[Federal Register Volume 59, Number 194 (Friday, October 7, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-24832]


[[Page Unknown]]

[Federal Register: October 7, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 403

[OBS-001-FC]

 

Medicare Program; Information, Counseling, and Assistance Grants 
Program

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Final rule with comment period.

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SUMMARY: This rule establishes, for fiscal years 1994 and beyond, a 
minimum level of funding for grants made to States, Commonwealths, and 
Territories to provide individuals eligible to receive benefits under 
the Medicare program with information, counseling, and assistance 
related to obtaining adequate and appropriate health insurance 
coverage. It also sets forth the following in regulations: A 
description of the methodology used to determine the total amount of 
the grant award; the conditions for eligibility for the grant; 
limitations on the use of grant funds in certain circumstances; 
reporting requirements; and an opportunity to appeal our determination 
regarding a State's grant application.
    The provisions of this rule are in accordance with section 4360 of 
the Omnibus Budget Reconciliation Act of 1990.
    In addition, this rule eliminates the supplemental coordinated care 
grants program.

DATES: Effective Date: October 7, 1994.
    Comment Period: Comments must be received at the appropriate 
address, as provided below, no later than 5 p.m. on December 6, 1994. 
Because we intend to make grant awards before October 1, 1994, it is 
not possible for us to consider the comments with respect to the fiscal 
year (FY) 1994 grant awards. We will, however, consider the comments 
for grants made available in future years and, if appropriate, for the 
revision of the regulations established by this rule.

ADDRESSES: Mail written comments (1 original and 3 copies) to the 
following address: Health Care Financing Administration, Department of 
Health and Human Services, Attention: OBS-001-FC, P.O. Box 26688, 
Baltimore, MD 21207.
    If you prefer, you may deliver your written comments (1 original 
and 3 copies) to one of the following addresses:

Room 309-G, Hubert H. Humphrey Building, 200 Independence Avenue SW., 
Washington, DC 20201, or
Room 132, East High Rise Building, 6325 Security Boulevard, Baltimore, 
MD 21207.

    Because of staffing and resource limitations, we cannot accept 
comments by facsimile (FAX) transmission. In commenting, please refer 
to file code OBS-001-FC. Comments received timely will be available for 
public inspection as they are received, generally beginning 
approximately 3 weeks after publication of a document, in Room 309-G of 
the Department's offices at 200 Independence Avenue SW., Washington, 
DC, on Monday through Friday of each week from 8:30 a.m. to 5 p.m. 
(phone: (202) 690-7890).

FOR FURTHER INFORMATION CONTACT: Eric Lang, (410) 966-3199.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 4360 of the Omnibus Budget Reconciliation Act of 1990 (OBRA 
'90), Public Law 101-508, and applicable appropriations authorize us to 
make grants to States, Commonwealths, and Territories for health 
insurance advisory service programs for Medicare beneficiaries. 
(Hereinafter, unless otherwise indicated, the term ``State'' or 
``States'' includes the 50 States, the District of Columbia, Puerto 
Rico, the Virgin Islands, Guam, and American Samoa.) Grant funds are 
available to support providing information, counseling, and assistance 
(ICA) relating to Medicare, Medicaid, Medicare supplemental policies, 
long-term care insurance, and other health insurance benefit 
information. Thus, this funding activity is known as the Health 
Insurance ICA Grants Program.
    Section 4360(a) of OBRA '90 specifies that, in order to be eligible 
for a grant under this program, the State must have a Federally-
approved Medicare supplemental regulatory program under section 1882 of 
the Social Security Act (the Act) (42 USC 1395ss). Section 1882 
addresses the certification of Medicare supplemental health insurance 
policies. In general, section 1882(b) provides that, if a State 
establishes, under State law, a regulatory program that applies the 
standards and requirements that the Secretary would apply to Medicare 
supplemental health insurance policies under section 1882(c) and that 
meets certain other criteria, those Medicare supplemental policies 
issued by the State are deemed to meet the standards and requirements 
that the Secretary would, herself, apply. Thus, in order to be eligible 
for an ICA grant a State must operate a regulatory program that we 
determine meets the criteria of section 1882(b) of the Act.
    Section 4360(b) of OBRA '90 specifies that, in submitting an 
application for an ICA grant, the State must submit a plan for a State-
wide ICA program. It also specifies the minimum information that the 
program must provide to Medicare beneficiaries.
    Grant funding is available to States for projects to plan, 
implement, operate, and/or enhance a variety of ICA activities. States 
may request grant funds to develop new health insurance ICA programs or 
to enhance existing health insurance ICA programs that meet the 
requirements specified in section 4360 of OBRA '90.
    Section 4360(a) requires us to publish regulations to establish a 
minimum level of funding for a health insurance ICA grant.
    Subject to congressional appropriations, in accordance with the 
requirements of section 4360 of OBRA '90, we will announce the 
availability of funding for health insurance ICA grants. Solicitation 
and grant application packages will be mailed to the Governor (or his 
or her designee) of each eligible State. The closing date for receipt 
of applications will be approximately 60 days thereafter. Awards for 
health insurance ICA grants will be made before October 1 of the year 
in which the solicitation is made. ICA grants will be administered in 
accordance with the provisions of: 42 CFR part 403, subpart E; 45 CFR 
part 74, (which concerns administration of grants) as specified by 
Sec. 74.4(a)(2); 45 CFR part 92 (which concerns uniform administrative 
requirements for grants and cooperative agreements to State and local 
governments); the terms of the solicitation; and the terms of the 
notice of grant award.

