50214 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Rules and Regulations 

* * * * * 

[FR Doc. 05–16929 Filed 8–25–05; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Part 405 

[CMS–4064–IFC3] 

RIN–0938–AM73 

Medicare Program; Changes to the 

Medicare Claims Appeal Procedures: 

Correcting Amendment to a Correcting 

Amendment 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Correcting amendment. 

SUMMARY: This correcting amendment 

corrects a technical error in the 

correcting amendment that appeared in 

the Federal Register, entitled ‘‘Medicare 

Program; Changes to the Medicare 

Claims Appeal Procedures: Correcting 

Amendment to an Interim Final Rule.’’ 

DATES: Effective Date: This correcting 

amendment is effective September 26, 

2005. 

FOR FURTHER INFORMATION CONTACT: 

Arrah Tabe-Bedward, (410) 786–7129. 

SUPPLEMENTARY INFORMATION: 

I. Background 

We have identified a technical error 

that appeared in a correcting 

amendment entitled ‘‘Medicare 

Program; Changes to the Medicare 

Claims Appeal Procedures: Correcting 

Amendment to an Interim Final Rule.’’ 

(70 FR 37700, June 30, 2005) In this 

correcting amendment, we are 

correcting that technical error. 

II. Correction of Error 

A. Technical Correction to the 

Regulations Text 

In § 405.1020 of the regulation text, 

we incorrectly stated the section’s title 

as ‘‘Time frames for deciding an appeal 

for a hearing before an ALJ.’’ It should 

have read, ‘‘Time and place for a 

hearing before an ALJ.’’ We correct this 

technical error in section B of this 

correcting amendment. 

III. Waiver of Proposed Rulemaking 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register to provide a period for public 

comment before the provisions of a rule 

take effect. However, we can waive this 

procedure if we find good cause for 

doing so, and incorporate a statement of 

this finding and the reasons for it into 

the rule. A finding that a notice and 

comment period is impracticable, 

unnecessary, or contrary to the public 

interest constitutes good cause for 

waiving this procedure. 

We believe that it is unnecessary to 

seek public comment on the correction 

of this editorial error. Further, it is in 

the public’s interest to correct this 

editorial error because it makes the 

section more understandable to parties 

pursuing Medicare appeals under these 

procedures. Therefore, we find good 

cause to waive notice and comment 

procedures. 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare-Hospital 

Insurance; and Program No. 93.774, 

Medicare-Supplementary Medical Insurance 

Program) 

Correction of Regulation Text Error 

■ Accordingly, 42 CFR chapter IV is 

corrected by making the following 

correction to part 405: 

PART 405—[CORRECTED] 

■ 1. The authority citation for part 405 

continues to read as follows: 

Authority: Secs. 205(a), 1102, 1861, 

1862(a), 1869, 1871, 1874, 1881, and 1886(k) 

of the Social Security Act (42 U.S.C. 405(a), 

1302, 1395x, 1395y(a), 1395ff, 1395hh, 

1395kk, 1395rr and 1395ww(k)) and Sec. 353 

of the Public Health Service Act (42 U.S.C. 

263a). 

§ 405.1020 [Corrected] 

■ 2. Section 405.1020 is amended by 

revising the section title to read as 

follows: 

§ 405.1020 Time and place for a hearing 

before an ALJ. 

* * * * * 

Dated: August 16, 2005. 

Ann C. Agnew, 

Executive Secretary to the Department. 

[FR Doc. 05–16711 Filed 8–25–05; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Part 433 

[CMS–2210–IFC] 

RIN 0938–AO04 

Medicaid Program; State Allotments 

for Payment of Medicare Part B 

Premiums for Qualifying Individuals: 

Federal Fiscal Year 2005 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Interim final rule with comment 

period. 

SUMMARY: This interim final rule with 

comment period sets forth the 

methodology used to compute State 

allotments that are available to pay 

Medicare Part B premiums for 

qualifying individuals, allows changes 

to the State allotments and describes the 

methodology used to determine the 

changes to each State’s allotment. 

DATES: Effective date: These regulations 

are effective August 26, 2005 for 

allotments for payment of Medicare Part 

B premiums from the allocation for 

fiscal year 2005. 

