[Federal Register Volume 76, Number 54 (Monday, March 21, 2011)]
[Notices]
[Pages 15316-15320]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-6565]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-2318-N]
RIN 0938-AQ42
Medicaid Program; State Allotments for Payment of Medicare Part B
Premiums for Qualifying Individuals: Federal Fiscal Year 2010 and
Federal Fiscal Year 2011
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice contains charts providing the States' final
allotments available to pay the Medicare Part B premiums for Qualifying
Individuals (QIs) for the Federal fiscal year (FY) 2010 and the
preliminary QI allotments for FY 2011. The amounts of these QI
allotments were determined in accordance with the methodology set forth
in regulations and reflect funding for the QI program made available
under recent legislation.
DATES: Effective dates: This notice is effective on February 25, 2011.
The final QI allotments for payment of Medicare Part B premiums for FY
2010 are effective October 1, 2009. The preliminary QI allotments for
FY 2011 are effective October 1, 2010.
FOR FURTHER INFORMATION CONTACT: Richard Strauss, (410) 786-2019.
SUPPLEMENTARY INFORMATION:
I. Background
A. Allotments for FY 2010
Section 111 of the Medicare Improvements for Patients and Providers
Act of 2008 (MIPPA) (Pub. L. 110-275) and section 2 of the QI Program
Supplemental Funding Act of 2008 (the SFA) (Pub. L. 110-379) provided
$480 million for FY 2009 and $150 million for the first quarter of FY
2010 (that is, through December 31, 2009). Section 5005 of the American
Recovery and Reinvestment Act of 2009 (ARRA, Pub. L. 111-5, enacted on
February 17, 2009) extended the QI program by providing $412.5 million
in additional funds for the remaining three quarters of FY 2010 and
$150 million in funds for the first quarter of 2011 (that is, through
December 31, 2010).
Most recently with respect to funding for the QI program for FY
2010, section 3 of the ``Emergency Aid to American Survivors of the
Haiti Earthquake Act'' enacted on January 27, 2010 (Haiti Earthquake
Act, Pub. L. 111-127) amended section 1933(g)(2)(M) of the Social
Security Act (the Act) to provide an additional $50 million in funding
for States' FY 2010 QI allotments. Prior to enactment of the Haiti
Earthquake Act, there was only $562.5 million available for States' FY
2010 QI allotments. Under the current Medicaid statute, as amended by
the Haiti Earthquake Act, a total of $612.5 million is available for
States' QI program in FY 2010.
B. Allotments for FY 2011 and Thereafter
As previously stated, section 5005 of the American Recovery and
Reinvestment Act of 2009 (ARRA, Pub. L. 111-5, enacted on February 17,
2009) extended the QI program by providing $150 million in additional
funds for the first quarter of FY 2011 (that is, through December 31,
2010). Section 3 of the ``Emergency Aid to American Survivors of the
Haiti Earthquake Act'' enacted on January 27, 2010 (Haiti Earthquake
Act, Pub. L. 111-127) amended section 1933(g)(2)(M) of the Social
Security Act (the Act) and provided an additional $15 million for
States' FY 2011 QI allotments; that brings the total funds available
for the QI program in FY 2011 to $165 million. Most recently, section
110 of the Medicare and Medicaid Extenders Act of 2010 (Pub. L. 111-
309, enacted on December 15, 2010) amended section 1933 of the Social
Security Act and provides for $720 million for the QI program in FY
2011 in addition to the currently available $165 million for a total of
$885 million available for funding the QI program for FY 2011. Finally,
the Medicare and Medicaid Extenders Act of 2010 (Pub. L. 111-309) also
made available $280 million for the QI program for the first quarter of
FY 2012 (that is, through December 31, 2011).
C. Current Regulations and Methodology for Calculating the Fiscal Year
QI Allotments
The amounts of the final FY 2010 and preliminary FY 2011 QI
allotments, as contained in this notice, were determined in accordance
with the methodology set forth in existing regulations at 42 CFR
433.10(c)(5), as amended in the Federal Register published on November
24, 2008 (73 FR 70893), and reflecting funding for the QI program made
available under the legislation discussed above.
II. Charts
The final QI allotments for FY 2010 and the preliminary QI
allotments for FY 2011 are shown by State in Chart 1 and Chart 2 below,
respectively:
Chart 1--Final Qualifying Individuals Allotments for October 1, 2009
through September 30, 2010
Chart 2--Preliminary Qualifying Individuals Allotments for October 1,
2010 through September 30, 2011
The following describes the information contained in the columns of
Chart 1 and Chart 2:
Column A--State. Column A shows the name of each State.
Columns B through D show the determination of an Initial QI
Allotment for FY 2010 (Chart 1) or FY 2011 (Chart 2) for each State,
based only on the indicated Census Bureau data.
