Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 21329 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

Dated: December 17, 2009. 

Charlene Frizerra, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: February 22, 2010. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2010–8502 Filed 4–22–10; 8:45 am] 

BILLING CODE 4120–01–C 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2309–N] 

RIN 0938–AP90 

Medicaid Program; State Allotments 

for Payment of Medicare Part B 

Premiums for Qualifying Individuals: 

Federal Fiscal Year 2009 and Federal 

Fiscal Year 2010 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice sets forth final 

allotments available to States to pay the 

Medicare Part B premiums for 

Qualifying Individuals (QIs) for the 

Federal fiscal year (FY) 2009 and the 

preliminary QI allotments for FY 2010. 

The amounts of these QI allotments 

were determined in accordance with the 

methodology set forth in regulations, as 

amended in the Federal Register 

published on November 24, 2008, and 

reflect funding for the QI program made 

available under recent legislation. 

DATES: Effective dates: The final QI 

allotments for payment of Medicare Part 

B premiums for FY 2009 are effective 

October 1, 2008. The preliminary QI 

allotments for FY 2010 are effective 

October 1, 2009. 

FOR FURTHER INFORMATION CONTACT: 

Richard Strauss, (410) 786–2019. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. History of the QI Program 

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 

State Medicaid plans must provide for 

some or all types of Medicare costsharing for three eligibility groups of 

low-income Medicare beneficiaries. 

These three groups included qualified 

Medicare beneficiaries (QMBs), 

specified low-income Medicare 


WReier-Aviles on DSKGBLS3C1PROD with NOTICESEN23AP10.028</GPH>
21330 Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 

beneficiaries (SLMBs), and qualified 

disabled and working individuals 

(QDWIs). 

A QMB is an individual entitled to 

Medicare Part A with income at or 

below 100 percent of the Federal 

poverty level (FPL). 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. Effective 

January 1, 2010, the resource limits for 

a QMB, SLMB, and QI are $6,600 for a 

single person and $9,910 for a married 

person living with a spouse and no 

other dependents. These resource limits 

are adjusted January 1 of each year, 

based upon the change in the annual 

consumer price index (CPI) since 

September of the previous year. 

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 

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), (Pub. L. 105–33), 

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, under BBA, 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 QIs 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 BBA also added the 

second group of QIs under section 

1902(a)(10)(E)(iv)(II) of the Act, which 

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 eligibility 

group of QIs ended on December 31, 

2002, and 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 FPL) through the 

following FY, but maintained the 

annual funding at the FY 2002 level. 

Section 1933(g) of the Act was amended 

by the Extension of Medicare CostSharing for Medicare Part B Premium 

for Qualifying Individuals Act, (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 

FPL) 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 of 

the Act 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 

QI 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 FY 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, we 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, based on several 

legislative actions, coverage has 

continued (as discussed below) through 

December 31, 2010. 

The Federal medical assistance 

percentage, for Medicaid payment of 

Medicare Part B premiums for QIs, 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 FY 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 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 level, and who are not 

otherwise eligible for Medicaid; to (b) 

the sum of all individuals for all eligible 

States. 

WReier-Aviles on DSKGBLS3C1PROD with NOTICES

Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 21331 

B. Allotments for FY 2005 Through 2009 

In FY 2005, some States exhausted 

their FY 2005 allotments before the end 

of the FY, which caused States 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 

FY 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 used to determine 

the FY 2005 allotments. 

We believe that it was the 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 in the 

Federal Register an interim final rule 

(70 FR 50214), 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 August 26, 2005 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 

FY 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 FY allotment be based upon a ratio 

of the amount of ‘‘total number of 

individuals described in section 

1902(a)(10)(E)(iv) of the Act 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 funds 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 FY 2005. The 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 

August 26, 2005 interim final rule 

published in the Federal Register, 

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 FY 2005, the 

rule permitted FY 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 States with FY 

QI allotments that might be greater than 

their QI expenditures for the FY, 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 August 26, 2005 

interim final rule, the authorization for 

the QI benefit was scheduled to expire 

at the end of calendar year (CY) 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 CY 2005. 