II. Provisions of this Final Rule With Comment Period

    On August 26, 1992, we published an interim final rule with comment 
period (57 FR 38616) that established a minimum level of funding for 
health insurance ICA grants made for fiscal years 1992 and 1993. Those 
provisions are contained at 42 CFR part 403, subpart E. In general, 
this final rule amends those provisions in order to establish a basis 
in regulations for continuation funding beyond FY 1993. It also 
eliminates the program of supplemental coordinated care grants. The 
provisions of this final rule with comment period are discussed below.

A. Eligibility for Grants

    Based on sections 4360 (a) and (b) of OBRA '90, this rule 
specifies, in Sec. 403.501, that, in order to be eligible for a health 
insurance ICA grant, the State must--
     Have a Federally-approved Medicare supplemental regulatory 
program under section 1882 of the Act; and
     Submit a timely application to us that meets the 
requirements of section 4360 of OBRA '90; 42 CFR part 403, subpart E; 
and our solicitation for grant applications.

B. Availability and Duration of Funds for Grants

    This rule specifies, at Sec. 403.502, that grants for a fiscal 
period will be approved subject to congressional appropriation of funds 
and, if applicable, satisfactory progress in each State's project under 
a preceding health insurance ICA grant. (The criteria by which progress 
will be evaluated and the performance standards for determining whether 
satisfactory progress has been made will be specified in the notice of 
grant award sent to each State.) Note that we may, at our discretion, 
set aside a portion of the appropriated funds to be used for ICA-
related activities. The grant award is based on a 12-month period and 
is made by the close of a fiscal year for each State application 
approved by that date. However, information regarding the timing of the 
award and its duration will be included in the notice of grant 
solicitation, rather than included in the regulations.