Column B--Number of Individuals. Column B contains the estimated
average number of Medicare beneficiaries for each State that are not
covered by Medicaid whose family income is at least 120 but less than
135 percent of the federal poverty level. With respect to the final FY
2010 QI allotment (Chart 1), Column B contains the number of such
individuals for the years 2006 through 2008, as obtained from the
Census Bureau's Annual Social and Economic Supplement to the 2009
Current Population Survey. With respect to the preliminary FY 2011 QI
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allotment (Chart 2), Column B contains the number of such individuals
for the years 2007 through 2009, as obtained from the Census Bureau's
Annual Social and Economic Supplement to the 2010 Current Population
Survey.
Column C--Percentage of Total. Column C provides the percentage of
the total number of individuals for each State, that is, the Number of
Individuals for the State in Column B divided by the sum total of the
Number of Individuals for all States in Column B.
Column D--Initial QI Allotment. Column D contains each State's
Initial QI Allotment for FY 2010 (Chart 1) or FY 2011 (Chart 2),
calculated as the State's Percentage of Total in Column C multiplied by
the total amount available Nationally for QI allotments for the fiscal
year. The total amount available Nationally for QI allotments each
fiscal year is $612,500,000 for FY 2010 (Chart 1) and $885,000,000 for
FY 2011 (Chart 2).
Columns E through L show the determination of the States' Final QI
Allotments for FY 2010 (Chart 1) or Preliminary QI Allotments for FY
2011 (Chart 2).
Column E--FY 2010 Estimated QI Expenditures. Column E contains the
States' estimates of their total QI expenditures for FY 2010 (Chart 1)
or FY 2011 (Chart 2) based on information obtained from States in the
summer of 2010.
Column F--Need (Difference). Column F contains the additional
amount of QI allotment needed for those States whose estimated
expenditures in Column E exceeded their Initial QI allotments in Column
D for FY 2010 (Chart 1) or for FY 2011 (Chart 2) for such States,
Column F shows the amount in Column E minus the amount in Column D. For
other ``Non-Need'' States, Column F shows ``NA''.
Column G--Percent of Total Need States. For States whose projected
QI expenditures in Column E are greater than their initial QI allotment
in Column D for FY 2010 (Chart 1) or FY 2011 (Chart 2), respectively,
Column G shows the percentage of total need, determined as the amount
for each Need State in Column F divided by the sum of the amounts for
all States in Column F. For Non-Need States, the entry in Column G is
``NA''.
Column H--Reduction Pool for Non-Need States. Column H shows the
amount of the pool of surplus QI allotments for FY 2010 (Chart 1) or FY
2011 (Chart 2), respectively, for those States that project QI
expenditures for the fiscal year that are less than the Initial QI
allotment for the fiscal year (referred to as non-need States). For
States whose estimates of QI expenditures for FY 2010 or FY 2011,
respectively, in Column E are equal to or less than their Initial FY
2010 or FY 2011 QI allotments in Column D for FY 2010 or FY 2011,
Column H shows the amount in Column D minus the amount in Column E. For
the States with a need, Column H shows ``Need''. The reduction pool of
excess QI allotments is equal to the sum of the amounts in Column H.
Column I--Percent of Total Non-Need States. For States whose
projected QI expenditures in Column E are less than their Initial QI
allotment in Column D for FY 2010 (Chart 1) or FY 2011 (Chart 2),
Column I shows the percentage of the total reduction pool in Column H,
determined as the amount for each Non-Need State in Column H divided by
the sum of the amounts for all States in Column H. For Need States, the
entry in Column I is ``Need''.
Column J--Reduction Adjustment for Non-Need States. Column J shows
the amount of adjustment needed to reduce the Initial QI allotments in
Column D for FY 2010 (Chart 1) or FY 2011 (Chart 2) for Non-Need States
in order to address the total need shown in Column F. The amount in
Column J is determined as the percentage in column I for Non-Need
States multiplied by the lesser of the total need in Column F (equal to
the sum of Needs in Column F) or the total Reduction Pool in Column H
(equal to the sum of the Non-Need amounts in Column H). For Need
States, the entry in Column J is ``Need''.
Column K--Increase Adjustment for Need States.
Column K shows the amount of adjustment to increase the Initial QI
Allotment in Column D for FY 2010 (Chart 1) or FY 2011 (Chart 2) for
Need States in order to address the total need shown for the fiscal
year in Column F. The amount in Column K is determined as the
percentage in Column G for Need States multiplied by the lesser of the
total need in Column F (equal to the sum of Needs in Column F) or the
total Reduction Pool in Column H (equal to the sum of the Non-Need
amounts in Column H). For Non-Need States, the entry in Column K is
``NA''.
