Medicaid Program; Final State Allotments for Payment of Medicare Part B Premiums for Qualifying Individuals for Federal Fiscal Year 2007, 17348-17353 [E8-5748]
Download as PDF
<![CDATA[
mstockstill on PROD1PC66 with NOTICES
17348
Federal Register / Vol. 73, No. 63 / Tuesday, April 1, 2008 / Notices
The CAP Physician Election
Agreement is used annually by
physicians to elect to participate in the
CAP or to make changes to the previous
year’s selections. The information
collected by these documents is used by
CMS, its Medicare contractor, and the
approved CAP vendor to meet
programmatic requirements pertaining
to physician election as established by
the MMA. Form Number: CMS–10167
(OMB# 0938–0955); Frequency: Yearly;
Affected Public: Business or other forprofits; Number of Respondents: 3,800;
Total Annual Responses: 3,800; Total
Annual Hours: 7,600.
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Use of Restraint
and Seclusion in Psychiatric Residential
Treatment Facilities (PRTFs) for
Individuals Under Age 21; Use: PRTFs
are required to report deaths, serious
injuries and attempted suicides to the
State Medicaid Agency and the
Protection and Advocacy Organization.
They are also required to provide
residents the restraint and seclusion
policy in writing, and to document in
the residents’ records all activities
involving the use of restraint and
seclusion. Form Number: CMS–R–306
(OMB# 0938–0833); Frequency:
Annually; Affected Public: Private
Sector: Business or other for-profits;
Number of Respondents: 500; Total
Annual Responses: 329,500; Total
Annual Hours: 501,750.
4. Type of Information Collection
Request: New Collection; Title of
Information Collection: Health
Insurance Flexibility and Accountability
(HIFA) Evaluation; Use: The HIFA
initiative sought to increase health
coverage of uninsured populations
through a flexible waiver process
emphasizing public subsidy of
Employer-Sponsored Insurance (ESI).
Testing whether that approach reduces
the rate/number of uninsured is
critically important to CMS. The
proposed survey of HIFA enrollees in
New Mexico and Oregon would provide
the only data available to test certain
fundamental HIFA effects, especially
with reference to reduction of the
uninsured population, the effectiveness
of premium assistance for ESI and the
possibility of crowd-out of private
coverage. Form Number: CMS–10262
(OMB# 0938–NEW); Frequency: Once;
Affected Public: Individuals or
households; Number of Respondents:
800; Total Annual Responses: 800; Total
Annual Hours: 400.
5. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
VerDate Aug<31>2005
16:40 Mar 31, 2008
Jkt 214001
Information Collection: Monthly State
File of Medicaid/Medicare Dual Eligible
Enrollees; Use: The monthly file of dual
eligible enrollees will be used to
determine those duals with drug
benefits for the phased down State
contribution process required by the
Medicare Modernization Act of 203.
These data are also used to support Part
D subsidy determinations and autoassignment of individuals to Part D
plans. Form Number: CMS–10143
(OMB# 0938–0958); Frequency:
Monthly; Affected Public: State, Local or
Tribal Governments; Number of
Respondents: 51; Total Annual
Responses: 612; Total Annual Hours:
6,120.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS’ Web site
address at https://www.cms.hhs.gov/
PaperworkReductionActof1995, or
E-mail your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov, or call the
Reports Clearance Office on (410) 786–
1326.
In commenting on the proposed
information collections please reference
the document identifier or OMB control
number. To be assured consideration,
comments and recommendations must
be submitted in one of the following
ways by June 2, 2008.
1. Electronically. You may submit
your comments electronically to https://
www.regulations.gov. Follow the
instructions for ‘‘Comment or
Submission’’ or ‘‘More Search Options’’
to find the information collection
document(s) accepting comments.
2. By regular mail. You may mail
written comments to the following
address: CMS, Office of Strategic
Operations and Regulatory Affairs,
Division of Regulations Development,
Room C4–26–05, 7500 Security
Boulevard, Baltimore, Maryland 21244–
1850.
Dated: March 21, 2008.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E8–6510 Filed 3–31–08; 8:45 am]
BILLING CODE 4120–01–P
PO 00000
Frm 00055
Fmt 4703
Sfmt 4703
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–2231–N]
RIN 0938–AP23
Medicaid Program; Final State
Allotments for Payment of Medicare
Part B Premiums for Qualifying
Individuals for Federal Fiscal Year
2007
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
SUMMARY: This Notice sets forth the
methodology and process used to
compute and issue each State’s final
allotment for fiscal year (FY) 2007 that
is available to pay Medicare Part B
premiums for qualifying individuals.
DATES: Effective date: Final allotments
for payment of Medicare Part B
premiums for FY 2007 are effective
October 1, 2006, through September 30,
2007.
FOR FURTHER INFORMATION CONTACT:
Deborah Abshire, (410) 786–9291.
SUPPLEMENTARY INFORMATION:
I. Background
A. Allotments Prior to FY 2005
Section 1902 of the Social Security
Act (the Act) sets forth the requirements
for State plans for medical assistance.
Before 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
E:\FR\FM\01APN1.SGM
01APN1
mstockstill on PROD1PC66 with NOTICES
Federal Register / Vol. 73, No. 63 / Tuesday, April 1, 2008 / Notices
(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
are eligible QMBs but 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 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 in
2003, section 401 of the Welfare Reform
Bill (Pub. L. 108–89), enacted on
October 1, 2003, eliminated reference to
the second QI benefit (for the 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). In 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 following fiscal year, but
maintained the annual funding at the
FY 2002 level. The Act was amended by
Extension of Medicare Cost-Sharing for
the Medicare Part B Premium for
Qualifying Individuals, (Pub. L. 108–
448), enacted December 8, 2004, which
continued coverage of this group of QIs
(whose income is at least 120 percent
but less than 135 percent of the Federal
VerDate Aug<31>2005
16:40 Mar 31, 2008
Jkt 214001
poverty line) 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) of the Act 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).
Further, 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
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.
On March 29, 1999, the Department of
Health and Human Services published a
notice in the Federal Register (64 FR
14931) 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
PO 00000
Frm 00056
Fmt 4703
Sfmt 4703
17349
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
through FY 2002, through several
continuing resolutions, coverage has
been continued through fiscal year
2007, 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.
B. Allotments for FY 2005
In FY 2005, some States exhausted
their FY 2005 allotments before the end
of the fiscal year, which caused them to
deny benefits to eligible persons under
section 1933(b)(3) of the Act, while
other States projected a surplus in their
allotments. We asked those States that
exhausted or expected 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 that did not expect to use
their full allotments in FY 2005 to
project the difference between the
amount they expected to spend and
their allotment, that is, their surplus.
