34478 Federal Register / Vol. 65, No. 104 / Tuesday, May 30, 2000 / Notices

The following additional

requirements are applicable to this

program. For a complete description of

each, see the ATTACHMENT in the

application kit.

AR–7 Executive Order 12372 Review

AR–9 Paperwork Reduction Act

Requirements

AR–10 Smoke-Free Workplace

Requirements

AR–11 Healthy People 2010

AR–12 Lobbying Restrictions

I. Authority and Catalog of Federal

Domestic Assistance Number

This program is authorized by Section

301 (a) (42 U.S.C. 241(a)) and Section

317 (42 U.S.C. 247b) of the Public

Health Service Act, as amended. The

Catalog of Federal Domestic Assistance

number is 93.184.

J. Where To Obtain Additional

Information

This and other funding opportunities

may be found on the CDC home page on

the Internet: http://www.cdc.gov. To

receive additional written information

and to request an application kit, call 1–

888–GRANTS4 (1–888–472–6874). You

will be asked to leave your name,

address, and telephone number and will

be instructed to identify the

Announcement Number of interest.

If you have any questions after

reviewing the contents of all the

documents, business management

technical assistance may be obtained

from:

William Paradies, Grants Management

Specialist, Grants Management

Branch, Procurement and Grants

Office, Centers for Disease Control

and Prevention (CDC), 2920

Brandywine Road, Room 3000,

Atlanta, Georgia 30341–4146,

Telephone: (770) 488–2721, E-mail:

wep2@cdc.gov

General program assistance can be

obtained from: Jack Stubbs, Disability

and Health Branch, National Center

for Environmental Health, CDC, 4770

Buford Highway, Building 101,

Mailstop F–29, Atlanta, Georgia

30341, Telephone: (770) 488–7096, Email: jbs2@cdc.gov

Dated: May 23, 2000.

John L. Williams,

Director, Procurement and Grants Office,

Centers for Disease Control and Prevention

(CDC).

[FR Doc. 00–13390 Filed 5–26–00; 8:45 am]

BILLING CODE 4163–18–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

HCFA–2063–N

RIN 0938–AJ72

Medicaid Program; State Allotments

for Payment of Medicare Part B

Premiums for Qualifying Individuals:

Federal Fiscal Year 2000

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Notice.

SUMMARY: The Social Security Act

provides for the Medicaid program to

pay all or part of the Medicare Part B

premiums for 5 years (Federal fiscal

years 1998 through 2002) for two

specific eligibility groups of low-income

Medicare beneficiaries, referred to as

Qualifying Individuals. This notice

announces the Federal fiscal year 2000

allotments that are available for State

agencies to pay Medicare Part B

premiums for these eligibility groups.

EFFECTIVE DATE: This notice is effective

October 1, 1999 for allotments for

payment of Medicare Part B premiums

for individuals in calendar year 2000

from the allocation for fiscal year 2000.

FOR FURTHER INFORMATION CONTACT:

Miles McDermott, (410) 786–3722.

SUPPLEMENTARY INFORMATION:

I. Background

A. Before the Balanced Budget Act of

1997

Before the enactment of the Balanced

Budget Act of 1997 (BBA), section

1902(a)(10)(E) of the Social Security Act

(the Act) specified that the State

Medicaid plan must provide for

Medicare cost-sharing for three

eligibility groups of low-income

Medicare beneficiaries. These three

groups included Qualified Medicare

Beneficiaries (QMBs), Specified Lowincome Medicare Beneficiaries (SLMBs),

and Qualified Disabled and Working

Individuals (QDWIs).

A QMB is an individual entitled to

Medicare Part A with income at or

below the Federal poverty level and

resources below $4,000 for an

individual and $6,000 for a couple. An

SLMB is an individual who meets the

QMB criteria, except that his or her

income is between a State-established

level (at or below the Federal poverty

level) and 120 percent of the Federal

poverty level. A QDWI is an individual

who is entitled to enroll in Medicare

Part A, whose income does not exceed

200 percent of the Federal poverty level

for a family of the size involved, whose

resources do not exceed twice the

amount allowed under the

Supplementary Security Income (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.

