Department of Health and Human Services, Centers for Medicare and Medicaid Services: Medicaid Program; Premiums and Cost Sharing
GAO-09-241R: Dec 10, 2008
- Full Report:
GAO reviewed the Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) new rule on Medicaid program premiums and cost sharing. GAO found that (1) the final rule implements and interprets the provisions of sections 6041, 6042, and 6043 of the Deficit Reduction Act of 2005 and section 405(a)(1) of the Tax Relief and Health Care Act of 2006 (TRHCA) including limitations on cost sharing for individuals with family incomes at or below 100 percent of the federal poverty line, amended the Social Security Act to provide state Medicaid agencies with increased flexibility to impose premium and cost sharing requirements on certain Medicaid recipients, and also address cost sharing for non-preferred drugs and non-emergency care furnished in a hospital emergency department; and (2) CMS complied with the applicable requirements in promulgating the rule.
Department of Health and Human Services, Centers for Medicare and Medicaid Services: Medicaid Program; Premiums and Cost Sharing, GAO-09-241R, December 10, 2008
The Honorable Charles B. Rangel
The Honorable Jim McCrery
Ranking Minority Member
Committee on Ways and Means
House of Representatives
Pursuant to section 801(a)(2)(A) of title 5, United States Code, this is our report on a major rule promulgated by the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), entitled Medicaid Program; Premiums and Cost Sharing (RIN: 0938-AO47). We received the rule on
The final rule implements and interprets the provisions of sections 6041, 6042, and 6043 of the Deficit Reduction Act of 2005 (DRA), Pub. L. No. 109-171, 120 Stat. 4 (
Enclosed is our assessment of the CMS's compliance with the procedural steps required by section 801(a)(1)(B)(i) through (iv) of title 5 with respect to the rule. Our review indicates that CMS complied with the applicable requirements.
If you have any questions about this report or wish to contact GAO officials responsible for the evaluation work relating to the subject matter of the rule, please contact Michael R. Volpe, Assistant General Counsel, at (202) 512-8236.
Robert J. Cramer
Associate General Counsel
REPORT UNDER 5 U.S.C. sect. 801(a)(2)(A) ON A MAJOR RULE
ISSUED BY THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES,
CENTERS FOR MEDICARE AND MEDICAID SERVICES
"MEDICAID PROGRAM; PREMIUMS AND COST SHARING"
(i) Cost-benefit analysis
CMS performed a cost-benefit analysis of the final rule. CMS estimates the impact for Medicaid enrollees as a cost increase of $105 million in 2007, $155 million in 2008, $255 million in 2009, $375 million in 2010, and $455 million in 2011. CMS states that although these estimates reflect an increase of costs on beneficiaries, the final rule will not pose a barrier to accessing health care. This is because the law provides that states can impose alternate cost sharing. CMS also expects that the final rule will promote the modernization of the Medicaid program.
(ii) Agency actions relevant to the Regulatory Flexibility Act, 5 U.S.C. sections 603-605, 607, and 609
CMS certified that the final rule would not have a significant impact on a substantial number of small entities, and therefore, did not prepare a Final Regulatory Flexibility Analysis.
(iii) Agency actions relevant to sections 202-205 of the Unfunded Mandates Reform Act of 1995, 2 U.S.C. sections 1532-1535
CMS determined that the final rule would likely result in new spending by Medicaid enrollees in excess of the threshold of approximately $130 million in the Unfunded Mandates Reform Act. The final rule outlines the total increase in Medicaid enrollees cost sharing as a result of all the provisions of the Deficit Reduction Act of 2005. This includes an estimated cost increase to Medicaid recipients of $105 million in 2007, $155 million in 2008, $255 million in 2009, $375 million in 2010, and $455 million in 2011.
(iv) Other relevant information or requirements under acts and executive orders
Administrative Procedure Act, 5 U.S.C. sections 551 et seq.
The final rule was issued using the notice and comment procedures found at 5 U.S.C. sect. 553. CMS published a proposed rule in the Federal Register on
Paperwork Reduction Act, 44 U.S.C. sections 3501-3520
The final rule contains information collection requirements that were submitted for review by the Office of Management and Budget (OMB) as required by the Act. OMB approved these information collections under OMB number 0938-0993. In response to comments on the proposed rule, however, CMS revised the information collection requirements and has submitted these revisions to OMB for approval. Moreover, CMS has requested comments on the revisions to the information collection requirements in the final rule.
Statutory authorization for the rule
The final rule implements and interprets the provisions of sections 6041, 6042, and 6043 of the Deficit Reduction Act of 2005, Pub. L. No. 109-171 (
Executive Order No. 12,866
The final rule was reviewed by OMB and found to be an economically significant regulatory action under the Order.
Executive Order No. 13,132 (Federalism)
CMS determined that the final rule would not impose substantial direct requirements costs on state and local governments.