After all States reported these figures, it
was evident that the total surplus
exceeded the total need. In spite of there
being adequate overall funding for the
QI benefit, some eligible individuals
would have been denied benefits due to
the allocation methodology initially
E:\FR\FM\01APN1.SGM
01APN1
mstockstill on PROD1PC66 with NOTICES
17350
Federal Register / Vol. 73, No. 63 / Tuesday, April 1, 2008 / Notices
used to determine the FY 2005
allotments.
We believed that it was 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 attributed the difference between
the surplus in available QI allotments
for some States and the need in other
States in FY 2005 as due to the
imprecision in the data that we used to
provide States with their initial
allocations under section 1933 of the
Act. Therefore, on August 26, 2005 we
published an interim final rule in the
Federal Register (70 FR 50214) under
which we compensated for this
imprecision in order to enable States to
enroll those QIs whom they would have
been able to enroll had the data been
more precise.
The interim final rule amended 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. Section
433.10(c)(5)(iv) states that CMS will
notify States of any changes in
allotments resulting from any
reallocations.
The FY 2005 allotments were
determined by applying the 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 represented a rough
proxy to attain the statutory number.
Actual expenditure data, however,
revealed that the Census Bureau data
yielded an inappropriate distribution of
the total appropriated fund as evidenced
by the fact that several States projected
significant shortfalls in their allotments,
while many other States projected a
significant surplus by the end of the
fiscal year 2005. Census Bureau data
were not 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
VerDate Aug<31>2005
16:40 Mar 31, 2008
Jkt 214001
Secretary to estimate the allocation of
the allotments among the States, it did
not preclude a subsequent readjustment
of that allocation, when it became clear
that the data used for that estimate did
not effectuate the statutory objective.
The interim final rule published in the
Federal Register on August 26, 2005
permitted in this specific circumstance
a redistribution of surplus funds, as it
was demonstrated that the States’
projections and estimates resulted in an
inequitable initial allocation for FY
2005, 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 the August 26, 2005 interim final
rule, we codified the methodology we
have been using to approximate the
statutory formula for determining State
allotments. However, since certain
States projected a deficit in their
allotment before the end of fiscal year
2005, the rule permitted fiscal year 2005
funds to be reallocated from the surplus
States to the need States. The regulation
specified the methodology for
computing the annual allotments, and
for reallocating funds in this
circumstance. The formula used to
reallocate funds was intended to
minimize the 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. At the time of
the publication of the interim final rule
on August 26, 2005, the authorization
for the QI benefit expired at the end of
calendar year 2005, and no additional
funds were appropriated for the QI
benefit beyond September 30, 2005;
therefore, the regulation specified a
sunset at the end of calendar year 2005.
C. Allotments for FY 2006 and FY 2007
On October 20, 2005 the ‘‘QI, TMA,
and Abstinence Programs Extension and
Hurricane Katrina Unemployment Relief
Act of 2005’’ was enacted by the
Congress (Pub. L. 109–91) (QI, TMA,
and Abstinence Act of 2005). Section
101 of the QI, TMA, and Abstinence Act
extended the QI program through
September 30, 2007 with no change in
funding, that is, under this legislation
$400 million per fiscal year was
appropriated for each of FY 2006 and
FY 2007. The provisions of section 101
of the QI, TMA, and Abstinence Act of
2005 were effective as of September 30,
2005.
On October 16, 2006 we published a
final rule in the Federal Register (71 FR
60663), which implemented the
provisions of section 101 of the QI,
PO 00000
Frm 00057
Fmt 4703
Sfmt 4703
TMA, and Abstinence Act relating the
QI allotments for final FY 2006
allotments and preliminary FY 2007
allotments. As indicated in that final
rule, we believe that the clear intent of
the statute is to provide benefits to
eligible persons up to the full amount of
funds made available for the program in
each fiscal year. We recognized that
because of the imprecision in data for
computing the States’ QI allotments for
a fiscal year, some States would
experience either surpluses or shortages
in their FY 2006 and FY 2007
allotments. In accordance with section
433.10(c), the FY 2006 and FY 2007 QI
allotments were designed to compensate
for the imprecision in data to permit
shortage States to enroll more QIs than
otherwise would have been possible.
D. Allotments for FY 2008 and
Thereafter
On September 29, 2007, the President
signed the ‘‘TMA, Abstinence
Education, and QI Program Extension
Act of 2007’’ (QI, TMA, and Abstinence
Act of 2007) (Pub. L. 110–90). Section
3 of the QI, TMA, and Abstinence Act
of 2007 extends the QI program through
December 31, 2007 and allocates $100
million for such period. We will address
this allocation and extend the allocation
methodology’s regulatory sunset in a
subsequent rulemaking. If additional
funding is authorized to extend the QI
Program for some or all of the calendar
year 2008 or beyond, we will also issue
a notice in the Federal Register to
announce the QI allotments to be
provided in accordance with the
extending legislation.
II. Provisions of the Notice
This notice sets forth the final QI
allotments for FY 2007.
In the final rule published on October
16, 2006 (71 FR 60663), we set forth a
two step/two phase methodology/
process for determining States’ QI
allotments for FY 2007, and that
regulation implemented phase one of
the process. Under the first step of
phase one, an ‘‘initial’’ allocation was
determined for each State under the
formula specified in section 1933 of the
Act and based only on the data obtained
from the Census Bureau (the 3-year
average of the number of Medicare
beneficiaries in the State who are not
enrolled in the Medicaid program but
whose incomes are at least 120 percent
of the FPL and less than 135 percent of
the FPL). However, we further obtained
States’ projected QI expenditures for the
fiscal year. We then compared the initial
allocations for the fiscal year to the
States’ projected QI expenditures for the
fiscal year to determine those States
E:\FR\FM\01APN1.SGM
01APN1
mstockstill on PROD1PC66 with NOTICES
Federal Register / Vol. 73, No. 63 / Tuesday, April 1, 2008 / Notices
with a projected need (that is, those
States whose initial allocation is less
than their projected expenditures) or a
projected surplus (that is, those States
whose initial allocation is greater than
the projected expenditures) for FY 2007.
Under the second step of the process,
implemented now through this notice,
we adjusted the States’ initial
allocations by considering the States’
projected QI expenditures for FY 2007.
