20 CFR 404.900(a) to correct an outdated citation 
to the HHS regulations. We replaced the reference to 42 CFR 405.701(c) 
with 42 CFR 405.904(a)(1). 42 CFR 405.904(a)(1) provides that we make 
initial determinations and reconsiderations of Medicare Part A and B 
applications and entitlement, and HHS handles Medicare appeals 
following a reconsideration.

Regulatory Procedures

    We follow the Administrative Procedure Act (APA) rulemaking 
procedures specified in 5 U.S.C. 553 when we develop regulations. 
Generally, the APA requires that an agency provide prior notice and 
opportunity for public comment before issuing a final rule. The APA 
provides exceptions to its notice and public comment procedures when an 
agency finds good cause for dispensing with such procedures because 
they are impracticable, unnecessary, or contrary to the public 
interest, and the agency incorporates a statement of the finding and 
its reasons in the rule issued.\5\
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    \5\ 5 U.S.C. 553(b)(B).
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    We find that good cause exists for proceeding without prior public 
notice and comment with respect to the changes that freeze the MAGI 
threshold and ranges at 2010 levels from January 1, 2011 until December 
31, 2019 and that remove the requirement that individuals consent to 
our release of relevant tax information to HHS for adjudication of 
IRMAA appeals. These changes are nondiscretionary under the Affordable 
Care Act. Accordingly, we find that prior public comment with respect 
to these changes is unnecessary.
    We also find that good cause exists for proceeding without prior 
public notice and comment with respect to the changes that remove the 
outdated phase-in procedures from our rules. The language we are 
removing has no current effect and has not applied since we completed 
the IRMAA phase-in in 2009. Therefore, we find prior comment with 
respect to these changes is also unnecessary.
    We also find that good cause exists for proceeding without prior 
public notice and comment with respect to the change to 20 CFR 
404.900(a) because it is a technical change that only updates a 
citation to the HHS regulations. Therefore, we also find that prior 
public comment with respect to this change is unnecessary.
    Additionally, we find that good cause exists for dispensing with 
the 30-day delay in the effective date of this rule. For the reasons we 
stated above, we find that it is unnecessary to delay the effective 
date of the changes we are making in this interim final rule. 
Accordingly, we are making this interim final rule effective September 
18, 2013.

Executive Order 12866

    We consulted with the Office of Management and Budget (OMB) and 
determined that this interim rule meets the criteria for a significant 
regulatory action under Executive Order 12866. It was subject to OMB 
review.

Regulatory Flexibility Act

    We certify that this interim final rule will not have a significant 
economic impact on a substantial number of small entities because it 
affects individuals only. Therefore, a regulatory flexibility analysis 
is not required under the Regulatory Flexibility Act, as amended.

Paperwork Reduction Act (PRA)

    These rules do not impose any new public reporting burdens under 
the PRA or affect any existing OMB-approved PRA collections.

(Catalog of Federal Domestic Assistance Program Nos. 93.774 Medicare 
Supplementary Medical Insurance; 96.002 Social Security--Retirement 
Insurance.)

List of Subjects

20 CFR Part 404

    Administrative practice and procedure, Aged, Alimony, Blind, 
Disability benefits, Government employees, Income taxes, Insurance, 
Investigations, Old-age, Survivors and disability insurance, Penalties, 
Railroad retirement, Reporting and recordkeeping requirements, Social 
Security, Travel and transportation expenses, Treaties, Veterans, 
Vocational rehabilitation.

[[Page 57259]]

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.

    Dated: September 9, 2013.
Carolyn W. Colvin,
Acting Commissioner of Social Security.

    For the reasons set out in the preamble, we amend 20 CFR chapter 
III, part 404, subpart J and 20 CFR chapter III, part 418, subpart B as 
set forth below:

PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE 
(1950- )

Subpart J--Determinations, Administrative Review Process, and 
Reopening of Determinations and Decisions

0
1. The authority citation for subpart J of part 404 continues to read 
as follows:

    Authority: Secs. 201(j), 204(f), 205(a)-(b), (d)-(h), and (j), 
221, 223(i), 225, and 702(a)(5) of the Social Security Act (42 
U.S.C. 401(j), 404(f), 405(a)-(b), (d)-(h), and (j), 421, 423(i), 
425, and 902(a)(5)); sec. 5, Pub. L. 97-455, 96 Stat. 2500 (42 
U.S.C. 405 note); secs. 5, 6(c)-(e), and 15, Pub. L. 98-460, 98 
Stat. 1802 (42 U.S.C. 421 note); sec. 202, Pub. L. 108-203, 118 
Stat. 509 (42 U.S.C. 902 note).


