Medicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying Individuals: Federal Fiscal Year 2005, 50214-50220 [05-16973]
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Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Rules and Regulations
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[FR Doc. 05–16929 Filed 8–25–05; 8:45 am]
BILLING CODE 6560–50–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 405
[CMS–4064–IFC3]
RIN–0938–AM73
Medicare Program; Changes to the
Medicare Claims Appeal Procedures:
Correcting Amendment to a Correcting
Amendment
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Correcting amendment.
AGENCY:
SUMMARY: This correcting amendment
corrects a technical error in the
correcting amendment that appeared in
the Federal Register, entitled ‘‘Medicare
Program; Changes to the Medicare
Claims Appeal Procedures: Correcting
Amendment to an Interim Final Rule.’’
DATES: Effective Date: This correcting
amendment is effective September 26,
2005.
FOR FURTHER INFORMATION CONTACT:
Arrah Tabe-Bedward, (410) 786–7129.
procedure if we find good cause for
doing so, and incorporate a statement of
this finding and the reasons for it into
the rule. A finding that a notice and
comment period is impracticable,
unnecessary, or contrary to the public
interest constitutes good cause for
waiving this procedure.
We believe that it is unnecessary to
seek public comment on the correction
of this editorial error. Further, it is in
the public’s interest to correct this
editorial error because it makes the
section more understandable to parties
pursuing Medicare appeals under these
procedures. Therefore, we find good
cause to waive notice and comment
procedures.
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program)
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare-Hospital
Insurance; and Program No. 93.774,
Medicare-Supplementary Medical Insurance
Program)
Correction of Regulation Text Error
Accordingly, 42 CFR chapter IV is
corrected by making the following
correction to part 405:
■
PART 405—[CORRECTED]
1. The authority citation for part 405
continues to read as follows:
■
SUPPLEMENTARY INFORMATION:
I. Background
We have identified a technical error
that appeared in a correcting
amendment entitled ‘‘Medicare
Program; Changes to the Medicare
Claims Appeal Procedures: Correcting
Amendment to an Interim Final Rule.’’
(70 FR 37700, June 30, 2005) In this
correcting amendment, we are
correcting that technical error.
II. Correction of Error
A. Technical Correction to the
Regulations Text
In § 405.1020 of the regulation text,
we incorrectly stated the section’s title
as ‘‘Time frames for deciding an appeal
for a hearing before an ALJ.’’ It should
have read, ‘‘Time and place for a
hearing before an ALJ.’’ We correct this
technical error in section B of this
correcting amendment.
Authority: Secs. 205(a), 1102, 1861,
1862(a), 1869, 1871, 1874, 1881, and 1886(k)
of the Social Security Act (42 U.S.C. 405(a),
1302, 1395x, 1395y(a), 1395ff, 1395hh,
1395kk, 1395rr and 1395ww(k)) and Sec. 353
of the Public Health Service Act (42 U.S.C.
263a).
§ 405.1020
[Corrected]
2. Section 405.1020 is amended by
revising the section title to read as
follows:
■
§ 405.1020 Time and place for a hearing
before an ALJ.
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Dated: August 16, 2005.
Ann C. Agnew,
Executive Secretary to the Department.
[FR Doc. 05–16711 Filed 8–25–05; 8:45 am]
BILLING CODE 4120–01–P
III. Waiver of Proposed Rulemaking
We ordinarily publish a notice of
proposed rulemaking in the Federal
Register to provide a period for public
comment before the provisions of a rule
take effect. However, we can waive this
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 433
[CMS–2210–IFC]
RIN 0938–AO04
Medicaid Program; State Allotments
for Payment of Medicare Part B
Premiums for Qualifying Individuals:
Federal Fiscal Year 2005
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Interim final rule with comment
period.
AGENCY:
SUMMARY: This interim final rule with
comment period sets forth the
methodology used to compute State
allotments that are available to pay
Medicare Part B premiums for
qualifying individuals, allows changes
to the State allotments and describes the
methodology used to determine the
changes to each State’s allotment.
DATES: Effective date: These regulations
are effective August 26, 2005 for
allotments for payment of Medicare Part
B premiums from the allocation for
fiscal year 2005.
Comment date: To be assured
consideration, comments must be
received at one of the addresses
provided below, no later than 5 p.m. on
October 25, 2005.
ADDRESSES: In commenting, please refer
to file code CMS–2210–IFC. Because of
staff and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.
You may submit comments in one of
three ways (no duplicates, please):
1. Electronically. You may submit
electronic comments on specific issues
in this regulation to https://
www.cms.hhs.gov/regulations/
ecomments. (Attachments should be in
Microsoft Word, WordPerfect, or Excel;
however, we prefer Microsoft Word.)
2. By regular mail. You may mail
written comments (one original and two
copies) to the following address ONLY:
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, Attention: CMS–2210–
IFC, P.O. Box 8011, Baltimore, MD
21244–8011.
Please allow sufficient time for mailed
comments to be received before the
close of the comment period.
3. By express or overnight mail. You
may send written comments (one
original and two copies) to the following
address ONLY: Centers for Medicare &
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Medicaid Services, Department of
Health and Human Services, Attention:
CMS–2210–IFC, Mail Stop C4–26–05,
7500 Security Boulevard, Baltimore, MD
21244–1850.
4. By hand or courier. If you prefer,
you may deliver (by hand or courier)
your written comments (one original
and two copies) before the close of the
comment period to one of the following
addresses. If you intend to deliver your
comments to the Baltimore address,
please call telephone number (410) 786–
7195 in advance to schedule your
arrival with one of our staff members.
Room 445–G, Hubert H. Humphrey
Building, 200 Independence Avenue,
SW., Washington, DC 20201; or 7500
Security Boulevard, Baltimore, MD
21244–1850.
(Because access to the interior of the
HHH Building is not readily available to
persons without Federal Government
identification, commenters are
encouraged to leave their comments in
the CMS drop slots located in the main
lobby of the building. A stamp-in clock
is available for persons wishing to retain
a proof of filing by stamping in and
retaining an extra copy of the comments
being filed.)
Comments mailed to the addresses
indicated as appropriate for hand or
courier delivery may be delayed and
received after the comment period.
FOR FURTHER INFORMATION CONTACT:
Christine Gerhardt, (410) 786–0693.
Submitting Comments: We welcome
comments from the public on all issues
set forth in this rule to assist us in fully
considering issues and developing
policies. You can assist us by
referencing the file code CMS–2210–IFC
and the specific ‘‘issue identifier’’ that
precedes the section on which you
choose to comment.
Inspection of Public Comments: All
comments received before the close of
the comment period are available for
viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. We post all electronic
comments received before the close of
the comment period on its public Web
site as soon as possible after they have
been received. Hard copy comments
received timely will be available for
public inspection as they are received,
generally beginning approximately 3
weeks after publication of a document,
at the headquarters of the Centers for
Medicare & Medicaid Services, 7500
Security Boulevard, Baltimore,
Maryland 21244, Monday through
Friday of each week from 8:30 a.m. to
4 p.m. To schedule an appointment to
view public comments, phone 1 800–
743–3951.