This was done by proportionately
reducing the QI allotments of States
with surpluses for the fiscal year by the
amount of the total need for States that
do not have sufficient QI allotments for
the fiscal year. We are thus completing
the two phase methodology/process for
the fiscal year. This notice accounts for
the fact that at the beginning of the
fiscal year, we determined the initial
allocations based on the Census Bureau
data, obtained States’ projections of QI
expenditures for the fiscal year, and
made any adjustments based on the
projected surpluses/needs for the fiscal
year. The amounts of the States’ QI
allotments determined under this first
phase at the beginning of the fiscal year
were considered the States’ ‘‘initial’’ QI
allotments for the fiscal year and are
shown on the table below. Now, under
phase two of the process, during the
fourth quarter of the fiscal year we
obtained States’ updated projected QI
expenditures for the fiscal year. We then
established the ‘‘final’’ QI allotments for
the fiscal year based on these updated
projections.
As indicated in this notice and as
shown on the table below, the States’
final QI allotments for FY 2007 are
determined by comparing the initial QI
allotments for the fiscal year (again
which are calculated based on the
Census Bureau data) to the States’
updated projections of QI expenditures
for the fiscal year; this establishes those
States with a ‘‘final’’ projected need (the
initial allocation is less than the
updated projected expenditures) or a
surplus (initial allocation is greater than
the updated projected expenditures) for
the fiscal year. Using the updated
projected QI expenditures, we adjusted
the States’ initial allocations by
reducing the surplus States’ initial
allotments proportionately to meet the
need States’ deficits. This is the same
methodology we used for determining
the FY 2005 allotments as published in
the interim final rule published on
August 26, 2005, in the Federal
Register; the only change was that in
VerDate Aug<31>2005
16:40 Mar 31, 2008
Jkt 214001
computing the FY 2007 allotments, we
determined the preliminary allotments
at the beginning of the fiscal year using
States’ preliminary projected QI
expenditures, and then we determined
the final QI allotments later in the fiscal
year using States’ updated projected QI
expenditures. The formula used to
reallocate the available funds to need
States is intended to minimize the
impact on surplus States, to equitably
distribute the total needed amount
among those surplus States, and to meet
the needs for those States projecting
deficits.
Since under the QI, TMA, and
Abstinence Act of 2005, the
authorization for the QI benefit expires
at the end of calendar year 2007, the QI
regulation will sunset at the end of
calendar year 2007. We will amend the
sunset date in the regulation to take into
account the extension set out in the QI,
TMA, and Abstinence Act of 2007 in a
subsequent rulemaking.
Based on the process described above,
the resulting final allotments for FY
2007 are shown by State in the table
below. In this table each column
contains data defined as follows:
Column A—State. Column A shows
the name of each State. Columns B
through D show the determination of
the States’ Final FY 2007 QI Allotments,
based only on Census Bureau data.
Column B—Number of Individuals.
Column B contains the estimated
average number of Medicare
beneficiaries for the years 2004 through
2006 that are not covered by Medicaid
whose family income is between 120
and 135 percent of the poverty level for
each State, in thousands, as obtained
from the Census Bureau’s Annual Social
and Economic Supplement to the
Current Population Survey through
December 31, 2006.
Column C—Percentage of Total.
Column C provides the percentage of
total number of individuals for each
State, determined as the Number of
Individuals for the State in Column B
divided by the sum of the Number of
Individuals for all States in Column B.
Column D—Initial QI Allotment.
Column D contains each State’s Initial
FY 2007 QI allotment, calculated as the
State’s Percentage of Total in Column C
multiplied by $400,000,000, the total
amount available for FY 2007 for all
States.
Columns E through J show the
determination of the States’ Final FY
2007 QI Allotments.
PO 00000
Frm 00058
Fmt 4703
Sfmt 4703
17351
Column E—FY 2007 Estimated QI
Expenditures. Column E contains the
States’ most recent estimates of their
total QI expenditures for FY 2007
requested from States as of August 31,
2007.
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 Initial FY 2007
QI allotments in Column D; for those
States, Column F shows the amount in
Column E minus the amount in 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 2007
QI allotments for those States that
project they will not need all of their FY
2007 QI allotments (referred to as NonNeed States). For States whose estimates
of QI expenditures for FY 2007 in
Column E are equal to or less than their
Initial FY 2007 QI allotments in Column
D, Column G shows the amount in
Column D minus the amount in Column
E. For the States with a need, Column
G shows ‘‘Need.’’ The pool of excess QI
allotments is equal to the sum of the
amounts in Column G.
Column H—Percent of Total NonNeed States. Column H shows the
percentage of the total excess FY 2007
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’ Initial FY
2007 QI allotments in Column D in
order to provide for the total need
shown in Column F. The amount in
Column I is determined as the
percentage in Column H for Non-Need
States multiplied by the sum of the need
for all States from Column F.
Column J—Final FY 2007 QI
Allotment. Column J contains the Final
FY 2007 QI allotment for each State. For
States that need additional amounts
based on their FY 2007 Estimated QI
Expenditures in Column E, Column J is
equal to the Initial FY 2007 QI
Allotment in Column D plus the amount
of Need Column F. For Non-Need
States, Column J is equal to the Initial
FY 2007 QI Allotment in Column D
minus the amount in Column I.
E:\FR\FM\01APN1.SGM
01APN1
17352
Federal Register / Vol. 73, No. 63 / Tuesday, April 1, 2008 / Notices
FINAL FY 2007 QUALIFIED INDIVIDUALS ALLOTMENTS
FY 2007 estimated QI
expenditures 1
Need (difference)
If E>D, E–D
Reduction
pool for
non-need
states
If D>=E, D–
E
Percent of
total nonneed states
G/(Total of
G)
Reduction
for nonneed states
(Col H ×
Tot. Col F)
$61,713,005
Final FY
2007 QI
allotment 2
E
F
G
H
I
J
Initial QI allotments for FY 2007
State
Number of
individuals 3
(000s)
Percentage
of total
Col B/Tot.
Col B
A
B
C
Initial QI allotment Col C
x
$400,000,000
D
( 4)
(4)
( 4)
Alabama ..................................
Alaska ......................................
Arizona ....................................
Arkansas .................................
California .................................
Colorado ..................................
Connecticut .............................
Delaware .................................
District of Columbia .................
Florida .....................................
Georgia ....................................
Hawaii ......................................
Idaho .......................................
Illinois ......................................
Indiana .....................................
Iowa .........................................
Kansas ....................................
Kentucky ..................................
Louisiana .................................
Maine .......................................
Maryland ..................................
Massachusetts ........................
Michigan ..................................
Minnesota ................................
Mississippi ...............................
Missouri ...................................
Montana ..................................
Nebraska .................................
Nevada ....................................
New Hampshire .......................
New Jersey .............................
New Mexico .............................
