15316 Federal Register / Vol. 76, No. 54 / Monday, March 21, 2011 / Notices 

ESTIMATED ANNUALIZED BURDEN HOURS

Respondent category Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden 

response 

(in hours) 

Emergency Department and Primary Care ................................................................................. 43 1 1 

Public Health and Preparedness/Coalition Leader ..................................................................... 20 1 1 

Petunia Gissendaner, 

Acting Reports Clearance Officer, Centers for 

Disease Control and Prevention. 

[FR Doc. 2011–6504 Filed 3–18–11; 8:45 am] 

BILLING CODE 4163–18–P 

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. 

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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Federal Register / Vol. 76, No. 54 / Monday, March 21, 2011 / Notices 15317 

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 NonNeed 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 NonNeed 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 NonNeed 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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Federal Register / Vol. 76, No. 54 / Monday, March 21, 2011 / Notices 15319 

BILLING CODE 4120–01–C 

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 noticeand-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 


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15320 Federal Register / Vol. 76, No. 54 / Monday, March 21, 2011 / Notices 

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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