C. Number and Size of Grants

    This rule revises the provisions at existing Sec. 403.504. We 
continue to provide, at Sec. 403.504(a) for two types of grants: (1) 
New program grants, and (2) existing program enhancement grants for 
States with ``substantially similar'' health insurance ICA programs. We 
are interested in establishing or enhancing health insurance ICA 
programs in all eligible States. Therefore, under Sec. 403.504(b), each 
eligible State that submits an acceptable application will receive a 
grant that consists of two parts: a fixed amount (the minimum funding 
level) and a variable amount. Under Sec. 403.504(b), the grant 
available to each of the 50 States, Puerto Rico, and the District of 
Columbia equals $75,000 (the fixed amount), plus a per capita payment 
per resident Medicare beneficiary. Because of their relatively small 
populations, the grant available to the Virgin Islands, Guam, and 
American Samoa is $25,000 each (the fixed amount), plus a per capita 
payment per Medicare beneficiary residing in the territory.
    The establishment of the fixed amount portion of the grant award as 
the minimum funding level is a change from the minimum funding level 
described at existing Sec. 403.504(b). (Existing Sec. 403.504(b), which 
was applicable for fiscal years 1992 and 1993, provided that the 
minimum funding level consisted of two parts: a basic (fixed) portion 
and a variable portion.) We believe it is clearer (more descriptive) to 
establish as the minimum funding level a fixed, stated dollar amount 
and to consider the variable amount as being in addition to the minimum 
funding level. This change will not affect the amount of the grant 
award. The grant award will still consist of the fixed portion amount 
and the variable portion amount.
    The calculation of the variable portion of the grant is described 
at existing Sec. 403.405(c). We base the variable portion of the grant 
on the amount of available funds and a comparison of each State with 
the average of all of the States except the State being compared with 
respect to three factors that relate to the size of the State's 
Medicare population and where that population resides. The three 
factors are: the percentage of nationwide Medicare beneficiaries 
residing in the State, the State's proportion of Medicare beneficiaries 
to its total population, and the percentage of the State's Medicare 
beneficiary population that resides in rural areas.
    Nationally, the average variable payment is 10.75 cents. A State 
with a higher than average proportion of Medicare beneficiaries to its 
total State population and/or a higher than average proportion of rural 
Medicare beneficiaries will receive variable funds greater than 10.75 
cents per beneficiary under this grant program. Of the total variable 
portion of the award, approximately 75 percent is based on the number 
of Medicare beneficiaries in the State; approximately 10 percent is 
based on the proportion of Medicare beneficiaries to the total State 
population; and approximately 15 percent is based on the percentage of 
the State's Medicare beneficiary population that resides in rural 
areas. (We based population estimates on the U.S. Census estimates for 
1990. The Medicare beneficiary estimates came from our beneficiary 
enrollment database as of July 1990. We consider ``rural areas'' to be 
counties located outside of metropolitan statistical areas.)
    At the time we announce the availability of grant funding, we 
provide each State with an estimate of the amount of funds that may be 
awarded to it. As part of its application, the State submits a budget 
based on the estimated amount. When the grant awards are made, we 
allocate all available monies based on the methodology described above. 
If the grant amount the State receives is different than the 
anticipated amount on which its budget was based, the State must 
submit, along with its acceptance of the grant award, a revised budget 
that is based on the amount of the award.
    It has come to our attention that the provisions at existing 
Sec. 403.504, particularly paragraph (d) of that section, have caused 
confusion because they do not clearly reflect the above process. (Some 
interpreted paragraph (d) as indicating that there was a two-step 
process involved in applying for the grants. That is, that a State 
applied for and was awarded a basic grant and that, if there were 
additional funds available, the State submitted another application and 
a subsequent award was made.) This rule revises Sec. 403.504 to more 
clearly reflect the award process.

D. Limitations

    In accordance with section 4360(c) of OBRA '90, this rule retains 
existing Secs. 403.508 (a) and (b), with editorial changes. Paragraphs 
(a) and (b) provide that a State that receives a grant under this 
program may, with one exception, use the grant for any expenses 
incurred in planning, developing, implementing, and/or operating the 
program for which the grant is made. The exception applies to a State 
that receives a grant to supplement an existing ``substantially 
similar'' program. In this case, the State must not use the grant to 
supplant funds for activities that were conducted immediately preceding 
the date of the initial award of the grant and funded through other 
sources (including in-kind contributions), but must maintain the 
activities of the program at least at the level that those activities 
were conducted immediately preceding that date. (States will be 
required to provide information to document their maintenance of effort 
and funding levels.)

E. Reporting Requirements

    In accordance with section 4360(e) of OBRA '90, which requires the 
State to submit to us an annual report on its ICA program, this rule 
provides that a State that receives a grant under this program must 
submit at least one annual report to us and any additional reports we 
prescribe in the notice of grant award. It further specifies that HCFA 
will advise the State of the requirements concerning the frequency, 
timing, and contents of the report(s) in the notice of grant award that 
it sends to the State. This rule removes existing paragraph (d) 
(``Annual report'') from Sec. 403.508 and establishes a new 
Sec. 403.510 (``Reporting requirements'') to set forth the reporting 
requirements as described above.