New York .................................
North Carolina .........................
North Dakota ...........................
Ohio .........................................
Oklahoma ................................
Oregon ....................................
Pennsylvania ...........................
Rhode Island ...........................
South Carolina ........................
South Dakota ..........................
Tennessee ...............................
Texas .......................................
Utah .........................................
Vermont ...................................
Virginia ....................................
Washington .............................
West Virginia ...........................
Wisconsin ................................
Wyoming .................................
27.0
1.7
35
21
118
13
16
4
3
104
45
5
6
80
58
15
12
30
32
8
20
44
52
14
18
46
7
10
10
8
41
11
89
64
5
60
18
21
69
7
27
4
32
96
5
3
33
26
18
23
2
1.78
0.11
2.31
1.38
7.80
0.88
1.05
0.26
0.18
6.87
2.96
0.31
0.40
5.29
3.80
0.97
0.79
2.00
2.11
0.55
1.32
2.92
3.40
0.94
1.16
3.01
0.46
0.66
0.68
0.53
2.70
0.72
5.86
4.24
0.33
3.97
1.21
1.38
4.55
0.44
1.76
0.29
2.09
6.30
0.33
0.22
2.17
1.73
1.21
1.49
0.13
$7,114,625
439,174
9,222,661
5,533,597
31,181,379
3,513,395
4,216,074
1,054,018
702,679
27,492,314
11,857,708
1,229,688
1,581,028
21,168,204
15,195,433
3,864,734
3,162,055
7,992,973
8,432,148
2,195,872
5,270,092
11,682,038
13,614,405
3,776,899
4,655,248
12,033,377
1,844,532
2,635,046
2,722,881
2,108,037
10,803,689
2,898,551
23,451,910
16,952,130
1,317,523
15,898,112
4,830,918
5,533,597
18,181,818
1,756,697
7,026,790
1,141,853
8,344,313
25,208,608
1,317,523
878,349
8,695,652
6,938,955
4,830,918
5,972,771
527,009
$19,850,000
130,000
11,466,582
6,190,217
12,989,337
2,292,718
7,889,657
257,954
20,084
30,089,989
18,295,552
538,360
1,438,000
14,400,000
6,293,236
2,465,061
1,856,338
8,166,944
11,442,532
3,834,061
3,634,249
7,426,293
8,552,043
3,687,449
9,000,000
3,246,344
799,103
2,181,470
2,208,927
881,027
9,990,271
2,299,667
38,375,979
17,598,664
441,201
15,412,487
7,695,103
7,045,898
20,005,059
1,933,820
7,476,000
869,000
369,605
22,907,835
755,851
2,682,376
6,500,000
5,072,243
3,568,573
2,000,375
443,190
$12,735,375
NA
2,243,921
656,620
NA
NA
3,673,583
NA
NA
2,597,675
6,437,844
NA
NA
NA
NA
NA
NA
173,971
3,010,384
1,638,189
NA
NA
NA
NA
4,344,752
NA
NA
NA
NA
NA
NA
NA
14,924,069
646,534
NA
NA
2,864,185
1,512,301
1,823,241
177,123
449,210
NA
NA
NA
NA
1,804,027
NA
NA
NA
NA
NA
$309,174
( 4)
( 4)
18,192,042
1,220,677
( 4)
796,064
682,595
( 4)
( 4)
691,328
143,028
6,768,204
8,902,197
1,399,673
1,305,717
( 4)
( 4)
( 4)
1,635,843
4,255,745
5,062,362
89,450
( 4)
8,787,033
1,045,429
453,576
513,954
1,227,010
813,418
598,884
( 4)
( 4)
876,322
485,625
( 4)
( 4)
( 4)
( 4)
( 4)
272,853
7,974,708
2,300,773
561,672
( 4)
2,195,652
1,866,712
1,262,345
3,972,396
83,819
0.3564
(4)
( 4)
20.9716
1.4072
(4)
0.9177
0.7869
( 4)
(4)
0.7970
0.1649
7.8023
10.2623
1.6135
1.5052
( 4)
( 4)
( 4)
1.8858
4.9060
5.8358
0.1031
( 4)
10.1296
1.2052
0.5229
0.5925
1.4145
0.9377
0.6904
( 4)
( 4)
1.0102
0.5598
( 4)
(4)
( 4)
( 4)
(4)
0.3145
9.1931
2.6523
0.6475
(4)
2.5311
2.1519
1.4552
4.5793
0.0966
$219,953
( 4)
(4)
12,942,175
868,413
( 4)
566,336
485,611
( 4)
( 4)
491,824
101,753
4,815,033
6,333,197
995,755
928,913
( 4)
( 4)
( 4)
1,163,771
3,027,620
3,601,464
63,637
( 4)
6,251,268
743,739
322,683
365,637
872,919
578,682
426,058
(4)
( 4)
623,433
345,483
(4)
( 4)
( 4)
(4)
( 4)
194,113
5,673,363
1,636,815
399,585
( 4)
1,562,030
1,328,015
898,057
2,826,041
59,631
$19,850,000
219,222
11,466,582
6,190,217
18,239,204
2,644,981
7,889,657
487,683
217,068
30,089,989
18,295,552
737,864
1,479,275
16,353,171
8,862,235
2,868,979
2,233,142
8,166,944
11,442,532
3,834,061
4,106,321
8,654,418
10,012,941
3,713,263
9,000,000
5,782,110
1,100,793
2,312,363
2,357,244
1,235,118
10,225,008
2,472,493
38,375,979
17,598,664
694,090
15,552,629
7,695,103
7,045,898
20,005,059
1,933,820
7,476,000
947,740
2,670,949
23,571,793
917,939
2,682,376
7,133,622
5,610,939
3,932,861
3,146,731
467,379
Total .................................
1,518
100.00
400,000,000
374,966,724
61,713,005
86,746,281
100.0000
61,713,005
400,000,000
Footnotes:
1 FY 2007 Estimates from August 2007 CMS Survey of States.
2 For (4) States Final FY 2007 QI Allotment is equal to Initial QI Allotment in Column D increased by amount in Column F. For Non-(4) States Final FY 2007 QI Allotment is equal to Initial QI Allotment in Column D reduced by amount in Column I.
3 Three-year average (2004–2006) of number (000) of Medicare beneficiaries in State who are not enrolled in Medicaid but whose incomes are at least 120 but less
than 135 of FPL.
4 Need.
Source: Census Bureau Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS) for past 3 years through March of 2006.
mstockstill on PROD1PC66 with NOTICES
III. Collection of Information
Requirements
Paperwork Reduction Act of 1995 (44
U.S.C. 35).