0
2. Amend Sec.  404.900 by removing ``42 CFR 405.701(c)'' from paragraph 
(a) and adding in its place ``42 CFR 405.904(a)(1).''

PART 418--MEDICARE SUBSIDIES

Subpart B--Medicare Part B Income-Related Monthly Adjustment Amount

0
3. The authority citation for subpart B of part 418 continues to read 
as follows:

    Authority: Secs. 702(a)(5) and 1839(i) of the Social Security 
Act (42 U.S.C. 902(a)(5) and 1395r(i)).


Sec.  418.1001  [Amended]

0
4. Amend Sec.  418.1001 by removing the last sentence of paragraph (b).

0
5. Amend Sec.  418.1101 by revising paragraph (c) to read as follows:


Sec.  418.1101  What is the income-related monthly adjustment amount?

* * * * *
    (c) We will determine your income-related monthly adjustment amount 
using the method described in Sec.  418.1120.

0
6. Amend Sec.  418.1105 by revising paragraphs (b) and (c) to read as 
follows:


Sec.  418.1105  What is the threshold?

* * * * *
    (b) From January 1, 2011 through December 31, 2019, the modified 
adjusted gross income threshold is $170,000 for individuals with a 
Federal income tax filing status of married filing jointly. The 
threshold is $85,000 for individuals with any other filing status.
    (c) Starting on January 1, 2020, the threshold amounts will resume 
adjustment for inflation as required by section 1839(i)(5) of the Act. 
In each year thereafter, CMS will set all modified adjusted gross 
income threshold amounts for the following year by increasing the 
preceding year's threshold amounts by any percentage increase in the 
Consumer Price Index rounded to the nearest $1,000. CMS will publish 
the amounts in the Federal Register in September of each year. 
Published threshold amounts will be effective January 1 of the next 
calendar year, for the full calendar year.

0
7. Revise Sec.  418.1115 to read as follows:


Sec.  418.1115  What are the modified adjusted gross income ranges?

    (a) We list the modified adjusted gross income ranges for the 
calendar years 2011 through and including 2019 for each Federal tax 
filing category in paragraphs (b), (c) and (d) of this section. We will 
use your modified adjusted gross income amount together with your tax 
filing status to determine the amount of your income-related monthly 
adjustment for these calendar years.
    (b) For calendar years 2011 through and including 2019, the 
modified adjusted gross income ranges for individuals with a Federal 
tax filing status of single, head of household, qualifying widow(er) 
with dependent child, and married filing separately when the individual 
has lived apart from his/her spouse for the entire tax year for the 
year we use to make our income-related monthly adjustment amount 
determination are as follows:
    (1) Greater than $85,000 and less than or equal to $107,000;
    (2) Greater than $107,000 and less than or equal to $160,000;
    (3) Greater than $160,000 and less than or equal to $214,000; and
    (4) Greater than $214,000.
    (c) For calendar years 2011 through and including 2019, the 
modified adjusted gross income ranges for individuals who are married 
and filed a joint tax return for the tax year we use to make the 
income-related monthly adjustment amount determination are as follows:
    (1) Greater than $170,000 and less than or equal to $214,000;
    (2) Greater than $214,000 and less than or equal to $320,000;
    (3) Greater than $320,000 and less than or equal to $428,000; and
    (4) Greater than $428,000.
    (d) For calendar years 2011 through and including 2019, the 
modified adjusted gross income ranges for married individuals who file 
a separate return and have lived with their spouse at any time during 
the tax year we use to make the income-related monthly adjustment 
amount determination are as follows:
    (1) Greater than $85,000 and less than or equal to $129,000; and
    (2) Greater than $129,000.
    (e) In 2019, CMS will set all modified adjusted gross income ranges 
for 2020 and publish them in the Federal Register. In each year 
thereafter, CMS will set all modified adjusted gross income ranges by 
increasing the preceding year's ranges by any percentage increase in 
the Consumer Price Index rounded to the nearest $1,000 and will publish 
the amounts for the following year in September of each year.

0
8. Revise Sec.  418.1120 to read as follows:


Sec.  418.1120  How do we determine your income-related monthly 
adjustment amount?

    (a) We will determine your income-related monthly adjustment amount 
by using your tax filing status and modified adjusted gross income.
    (b) Tables of applicable percentage. The tables in paragraphs 
(b)(1) through (b)(3) of this section contain the modified adjusted 
gross income ranges for calendar years 2011 through and including 2019 
in the column on the left in each table. The middle column in each 
table shows the percentage of the unsubsidized Medicare Part B premium 
that will be paid by individuals with modified adjusted gross income 
that falls within each of the ranges. The column on the right in each 
table shows the percentage of the Medicare Part B premium that will be 
subsidized by contributions from the Federal Government. We use your 
tax filing status and your modified adjusted gross income for the tax 
year to determine which income-related monthly adjustment amount to 
apply to you. The dollar amount of income-related monthly adjustment 
for each range will be set annually for each year after 2019 as 
described in paragraph (c) of this section. The modified adjusted gross 
income ranges will be adjusted annually after 2019 as described in 
Sec.  418.1115(e).