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SUPPLEMENTARY INFORMATION:
I. Background
[If you choose to comment on issues in
this section, please include the caption
‘‘BACKGROUND’’ at the beginning of
your comments.]
Section 1902 of the Social Security
Act (the Act) sets forth the requirements
for State plans for medical assistance.
Prior to August 5, 1997, section
1902(a)(10)(E) of the Act specified that
the State Medicaid plan must provide
for some or all types of Medicare costsharing for three eligibility groups of
low-income Medicare beneficiaries.
These three groups included qualified
Medicare beneficiaries (QMBs),
specified low-income Medicare
beneficiaries (SLMBs), and qualified
disabled and working individuals
(QDWIs).
A QMB is an individual entitled to
Medicare Part A with income at or
below the Federal poverty line (FPL)
and resources below $4,000 for an
individual and $6,000 for a couple. A
SLMB is an individual who meets the
QMB criteria, except that his or her
income is above 100 percent of the FPL
and does not exceed 120 percent of the
FPL. A QDWI is a disabled individual
who is entitled to enroll in Medicare
Part A under section 1818A of the Act,
whose income does not exceed 200
percent of the FPL for a family of the
size involved, whose resources do not
exceed twice the amount allowed under
the Supplementary Security Income
(SSI) program, and who is not otherwise
eligible for Medicaid. The definition of
Medicare cost-sharing at section
1905(p)(3) of the Act includes payment
for premiums for Medicare Part B.
Section 4732 of the Balanced Budget
Act of 1997 (BBA), enacted on August
5, 1997, amended section 1902(a)(10)(E)
of the Act to require States to provide
for Medicaid payment of the Medicare
Part B premiums for two additional
eligibility groups of low-income
Medicare beneficiaries, referred to as
qualifying individuals (QIs).
Specifically, a new section
1902(a)(10)(E)(iv)(I) of the Act was
added, under which States must pay the
full amount of the Medicare Part B
premium for qualifying individuals who
would be QMBs but for the fact that
their income level is at least 120 percent
of the FPL but less than 135 percent of
the FPL for a family of the size involved.
These individuals cannot otherwise be
eligible for medical assistance under the
approved State Medicaid plan. The
second group of QIs added under
section 1902(a)(10)(E)(iv)(II) of the Act
includes Medicare beneficiaries who
would be QMBs except that their
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income is at least 135 percent but less
than 175 percent of the FPL for a family
of the size involved, who are not
otherwise eligible for Medicaid under
the approved State plan. These QIs were
eligible for only a portion of Medicare
cost sharing consisting only of a
percentage of the increase in the
Medicare Part B premium attributable to
the shift of Medicare home health
coverage from Part A to Part B (as
provided in section 4611 of the BBA).
Coverage of the second group of QIs
ended on December 31, 2002 and the
2003 Welfare Reform Bill (Pub. L. 108–
89) eliminated reference to the QI–2
benefit. In each of the years 2002 and
2003, Continuing Resolutions extended
the coverage of the first group of QIs
(whose income is at least 120 percent
but less than 135 percent of the Federal
poverty line) through the next fiscal
year, but maintained the annual funding
at the FY 2002 level. In 2004, ‘‘A Bill
to Amend Title XIX of the Social
Security Act to Extend Medicare CostSharing for the Medicare Part B
Premium for Qualifying Individuals’’
(Pub. L. 108–448) continued coverage of
this group through September 30, 2005,
again with no change in funding.
The BBA also added a new section
1933 to the Act to provide for Medicaid
payment of Medicare Part B premiums
for QIs. (The previous section 1933 was
re-designated as section 1934.) Section
1933(a) specifies that a State plan must
provide, through a State plan
amendment, for medical assistance to
pay for the cost of Medicare cost-sharing
on behalf of QIs who are selected to
receive assistance.
Section 1933(b) of the Act sets forth
the rules that States must follow in
selecting QIs and providing payment for
Medicare Part B premiums. Specifically,
the State must permit all qualifying
individuals to apply for assistance and
must select individuals on a first-come,
first-served basis (that is, the State must
select QIs in the order in which they
apply). Under section 1933(b)(2)(B) of
the Act, in selecting persons who will
receive assistance in years after 1998,
States must give preference to those
individuals who received assistance as
QIs, QMBs, SLMBs, or QDWIs in the last
month of the previous year and who
continue to be (or become) QIs. Under
section 1933(b)(4) of the Act, persons
selected to receive assistance in a
calendar year are entitled to receive
assistance for the remainder of the year,
but not beyond, as long as they continue
to qualify. The fact that an individual is
selected to receive assistance at any
time during the year does not entitle the
individual to continued assistance for
any succeeding year. Because the State’s
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allotment is limited by law, section
1933(b)(3) of the Act provides that the
State must limit the number of QIs so
that the amount of assistance provided
during the year is approximately equal
to the allotment for that year.
Section 1933(c) of the Act limits the
total amount of Federal funds available
for payment of Part B premiums for QIs
each fiscal year and specifies the
formula that is to be used to determine
an allotment for each State from this
total amount. For States that executed a
State plan amendment in accordance
with section 1933(a) of the Act, a total
of $1.5 billion was allocated over 5
years as follows: $200 million in FY
1998; $250 million in FY 1999; $300
million in FY 2000; $350 million in FY
2001; and $400 million in FY 2002. In
1999, the Department published a notice
(64 FR 14931, March 29, 1999) to advise
States of the methodology used to
calculate allotments and each State’s
specific allotment for that year.
Following that notice, there was no
change in methodology and States have
been notified annually of their
allotments. We did not include the
methodology for computing the
allocation in our regulations. Although
the BBA originally provided coverage of
QIs only through FY 2002, through
several continuing resolutions, coverage
has been continued through the current
fiscal year, but without any increase in
total allocation over the FY 2002 level.
The Federal medical assistance
percentage for Medicaid payment of
Medicare Part B premiums for
qualifying individuals is 100 percent for
expenditures up to the amount of the
State’s allotment. No Federal funds are
available for expenditures in excess of
the State allotment amount. The Federal
matching rate for administrative
expenses associated with the payment
of Medicare Part B premiums for QIs
remains at the 50 percent matching
level. Federal financial participation in
the administrative expenses is not
counted against the State’s allotment.
The amount available for each fiscal
year is to be allocated among States
according to the formula set forth in
section 1933(c)(2) of the Act. The
formula provides for an amount to each
State that is to be based on each State’s
share of the Secretary’s estimate of the
ratio of: (a) An amount equal to the total
number of individuals in the State who
meet all but the income requirements
for QMBs, whose incomes are at least
120 percent but less than 135 percent of
the Federal poverty line, and who are
not otherwise eligible for Medicaid, to
(b) the sum of all those individuals for
all eligible States.