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
IV. Regulatory Impact Statement
VerDate Aug<31>2005
16:40 Mar 31, 2008
Jkt 214001
We have examined the impact of this
notice as required by Executive Order
12866 (September 1993, Regulatory
Planning and Review), the Regulatory
Flexibility Act (RFA) (September 19,
PO 00000
Frm 00059
Fmt 4703
Sfmt 4703
1980, Pub. L. 96–354), section 1102(b) of
the Social Security Act, the Unfunded
Mandates Reform Act of 1995 (Pub. L.
104–4), Executive Order 13132 on
Federalism, and the Congressional
Review Act (5 U.S.C. 804(2)).
Executive Order 12866 (as amended
by Executive Order 13258, which
merely reassigns responsibility of
E:\FR\FM\01APN1.SGM
01APN1
mstockstill on PROD1PC66 with NOTICES
Federal Register / Vol. 73, No. 63 / Tuesday, April 1, 2008 / Notices
duties) 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 notice sets forth the amounts of
States’ final FY 2007 allotments for
payment of Medicare Part B premiums
for qualifying individuals determined in
accordance with existing statutory and
regulatory provisions. Because this
notice merely redistributes allotments
that have already been made, it has no
impact. As a result, it does not reach the
economic threshold of being 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.
As indicated previously, this notice is
applicable only to States. Moreover, 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. The existing
statute and regulations permit, 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 final FY 2007
allotments set forth in this notice 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. The
changes in allotments will not result in
fewer individuals receiving the QI
benefit in any State. The FY 2007 costs
VerDate Aug<31>2005
16:40 Mar 31, 2008
Jkt 214001
for this provision have been included in
the FY 2007 President’s Budget.
Section 1102(b) of the 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 notice 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 (URMA)
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 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 any
costs on State or local governments, the
requirements of E.O. 13132 are not
applicable.
In accordance with the provisions of
Executive Order 12866, this notice was
reviewed by the Office of Management
and Budget.
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: November 20, 2007.
Kerry Weems,
Acting Administrator, Centers for Medicare
& Medicaid Services.
Approved: December 3, 2007.
Michael O. Leavitt,
Secretary.
Editorial Note: This document was
received at the Office of the Federal Register
on March 18, 2008.
[FR Doc. E8–5748 Filed 3–31–08; 8:45 am]
BILLING CODE 4120–01–P
PO 00000
Frm 00060
Fmt 4703
Sfmt 4703
17353
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
CMS–3197–N
Medicare Program; Meeting of the
Medicare Evidence Development and
Coverage Advisory Committee—May
21, 2008
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice of meeting.
AGENCY:
SUMMARY: This notice announces that a
public meeting of the Medicare
Evidence Development & Coverage
Advisory Committee (MedCAC)
(‘‘Committee’’) will be held on
Wednesday, May 21, 2008. The
Committee generally provides advice
and recommendations concerning the
adequacy of scientific evidence needed
to determine whether certain medical
items and services are reasonable and
necessary under the Medicare statute.
This meeting will focus on the design
and methodological issues that
challenge clinical research regarding
innovative neurorehabilitation
techniques. The meeting will discuss
the various kinds of evidence that are
useful to support requests for Medicare
coverage in this field. This meeting is
open to the public in accordance with
the Federal Advisory Committee Act (5
U.S.C. App. 2, section 10(a)).
DATES: Meeting Date: The public
meeting will be held 7:30 a.m. until 4:30
p.m., d.s.t. on Wednesday, May 21,
2008.
Deadline for Submission of Written
Comments: Written comments must be
received at the address specified in the
ADDRESSES section of this notice by 5
p.m., d.s.t. on April 21, 2008. Once
submitted, comments are final.
Deadlines for Speaker Registration
and Presentation Materials: The
deadline to register to be a speaker, and
to submit materials and writings that
will be used in support of an oral
presentation, is 5 p.m., d.s.t. on
Monday, April 21, 2008. Speakers may
register by phone or via e-mail by
contacting the person listed in the FOR
FURTHER INFORMATION CONTACT section of
this notice. Presentation materials must
be received at the address specified in
the ADDRESSES section of this notice.
Deadline for All Other Attendees
Registration: Individuals may register by
phone or via e-mail by contacting the
person listed in the FOR FURTHER
INFORMATION CONTACT section of this
notice by 5 p.m., d.s.t. on Wednesday,
May 14, 2008.
E:\FR\FM\01APN1.SGM
01APN1
]]>Agencies
[Federal Register Volume 73, Number 63 (Tuesday, April 1, 2008)]
[Notices]
[Pages 17348-17353]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-5748]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-2231-N]
RIN 0938-AP23
Medicaid Program; Final State Allotments for Payment of Medicare
Part B Premiums for Qualifying Individuals for Federal Fiscal Year 2007
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This Notice sets forth the methodology and process used to
compute and issue each State's final allotment for fiscal year (FY)
2007 that is available to pay Medicare Part B premiums for qualifying
individuals.
DATES: Effective date: Final allotments for payment of Medicare Part B
premiums for FY 2007 are effective October 1, 2006, through September
30, 2007.
FOR FURTHER INFORMATION CONTACT: Deborah Abshire, (410) 786-9291.
SUPPLEMENTARY INFORMATION:
I. Background
A. Allotments Prior to FY 2005
Section 1902 of the Social Security Act (the Act) sets forth the
requirements for State plans for medical assistance. Before 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
[[Page 17349]]
(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 are eligible QMBs but 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 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
in 2003, section 401 of the Welfare Reform Bill (Pub. L. 108-89),
enacted on October 1, 2003, eliminated reference to the second QI
benefit (for the 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). In 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 following fiscal year, but maintained
the annual funding at the FY 2002 level. The Act was amended by
Extension of Medicare Cost-Sharing for the Medicare Part B Premium for
Qualifying Individuals, (Pub. L. 108-448), enacted December 8, 2004,
which continued coverage of this group of QIs (whose income is at least
120 percent but less than 135 percent of the Federal poverty line)
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) of the
Act 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). Further, 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
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.
On March 29, 1999, the Department of Health and Human Services
published a notice in the Federal Register (64 FR 14931) 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 through FY 2002, through several continuing
resolutions, coverage has been continued through fiscal year 2007, 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.
