1657661863 Inn Social Default

Medicare, Medicaid, and Children’s Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2023

Agency: “Centers for Medicare and Medicaid Services (CMS), HHS.”

SecurityBenefits 728 X 90 2022 09 3

SUMMARY: This notice announces s $688.00 calendar year (CY) 2023 application fee for institutional providers initially enrolling in the Medicare or Medicaid program or the Children’s Health Insurance Program (CHIP); revalidation of 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, 2023 and on or before December 31, 2023.

DATES: The application fee announced in this notice is effective January 1, 2023.

CONTACT FOR FURTHER INFORMATION: Frank Whelan(410) 786-1302.


I. Background In the February 2, 2011 Federal Register (76 FR 5862), we published a final rule with comment period entitled “Medicare, Medicaid, and Children’s Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions, and Compliance Plans for Providers and Providers.” This rule finalized, among other things, provisions related to the submission of application fees as part of the Medicare, Medicaid, and CHIP provider registration 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 initially join the Medicare or Medicaid programs or CHIP revalidate enroll. their enrollment, or the addition of a new Medicare practice location is 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 submitting a paper Medicare enrollment application by submitting the CMS-855A, CMS-855B (not physician and nonphysician 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 will 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 et seq SEC 455.460, the application fee is not required for either:

* A Medicare physician or nonphysician practitioner submitting a CMS-855I.

* A prospective or revalidating Medicaid or CHIP provider–

++ Who is an individual physician or non-physician practitioner; or

++ It is enrolled as an institutional provider in Title XVIII of the Act or 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 enacted s $500 application fee for institutional providers in CY 2010. In accordance with section 1866(j)(2)(C)(i)(II) of the Act, SEC 424.514(d)(2) provides that for CY 2011 and subsequent years, the previous 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, every year since 2011 we have published in the Federal Register an announcement of the application fee amount for the upcoming CY based on this formula. Most recently, in the 25 October 2021 Federal Register (86 FR 58917), we published a notice setting a fee amount for the period of January 1, 2022 by December 31, 2022 of $631.00. The $631.00 fee amount for CY 2022 was used to calculate the fee amount for 2023 as specified in SEC 424.514(d)(2).

According to Bureau of Labor Statistics (BLS) data, the CPI-U increase for the period of 1 July 2021 by 30 June 2022 was 9.1 percent. As required by SEC 424.514(d)(2), the preceding year’s fee of $631 will be adjusted by 9.1 percent. This results in a CY 2023 application fee amount of $688.42 ($631 x 1.091). Since we have to round this to the nearest whole dollar amount, the resulting application fee amount for CY 2023 is $688.00.

III. Collection of information requirements

This document does not set out information collection requirements (ie reporting, record keeping or third party disclosure requirements). Accordingly, it is not necessary for review by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995. However, it does refer to previously approved information collections. The CMS-855A, CMS-855B, CMS-855I, and CMS-855S applications are approved under OMB control numbers 0938-0685, 0938-1377, 0938-1355, and 0938-1056, respectively.

IV. Regulatory Impact Statement

A. Background and Review Requirements

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, 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 USC 804(2)).

Executive Orders 12866 and 13563 direct agencies to evaluate 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, distributional impacts, and fairness. A Regulatory Impact Analysis (RIA) must be prepared for important rules with economically significant consequences ($100 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 $100 million. Therefore, this notice does not reach the $100 million economic threshold and is not considered a major notice.

B. Costs

The costs associated with this notice involve the increase in the application fee amount that certain providers and suppliers must pay in CY 2023. The CY 2023 cost estimates are as follows:

1. Medicare

Based on CMS data, we estimate that in CY 2023 approximately–

* 14,726 institutional providers who newly enroll will be subject to and pay an application fee; and

* 47,000 revalidating institutional providers will be subject to and pay an application fee.

Using a figure of 61,726 (14,726 new enrollees + 47,000 revalidating) institutional providers, we estimate an increase in the cost of the Medicare application fee requirement in CY 2023 of $3,518,382 (or 61,726 x $57 (or $688 minus $631)) of our CY 2022 projections.

2. Medicaid and CHIP

Based on CMS and state statistics, we estimate that approximately 30,000 (9,000 new enrollees + 21,000 revalidating) Medicaid and CHIP institutional providers will be subject to an application fee in CY 2023. Using this figure, we project a increase in the cost of the Medicaid and CHIP application fee requirement in CY 2023 from $1,710,000 (or 30,000 x $57 (or $688 minus $631)) of our CY 2022 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 2023 as $5,228,382 ($3,518,382 + $1,710,000) of our CY 2022 projections.

We do not expect any negative impact on equity from the increase in the application fee amount, which we have calculated in accordance with the requirements specified in statute and regulation. Previous application fee increases have not had such a noticeable effect, and we reiterate that the fee requirement does not apply to individual physicians and nonphysician practitioners who complete the CMS-855I, representing the overwhelming majority of the more than 2 million Medicare -represent registered suppliers. and suppliers.

The RFA requires agencies to analyze options for regulatory relief from small businesses. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small government jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by revenue of less than $8 million on $41.5 million in any 1 year. Individuals and states are not included in the definition of a small entity. As we 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 a regulatory impact analysis if a rule could have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must comply with 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 a Metropolitan Statistical Area for Medicare payment regulations and has fewer than 100 beds. We are not preparing an analysis for section 1102(b) of the Act because we have determined, and the Secretary certifies, 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 (UMRA) also requires agencies to assess expected 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 2022, that threshold was approx $165 million. The Agency has determined that the cost of this notice will have minimal impact, as the threshold is not met under the UMRA.

Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes significant 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 do not apply.

In accordance with the provisions of Executive Order 12866, this notice has been revised by the Office of Management and Budget.

The Administrator of the Centers for Medicare and Medicaid Services (CMS), Chiquita Brooks-LaSureafter reviewing and approving this document, authorizes Lynette Wilsonwhich is the Federal Register link, to electronically sign this document.

Dated: 29 November 2022.

Lynette Wilson,

Federal Register liaison, Centers for Medicare and Medicaid Services.

[FR Doc. 2022-26340 Filed 12-2-22; 8:45 am]


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