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In FY 2005, some States have
exhausted their current allotments
before the end of the fiscal year, which
has caused them to deny benefits to
eligible persons under section
1933(b)(3) of the Act, while other States
project a surplus in their allotments. We
asked those States which have
exhausted or expect to exhaust their FY
2005 allotments before the end of the
fiscal year to project the amount of
funds that would be required to grant
eligibility to all eligible persons in their
State, that is, their need. We also asked
those States which do not expect to use
their full allotments in FY 2005 to
project the difference between the
amount they expect to spend and their
allotment, that is, their surplus. All
States reported these figures, and it was
evident that the total surplus exceeds
the total need. In spite of there being
adequate overall funding for the QI
benefit, some eligible individuals are
being denied benefits due to the
allocation methodology used to
determine the FY 2005 allotments. We
believe that it is the clear intent of the
statute to provide benefits to eligible
persons up to the full amount of funds
made available for the program. We
attribute this to imprecision in the data
which we used to provide States with
their initial allocations under section
1933 of the Act. This interim final rule
would attempt to compensate for this
imprecision and enable States to enroll
those QIs whom they would have been
able to enroll had the data been more
precise.
II. Provisions of the Interim Final Rule
[If you choose to comment on issues in
this section, please include the caption
‘‘PROVISIONS’’ at the beginning of your
comments.]
This interim final rule amends 42 CFR
433.10(c) to specify the formula and the
data to be used to determine States’
allotments and to revise, under certain
circumstances, individual State
allotments for a Federal fiscal year for
the Medicaid payment of Medicare Part
B premiums for qualifying individuals
identified under section
1902(a)(10)(E)(iv) of the Act.
The FY 2005 allotments were derived
by applying U.S. Census Bureau data to
the formula set forth in section
1933(c)(2)of the Act. However, the
statute requires that the allocation of the
fiscal year allotment be based upon a
ratio of the amount of ‘‘total number of
individuals described in section
1902(a)(10)(E)(iv) in the State’’ to the
sum of these amounts for all States.
Because this formula requires an
estimate of an unknown number, that is,
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the number of individuals who could be
QIs (rather than the number of
individuals who were QIs in a previous
period), our use of the Census Bureau
data in the formula was a rough proxy
to attain the statutory number. Actual
expenditure data recently received,
however, reveal that the Census Bureau
data yielded an inappropriate
distribution of the total appropriated
fund as evidenced by the fact that
several States have projected significant
shortfalls in their allotments, while
many other States project a significant
surplus by the end of the fiscal year
2005. Census Bureau data may not have
been accurate for the purpose of
projecting States’ needs because the data
could not take into consideration all
variables that contribute to QI eligibility
and enrollment, such as resource levels
and the application process itself. While
section 1933 of the Act requires the
Secretary to estimate the allocation of
the allotments among the States, it does
not preclude a subsequent readjustment
of that allocation, when it becomes clear
that the data used for that estimate did
not effectuate the statutory objective.
This interim final rule permits, in this
specific circumstance, a redistribution
of surplus funds, as it has been
demonstrated that the projections and
estimates resulted in an inequitable
initial allocation, such that some States
were granted an allocation in excess of
their total projected need, while the
allocation granted to other States proved
insufficient to meet their projected QI
expenditures.
In this interim final rule, we are
codifying the methodology we have
been using to approximate the statutory
formula for determining State
allotments. However, since certain
States project a deficit in their allotment
before the end of fiscal year 2005, this
rule permits fiscal year 2005 funds to be
reallocated from the surplus States to
the need States. The regulation specifies
the methodology for computing the
annual allotments, and for reallocating
funds in this circumstance. The formula
used to reallocate funds is intended to
minimize impact on surplus States, to
equitably distribute the total needed
amount among those surplus States, and
to meet the immediate needs for those
States projecting deficits. Since the
authorization for the QI benefit expires
at the end of calendar year 2005 and
currently no funds have been
appropriated for the QI benefit beyond
September 30, 2005, this regulation will
sunset at the end of calendar year 2005.
Should the Congress authorize an
extension of the QI benefit and
appropriate additional funds for
allocation among the States, we will
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amend the sunset date in this regulation
to take into account any extension.
The resulting allotments are shown by
State in the table below. In this table
each column contains data defined as
follows:
Chart—Revised FY 2005 Qualified
Individuals Allotments
Column A—State. Column A shows
the name of each State. Columns B
through D shows the calculation of the
prior FY 2005 QI Allotments.
Column B—Number of Individuals.
Column B contains the estimated
number of eligibles for each State, in
thousands, as obtained from the Census
Bureau.
Column C—State Share of Column B.
Column C provides the percentage of
total eligibles for each State, determined
as the number of individuals for the
State in Column B divided by the Total
Number of Individuals for all States in
Column B.
Column D—Prior FY 2005 QI
Allotments. Column D contains each
State’s prior FY 2005 QI allotments,
calculated as the State’s percentage of
total eligibles in Column C multiplied
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by the total amount available for FY
2005 for all States ($400,000,000).
Columns E through J shows the
determination of the States’ revised FY
2005 QI allotments.
Column E—FY 2005 Estimated QI
Expenditures. Column E contains the
States’ most recent estimates of their
total QI expenditures for FY 2005.
Column F—Need (Difference).
Column F contains the additional
amount of QI allotment needed for those
States whose estimated expenditures in
Column E exceed their original FY 2005
QI allotment in Column D; for such
States Column E shows the difference of
Column E minus Column D. For other
States, Column F shows ‘‘NA’’.
Column G—Reduction Pool for NonNeed States. Column G contains the
amount of the pool of surplus FY 2005
QI allotments for those States that
project they will not need all of their FY
2005 QI allotment. For States whose
estimates of QI expenditures for FY
2005 in Column E are equal to or less
than their original FY 2005 QI allotment
in Column D (referred to as non-need
States), Column G shows the difference
of Column D minus Column E.
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Column H—Percent of Total NonNeed States. Column H shows the
percentage of the total excess FY 2005
allotments for each Non-Need State,
determined as the amount for each NonNeed State in Column G divided by the
sum of the amounts for all states in
Column G.
Column I—Reduction for Non-Need
States. Column I shows the amount of
reduction to Non-Need States’ prior FY
2005 QI allotments in Column D in
order provide for the total need shown
in Column F (due to rounding
adjustments, this total need is
$8,914,634). The amount in Column I is
determined as the percentage in Column
H for Non-Need States multiplied by the
total in Column F.
Column J—Revised FY 2005 QI
Allotments. Column J contains the
revised FY 2005 QI allotments for each
State. For States that needed additional
amounts based on their estimates,
Column J is equal to the amount in
Column D plus the additional need in
Column F. For Non-Need States,
Column J is equal to the amount in
Column D minus the amount in Column
I.
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Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Rules and Regulations
III. Collection of Information
Requirements
This document does not impose
information collection and
recordkeeping requirements.