B. Allotments for FY 2005
In FY 2005, some States exhausted their FY 2005 allotments before
the end of the fiscal year, which caused them to deny benefits to
eligible persons under section 1933(b)(3) of the Act, while other
States projected a surplus in their allotments. We asked those States
that exhausted or expected 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 that did not expect to
use their full allotments in FY 2005 to project the difference between
the amount they expected to spend and their allotment, that is, their
surplus. After all States reported these figures, it was evident that
the total surplus exceeded the total need. In spite of there being
adequate overall funding for the QI benefit, some eligible individuals
would have been denied benefits due to the allocation methodology
initially
[[Page 17350]]
used to determine the FY 2005 allotments.
We believed that it was 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 attributed the difference between the
surplus in available QI allotments for some States and the need in
other States in FY 2005 as due to the imprecision in the data that we
used to provide States with their initial allocations under section
1933 of the Act. Therefore, on August 26, 2005 we published an interim
final rule in the Federal Register (70 FR 50214) under which we
compensated for this imprecision in order to enable States to enroll
those QIs whom they would have been able to enroll had the data been
more precise.
The interim final rule amended 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. Section 433.10(c)(5)(iv) states that CMS
will notify States of any changes in allotments resulting from any
reallocations.
The FY 2005 allotments were determined by applying the 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
represented a rough proxy to attain the statutory number. Actual
expenditure data, however, revealed that the Census Bureau data yielded
an inappropriate distribution of the total appropriated fund as
evidenced by the fact that several States projected significant
shortfalls in their allotments, while many other States projected a
significant surplus by the end of the fiscal year 2005. Census Bureau
data were not 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 did not preclude a subsequent readjustment of that
allocation, when it became clear that the data used for that estimate
did not effectuate the statutory objective. The interim final rule
published in the Federal Register on August 26, 2005 permitted in this
specific circumstance a redistribution of surplus funds, as it was
demonstrated that the States' projections and estimates resulted in an
inequitable initial allocation for FY 2005, 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 the August 26, 2005 interim final rule, we codified the
methodology we have been using to approximate the statutory formula for
determining State allotments. However, since certain States projected a
deficit in their allotment before the end of fiscal year 2005, the rule
permitted fiscal year 2005 funds to be reallocated from the surplus
States to the need States. The regulation specified the methodology for
computing the annual allotments, and for reallocating funds in this
circumstance. The formula used to reallocate funds was intended to
minimize the 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. At the time of
the publication of the interim final rule on August 26, 2005, the
authorization for the QI benefit expired at the end of calendar year
2005, and no additional funds were appropriated for the QI benefit
beyond September 30, 2005; therefore, the regulation specified a sunset
at the end of calendar year 2005.
C. Allotments for FY 2006 and FY 2007
On October 20, 2005 the ``QI, TMA, and Abstinence Programs
Extension and Hurricane Katrina Unemployment Relief Act of 2005'' was
enacted by the Congress (Pub. L. 109-91) (QI, TMA, and Abstinence Act
of 2005). Section 101 of the QI, TMA, and Abstinence Act extended the
QI program through September 30, 2007 with no change in funding, that
is, under this legislation $400 million per fiscal year was
appropriated for each of FY 2006 and FY 2007. The provisions of section
101 of the QI, TMA, and Abstinence Act of 2005 were effective as of
September 30, 2005.
On October 16, 2006 we published a final rule in the Federal
Register (71 FR 60663), which implemented the provisions of section 101
of the QI, TMA, and Abstinence Act relating the QI allotments for final
FY 2006 allotments and preliminary FY 2007 allotments. As indicated in
that final rule, we believe that the clear intent of the statute is to
provide benefits to eligible persons up to the full amount of funds
made available for the program in each fiscal year. We recognized that
because of the imprecision in data for computing the States' QI
allotments for a fiscal year, some States would experience either
surpluses or shortages in their FY 2006 and FY 2007 allotments. In
accordance with section 433.10(c), the FY 2006 and FY 2007 QI
allotments were designed to compensate for the imprecision in data to
permit shortage States to enroll more QIs than otherwise would have
been possible.
D. Allotments for FY 2008 and Thereafter
On September 29, 2007, the President signed the ``TMA, Abstinence
Education, and QI Program Extension Act of 2007'' (QI, TMA, and
Abstinence Act of 2007) (Pub. L. 110-90). Section 3 of the QI, TMA, and
Abstinence Act of 2007 extends the QI program through December 31, 2007
and allocates $100 million for such period. We will address this
allocation and extend the allocation methodology's regulatory sunset in
a subsequent rulemaking. If additional funding is authorized to extend
the QI Program for some or all of the calendar year 2008 or beyond, we
will also issue a notice in the Federal Register to announce the QI
allotments to be provided in accordance with the extending legislation.
II. Provisions of the Notice
This notice sets forth the final QI allotments for FY 2007.
In the final rule published on October 16, 2006 (71 FR 60663), we
set forth a two step/two phase methodology/process for determining
States' QI allotments for FY 2007, and that regulation implemented
phase one of the process. Under the first step of phase one, an
``initial'' allocation was determined for each State under the formula
specified in section 1933 of the Act and based only on the data
obtained from the Census Bureau (the 3-year average of the number of
Medicare beneficiaries in the State who are not enrolled in the
Medicaid program but whose incomes are at least 120 percent of the FPL
and less than 135 percent of the FPL). However, we further obtained
States' projected QI expenditures for the fiscal year. We then compared
the initial allocations for the fiscal year to the States' projected QI
expenditures for the fiscal year to determine those States
[[Page 17351]]
with a projected need (that is, those States whose initial allocation
is less than their projected expenditures) or a projected surplus (that
is, those States whose initial allocation is greater than the projected
expenditures) for FY 2007.
Under the second step of the process, implemented now through this
notice, we adjusted the States' initial allocations by considering the
States' projected QI expenditures for FY 2007. This was done by
proportionately reducing the QI allotments of States with surpluses for
the fiscal year by the amount of the total need for States that do not
have sufficient QI allotments for the fiscal year. We are thus
completing the two phase methodology/process for the fiscal year. This
notice accounts for the fact that at the beginning of the fiscal year,
we determined the initial allocations based on the Census Bureau data,
obtained States' projections of QI expenditures for the fiscal year,
and made any adjustments based on the projected surpluses/needs for the
fiscal year. The amounts of the States' QI allotments determined under
this first phase at the beginning of the fiscal year were considered
the States' ``initial'' QI allotments for the fiscal year and are shown
on the table below. Now, under phase two of the process, during the
fourth quarter of the fiscal year we obtained States' updated projected
QI expenditures for the fiscal year. We then established the ``final''
QI allotments for the fiscal year based on these updated projections.
