Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount for Calendar Year 2022
| Published date | 25 October 2021 |
| Citation | 86 FR 58917 |
| Record Number | 2021-23143 |
| Section | Notices |
| Court | Centers For Medicare & Medicaid Services |
Federal Register, Volume 86 Issue 203 (Monday, October 25, 2021)
[Federal Register Volume 86, Number 203 (Monday, October 25, 2021)]
[Notices]
[Pages 58917-58918]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-23143]
[[Page 58917]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-6091-N]
RIN 0938-ZB70
Medicare, Medicaid, and Children's Health Insurance Programs;
Provider Enrollment Application Fee Amount for Calendar Year 2022
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice announces a $631.00 calendar year (CY) 2022
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, 2022 and on or before December 31, 2022.
DATES: The application fee announced in this notice is effective on
January 1, 2022.
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, CMS-20134, 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), 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:
A Medicare physician or non-physician practitioner
submitting a CMS-855I.
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 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 calendar year (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. Each year since 2011, accordingly, we have
published in the Federal Register an announcement of the application
fee amount for the forthcoming CY based on the formula noted
previously. Most recently, in the November 23, 2020 Federal Register
(85 FR 74724), we published a notice announcing a fee amount for the
period of January 1, 2021 through December 31, 2021 of $599.00. The
$599.00 fee amount for CY 2021 was used to calculate the fee amount for
2022 as specified in Sec. 424.514(d)(2).
According to Bureau of Labor Statistics (BLS) data, the CPU-U
increase for the period of July 1, 2020 through June 30, 2021 was 5.4
percent. As required by Sec. 424.514(d)(2), the preceding year's fee
of $599 will be adjusted by 5.4 percent. This results in a CY 2022
application fee amount of $631.35 ($599 x 1.054). As we must round this
to the nearest whole dollar amount, the resultant application fee
amount for CY 2022 is $631.00.
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. However, it does reference previously approved information
collections. The Forms CMS-855A, CMS-855B, and CMS-855I are approved
under OMB control number 0938-0685; the Form CMS-855S is approved under
OMB control number 0938-1056.
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 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. A
regulatory impact analysis (RIA) must be prepared for major rules with
economically significant effects ($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
[[Page 58918]]
economic threshold and is not considered a major notice.
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 $7.5 million to $38.5 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 with comment
period (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 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 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 would 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 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 2021, that
threshold was approximately $158 million. The Agency has determined
that there will be minimal impact from the costs of this notice, 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 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.
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 2022. The CY 2022 cost estimates are as follows:
1. Medicare
Based on CMS data, we estimate that in CY 2022 approximately--
10,214 newly enrolling institutional providers will be
subject to and pay an application fee; and
42,117 revalidating institutional providers will be
subject to and pay an application fee.
Using a figure of 52,331 (10,214 newly enrolling + 42,117
revalidating) institutional providers, we estimate an increase in the
cost of the Medicare application fee requirement in CY 2022 of
$1,674,592 (or 52,331 x $32 (or $631 minus $599)) from our CY 2021
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
2022. Using this figure, we project an increase in the cost of the
Medicaid and CHIP application fee requirement in CY 2022 of $960,000
(or 30,000 x $32 (or $631 minus $599)) from our CY 2021 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 2022 to be $2,634,592 ($1,674,592 +
$960,000) from our CY 2021 projections.
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 Lynette Wilson, who is the Federal Register
Liaison, to electronically sign this document for purposes of
publication in the Federal Register.
Dated: October 19, 2021.
Lynette Wilson,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2021-23143 Filed 10-22-21; 8:45 am]
BILLING CODE 4120-01-P