Consequently, it need not be reviewed
by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. 35).
IV. Waiver of Notice With Comment
and 30-Day Delay in Effective Date
[If you choose to comment on issues in
this section, please include the caption
‘‘WAIVER OF ADVANCE PUBLIC
COMMENT’’ at the beginning of your
comments.]
We ordinarily publish an advance
notice in the Federal Register for
substantive rules to provide a period for
public comment. However, we may
waive that procedure if we find good
cause that notice and comment are
impractical, unnecessary, or contrary to
the public interest. In addition, we also
normally provide a delay of 30 days in
the effective date. However, if
adherence to this procedure would be
impractical, unnecessary, or contrary to
public interest, we may waive the delay
in the effective date.
We are publishing this rule as an
interim final rule because of the need to
notify individual States of the
limitations on Federal funds for their
Medicaid expenditures for payment of
Medicare Part B premiums for
qualifying individuals. Some States
have experienced deficits in their
current allotments that have caused
them to deny benefits to eligible
applicants, while other States project a
surplus in their allotments. This rule
permits redistribution of funds and will
allow all eligible applicants to receive
QI benefits during this calendar year.
Because access to Medicare Part B
coverage for QIs, who without this
coverage would have difficulty paying
for needed health care, is critically
important, we believe that it is in the
public interest to waive the usual notice
and comment procedure which we
undertake before making a rule final.
Also, for the reasons discussed above,
we find that good cause exists to
dispense with the normal requirement
that a regulation cannot become
effective any earlier than 30 days after
its publication. States which will have
access to additional funds to enroll QIs
need to know that these funds are
available as soon as possible, so they
can begin enrolling QIs. While we
believe those States which will have
diminished amounts available for this
fiscal year will have sufficient funds for
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enrolling all potential QIs in their
States, they also need to know as soon
as possible that a certain amount of their
unused allocation will no longer be
available to them for this fiscal year.
We are publishing this interim final
rule, with a 60-day period for public
comment. However, if we decide that
changes are necessary as a result of our
consideration of timely comments, we
will issue a final rule and respond to the
comments in that rule.
V. Regulatory Impact Statement
We have examined the impact of this
rule as required by Executive Order
12866 (September 1993, Regulatory
Planning and Review), the Regulatory
Flexibility Act (RFA) (September 19,
1980, Pub. L. 96–354), section 1102(b) of
the Social Security Act, the Unfunded
Mandates Reform Act of 1995 (Pub. L.
104–4), and Executive Order 13132.
Executive Order 12866 directs
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). This rule does not reach
the economic threshold and thus is not
considered a major rule.
The RFA requires agencies to analyze
options for regulatory relief for 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 $6 million to $29 million in any 1
year. Individuals and States are not
included in the definition of a small
entity.
This interim final rule with comment
period codifies our procedures for
implementing provisions of the
Balanced Budget Act of 1997 to allocate,
among the States, Federal funds to
provide Medicaid payment for Medicare
Part B premiums for low-income
Medicare beneficiaries. The total
amount of Federal funds available
during a Federal fiscal year and the
formula for determining individual
State allotments are specified in the law.
We have applied the statutory formula
for the State allotments. Because the
data specified in the law were not
initially available, we used comparable
data from the U.S. Census Bureau on the
number of possible qualifying
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Sfmt 4700
50219
individuals in the States. This rule also
permits, in a specific circumstance,
reallocation of funds to enable
enrollment of all eligible individuals to
the extent of the available funding.
We believe that the statutory
provisions implemented in this interim
final rule with comment period will
have a positive effect on States and
individuals. Federal funding at the 100
percent matching rate is available for
Medicare cost-sharing for Medicare Part
B premium payments for qualifying
individuals and, with the reallocation of
the State allotments a greater number of
low-income Medicare beneficiaries will
be eligible to have their Medicare Part
B premiums paid under Medicaid. In no
States will the changes in allotments
result in fewer individuals receiving the
QI benefit. The FY 2005 cost for this
provision has been included in the FY
2006 President’s Budget.
Section 1102(b) of the Social Security
Act requires us to prepare a regulatory
impact analysis for any rule that may
have a significant impact on the
operations of a substantial number of
small rural hospitals. The 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 a Core-Based Statistical
Area and has fewer than 100 beds.
We are not preparing analyses for
either the RFA or section 1102(b) of the
Act because we have determined and
certify that this interim final rule with
comment period will not have a
significant economic impact on a
substantial number of small entities or
a significant impact on the operations of
a substantial number of small rural
hospitals.
Section 202 of the Unfunded
Mandates Reform Act of 1995 also
requires that agencies assess anticipated
costs and benefits before issuing any
rule that may result in expenditure in
any 1 year by State, local, or tribal
governments, in the aggregate, or by the
private sector, of $110 million. This rule
will have no consequential effect on the
governments mentioned or on the
private sector.
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 regulation does not impose
any costs on State or local governments,
the requirements of E.O. 13132 are not
applicable.
E:\FR\FM\26AUR1.SGM
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50220
Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Rules and Regulations
In accordance with the provisions of
Executive Order 12866, this interim
final rule with comment period was
reviewed by the Office of Management
and Budget.
List of Subjects in 42 CFR Part 433
Administrative practice and
procedure, Child support, Claims, Grant
programs—health, Medicaid, Reporting
and recordkeeping requirements.
■ For the reasons set forth in the
preamble, the Centers for Medicare &
Medicaid Services amends 42 CFR
Chapter IV as set forth below:
PART 433—STATE FISCAL
ADMINISTRATION
1. The authority citation for part 433
continues to read as follows:
■
Authority: Sec. 1102 of the Social Security
Act (42 U.S.C. 1302).
2. Section 433.10 is amended by
adding new paragraph (c)(5) to read as
follows:
■
§ 433.10 Rates of FFP for program
services.
*
*
*
*
*
(c) * * *
(5) (i) Under section 1933(d) of the
Act, the Federal share of State
expenditures for Medicare Part B
premiums described in section
1905(p)(3)(A)(ii) of the Act on behalf of
Qualifying Individuals described in
section 1902(a)(10)(E)(iv) of the Act, is
100 percent, to the extent that the
assistance does not exceed the State’s
allocation under paragraph (c)(5)(ii) of
this section. To the extent that the
assistance exceeds that allocation, the
Federal share is 0 percent.
(ii) Under section 1933(c)(2) of the
Act and subject to paragraph (c)(5)(iii) of
this section, the allocation to each State
is equal to the total allocation specified
in section 1933(c)(1) of the Act
multiplied by the Secretary’s estimate of
the ratio of the total number of
individuals described in section
1902(a)(10)(E)(iv) of the Act in the State
to the total number of individuals
described in section 1902(a)(10)(E)(iv) of
the Act for all eligible States. In
estimating that ratio, the Secretary will
use data from the U.S. Census Bureau.