As indicated in this notice and as shown on the table below, the
States' final QI allotments for FY 2007 are determined by comparing the
initial QI allotments for the fiscal year (again which are calculated
based on the Census Bureau data) to the States' updated projections of
QI expenditures for the fiscal year; this establishes those States with
a ``final'' projected need (the initial allocation is less than the
updated projected expenditures) or a surplus (initial allocation is
greater than the updated projected expenditures) for the fiscal year.
Using the updated projected QI expenditures, we adjusted the States'
initial allocations by reducing the surplus States' initial allotments
proportionately to meet the need States' deficits. This is the same
methodology we used for determining the FY 2005 allotments as published
in the interim final rule published on August 26, 2005, in the Federal
Register; the only change was that in computing the FY 2007 allotments,
we determined the preliminary allotments at the beginning of the fiscal
year using States' preliminary projected QI expenditures, and then we
determined the final QI allotments later in the fiscal year using
States' updated projected QI expenditures. The formula used to
reallocate the available funds to need States is intended to minimize
the impact on surplus States, to equitably distribute the total needed
amount among those surplus States, and to meet the needs for those
States projecting deficits.
Since under the QI, TMA, and Abstinence Act of 2005, the
authorization for the QI benefit expires at the end of calendar year
2007, the QI regulation will sunset at the end of calendar year 2007.
We will amend the sunset date in the regulation to take into account
the extension set out in the QI, TMA, and Abstinence Act of 2007 in a
subsequent rulemaking.
Based on the process described above, the resulting final
allotments for FY 2007 are shown by State in the table below. In this
table each column contains data defined as follows:
Column A--State. Column A shows the name of each State. Columns B
through D show the determination of the States' Final FY 2007 QI
Allotments, based only on Census Bureau data.
Column B--Number of Individuals. Column B contains the estimated
average number of Medicare beneficiaries for the years 2004 through
2006 that are not covered by Medicaid whose family income is between
120 and 135 percent of the poverty level for each State, in thousands,
as obtained from the Census Bureau's Annual Social and Economic
Supplement to the Current Population Survey through December 31, 2006.
Column C--Percentage of Total. Column C provides the percentage of
total number of individuals for each State, determined as the Number of
Individuals for the State in Column B divided by the sum of the Number
of Individuals for all States in Column B.
Column D--Initial QI Allotment. Column D contains each State's
Initial FY 2007 QI allotment, calculated as the State's Percentage of
Total in Column C multiplied by $400,000,000, the total amount
available for FY 2007 for all States.
Columns E through J show the determination of the States' Final FY
2007 QI Allotments.
Column E--FY 2007 Estimated QI Expenditures. Column E contains the
States' most recent estimates of their total QI expenditures for FY
2007 requested from States as of August 31, 2007.
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 Initial FY 2007 QI allotments in
Column D; for those States, Column F shows the amount in Column E minus
the amount in 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 2007 QI allotments for those States
that project they will not need all of their FY 2007 QI allotments
(referred to as Non-Need States). For States whose estimates of QI
expenditures for FY 2007 in Column E are equal to or less than their
Initial FY 2007 QI allotments in Column D, Column G shows the amount in
Column D minus the amount in Column E. For the States with a need,
Column G shows ``Need.'' The pool of excess QI allotments is equal to
the sum of the amounts in Column G.
Column H--Percent of Total Non-Need States. Column H shows the
percentage of the total excess FY 2007 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' Initial FY 2007 QI allotments in
Column D in order to provide for the total need shown in Column F. The
amount in Column I is determined as the percentage in Column H for Non-
Need States multiplied by the sum of the need for all States from
Column F.
Column J--Final FY 2007 QI Allotment. Column J contains the Final
FY 2007 QI allotment for each State. For States that need additional
amounts based on their FY 2007 Estimated QI Expenditures in Column E,
Column J is equal to the Initial FY 2007 QI Allotment in Column D plus
the amount of Need Column F. For Non-Need States, Column J is equal to
the Initial FY 2007 QI Allotment in Column D minus the amount in Column
I.
[[Page 17352]]
Final FY 2007 Qualified Individuals Allotments
--------------------------------------------------------------------------------------------------------------------------------------------------------
Initial QI allotments for FY 2007 Reduction
---------------------------------------- Reduction Percent of for non-
FY 2007 Need pool for total non- need states Final FY
State Number of Percentage Initial QI estimated QI (difference) non-need need states (Col H x 2007 QI
individuals of total allotment expenditures If E>D, E-D states If G/(Total Tot. Col F) allotment
\3\ (000s) Col B/Tot. Col C x \1\ D>=E, D-E of G) \2\
Col B $400,000,000 $61,713,005
A B C D E F G H I J
--------------------------------------------------------------------------------------------------------------------------------------------------------
Alabama......................... 27.0 1.78 $7,114,625 $19,850,000 $12,735,375 (\4\) (\4\) (\4\) $19,850,000
Alaska.......................... 1.7 0.11 439,174 130,000 NA $309,174 0.3564 $219,953 219,222
Arizona......................... 35 2.31 9,222,661 11,466,582 2,243,921 (\4\) (\4\) (\4\) 11,466,582
Arkansas........................ 21 1.38 5,533,597 6,190,217 656,620 (\4\) (\4\) (\4\) 6,190,217
California...................... 118 7.80 31,181,379 12,989,337 NA 18,192,042 20.9716 12,942,175 18,239,204
Colorado........................ 13 0.88 3,513,395 2,292,718 NA 1,220,677 1.4072 868,413 2,644,981
Connecticut..................... 16 1.05 4,216,074 7,889,657 3,673,583 (\4\) (\4\) (\4\) 7,889,657
Delaware........................ 4 0.26 1,054,018 257,954 NA 796,064 0.9177 566,336 487,683
District of Columbia............ 3 0.18 702,679 20,084 NA 682,595 0.7869 485,611 217,068
Florida......................... 104 6.87 27,492,314 30,089,989 2,597,675 (\4\) (\4\) (\4\) 30,089,989
Georgia......................... 45 2.96 11,857,708 18,295,552 6,437,844 (\4\) (\4\) (\4\) 18,295,552
Hawaii.......................... 5 0.31 1,229,688 538,360 NA 691,328 0.7970 491,824 737,864