Column L--Final FY 2010 QI Allotment (Chart 1) or Preliminary FY
2011 QI Allotment (Chart 2).
Column L contains the Final QI Allotment for each State for FY 2010
(Chart 1) or the Preliminary QI Allotment for FY 2011 (Chart 2). For
States that need additional QI allotment amounts for the fiscal year
based on Estimated QI Expenditures in Column E as compared to their
Initial QI allotments in Column D for the fiscal year (States with a
projected need amount are shown in Column F), Column L is equal to the
Initial QI allotment in Column D for FY 2010 (Chart 1) or FY 2011
(Chart 2) plus the amount determined in Column K for Need States. For
Non-Need States (States with a projected surplus in Column H), Column L
is equal to the QI Allotment in Column D reduced by the Reduction
Adjustment amount in Column J.
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III. Waiver of Notice With Comment and 30-Day Delay in Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register and invite public comment on a proposed rule. The
notice of proposed rulemaking includes a reference to the legal
authority under which the rule 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, if 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. In
addition, we also normally provide a delay of 30 days in the effective
date. However, if adherence to this procedure would be impractical,
unnecessary, or contrary to public interest, we may waive the delay in
the effective date in accordance with the Administrative Procedure Act
(5 U.S.C. 551 et seq.).
We are publishing this notice without a comment period or delay in
effective date because of the need to notify individual States of the
limitations on Federal funds for their Medicaid expenditures for
payment of Medicare Part B premiums for qualifying individuals. Some
States have
[[Page 15320]]
experienced deficits in their current allotments that have caused them
to deny benefits to eligible applicants, while other States project a
surplus in their allotments. This notice adjusts the allocation of
Federal funds, which will reduce the impact of States denying coverage
to eligible QIs when there is sufficient funding to cover all or some
of these individuals. Because access to Medicare Part B coverage for
QIs, who without this coverage would have difficulty paying for needed
health care, is critically important, we believe that it is in the
public interest to waive the usual notice and comment procedure which
we undertake before making a rule final. Moreover, we are not making
any changes to the process we use for allocating allotments. We are
simply implementing a process already set forth in regulations. For
these reasons, we also believe a notice and comment process would be
unnecessary.
Therefore, for the reasons discussed above, we find that good cause
exists to dispense with the normal requirement that a notice cannot
become effective any earlier than 30 days after its publication. States
that will have access to additional funds for QIs need to know that
these funds are available as soon as possible. While we believe the
surplus States that will have diminished amounts available for this FY
will have sufficient funds for enrolling all potential QIs in their
States, they also need to know as soon as possible that a certain
amount of their unused allocation will no longer be available to them
for this FY.
IV. 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).
V. 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), and Executive Order 13132 on
Federalism and the Congressional Review Act (5 U.S.C. 804(2)).
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, if regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity). A regulatory impact
analysis (RIA) must be prepared for major rules with economically
significant effects ($100 million or more in any one year). This notice
does not reach the economic threshold and thus is not considered a
major rule.
The RFA requires agencies to analyze options for regulatory relief
for small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and small governmental
jurisdictions. Most hospitals and most other providers and suppliers
are small entities, either by nonprofit status or by having revenues of
$7 million to $34.5 million in any one year. Individuals and States are
not included in the definition of a small entity.
This notice codifies our procedures for implementing provisions of
the Balanced Budget Act of 1997 to allocate, among the States, Federal
funds to provide Medicaid payment for Medicare Part B premiums for low-
income Medicare beneficiaries. The total amount of Federal funds
available during a Federal fiscal year and the formula for determining
individual State allotments are specified in the law. We have applied
the statutory formula for the State allotments. Because the data
specified in the law were not initially available, we used comparable
data from the U.S. Census Bureau on the number of possible qualifying
individuals in the States. This notice also permits, in a specific
circumstance, reallocation of funds to enable enrollment of all
eligible individuals to the extent of the available funding.
We believe that the statutory provisions implemented in this 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 2010 and FY 2011 costs for this provision have been included in the
Mid-session Review of the FY 2011 President's Budget.
Section 1102(b) of the Social Security Act requires us to prepare a
regulatory impact analysis for any rule that may have a significant
impact on the operations of a substantial number of small rural
hospitals. The analysis must conform to the provisions of section 604
of the RFA. For purposes of section 1102(b) of the Act, we define a
small rural hospital as a hospital that is located outside of a
metropolitan 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 also
requires that agencies assess anticipated costs and benefits before
issuing any rule that may result in expenditure in any one year by
State, local, or tribal governments, in the aggregate, or by the
private sector, of $130 million. This notice 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 not reviewed by the Office of Management and Budget.
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)
Dated: February 9, 2011.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
Dated: February 28, 2011
Kathleen Sebelius,
Secretary.
[FR Doc. 2011-6565 Filed 3-18-11; 8:45 am]
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