B. After the Balanced Budget Act of

1997

Section 4732 of the BBA amended

section 1902(a)(10)(E) of the Act to

require States to provide for Medicaid

payment of the Medicare Part B

premiums, during the period beginning

January 1998 and ending December

2002, for two eligibility groups of lowincome Medicare beneficiaries, referred

to as Qualifying Individuals (QIs).

Under section 1902(a)(10)(E)(iv)(I) of

the Act, State agencies are required to

pay the full amount of the Medicare Part

B premium for selected QIs who would

be QMBs except that their income level

is at least 120 percent but less than 135

percent of the Federal poverty level for

a family of the size involved. These

individuals cannot otherwise be eligible

for medical assistance under the

approved State Medicaid plan.

The second group of QIs, under

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

includes Medicare beneficiaries who

would be QMBs except that their

income is at least 135 percent but less

than 175 percent of the Federal poverty

level for a family of the size involved.

These QIs may not be otherwise eligible

for Medicaid under the approved State

plan, but are eligible for a portion of

Medicare cost-sharing consisting only 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).

Section 4732(c) of the BBA also added

section 1933 of the Act, which specifies

the provisions for State coverage of the

Medicare cost-sharing for additional

low-income Medicare beneficiaries.

Section 1933(a) of the Act specifies

that a State agency 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 State agencies must follow

in selecting QIs and providing payment

for Medicare Part B premiums.

Specifically, the State agency must

permit all QIs to apply for assistance

and must select individuals on a firstcome, first-served basis in the order in

which they apply. Under section

1933(b)(2)(B) of the Act, when selecting

Federal Register / Vol. 65, No. 104 / Tuesday, May 30, 2000 / Notices 34479

persons who will receive assistance in

the years after 1998, State agencies 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 now become, QIs. Under section

1933(b)(4), persons selected to receive

assistance in a calendar year are entitled

to receive assistance for the remainder

of the year, but not beyond, as long as

they continue to qualify. The fact that

an individual is selected to receive

assistance at any time during the year

does not entitle the individual to

continued assistance for any succeeding

year. Because the State’s allotment is

limited by law, section 1933(b)(3) of the

Act provides that the State agency must

limit the number of QIs so that the

amount of assistance provided during

the year is approximately equal to the

State’s allotment for that year.

Section 1933(c) of the Act limits the

total amount of Federal funds available

for payment of Part B premiums each

fiscal year and specifies the formula to

be used to determine an allotment for

each State from this total amount. For

State agencies that execute 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.

The Federal matching rate 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 matching

funds are available for expenditures in

excess of the State’s allotment amount.

Administrative expenses associated

with the payment of Medicare Part B

premiums for QIs remain at the 50

percent matching level and may not be

taken from the State’s allotment.

The amount available for each fiscal

year is to be allocated among States

according to the formula set forth in

section 1933(c)(2) of the Act. The

formula provides for an amount to each

State agency that is to be based on each

State’s share of the Secretary’s estimate

of the ratio of—

(1) An amount equal to the sum of the

following:

(a) Twice the total number of

individuals 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; and

(b) The total number of individuals in

the State who meet all but the income

requirements for QMBs, whose incomes

are at least 135 percent but less than 175

percent of the Federal poverty level, and

who are not otherwise eligible for

Medicaid; to

(2) The sum of all of these individuals

under item (1) for all eligible States.

II. Provisions of This Notice

This notice announces the availability

of individual State allotments for

Federal fiscal year 2000 for the

Medicaid payment of Medicare Part B

premiums for QIs identified under

sections 1902(a)(10)(E)(iv)(I) and (II) of

the Act. The formula used to calculate

these allotments was described in detail

in the January 26, 1998 Federal Register

(63 FR 3754) and, except for the

incorporation of the latest data, has been

used here without changes.