Idaho........................... 6 0.40 1,581,028 1,438,000 NA 143,028 0.1649 101,753 1,479,275
Illinois........................ 80 5.29 21,168,204 14,400,000 NA 6,768,204 7.8023 4,815,033 16,353,171
Indiana......................... 58 3.80 15,195,433 6,293,236 NA 8,902,197 10.2623 6,333,197 8,862,235
Iowa............................ 15 0.97 3,864,734 2,465,061 NA 1,399,673 1.6135 995,755 2,868,979
Kansas.......................... 12 0.79 3,162,055 1,856,338 NA 1,305,717 1.5052 928,913 2,233,142
Kentucky........................ 30 2.00 7,992,973 8,166,944 173,971 (\4\) (\4\) (\4\) 8,166,944
Louisiana....................... 32 2.11 8,432,148 11,442,532 3,010,384 (\4\) (\4\) (\4\) 11,442,532
Maine........................... 8 0.55 2,195,872 3,834,061 1,638,189 (\4\) (\4\) (\4\) 3,834,061
Maryland........................ 20 1.32 5,270,092 3,634,249 NA 1,635,843 1.8858 1,163,771 4,106,321
Massachusetts................... 44 2.92 11,682,038 7,426,293 NA 4,255,745 4.9060 3,027,620 8,654,418
Michigan........................ 52 3.40 13,614,405 8,552,043 NA 5,062,362 5.8358 3,601,464 10,012,941
Minnesota....................... 14 0.94 3,776,899 3,687,449 NA 89,450 0.1031 63,637 3,713,263
Mississippi..................... 18 1.16 4,655,248 9,000,000 4,344,752 (\4\) (\4\) (\4\) 9,000,000
Missouri........................ 46 3.01 12,033,377 3,246,344 NA 8,787,033 10.1296 6,251,268 5,782,110
Montana......................... 7 0.46 1,844,532 799,103 NA 1,045,429 1.2052 743,739 1,100,793
Nebraska........................ 10 0.66 2,635,046 2,181,470 NA 453,576 0.5229 322,683 2,312,363
Nevada.......................... 10 0.68 2,722,881 2,208,927 NA 513,954 0.5925 365,637 2,357,244
New Hampshire................... 8 0.53 2,108,037 881,027 NA 1,227,010 1.4145 872,919 1,235,118
New Jersey...................... 41 2.70 10,803,689 9,990,271 NA 813,418 0.9377 578,682 10,225,008
New Mexico...................... 11 0.72 2,898,551 2,299,667 NA 598,884 0.6904 426,058 2,472,493
New York........................ 89 5.86 23,451,910 38,375,979 14,924,069 (\4\) (\4\) (\4\) 38,375,979
North Carolina.................. 64 4.24 16,952,130 17,598,664 646,534 (\4\) (\4\) (\4\) 17,598,664
North Dakota.................... 5 0.33 1,317,523 441,201 NA 876,322 1.0102 623,433 694,090
Ohio............................ 60 3.97 15,898,112 15,412,487 NA 485,625 0.5598 345,483 15,552,629
Oklahoma........................ 18 1.21 4,830,918 7,695,103 2,864,185 (\4\) (\4\) (\4\) 7,695,103
Oregon.......................... 21 1.38 5,533,597 7,045,898 1,512,301 (\4\) (\4\) (\4\) 7,045,898
Pennsylvania.................... 69 4.55 18,181,818 20,005,059 1,823,241 (\4\) (\4\) (\4\) 20,005,059
Rhode Island.................... 7 0.44 1,756,697 1,933,820 177,123 (\4\) (\4\) (\4\) 1,933,820
South Carolina.................. 27 1.76 7,026,790 7,476,000 449,210 (\4\) (\4\) (\4\) 7,476,000
South Dakota.................... 4 0.29 1,141,853 869,000 NA 272,853 0.3145 194,113 947,740
Tennessee....................... 32 2.09 8,344,313 369,605 NA 7,974,708 9.1931 5,673,363 2,670,949
Texas........................... 96 6.30 25,208,608 22,907,835 NA 2,300,773 2.6523 1,636,815 23,571,793
Utah............................ 5 0.33 1,317,523 755,851 NA 561,672 0.6475 399,585 917,939
Vermont......................... 3 0.22 878,349 2,682,376 1,804,027 (\4\) (\4\) (\4\) 2,682,376
Virginia........................ 33 2.17 8,695,652 6,500,000 NA 2,195,652 2.5311 1,562,030 7,133,622
Washington...................... 26 1.73 6,938,955 5,072,243 NA 1,866,712 2.1519 1,328,015 5,610,939
West Virginia................... 18 1.21 4,830,918 3,568,573 NA 1,262,345 1.4552 898,057 3,932,861
Wisconsin....................... 23 1.49 5,972,771 2,000,375 NA 3,972,396 4.5793 2,826,041 3,146,731
Wyoming......................... 2 0.13 527,009 443,190 NA 83,819 0.0966 59,631 467,379
-----------------------------------------------------------------------------------------------------------------------
Total....................... 1,518 100.00 400,000,000 374,966,724 61,713,005 86,746,281 100.0000 61,713,005 400,000,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
Footnotes:
\1\ FY 2007 Estimates from August 2007 CMS Survey of States.
\2\ For (\4\) States Final FY 2007 QI Allotment is equal to Initial QI Allotment in Column D increased by amount in Column F. For Non-(\4\) States Final
FY 2007 QI Allotment is equal to Initial QI Allotment in Column D reduced by amount in Column I.
\3\ Three-year average (2004-2006) of number (000) of Medicare beneficiaries in State who are not enrolled in Medicaid but whose incomes are at least
120 but less than 135 of FPL.
\4\ Need.
Source: Census Bureau Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS) for past 3 years through March of 2006.
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. Regulatory Impact Statement
We have examined the impact of this notice 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), Executive Order 13132 on
Federalism, and the Congressional Review Act (5 U.S.C. 804(2)).
Executive Order 12866 (as amended by Executive Order 13258, which
merely reassigns responsibility of
[[Page 17353]]
duties) 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 notice sets forth the amounts of
States' final FY 2007 allotments for payment of Medicare Part B
premiums for qualifying individuals determined in accordance with
existing statutory and regulatory provisions. Because this notice
merely redistributes allotments that have already been made, it has no
impact. As a result, it does not reach the economic threshold of being
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.
As indicated previously, this notice is applicable only to States.
Moreover, 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.
The existing statute and regulations permit, 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 final FY 2007 allotments set forth in this
notice 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. The changes in
allotments will not result in fewer individuals receiving the QI
benefit in any State. The FY 2007 costs for this provision have been
included in the FY 2007 President's Budget.
Section 1102(b) of the 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 notice 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 (URMA) 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 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 any costs on State or local governments, the requirements of
E.O. 13132 are not applicable.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
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: November 20, 2007.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
Approved: December 3, 2007.
Michael O. Leavitt,
Secretary.
Editorial Note: This document was received at the Office of the
Federal Register on March 18, 2008.
[FR Doc. E8-5748 Filed 3-31-08; 8:45 am]
BILLING CODE 4120-01-P