[[Page 57260]]

    (1) General table of applicable percentages. If, for the tax year, 
we use your filing status for your Federal income taxes for the tax 
year is single; head of household; qualifying widow(er) with dependent 
child; or married filing separately and you lived apart from your 
spouse for the entire tax year, we will use the general table of 
applicable percentages. When your modified adjusted gross income for 
the year we use is in the range listed in the left column in the 
following table, then the Federal Government's Part B premium subsidy 
of 75 percent is reduced to the percentage listed in the right column.
    You will pay an amount based on the percentage listed in the center 
column.

------------------------------------------------------------------------
                                         Beneficiary     Federal premium
   Modified adjusted gross income        percentage          subsidy
       effective in 2011-2019             (percent)         (percent)
------------------------------------------------------------------------
More than $85,000 but less than or                  35                65
 equal to $107,000..................
More than $107,000 but less than or                 50                50
 equal to $160,000..................
More than $160,000 but less than or                 65                35
 equal to $214,000..................
More than $214,000..................                80                20
------------------------------------------------------------------------

    (2) Table of applicable percentages for joint returns. If, for the 
tax year, we use your Federal tax filing status is married filing 
jointly for the tax year and your modified adjusted gross income for 
that tax year is in the range listed in the left column in the 
following table, then the Federal Government's Part B premium subsidy 
of 75 percent is reduced to the percentage listed in the right column. 
You will pay an amount based on the percentage listed in the center 
column.

------------------------------------------------------------------------
                                         Beneficiary     Federal premium
   Modified adjusted gross income        percentage          subsidy
       effective in 2011-2019             (percent)         (percent)
------------------------------------------------------------------------
More than $170,000 but less than or                 35                65
 equal to $214,000..................
More than $214,000 but less than or                 50                50
 equal to $320,000..................
More than $320,000 but less than or                 65                35
 equal to $428,000..................
More than $428,000..................                80                20
------------------------------------------------------------------------

    (3) Table of applicable percentages for married individuals filing 
separate returns. If, for the tax year, we use your Federal tax filing 
status is married filing separately, you lived with your spouse at some 
time during that tax year, and your modified adjusted gross income is 
in the range listed in the left column in the following table, then the 
Federal Government's Part B premium subsidy of 75 percent is reduced to 
the percentage listed in the right column. You will pay an amount based 
on the percentage listed in the center column.

------------------------------------------------------------------------
                                         Beneficiary     Federal premium
   Modified adjusted gross income        percentage          subsidy
       effective in 2011-2019             (percent)         (percent)
------------------------------------------------------------------------
More than $85,000 but less than or                  65                35
 equal to $129,000..................
More than $129,000..................                80                20
------------------------------------------------------------------------

    (c) For each year after 2019, CMS will annually publish in the 
Federal Register the dollar amounts for the income-related monthly 
adjustment amount described in paragraph (b) of this section.


Sec.  418.1125  [Amended]

0
9. Amend Sec.  418.1125 by removing paragraph (b) and redesignating 
paragraph (c) as paragraph (b).


Sec.  418.1130  [Removed and reserved]

0
10. Remove and reserve Sec.  418.1130.

0
11. Amend Sec.  418.1230 to remove paragraph (a), redesignate 
paragraphs (b) through (d) as paragraphs (a) through (c), and revise 
new paragraph (a) to read as follows:


Sec.  418.1230  What is the effective date of an income-related monthly 
adjustment amount initial determination that is based on a more recent 
tax year?

    (a) Subject to paragraph (b) of this section, when your modified 
adjusted gross income for the more recent tax year is significantly 
reduced as a result of a major life-changing event, our initial 
determination is generally effective on January 1 of the year in which 
you make your request. If your first month of enrollment or 
reenrollment in Medicare Part B is after January of the year for which 
you make your request, our initial determination is effective on the 
first day of your Medicare Part B enrollment or reenrollment.
* * * * *

0
12. Revise Sec.  418.1350 to read as follows:


Sec.  418.1350  What are the rules for review of a reconsidered 
determination or an administrative law judge decision?

    You may request a hearing before an OMHA administrative law judge 
consistent with HHS' regulations at 42 CFR part 405. You may seek 
further review of the administrative law judge's decision by requesting 
MAC review and judicial review in accordance with HHS' regulations.

[FR Doc. 2013-22445 Filed 9-17-13; 8:45 a.m.]
BILLING CODE 4191-02-P