On October 20, 2005, the QI, TMA, 

and Abstinence Programs Extension and 

Hurricane Katrina Unemployment Relief 

Act of 2005 (Pub. L. 109–91) was 

enacted. Section 101 of Public Law 109– 

91 extended the QI program through 

September 30, 2007 with no change in 

the level of funding; that is, under this 

legislation $400 million per FY was 

appropriated for each of FY 2006 and 

FY 2007. The provisions of section 101 

of Public Law 109–91 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 Public Law 

109–91 relating to the QI allotments for 

final FY 2006 allotments and 

preliminary FY 2007 allotments. As we 

stated in that final rule, we believe that 

the 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 FY. We recognized that 

because of the imprecise data for 

computing the States’ QI allotments for 

a FY, some States would experience 

either surpluses or shortages in their FY 

2006 and FY 2007 allotments. In 

accordance with § 433.10(c), the FY 

2006 and FY 2007 QI allotments were 

designed to compensate for the 

imprecise data to permit shortage States 

to enroll more QIs than otherwise would 

have been possible. 

Section 3 of the TMA, Abstinence 

Education, and QI Program Extension 

Act of 2007, Public Law 110–90 

(enacted on September 29, 2007) 

provided $100 million and extended the 

QI program through December 31, 2007. 

Section 203 of the Medicare, Medicaid, 

and SCHIP Extension Act of 2007 

(MMSEA) (Pub. L. 110–173, enacted on 

December 29, 2007) provided an 

additional $200 million and extended 

the QI program through June 30, 2008. 

Section 111 of the Medicare 

Improvements for Patients and 

Providers Act of 2008 (MIPPA) (Pub. L. 

110–275) enacted on July 15, 2008, and 

section 2 of the QI Program 

Supplemental Funding Act of 2008 (the 

SFA) enacted on October 8, 2008, (Pub. 

L. 110–379), extended and provided 

additional funds for the QI program. As 

amended by MIPPA and the SFA, a total 

of $415 million was made available for 

the QI program for FY 2008, and $480 

million was made available for the QI 

program for FY 2009. Additionally, 

WReier-Aviles on DSKGBLS3C1PROD with NOTICES

21332 Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 

$150 million was provided for the QI 

program for the first quarter of FY 2010 

(that is, October 1, 2009 through 

December 31, 2009). 

However, the then-existing regulation 

at § 433.10(c)(5)(v) authorized the 

methodology for determining each 

State’s QI allotment under the QI 

program only through FY 2007. 

Therefore, on November 24, 2008, we 

published an interim final rule with 

comment period entitled, ‘‘Medicaid 

Program; State Allotments for Payment 

of Medicare Part B Premiums for 

Qualifying Individuals: Federal Fiscal 

Year 2008 and Federal Fiscal Year 2009’’ 

(73 FR 70886). This rule revised 

paragraph § 433.10(c)(5)(ii) by changing 

the statutory reference ‘‘section 

1933(c)(1)’’ to ‘‘section 1933(g)’’. It also 

revised paragraph (c)(5)(iii) introductory 

text, and paragraphs (c)(5)(iii)(D), and 

(c)(5)(v) to more generally refer to the 

period for which QI program funding is 

available under the statute, rather than 

referring to particular years. 

C. Allotments for FY 2010 and 

Thereafter 

Section 5005 of the American 

Recovery and Reinvestment Act of 2009 

(the Recovery Act, 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 additional funds for the 

first quarter of 2011 (that is, through 

December 31, 2010). However, most 

recently, on January 27, 2010 the 

President signed into law the 

‘‘Emergency Aid to American Survivors 

of the Haiti Earthquake Act’’, P.L. 111– 

127 (Haiti Earthquake Act); section 3 of 

this legislation amends section 

1933(g)(2)(M) of the Act to make 

available $462.5 million for the last 

three quarters of FY 2010 (this replaces 

the $412.5 million provided under the 

Recovery Act for that period). Prior to 

enactment of the Haiti Earthquake Act, 

through the Recovery Act there was a 

total of $562.5 million available for 

States’ QI allotments for FY 2010. With 

the enactment of the Haiti Earthquake 

Act, a total of $612.5 million is available 

for States’ QI allotments for FY 2010. 

The Haiti Earthquake Act also amended 

section 1933(g)(2) of the Act to make 

$165 million available for the QI 

program for FY 2011 (this replaces the 

$150 million for FY 2011 previously 

provided under the Recovery Act). 

The amounts of the final FY 2009 and 

preliminary FY 2010 QI allotments were 

determined in accordance with the 

methodology set forth in existing 

Medicaid regulations at § 433.10(c)(5), 

as amended in the Federal Register 

published on November 24, 2008 (73 FR 

70893). 

II. Charts 

The Final QI Allotments for FY 2009 

and the Preliminary QI Allotments for 

FY 2010 are shown by State in Chart 1 

and Chart 2 below, respectively: 

Chart 1—Final Qualifying Individuals 

Allotments for October 1, 2008 through 

September 30, 2009. 

Chart 2—Preliminary Qualifying 

Individuals Allotments for October 1, 

2009 through September 30, 2010. 