(iii) If, based on projected
expenditures for a fiscal year, the
Secretary determines that the
expenditures described in paragraph
(c)(5)(i) of this section for one or more
States are projected to exceed the
allocation made to the State, the
Secretary may adjust each State’s fiscal
year 2005 allocation, as follows:
(A) The Secretary will compare each
State’s new projected total expenditures
VerDate Aug<18>2005
16:11 Aug 25, 2005
Jkt 205001
for the expenses described in paragraph
(c)(5)(i) of this section to the State’s
initial allocation, to determine the
extent of each State’s projected surplus
or deficit.
(B) The surplus of each State with a
projected surplus, as determined in
accordance with paragraph (c)(5)(iii)(A)
of this section will be added together to
arrive at the Total Projected Surplus.
(C) The deficit of each State with a
projected deficit, as determined in
accordance with paragraph (c)(5)(iii)(A)
of this section will be added together to
arrive at the Total Projected Deficit.
(D) Each State with a projected deficit
will receive an additional allocation
equal to the amount of its projected
deficit. The amount to be reallocated
from each State with a projected surplus
will be equal to A × B, where A equals
the Total Projected Deficit and B equals
the amount of the State’s projected
surplus as a percentage of the Total
Projected Surplus.
(iv) CMS will notify States of any
changes in allotments resulting from
any reallocations without opportunity
for prior comment. CMS will follow
applicable rulemaking procedures in
publishing revisions to the allotments
resulting from changes other those that
specified above.
(v) The provisions of this paragraph
(c)(5) will be in effect though the end of
calendar year 2005.
Authority: Sections 1902(a)(10), 1933 of
the Social Security Act (42 U.S.C. 1396a),
and Pub. L. 105–33.
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program)
Dated: August 9, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare &
Medicaid Services.
Approved: August 15, 2005.
Michael O. Leavitt,
Secretary.
[FR Doc. 05–16973 Filed 8–23–05; 9:19 am]
BILLING CODE 4120–01–P
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DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric
Administration
50 CFR Part 648
[Docket No. 040804229–4300–02; I.D.
081705H]
Magnuson-Stevens Fishery
Conservation and Management Act
Provisions; Fisheries of the
Northeastern United States; Northeast
Multispecies Fishery; Closure of the
Eastern U.S./Canada Area and the
Eastern U.S./Canada Haddock Special
Access Program Pilot Program
National Marine Fisheries
Service (NMFS), National Oceanic and
Atmospheric Administration (NOAA),
Commerce.
ACTION: Temporary rule; closure.
AGENCY:
SUMMARY: NMFS announces the closure
of the Eastern U.S./Canada Area,
including the Eastern U.S./Canada
Haddock Special Access Program (SAP)
Pilot Program, to limited access
Northeast (NE) multispecies days-at-sea
(DAS) vessels for the remainder of the
2005 fishing year (i.e., through April 30,
2006), unless otherwise notified by the
Administrator, Northeast Region, NMFS
(Regional Administrator). This closure
is based on a determination by the
Regional Administrator that 90 percent
of the total allowable catch (TAC) of
Georges Bank (GB) cod allocated to be
harvested from the Eastern U.S./Canada
Area has already been harvested during
the 2005 fishing year. This action is
being taken to prevent the 2005 TAC for
GB cod in the Eastern U.S./Canada Area
from being exceeded during the 2005
fishing year in accordance with the
regulations implemented under
Amendment 13 to the NE Multispecies
Fishery Management Plan and the
Magnuson-Stevens Fishery
Conservation and Management Act.
DATES: The closure of the Eastern U.S./
Canada Area to all limited access NE
multispecies DAS vessels is effective
0001 hr local time, August 26, 2005,
through 2400 hr local time, April 30,
2006. One exception to this prohibition
is discussed in the SUPPLEMENTARY
INFORMATION section of this temporary
rule.
FOR FURTHER INFORMATION CONTACT:
Douglas W. Christel, Fishery Policy
Analyst, (978) 281–9141, fax (978) 281–
9135.
SUPPLEMENTARY INFORMATION:
Regulations governing fishing activity in
the U.S./Canada Management Areas are
found at 50 CFR 648.85. In addition,
Frm 00072
Fmt 4700
Sfmt 4700
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26AUR1
]]>Agencies
[Federal Register Volume 70, Number 165 (Friday, August 26, 2005)]
[Rules and Regulations]
[Pages 50214-50220]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-16973]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 433
[CMS-2210-IFC]
RIN 0938-AO04
Medicaid Program; State Allotments for Payment of Medicare Part B
Premiums for Qualifying Individuals: Federal Fiscal Year 2005
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Interim final rule with comment period.
-----------------------------------------------------------------------
SUMMARY: This interim final rule with comment period sets forth the
methodology used to compute State allotments that are available to pay
Medicare Part B premiums for qualifying individuals, allows changes to
the State allotments and describes the methodology used to determine
the changes to each State's allotment.
DATES: Effective date: These regulations are effective August 26, 2005
for allotments for payment of Medicare Part B premiums from the
allocation for fiscal year 2005.
Comment date: To be assured consideration, comments must be
received at one of the addresses provided below, no later than 5 p.m.
on October 25, 2005.
ADDRESSES: In commenting, please refer to file code CMS-2210-IFC.
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of three ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to https://www.cms.hhs.gov/regulations/
ecomments. (Attachments should be in Microsoft Word, WordPerfect, or
Excel; however, we prefer Microsoft Word.)
2. By regular mail. You may mail written comments (one original and
two copies) to the following address ONLY: Centers for Medicare &
Medicaid Services, Department of Health and Human Services, Attention:
CMS-2210-IFC, P.O. Box 8011, Baltimore, MD 21244-8011.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments (one
original and two copies) to the following address ONLY: Centers for
Medicare &
[[Page 50215]]
Medicaid Services, Department of Health and Human Services, Attention:
CMS-2210-IFC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore,
MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to one of the following addresses. If you
intend to deliver your comments to the Baltimore address, please call
telephone number (410) 786-7195 in advance to schedule your arrival
with one of our staff members. Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security
Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
FOR FURTHER INFORMATION CONTACT: Christine Gerhardt, (410) 786-0693.
Submitting Comments: We welcome comments from the public on all
issues set forth in this rule to assist us in fully considering issues
and developing policies. You can assist us by referencing the file code
CMS-2210-IFC and the specific ``issue identifier'' that precedes the
section on which you choose to comment.
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all electronic
comments received before the close of the comment period on its public
Web site as soon as possible after they have been received. Hard copy
comments received timely will be available for public inspection as
they are received, generally beginning approximately 3 weeks after
publication of a document, at the headquarters of the Centers for
Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore,
Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4
p.m. To schedule an appointment to view public comments, phone 1 800-
743-3951.
SUPPLEMENTARY INFORMATION:
I. Background
[If you choose to comment on issues in this section, please include the
caption ``BACKGROUND'' at the beginning of your comments.]