F. Administration of Grants

    This rule adds Sec. 403.512(a) to identify those provisions that 
control the administration of the ICA grants. Section 403.512 specifies 
that health insurance ICA grants are administered in accordance with 
the provisions of 42 CFR part 403, subpart E; certain provisions of 45 
CFR part 74 (``Administration of Grants''), 45 CFR part 92 (``Uniform 
Administrative Requirements for Grants and Cooperative Agreements to 
State and Local Governments''), the terms of the solicitation, and 
terms of the notice of grant award. Section 403.512(a) also specifies 
that, except for the minimum funding levels established by 
Sec. 403.504(b)(1), in the event of conflict between a provision of the 
notice of grant award and any provision of the solicitation, subpart E 
of 42 CFR part 403, or of 45 CFR part 74 or part 92, the terms of the 
notice of grant award prevail.
    This rule adds Sec. 403.512(b) to state that HCFA provides notice 
to each applicant regarding HCFA's decision on an application for grant 
funding under Sec. 403.504.
    This rule adds Sec. 403.512(c) to enable States to appeal, under 45 
CFR part 16, HCFA's determination regarding its grant application. 45 
CFR part 16 contains procedures for appealing a final decision to our 
Departmental Grant Appeals Board.

G. Technical Change--Definition of ``State''

    This rule revises the definition of ``State'' at Sec. 403.500(c) to 
correct the inadvertent omission of ``the 50 States'' from the 
definition.

H. Elimination of Supplemental Coordinated Care Grants Program

    During fiscal years 1992 and 1993, supplemental grants were awarded 
to States for intensive, innovative approaches to making information, 
counseling, and/or assistance related to coordinated care benefits 
available to Medicare beneficiaries. The purpose of the grants was to 
encourage States with existing coordinated care programs to be more 
active in this area. We believe that States have now had adequate 
opportunity and funding to establish supplemental coordinated care 
materials and/or activities and that separate funding is no longer 
warranted. States should make provision in a grant awarded under 
Sec. 403.502 for any previous and/or current initiatives in ICA 
activities related to coordinated care. We may, however, make funds 
available from time to time to fund special ICA-related activities.

III. Collection of Information Requirements

    Section 403.510 of this document contains information collection 
and recordkeeping requirements that were approved by the Office of 
Management and Budget (OMB) under the Paperwork Reduction Act of 1980 
(44 U.S.C. 3501 et seq.) on January 2, 1994. The approval number is 
0938-0641 and the expiration date is January 31, 1997.

IV. Response to Comments

    Because of the large number of items of correspondence we normally 
receive on documents published for comment, we are not able to 
acknowledge or respond to them individually. Nevertheless, we will 
consider all comments that we received by the date and time specified 
in the ``Dates'' section of this preamble, and if we proceed with a 
subsequent document, we will respond to the comments in the preamble to 
that document.

V. Waiver of Prior Notice with Comment Period and of Delayed 
Effective Date

    We ordinarily publish a general notice of proposed rulemaking in 
the Federal Register and invite public comment on the proposed rule. 
That rule would have included a reference to the legal authority under 
which it is proposed, and the terms and substance of the proposed rule 
or a description of the subjects and issues involved. This procedure 
can be waived, however, when an agency finds good cause that a notice 
and comment procedure is impracticable, unnecessary, or contrary to the 
public interest, and incorporates a statement of the finding and its 
reasons in the rule issued. Further, we generally provide for final 
rules to be effective no sooner than 30 days after the date of 
publication unless we find good cause to waive the delay.
    In the case of this rule, its principal effect is to continue the 
funding of an existing program rather than to implement a new program. 
The affected entities, that is, the States, are already familiar with 
the program and will receive separate, individual notice. Further, it 
is desirable that regulations that will govern the administration of FY 
1994 grants be issued as soon as possible. Therefore, we find that it 
would be against the public interest to delay the publication of this 
rule pending completion of a prior public comment period. For the above 
reasons, we also find that it would be against the public interest to 
delay the effective date of this rule.