FY 2000 STATE ALLOTMENTS FOR PAYMENT OF PART B PREMIUMS UNDER SEC. 4732 OF THE BBA OF 1997

[In thousands]

State (a)

M1 1

(b)

M2 2

(c)

[2 × (a)] + (b)

State share of

(c)

(in percent)

State FY 2000

allocation

(dollars in

thousands)

AK ........................................................................................ 1 4 6 0.09 278

AL ......................................................................................... 37 82 156 1.41 7,231

AR ........................................................................................ 25 43 93 1.44 4.311

AZ ......................................................................................... 17 71 105 1.62 4.867

CA ........................................................................................ 102 327 531 8.20 24,614

CO ........................................................................................ 13 23 49 0.76 2,271

CT ........................................................................................ 6 52 64 0.99 2,967

DC ........................................................................................ 2 5 9 0.14 417

DE ........................................................................................ 5 10 20 0.31 927

FL ......................................................................................... 100 280 480 7.42 22,250

GA ........................................................................................ 33 92 158 2.44 7,324

HI .......................................................................................... 4 10 18 0.28 834

IA .......................................................................................... 13 54 80 1.24 3,708

ID .......................................................................................... 5 17 27 0.42 1,252

IL .......................................................................................... 56 179 291 4.50 13,489

IN .......................................................................................... 36 103 175 2.70 8,112

KS ........................................................................................ 14 57 85 1.31 3,940

KY ........................................................................................ 24 80 128 1.98 5,933

LA ......................................................................................... 29 75 133 2.06 6,165

MA ........................................................................................ 33 81 147 2.27 6,814

md ........................................................................................ 21 66 108 1.67 5,006

ME ........................................................................................ 8 18 34 0.53 1,576

MI ......................................................................................... 48 128 224 3.46 10,383

MN ........................................................................................ 26 63 115 1.78 5,331

MO ....................................................................................... 25 85 135 2.09 6,258

MS ........................................................................................ 16 40 72 1.11 3,337

MT ........................................................................................ 5 13 23 0.36 1,066

NC ........................................................................................ 48 115 211 3.26 9,781

ND ........................................................................................ 5 13 23 0.36 1,066

NE ........................................................................................ 12 31 55 0.85 2,549

NH ........................................................................................ 6 16 28 0.43 1,298

NJ ......................................................................................... 44 120 208 3.21 9,642

NM ........................................................................................ 10 20 40 0.62 1,854

NV ........................................................................................ 4 18 26 0.40 1,205

34480 Federal Register / Vol. 65, No. 104 / Tuesday, May 30, 2000 / Notices

FY 2000 STATE ALLOTMENTS FOR PAYMENT OF PART B PREMIUMS UNDER SEC. 4732 OF THE BBA OF 1997—

Continued

[In thousands]

State (a)

M1 1

(b)

M2 2

(c)

[2 × (a)] + (b)

State share of

(c)

(in percent)

State FY 2000

allocation

(dollars in

thousands)

NY ........................................................................................ 99 228 426 6.58 19,747

OH ........................................................................................ 72 183 327 5.05 15,158

OK ........................................................................................ 27 51 105 1.62 4,867

OR ........................................................................................ 13 44 70 1.08 3,245

PA ........................................................................................ 83 196 362 5.59 16,780

RI .......................................................................................... 9 24 42 0.65 1,947

SC ........................................................................................ 25 80 130 2.01 6,026

SD ........................................................................................ 5 11 21 0.32 973

TN ........................................................................................ 29 45 103 1.59 4,774

TX ......................................................................................... 79 212 370 5.72 17,151

UT ........................................................................................ 3 20 26 0.40 1,205

VA ........................................................................................ 13 86 112 1.73 5,192

VT ......................................................................................... 4 8 16 0.25 742

WA ....................................................................................... 17 44 78 1.21 3,616

WI ......................................................................................... 26 82 134 2.07 6,211

WV ....................................................................................... 18 45 81 1.25 3,755

WY ....................................................................................... 3 6 12 0.19 556

Total .............................................................................. 1358 3756 6472 100.00 300,000

1Three-year average (1996–1998) of number of Medicare beneficiaries in State who are not enrolled in medicaid but whoe incomes are at

least 120% but less than 135% of FPL. 2Three-year average (1996–1998) of number of Medicare beneficiaries in State who are not enroleld in Medicaid but whose incomes are at

least 135% but less than 175% of FPL.

III. Waiver of Advance Public Comment

and 30-Day Delay in Effective Date

We ordinarily publish an advance

notice in the Federal Register for a

notice containing substantive rules to

provide a period for public comment.

However, we may waive that procedure

if we find good cause that notice and

comment are impractical, unnecessary,

or contrary to the public interest. 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 the public interest, we may

waive the delay in the effective date.

We find good cause to waive notice

and comment procedure for this notice.