Section 1902 of the Social Security Act (the Act) sets forth the
requirements for State plans for medical assistance. Prior to August 5,
1997, section 1902(a)(10)(E) of the Act specified that the State
Medicaid plan must provide for some or all types of Medicare cost-
sharing for three eligibility groups of low-income Medicare
beneficiaries. These three groups included qualified Medicare
beneficiaries (QMBs), specified low-income Medicare beneficiaries
(SLMBs), and qualified disabled and working individuals (QDWIs).
A QMB is an individual entitled to Medicare Part A with income at
or below the Federal poverty line (FPL) and resources below $4,000 for
an individual and $6,000 for a couple. A SLMB is an individual who
meets the QMB criteria, except that his or her income is above 100
percent of the FPL and does not exceed 120 percent of the FPL. A QDWI
is a disabled individual who is entitled to enroll in Medicare Part A
under section 1818A of the Act, whose income does not exceed 200
percent of the FPL for a family of the size involved, whose resources
do not exceed twice the amount allowed under the Supplementary Security
Income (SSI) program, and who is not otherwise eligible for Medicaid.
The definition of Medicare cost-sharing at section 1905(p)(3) of the
Act includes payment for premiums for Medicare Part B.
Section 4732 of the Balanced Budget Act of 1997 (BBA), enacted on
August 5, 1997, amended section 1902(a)(10)(E) of the Act to require
States to provide for Medicaid payment of the Medicare Part B premiums
for two additional eligibility groups of low-income Medicare
beneficiaries, referred to as qualifying individuals (QIs).
Specifically, a new section 1902(a)(10)(E)(iv)(I) of the Act was added,
under which States must pay the full amount of the Medicare Part B
premium for qualifying individuals who would be QMBs but for the fact
that their income level is at least 120 percent of the FPL but less
than 135 percent of the FPL for a family of the size involved. These
individuals cannot otherwise be eligible for medical assistance under
the approved State Medicaid plan. The second group of QIs added under
section 1902(a)(10)(E)(iv)(II) of the Act includes Medicare
beneficiaries who would be QMBs except that their income is at least
135 percent but less than 175 percent of the FPL for a family of the
size involved, who are not otherwise eligible for Medicaid under the
approved State plan. These QIs were eligible for only a portion of
Medicare cost sharing consisting only of a percentage of the increase
in the Medicare Part B premium attributable to the shift of Medicare
home health coverage from Part A to Part B (as provided in section 4611
of the BBA).
Coverage of the second group of QIs ended on December 31, 2002 and
the 2003 Welfare Reform Bill (Pub. L. 108-89) eliminated reference to
the QI-2 benefit. In each of the years 2002 and 2003, Continuing
Resolutions extended the coverage of the first group of QIs (whose
income is at least 120 percent but less than 135 percent of the Federal
poverty line) through the next fiscal year, but maintained the annual
funding at the FY 2002 level. In 2004, ``A Bill to Amend Title XIX of
the Social Security Act to Extend Medicare Cost-Sharing for the
Medicare Part B Premium for Qualifying Individuals'' (Pub. L. 108-448)
continued coverage of this group through September 30, 2005, again with
no change in funding.
The BBA also added a new section 1933 to the Act to provide for
Medicaid payment of Medicare Part B premiums for QIs. (The previous
section 1933 was re-designated as section 1934.) Section 1933(a)
specifies that a State plan must provide, through a State plan
amendment, for medical assistance to pay for the cost of Medicare cost-
sharing on behalf of QIs who are selected to receive assistance.
Section 1933(b) of the Act sets forth the rules that States must
follow in selecting QIs and providing payment for Medicare Part B
premiums. Specifically, the State must permit all qualifying
individuals to apply for assistance and must select individuals on a
first-come, first-served basis (that is, the State must select QIs in
the order in which they apply). Under section 1933(b)(2)(B) of the Act,
in selecting persons who will receive assistance in years after 1998,
States must give preference to those individuals who received
assistance as QIs, QMBs, SLMBs, or QDWIs in the last month of the
previous year and who continue to be (or become) QIs. Under section
1933(b)(4) of the Act, persons selected to receive assistance in a
calendar year are entitled to receive assistance for the remainder of
the year, but not beyond, as long as they continue to qualify. The fact
that an individual is selected to receive assistance at any time during
the year does not entitle the individual to continued assistance for
any succeeding year. Because the State's
[[Page 50216]]
allotment is limited by law, section 1933(b)(3) of the Act provides
that the State must limit the number of QIs so that the amount of
assistance provided during the year is approximately equal to the
allotment for that year.
Section 1933(c) of the Act limits the total amount of Federal funds
available for payment of Part B premiums for QIs each fiscal year and
specifies the formula that is to be used to determine an allotment for
each State from this total amount. For States that executed a State
plan amendment in accordance with section 1933(a) of the Act, a total
of $1.5 billion was allocated over 5 years as follows: $200 million in
FY 1998; $250 million in FY 1999; $300 million in FY 2000; $350 million
in FY 2001; and $400 million in FY 2002. In 1999, the Department
published a notice (64 FR 14931, March 29, 1999) to advise States of
the methodology used to calculate allotments and each State's specific
allotment for that year. Following that notice, there was no change in
methodology and States have been notified annually of their allotments.
We did not include the methodology for computing the allocation in our
regulations. Although the BBA originally provided coverage of QIs only
through FY 2002, through several continuing resolutions, coverage has
been continued through the current fiscal year, but without any
increase in total allocation over the FY 2002 level.
The Federal medical assistance percentage for Medicaid payment of
Medicare Part B premiums for qualifying individuals is 100 percent for
expenditures up to the amount of the State's allotment. No Federal
funds are available for expenditures in excess of the State allotment
amount. The Federal matching rate for administrative expenses
associated with the payment of Medicare Part B premiums for QIs remains
at the 50 percent matching level. Federal financial participation in
the administrative expenses is not counted against the State's
allotment.
The amount available for each fiscal year is to be allocated among
States according to the formula set forth in section 1933(c)(2) of the
Act. The formula provides for an amount to each State that is to be
based on each State's share of the Secretary's estimate of the ratio
of: (a) An amount equal to the total number of individuals in the State
who meet all but the income requirements for QMBs, whose incomes are at
least 120 percent but less than 135 percent of the Federal poverty
line, and who are not otherwise eligible for Medicaid, to (b) the sum
of all those individuals for all eligible States.
In FY 2005, some States have exhausted their current allotments
before the end of the fiscal year, which has caused them to deny
benefits to eligible persons under section 1933(b)(3) of the Act, while
other States project a surplus in their allotments. We asked those
States which have exhausted or expect to exhaust their FY 2005
allotments before the end of the fiscal year to project the amount of
funds that would be required to grant eligibility to all eligible
persons in their State, that is, their need. We also asked those States
which do not expect to use their full allotments in FY 2005 to project
the difference between the amount they expect to spend and their
allotment, that is, their surplus. All States reported these figures,
and it was evident that the total surplus exceeds the total need. In
spite of there being adequate overall funding for the QI benefit, some
eligible individuals are being denied benefits due to the allocation
methodology used to determine the FY 2005 allotments. We believe that
it is the clear intent of the statute to provide benefits to eligible
persons up to the full amount of funds made available for the program.