VI. Regulatory Impact Statement

    Consistent with the Regulatory Flexibility Act (RFA) (5 U.S.C. 601 
through 612), we prepare a regulatory flexibility analysis unless the 
Secretary certifies that a rule will not have a significant economic 
impact on a substantial number of small entities. States and 
individuals are not included in the definition of small entities.
    In addition, section 1102(b) of the Act requires the Secretary to 
prepare a regulatory impact analysis if a rule may have a significant 
impact on the operations of a substantial number of small rural 
hospitals. This analysis must conform to the provisions of section 604 
of the RFA. For purposes of section 1102(b) of the Act, we define a 
small rural hospital as a hospital that is located outside of a 
Metropolitan Statistical Area and has fewer than 50 beds.
    This rule simply establishes the terms and conditions of funding 
for grants. It has no independent or consequential effect on the 
economy. The activities conducted under the grant may improve 
competition by informing consumers of health insurance alternatives.
    We are not preparing analyses for either the RFA or section 1102(b) 
of the Act because we have determined, and the Secretary certifies, 
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.
    In accordance with the provisions of Executive Order 12866, this 
regulation was not reviewed by the Office of Management and Budget.

List of Subjects in 42 CFR Part 403

    Health insurance, Hospitals, Intergovernmental relations, Medicare, 
Reporting and recordkeeping requirements.

    42 CFR chapter IV is amended as set forth below:

PART 400--INTRODUCTION; DEFINITIONS

    1. The authority citation for part 400 continues to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh) and 44 U.S.C. Chapter 35.
    2. In Sec. 400.310, the table is amended by adding, at the 
beginning of the listing, the numbers set forth below to read as 
follows:


Sec. 400.310  Display of currently valid OMB control numbers. 

------------------------------------------------------------------------
                                                             Current OMB
 Sections in 42 CFR that contain collections of information    control  
                                                                Nos.    
------------------------------------------------------------------------
403.510....................................................    0938-0641
------------------------------------------------------------------------

* * * * *

PART 403--SPECIAL PROGRAMS AND PROJECTS

Subpart E--Beneficiary Counseling and Assistance Grants

    1. The authority citation for part 403, subpart E is revised to 
read as follows:

    Authority: Sec. 1882 of the Social Security Act (42 U.S.C. 
1395ss) and section 4360 of Pub. L. 101-508 (42 U.S.C. 1395b-4).

    2. Section 403.500 is revised to read as follows:


Sec. 403.500  Basis, scope, and definition.

    (a) Basis. This subpart implements, in part, the provisions of 
section 4360 of Public Law 101-508 by establishing a minimum level of 
funding for grants made to States for the purpose of providing 
information, counseling, and assistance relating to obtaining adequate 
and appropriate health insurance coverage to individuals eligible to 
receive benefits under the Medicare program.
    (b) Scope of subpart. This subpart sets forth the following:
    (1) Conditions of eligibility for the grant.
    (2) Minimum levels of funding for those States qualifying for the 
grants.
    (3) Reporting requirements.
    (c) Definition. For purposes of this subpart, the term ``State'' 
includes (except where otherwise indicated by the context) the 50 
States, the District of Columbia, the Commonwealth of Puerto Rico, the 
Virgin Islands, Guam, and American Samoa.
    3. A new Sec. 403.501 is added to read as follows:


Sec. 403.501   Eligibility for grants.

    To be eligible for a grant under this subpart, the State must have 
an approved Medicare supplemental regulatory program under section 1882 
of the Act and submit a timely application to HCFA that meets the 
requirements of--
    (a) Section 4360 of Public Law 101-508 (42 USC 1395b-4);
    (b) This subpart; and
    (c) The applicable solicitation for grant applications issued by 
HCFA.
    4. Section 403.502 is revised to read as follows:


Sec. 403.502  Availability of grants.

    HCFA awards funds to States subject to congressional appropriations 
of funds and, if applicable, subject to the satisfactory progress in 
the State's project during the preceding grant period. The criteria by 
which progress is evaluated and the performance standards for 
determining whether satisfactory progress has been made is specified in 
the notice of grant award sent to each State. HCFA advises each State 
as to when to make application and provides information as to the 
timing of the grant award and the duration of the grant award. HCFA 
also provides an estimate of the amount of funds that may be available 
to the State.
    5. Section 403.504 is revised to read as follows:


Sec. 403.504  Number and size of grants.