The law sets out in detail the specific

amounts available for each Federal

fiscal year for Medicare Part B

premiums for QIs and the formula that

is used to determine individual State

allotments. In addition, the latest data

from the U. S. Census Bureau on the

number of possible QIs in the States,

used in the statutory formula as

discussed in section V of this notice, is

not available until too late in the

calendar year. Therefore, it would be

impracticable, unnecessary, and

contrary to the public interest to submit

this notice to the public for a notice and

comment procedure.

Also, because States can begin making

payments for Medicare Part B premiums

for QIs as early as January 1, 2000, we

are not making the effective date of the

notice the usual 30 days after

publication. For the reasons discussed

previously, we find good cause to waive

the usual 30-day delay.

IV. Effect of the Contract With America

Advancement Act

Normally, under 5 U.S.C. section 801,

as added by section 251 of Public Law

104–121, the effective date of a major

rule is delayed 60 days for

Congressional review. This has been

determined to be a major rule under 5

U.S.C. section 804(2). However, as

indicated in section III of this notice, we

have found that good cause exists to

dispense with prior notice and comment

procedures since they are unnecessary

and impracticable under the

circumstances. Under 5 U.S.C. section

808(2), a rule shall take effect at such

time as the Federal agency promulgating

the rule determines, if it finds, for good

cause, that prior notice and comment

procedures are unnecessary or

impracticable. Accordingly, under the

exemption provided in 5 U.S.C. section

808(2), this notice is effective October 1,

1999, for allotments for payments of

Medicare Part B premiums for

individuals in calendar year 2000 from

the allotment for Federal fiscal year

2000.

V. Regulatory Impact Statement

We have examined the impact of this

notice as required by Executive Order

12866 and the Regulatory Flexibility Act

(RFA) (Public Law 96–354). Executive

Order 12866 directs agencies to assess

all costs and benefits of available

regulatory alternatives and, when

regulation is necessary, to select

regulatory approaches that maximize

net benefits (including potential

economic, environmental, public health

and safety effects; distributive impacts;

and equity). The RFA requires agencies

to analyze options for regulatory relief

for small businesses. For purposes of the

RFA, States and individuals are not

considered to be small entities.

This notice allocates, among the

States, Federal funds to provide

Medicaid payment for Medicare Part B

premiums for QIs. 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 except for the use of

specified data. Because the data

specified in the law were not currently

available, we have used comparable

data from the U.S. Census Bureau on the

number of possible QIs in the States, as

described in detail in the January 26,

1998 Federal Register. These new

allotments for FY 2000 incorporate the

latest data from the Census Bureau

covering 1996 through 1998, as

specified in the footnote to the

preceding table.

We believe the statutory provisions

implemented in this notice will have a

Federal Register / Vol. 65, No. 104 / Tuesday, May 30, 2000 / Notices 34481

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 QIs, and a

greater number of low-income Medicare

beneficiaries will be eligible to have

their Medicare Part B premiums paid

under Medicaid.

Section 1102(b) of the Act requires us

to prepare a regulatory impact analysis

for any notice that may have a

significant impact on the operations of

a substantial number of small rural

hospitals. Such an analysis must

conform to the provisions of section 603

of the RFA. For purposes of section

1102(b) of the Act, we define a small

rural hospital as a hospital that is

located outside a Metropolitan

Statistical Area and has fewer than 50

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.

In accordance with the provisions of

Executive Order 12866, this notice was

reviewed by the Office of Management

and Budget.

We have reviewed this notice under

the threshold criteria of Executive Order

13132 of August 4, 1999, Federalism,

published in the Federal Register on

August 10, 1999 (64 FR 43255). The

Executive Order is effective on

November 2, 1999, which is 90 days

after the date of the Order. We have

determined that this notice does not

significantly affect the rights, roles, and

responsibilities of States.

Authority: Sections 1902(a)(10)(E) and

1933 of the Social Security Act (42 U.S.C.

1396a(a)(10)(E) and 1396x).

(Catalog of Federal Domestic Assistance

Program No. 93.778, Medical Assistance

Program)

Dated: September 28, 1999.

Michael M. Hash,

Deputy Administrator, Health Care Financing

Administration.

Dated: November 22, 1999.

Donna E. Shalala,

Secretary.

Editorial Note. This document was

received at the Office of the Federal Register

May 23, 2000.