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 2009 (Chart 1) or FY 2010 (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 percent but less 

than 135 percent of the poverty level. 

With respect to the final FY 2009 QI 

allotment (Chart 1), Column B contains 

the number of such individuals for the 

years 2005 through 2007, as obtained 

from the Census Bureau’s Annual Social 

and Economic Supplement to the 2008 

Current Population Survey. With 

respect to the preliminary FY 2010 QI 

allotment (Chart 2), 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. 

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 2009 (Chart 1) or 

FY 2010 (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 FY. 

The total amount available nationally 

for QI allotments each FY is 

$480,000,000 for FY 2009 (Chart 1) and 

$612,500,000 for FY 2010 (Chart 2). 

Columns E through L show the 

determination of the States’ Final QI 

Allotments for FY 2009 (Chart 1) or 

Preliminary QI Allotments for FY 2010 

(Chart 2). 

Column E—FY 2009 Estimated QI 

Expenditures. Column E contains the 

States’ estimates of their total QI 

expenditures for FY 2009 (Chart 1) or 

FY 2010 (Chart 2) based on information 

obtained from States in the summer of 

2009. 

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 2009 

(Chart 1) or for FY 2010 (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 2009 (Chart 1) or FY 

2010 (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 2009 (Chart 1) or FY 

2010 (Chart 2), respectively, for those 

States that project QI expenditures for 

the FY (in Column E) that are less than 

the initial QI allotments (in Column D) 

for the FY (referred to as non-need 

States). The amount in Column H is 

calculated as the amount in Column D 

minus the amount in Column E, 

representing the surplus of QI allotment 

funds for the indicated FYs. There will 

only be an amount shown in Column H 

for States whose projected QI 

expenditures in Column E are less than 

the initial QI allotment for the FY 

shown in Column D.’’ 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 2009 (Chart 1) or FY 2010 (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 

WReier-Aviles on DSKGBLS3C1PROD with NOTICES

Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 21333 

for FY 2009 (Chart 1) or FY 2010 (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 

2009 (Chart 1) or FY 2010 (Chart 2) for 

Need States in order to address the total 

need shown for the FY 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 2009 QI 

Allotment (Chart 1) or Preliminary FY 

2010 QI Allotment (Chart 2). Column L 

contains the Final QI Allotment for each 

State for FY 2009 (Chart 1) or the 

Preliminary QI Allotment for FY 2010 

(Chart 2). For Need States, additional QI 

allotment amounts for the FY are based 

on the Estimated QI Expenditures in 

Column E as compared to their Initial QI 

allotments in Column D for the FY 

(States with a projected need amount 

are shown in Column F); and Column L 

is equal to the Initial QI Allotment in 

Column D for FY 2009 (Chart 1) or FY 

2010 (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. 

BILLING CODE 4120–01–P 

WReier-Aviles on DSKGBLS3C1PROD with NOTICES

21334 Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 


WReier-Aviles on DSKGBLS3C1PROD with NOTICESEN23AP10.029</GPH>
Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 21335 


WReier-Aviles on DSKGBLS3C1PROD with NOTICESEN23AP10.030</GPH>
21336 Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 

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 substances 

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 

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 regulation 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 notice 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 on Regulatory Planning and 

Review, the Regulatory Flexibility Act 

(RFA) (September 19, 1980, Pub. L. 96– 

354), section 1102(b) of the Social 

Security Act, section 202 of the 

Unfunded Mandates Reform Act of 1995 

(March 22, 1995; Pub. L. 104–4), 

Executive Order 13132 on Federalism 

(August 4, 1999) 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 1 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 1 

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 FY 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. Also, as a result of the 

reallocation of 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 2009 and FY 2010 

costs for this provision have been 

included in the Mid-session Review of 

the FY 2010 President’s Budget. 

Section 1102(b) of the Social Security 

Act (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 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 (UMRA) 

(Pub. L. 104–4) also requires that 

agencies assess anticipated costs and 

benefits before issuing any rule whose 

mandates require spending in any 1 year 

of $100 million in 1995 dollars, updated 

annually for inflation. In 2010, that 

threshold is approximately $135 

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 

WReier-Aviles on DSKGBLS3C1PROD with NOTICES

Federal Register / Vol. 75, No. 78 / Friday, April 23, 2010 / Notices 21337 

that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has federalism implications. 

Since this regulation does not impose 

any costs on State or local governments, 

the requirements of Executive Order 

13132 are not applicable. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

Dated: December 17, 2009. 