    (a) General. HCFA awards the following types of grants:
    (1) New program grants.
    (2) Existing program enhancement grants.
    (b) Grant Award. Each eligible State that submits an acceptable 
application receives a grant including a fixed amount (minimum funding 
level) and a variable amount.
    (1) A fixed portion is awarded to States in the following amounts:
    (i) Each of the 50 States, $75,000.
    (ii) The District of Columbia, $75,000.
    (iii) Puerto Rico, $75,000.
    (iv) American Samoa, $25,000.
    (v) Guam, $25,000.
    (vi) The Virgin Islands, $25,000.
    (2) A variable portion, which is based on the number and location 
of Medicare beneficiaries residing in the State is awarded to each 
State. The variable amount a particular State receives is determined as 
set forth in paragraph (c) of this section.
    (c) Calculation of variable portion of the grant. (1) HCFA bases 
the variable portion of the grant on--
    (i) The amount of available funds, and
    (ii) A comparison of each State with the average of all of the 
States (except the State being compared) with respect to three factors 
that relate to the size of the State's Medicare population and where 
that population resides.
    (2) The factors HCFA uses to compare States' Medicare populations 
comprise separate components of the variable amount. These factors, and 
the extent to which they each contribute to the variable amount, are as 
follows:
    (i) Approximately 75 percent of the variable amount is based on the 
number of Medicare beneficiaries living in the State as a percentage of 
all Medicare beneficiaries nationwide.
    (ii) Approximately 10 percent of the variable amount is based on 
the percentage of the State's total population who are Medicare 
beneficiaries.
    (iii) Approximately 15 percent of the variable amount is based on 
the percentage of the State's Medicare beneficiaries that reside in 
rural areas (``rural areas'' are defined as all areas not included 
within a Metropolitan Statistical Area).
    (3) Based on the foregoing four factors (that is, the amount of 
available funds and the three comparative factors), HCFA determines a 
variable rate for each participating State for each grant period.
    (d) Submission of revised budget. A State that receives an amount 
of grant funds under this subpart that differs from the amount 
requested in the budget submitted with its application must submit a 
revised budget to HCFA, along with its acceptance of the grant award, 
that reflects the amount awarded.


Sec. 403.506  [Removed]

    6. Section 403.506 is removed.
    7. Section 403.508 is revised to read as follows:


Sec. 403.508  Limitations.

    (a) Use of grants. Except as specified in paragraph (b) of this 
section, a State that receives a grant under this subpart may use the 
grant for any reasonable expenses incurred in planning, developing, 
implementing, and/or operating the program for which the grant is made.
    (b) Maintenance of effort. A State that receives a grant to 
supplement an existing program (that is, an existing program 
enhancement grant)--
    (1) Must not use the grant to supplant funds for activities that 
were conducted immediately preceding the date of the initial award of a 
grant made under this subpart and funded through other sources 
(including in-kind contributions).
    (2) Must maintain the activities of the program at least at the 
level that those activities were conducted immediately preceding the 
initial award of a grant made under this subpart.
    8. Sections 403.510 and 403.512 are added to read as follows:


Sec. 403.510  Reporting requirements.

    A State that receives a grant under this subpart must submit at 
least one annual report to HCFA and any additional reports as HCFA may 
prescribe in the notice of grant award. HCFA advises the State of the 
requirements concerning the frequency, timing, and contents of reports 
in the notice of grant award that it sends to the State.


Sec. 403.512  Administration.

    (a) General. Administration of grants will be in accordance with 
the provisions of this subpart, 45 CFR part 92 (``Uniform 
Administrative Requirements for Grants and Cooperative Agreements to 
State and Local Governments''), 45 CFR 74.4, the terms of the 
solicitation, and the terms of the notice of grant award. Except for 
the minimum funding levels established by Sec. 403.504(b)(1), in the 
event of conflict between a provision of the notice of grant award, any 
provision of the solicitation, or of any regulation enumerated in 45 
CFR 74.4 or in part 92, the terms of the notice of grant award control.
    (b) Notice. HCFA provides notice to each applicant regarding HCFA's 
decision on an application for grant funding under Sec. 403.504.
    (c) Appeal. Any applicant for a grant under this subpart has the 
right to appeal HCFA's determination regarding its application. Appeal 
procedures are governed by the regulations at 45 CFR part 16 
(Procedures of the Departmental Grant Appeals Board).

(Catalog of Federal Domestic Assistance Program No. 93.774, 
Medicare--Supplementary Medical Insurance Program)

    Dated: August 25, 1994.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.

    Dated: September 29, 1994.
Donna E. Shalala,
Secretary.
[FR Doc. 94-24832 Filed 10-6-94; 8:45 am]
BILLING CODE 4120-01-P