[FR Doc. 00–13346 Filed 5–26–00; 8:45 am]

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

[HCFA–9001–N]

Medicare and Medicaid Programs;

Quarterly Listing of Program

Issuances—Third Quarter, 1999

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Notice.

SUMMARY: This notice lists HCFA

manual instructions, substantive and

interpretive regulations, and other

Federal Register notices that were

published during July, August, and

September of 1999, relating to the

Medicare and Medicaid programs. This

notice also identifies certain devices

with investigational device exemption

numbers approved by the Food and

Drug Administration that potentially

may be covered under Medicare.

Section 1871(c) of the Social Security

Act requires that we publish a list of

Medicare issuances in the Federal

Register at least every 3 months.

Although we are not mandated to do so

by statute, for the sake of completeness

of the listing, we are also including all

Medicaid issuances and Medicare and

Medicaid substantive and interpretive

regulations (proposed and final)

published during this timeframe.

FOR FURTHER INFORMATION CONTACT: It is

possible that an interested party may

have a specific information need and

not be able to determine from the listed

information whether the issuance or

regulation would fulfill that need.

Consequently, we are providing

information contact persons to answer

general questions concerning these

items. Copies are not available through

the contact persons.

Questions concerning Medicare items

in Addendum III may be addressed to

Bridget Wilhite, Office of

Communications and Operations

Support, Division of Regulations and

Issuances, Health Care Financing

Administration, C5–16–03, 7500

Security Boulevard, Baltimore, MD

21244–1850, (410) 786–5248.

Questions concerning Medicaid items

in Addendum III may be addressed to

Betty Stanton, Center for Medicaid State

Operations, Policy Coordination and

Planning Group, Health Care Financing

Administration, S2–26–13, 7500

Security Boulevard, Baltimore, MD

21244–1850, (410) 786–3247.

Questions concerning Food and Drug

Administration-approved

investigational device exemptions may

be addressed to Sharon Hippler, Office

of Clinical Standards and Quality,

Coverage and Analysis Group, Health

Care Financing Administration, C4–11–

04, 7500 Security Boulevard, Baltimore,

MD 21244–1850, (410) 786–4633.

Questions concerning all other

information may be addressed to

Trenesha Fultz, Office of

Communications and Operations

Support, Division of Regulations and

Issuances, Health Care Financing

Administration, C5–12–08, 7500

Security Boulevard, Baltimore, MD

21244–1850, (410) 786–3822.

SUPPLEMENTARY INFORMATION: 

I. Program Issuances

The Health Care Financing

Administration (HCFA) is responsible

for administering the Medicare and

Medicaid programs. These programs pay

for health care and related services for

39 million Medicare beneficiaries and

35 million Medicaid recipients.

Administration of these programs

involves (1) furnishing information to

Medicare beneficiaries and Medicaid

recipients, health care providers, and

the public and (2) effective

communications with regional offices,

State governments, State Medicaid

Agencies, State Survey Agencies,

various providers of health care, fiscal

intermediaries and carriers that process

claims and pay bills, and others. To

implement the various statutes on

which the programs are based, we issue

regulations under the authority granted

to the Secretary of the Department of

Health and Human Services under

sections 1102, 1871, 1902, and related

provisions of the Social Security Act

(the Act). We also issue various

manuals, memoranda, and statements

necessary to administer the programs

efficiently.

Section 1871(c)(1) of the Act requires

that we publish a list of all Medicare

manual instructions, interpretive rules,

and guidelines of general applicability

not issued as regulations at least every

3 months in the Federal Register. We

published our first notice June 9, 1988

(53 FR 21730). Although we are not

mandated to do so by statute, for the

sake of completeness of the listing of

operational and policy statements, we

are continuing our practice of including

Medicare substantive and interpretive

regulations (proposed and final)

published during the 3-month time

frame.

II. How To Use the Addenda

This notice is organized so that a

reader may review the subjects of all

manual issuances, memoranda,

substantive and interpretive regulations,

or Food and Drug AdministrationVerDate 11<MAY>2000 19:56 May 26, 2000 Jkt 190000 PO 00000 Frm 00046 Fmt 4703 Sfmt 4703 E:\FR\FM\30MYN1.SGM pfrm11 PsN: 30MYN1