We attribute this to imprecision in the data which we used to provide
States with their initial allocations under section 1933 of the Act.
This interim final rule would attempt to compensate for this
imprecision and enable States to enroll those QIs whom they would have
been able to enroll had the data been more precise.
II. Provisions of the Interim Final Rule
[If you choose to comment on issues in this section, please include the
caption ``PROVISIONS'' at the beginning of your comments.]
This interim final rule amends 42 CFR 433.10(c) to specify the
formula and the data to be used to determine States' allotments and to
revise, under certain circumstances, individual State allotments for a
Federal fiscal year for the Medicaid payment of Medicare Part B
premiums for qualifying individuals identified under section
1902(a)(10)(E)(iv) of the Act.
The FY 2005 allotments were derived by applying U.S. Census Bureau
data to the formula set forth in section 1933(c)(2)of the Act. However,
the statute requires that the allocation of the fiscal year allotment
be based upon a ratio of the amount of ``total number of individuals
described in section 1902(a)(10)(E)(iv) in the State'' to the sum of
these amounts for all States. Because this formula requires an estimate
of an unknown number, that is, the number of individuals who could be
QIs (rather than the number of individuals who were QIs in a previous
period), our use of the Census Bureau data in the formula was a rough
proxy to attain the statutory number. Actual expenditure data recently
received, however, reveal that the Census Bureau data yielded an
inappropriate distribution of the total appropriated fund as evidenced
by the fact that several States have projected significant shortfalls
in their allotments, while many other States project a significant
surplus by the end of the fiscal year 2005. Census Bureau data may not
have been accurate for the purpose of projecting States' needs because
the data could not take into consideration all variables that
contribute to QI eligibility and enrollment, such as resource levels
and the application process itself. While section 1933 of the Act
requires the Secretary to estimate the allocation of the allotments
among the States, it does not preclude a subsequent readjustment of
that allocation, when it becomes clear that the data used for that
estimate did not effectuate the statutory objective.
This interim final rule permits, in this specific circumstance, a
redistribution of surplus funds, as it has been demonstrated that the
projections and estimates resulted in an inequitable initial
allocation, such that some States were granted an allocation in excess
of their total projected need, while the allocation granted to other
States proved insufficient to meet their projected QI expenditures.
In this interim final rule, we are codifying the methodology we
have been using to approximate the statutory formula for determining
State allotments. However, since certain States project a deficit in
their allotment before the end of fiscal year 2005, this rule permits
fiscal year 2005 funds to be reallocated from the surplus States to the
need States. The regulation specifies the methodology for computing the
annual allotments, and for reallocating funds in this circumstance. The
formula used to reallocate funds is intended to minimize impact on
surplus States, to equitably distribute the total needed amount among
those surplus States, and to meet the immediate needs for those States
projecting deficits. Since the authorization for the QI benefit expires
at the end of calendar year 2005 and currently no funds have been
appropriated for the QI benefit beyond September 30, 2005, this
regulation will sunset at the end of calendar year 2005. Should the
Congress authorize an extension of the QI benefit and appropriate
additional funds for allocation among the States, we will
[[Page 50217]]
amend the sunset date in this regulation to take into account any
extension.
The resulting allotments are shown by State in the table below. In
this table each column contains data defined as follows:
Chart--Revised FY 2005 Qualified Individuals Allotments
Column A--State. Column A shows the name of each State. Columns B
through D shows the calculation of the prior FY 2005 QI Allotments.
Column B--Number of Individuals. Column B contains the estimated
number of eligibles for each State, in thousands, as obtained from the
Census Bureau.
Column C--State Share of Column B. Column C provides the percentage
of total eligibles for each State, determined as the number of
individuals for the State in Column B divided by the Total Number of
Individuals for all States in Column B.
Column D--Prior FY 2005 QI Allotments. Column D contains each
State's prior FY 2005 QI allotments, calculated as the State's
percentage of total eligibles in Column C multiplied by the total
amount available for FY 2005 for all States ($400,000,000).
Columns E through J shows the determination of the States' revised
FY 2005 QI allotments.
Column E--FY 2005 Estimated QI Expenditures. Column E contains the
States' most recent estimates of their total QI expenditures for FY
2005.
Column F--Need (Difference). Column F contains the additional
amount of QI allotment needed for those States whose estimated
expenditures in Column E exceed their original FY 2005 QI allotment in
Column D; for such States Column E shows the difference of Column E
minus Column D. For other States, Column F shows ``NA''.
Column G--Reduction Pool for Non-Need States. Column G contains the
amount of the pool of surplus FY 2005 QI allotments for those States
that project they will not need all of their FY 2005 QI allotment. For
States whose estimates of QI expenditures for FY 2005 in Column E are
equal to or less than their original FY 2005 QI allotment in Column D
(referred to as non-need States), Column G shows the difference of
Column D minus Column E.
Column H--Percent of Total Non-Need States. Column H shows the
percentage of the total excess FY 2005 allotments for each Non-Need
State, determined as the amount for each Non-Need State in Column G
divided by the sum of the amounts for all states in Column G.
Column I--Reduction for Non-Need States. Column I shows the amount
of reduction to Non-Need States' prior FY 2005 QI allotments in Column
D in order provide for the total need shown in Column F (due to
rounding adjustments, this total need is $8,914,634). The amount in
Column I is determined as the percentage in Column H for Non-Need
States multiplied by the total in Column F.
Column J--Revised FY 2005 QI Allotments. Column J contains the
revised FY 2005 QI allotments for each State. For States that needed
additional amounts based on their estimates, Column J is equal to the
amount in Column D plus the additional need in Column F. For Non-Need
States, Column J is equal to the amount in Column D minus the amount in
Column I.
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III. Collection of Information Requirements
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995 (44 U.S.C. 35).
IV. Waiver of Notice With Comment and 30-Day Delay in Effective Date
[If you choose to comment on issues in this section, please include the
caption ``WAIVER OF ADVANCE PUBLIC COMMENT'' at the beginning of your
comments.]
We ordinarily publish an advance notice in the Federal Register for
substantive rules to provide a period for public comment. However, we
may waive that procedure if we find good cause that notice and comment
are impractical, unnecessary, or contrary to the public interest. In
addition, we also normally provide a delay of 30 days in the effective
date. However, if adherence to this procedure would be impractical,
unnecessary, or contrary to public interest, we may waive the delay in
the effective date.