Charlene Frizzera, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Approved: January 22, 2010. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2010–8498 Filed 4–13–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1343–NC] 

Medicare and Medicaid Programs; 

Announcement of an Application From 

a Hospital Requesting Waiver for 

Organ Procurement Service Area 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice with comment period. 

SUMMARY: A hospital has requested a 

waiver of statutory requirements that 

would otherwise require the hospital to 

enter into an agreement with its 

designated Organ Procurement 

Organization (OPO). The request was 

made in accordance with section 

1138(a)(2) of the Social Security Act (the 

Act). This notice requests comments 

from OPOs and the general public for 

our consideration in determining 

whether we should grant the requested 

waiver. 

DATES: Comment Date: To be assured 

consideration, comments must be 

received at one of the addresses 

provided below, no later than 5 p.m. on 

June 22, 2010. 

ADDRESSES: In commenting, please refer 

to file code CMS–1343–NC. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

four ways (please choose only one of the 

ways listed): 

1. Electronically. You may submit 

electronic comments on this regulation 

to http://www.regulations.gov. Follow 

the instructions under the ‘‘More Search 

Options’’ tab. 

2. By regular mail. You may mail 

written comments to the following 

address ONLY: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–1343–NC, P.O. Box 8010, 

Baltimore, MD 21244–1850. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By express or overnight mail. You 

may send written comments to the 

following address ONLY: Centers for 

Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–1343–NC, 

Mail Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

4. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments before the close 

of the comment period to either of the 

following addresses: a. For delivery in 

Washington, DC—Centers for Medicare 

& Medicaid Services, Department of 

Health and Human Services, Room 445– 

G, Hubert H. Humphrey Building, 200 

Independence Avenue, SW., 

Washington, DC 20201. 

(Because access to the interior of the 

Hubert H. Humphrey Building is not 

readily available to persons without 

Federal government identification, 

commenters are encouraged to leave 

their comments in the CMS drop slots 

located in the main lobby of the 

building. A stamp-in clock is available 

for persons wishing to retain a proof of 

filing by stamping in and retaining an 

extra copy of the comments being filed.) 

b. For delivery in Baltimore, MD— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786– 

9994 in advance to schedule your 

arrival with one of our staff members. 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: 

Mark A. Horney, (410) 786–4554. 

SUPPLEMENTARY INFORMATION: Inspection 

of Public Comments: All comments 

received before the close of the 

comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post all comments 

received before the close of the 

comment period on the following Web 

site as soon as possible after they have 

been received: http:// 

www.regulations.gov. Follow the search 

instructions on that Web site to view 

public comments. 

Comments received timely will also 

be available for public inspection as 

they are received, generally beginning 

approximately 3 weeks after publication 

of a document, at the headquarters of 

the Centers for Medicare & Medicaid 

Services, 7500 Security Boulevard, 

Baltimore, Maryland 21244, Monday 

through Friday of each week from 8:30 

a.m. to 4 p.m. To schedule an 

appointment to view public comments, 

phone 1–800–743–3951. 

I. Background 

Organ Procurement Organizations 

(OPOs) are not-for-profit organizations 

that are responsible for the 

procurement, preservation, and 

transport of transplantable organs to 

transplant centers throughout the 

country. Qualified OPOs are designated 

by the Centers for Medicare & Medicaid 

Services (CMS) to recover or procure 

organs in CMS-defined exclusive 

geographic service areas, pursuant to 

section 371(b)(1) of the Public Health 

Service Act (42 U.S.C. 273(b)(1) and our 

regulations at 42 CFR 486.306. Once an 

OPO has been designated for an area, 

hospitals in that area that participate in 

Medicare and Medicaid are required to 

work with that OPO in providing organs 

for transplant, pursuant to section 

1138(a)(1)(C) of the Social Security Act 

(the Act) and our regulations at 42 CFR 

482.45. 

Section 1138(a)(1)(A)(iii) of the Act 

provides that a hospital must notify the 

designated OPO (for the service area in 

which it is located) of potential organ 

donors. Under section 1138(a)(1)(C) of 

the Act, every participating hospital 

must have an agreement to identify 

potential donors only with its 

designated OPO. 

However, section 1138(a)(2)(A) of the 

Act provides that a hospital may obtain 

a waiver of the above requirements from 

the Secretary under certain specified 

conditions. A waiver allows the hospital 

to have an agreement with an OPO other 

than the one initially designated by 

CMS, if the hospital meets certain 

conditions specified in section 

1138(a)(2)(A) of the Act. In addition, the 

Secretary may review additional criteria 

described in section 1138(a)(2)(B) of the 

WReier-Aviles on DSKGBLS3C1PROD with NOTICES