We are publishing this rule as an interim final rule because of the
need to notify individual States of the limitations on Federal funds
for their Medicaid expenditures for payment of Medicare Part B premiums
for qualifying individuals. Some States have experienced deficits in
their current allotments that have caused them to deny benefits to
eligible applicants, while other States project a surplus in their
allotments. This rule permits redistribution of funds and will allow
all eligible applicants to receive QI benefits during this calendar
year. Because access to Medicare Part B coverage for QIs, who without
this coverage would have difficulty paying for needed health care, is
critically important, we believe that it is in the public interest to
waive the usual notice and comment procedure which we undertake before
making a rule final.
Also, for the reasons discussed above, we find that good cause
exists to dispense with the normal requirement that a regulation cannot
become effective any earlier than 30 days after its publication. States
which will have access to additional funds to enroll QIs need to know
that these funds are available as soon as possible, so they can begin
enrolling QIs. While we believe those States which will have diminished
amounts available for this fiscal year will have sufficient funds for
enrolling all potential QIs in their States, they also need to know as
soon as possible that a certain amount of their unused allocation will
no longer be available to them for this fiscal year.
We are publishing this interim final rule, with a 60-day period for
public comment. However, if we decide that changes are necessary as a
result of our consideration of timely comments, we will issue a final
rule and respond to the comments in that rule.
V. Regulatory Impact Statement
We have examined the impact of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354),
section 1102(b) of the Social Security Act, the Unfunded Mandates
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 directs 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). This rule
does not reach the economic threshold and thus is not considered a
major rule.
The RFA requires agencies to analyze options for regulatory relief
for 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
$6 million to $29 million in any 1 year. Individuals and States are not
included in the definition of a small entity.
This interim final rule with comment period codifies our procedures
for implementing provisions of the Balanced Budget Act of 1997 to
allocate, among the States, Federal funds to provide Medicaid payment
for Medicare Part B premiums for low-income Medicare beneficiaries. The
total amount of Federal funds available during a Federal fiscal year
and the formula for determining individual State allotments are
specified in the law. We have applied the statutory formula for the
State allotments. Because the data specified in the law were not
initially available, we used comparable data from the U.S. Census
Bureau on the number of possible qualifying individuals in the States.
This rule also permits, in a specific circumstance, reallocation of
funds to enable enrollment of all eligible individuals to the extent of
the available funding.
We believe that the statutory provisions implemented in this
interim final rule with comment period will have a positive effect on
States and individuals. Federal funding at the 100 percent matching
rate is available for Medicare cost-sharing for Medicare Part B premium
payments for qualifying individuals and, with the reallocation of the
State allotments a greater number of low-income Medicare beneficiaries
will be eligible to have their Medicare Part B premiums paid under
Medicaid. In no States will the changes in allotments result in fewer
individuals receiving the QI benefit. The FY 2005 cost for this
provision has been included in the FY 2006 President's Budget.
Section 1102(b) of the Social Security Act requires us to prepare a
regulatory impact analysis for any rule that may have a significant
impact on the operations of a substantial number of small rural
hospitals. The 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 a Core-Based
Statistical Area and has fewer than 100 beds.
We are not preparing analyses for either the RFA or section 1102(b)
of the Act because we have determined and certify that this interim
final rule with comment period will not have a significant economic
impact on a substantial number of small entities or a significant
impact on the operations of a substantial number of small rural
hospitals.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule that may result in expenditure in any 1 year by State,
local, or tribal governments, in the aggregate, or by the private
sector, of $110 million. This rule will have no consequential effect on
the governments mentioned or on the private sector.
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 regulation does not impose any costs on State
or local governments, the requirements of E.O. 13132 are not
applicable.
[[Page 50220]]
In accordance with the provisions of Executive Order 12866, this
interim final rule with comment period was reviewed by the Office of
Management and Budget.
List of Subjects in 42 CFR Part 433
Administrative practice and procedure, Child support, Claims, Grant
programs--health, Medicaid, Reporting and recordkeeping requirements.
0
For the reasons set forth in the preamble, the Centers for Medicare &
Medicaid Services amends 42 CFR Chapter IV as set forth below:
PART 433--STATE FISCAL ADMINISTRATION
0
1. The authority citation for part 433 continues to read as follows:
Authority: Sec. 1102 of the Social Security Act (42 U.S.C.
1302).
0
2. Section 433.10 is amended by adding new paragraph (c)(5) to read as
follows:
Sec. 433.10 Rates of FFP for program services.
* * * * *
(c) * * *
(5) (i) Under section 1933(d) of the Act, the Federal share of
State expenditures for Medicare Part B premiums described in section
1905(p)(3)(A)(ii) of the Act on behalf of Qualifying Individuals
described in section 1902(a)(10)(E)(iv) of the Act, is 100 percent, to
the extent that the assistance does not exceed the State's allocation
under paragraph (c)(5)(ii) of this section. To the extent that the
assistance exceeds that allocation, the Federal share is 0 percent.
(ii) Under section 1933(c)(2) of the Act and subject to paragraph
(c)(5)(iii) of this section, the allocation to each State is equal to
the total allocation specified in section 1933(c)(1) of the Act
multiplied by the Secretary's estimate of the ratio of the total number
of individuals described in section 1902(a)(10)(E)(iv) of the Act in
the State to the total number of individuals described in section
1902(a)(10)(E)(iv) of the Act for all eligible States. In estimating
that ratio, the Secretary will use data from the U.S. Census Bureau.
(iii) If, based on projected expenditures for a fiscal year, the
Secretary determines that the expenditures described in paragraph
(c)(5)(i) of this section for one or more States are projected to
exceed the allocation made to the State, the Secretary may adjust each
State's fiscal year 2005 allocation, as follows:
(A) The Secretary will compare each State's new projected total
expenditures for the expenses described in paragraph (c)(5)(i) of this
section to the State's initial allocation, to determine the extent of
each State's projected surplus or deficit.
(B) The surplus of each State with a projected surplus, as
determined in accordance with paragraph (c)(5)(iii)(A) of this section
will be added together to arrive at the Total Projected Surplus.
(C) The deficit of each State with a projected deficit, as
determined in accordance with paragraph (c)(5)(iii)(A) of this section
will be added together to arrive at the Total Projected Deficit.
(D) Each State with a projected deficit will receive an additional
allocation equal to the amount of its projected deficit. The amount to
be reallocated from each State with a projected surplus will be equal
to A x B, where A equals the Total Projected Deficit and B equals the
amount of the State's projected surplus as a percentage of the Total
Projected Surplus.
(iv) CMS will notify States of any changes in allotments resulting
from any reallocations without opportunity for prior comment. CMS will
follow applicable rulemaking procedures in publishing revisions to the
allotments resulting from changes other those that specified above.
(v) The provisions of this paragraph (c)(5) will be in effect
though the end of calendar year 2005.
Authority: Sections 1902(a)(10), 1933 of the Social Security Act
(42 U.S.C. 1396a), and Pub. L. 105-33.
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)
Dated: August 9, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
Approved: August 15, 2005.
Michael O. Leavitt,
Secretary.
[FR Doc. 05-16973 Filed 8-23-05; 9:19 am]
BILLING CODE 4120-01-P