Comment date: To be assured 

consideration, comments must be 

received at one of the addresses 

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

October 25, 2005. 

ADDRESSES: In commenting, please refer 

to file code CMS–2210–IFC. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http:// 

www.cms.hhs.gov/regulations/ 

ecomments. (Attachments should be in 

Microsoft Word, WordPerfect, or Excel; 

however, we prefer Microsoft Word.) 

2. By regular mail. You may mail 

written comments (one original and two 

copies) to the following address ONLY: 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Attention: CMS–2210– 

IFC, P.O. Box 8011, Baltimore, MD 

21244–8011. 

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 (one 

original and two copies) to the following 

address ONLY: Centers for Medicare & 

Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Rules and Regulations 50215 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–2210–IFC, 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 (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786– 

7195 in advance to schedule your 

arrival with one of our staff members. 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

HHH 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.) 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

FOR FURTHER INFORMATION CONTACT: 

Christine Gerhardt, (410) 786–0693. 

Submitting Comments: We welcome 

comments from the public on all issues 

set forth in this rule to assist us in fully 

considering issues and developing 

policies. You can assist us by 

referencing the file code CMS–2210–IFC 

and the specific ‘‘issue identifier’’ that 

precedes the section on which you 

choose to comment. 

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 electronic 

comments received before the close of 

the comment period on its public Web 

site as soon as possible after they have 

been received. Hard copy comments 

received timely will 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. 

SUPPLEMENTARY INFORMATION: 

I. Background 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘BACKGROUND’’ at the beginning of 

your comments.] 

Section 1902 of the Social Security 

Act (the Act) sets forth the requirements 

for State plans for medical assistance. 

Prior to August 5, 1997, section 

1902(a)(10)(E) of the Act specified that 

the State Medicaid plan 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 

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 line (FPL) 

and resources below $4,000 for an 

individual and $6,000 for a couple. 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. 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 

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. 

Section 4732 of the Balanced Budget 

Act of 1997 (BBA), 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, 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 qualifying individuals who 

would be QMBs but for the fact that 

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 

second group of QIs added 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 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 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). 

Coverage of the second group of QIs 

ended on December 31, 2002 and the 

2003 Welfare Reform Bill (Pub. L. 108– 

89) eliminated reference to the QI–2 

benefit. In each of the years 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 Federal 

poverty line) through the next fiscal 

year, but maintained the annual funding 

at the FY 2002 level. In 2004, ‘‘A Bill 

to Amend Title XIX of the Social 

Security Act to Extend Medicare CostSharing for the Medicare Part B 

Premium for Qualifying Individuals’’ 

(Pub. L. 108–448) continued coverage of 

this group 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 was 

re-designated as section 1934.) Section 

1933(a) 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). 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 

50216 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Rules and Regulations 

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 fiscal year 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. In 

1999, the Department published a notice 

(64 FR 14931, March 29, 1999) 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 only through FY 2002, through 

several continuing resolutions, coverage 

has been continued through the current 

fiscal year, but without any increase in 

total allocation over the FY 2002 level. 

The Federal medical assistance 

percentage for Medicaid payment of 

Medicare Part B premiums for 

qualifying individuals 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 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 that is to be 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 line, and who are 

not otherwise eligible for Medicaid, to 

(b) the sum of all those individuals for 

all eligible States. 

In FY 2005, some States have 

exhausted their current allotments 

before the end of the fiscal year, which 

has caused them to deny benefits to 

eligible persons under section 

1933(b)(3) of the Act, while other States 

project a surplus in their allotments. We 

asked those States which have 

exhausted or expect to exhaust their FY 

2005 allotments before the end of the 

fiscal year 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 which do not expect to use 

their full allotments in FY 2005 to 

project the difference between the 

amount they expect to spend and their 

allotment, that is, their surplus. All 

States reported these figures, and it was 

evident that the total surplus exceeds 

the total need. In spite of there being 

adequate overall funding for the QI 

benefit, some eligible individuals are 

being denied benefits due to the 

allocation methodology used to 

determine the FY 2005 allotments. We 

believe that it is the clear intent of the 

statute to provide benefits to eligible 

persons up to the full amount of funds 

made available for the program. We 

attribute this to imprecision in the data 

which we used to provide States with 

their initial allocations under section 

1933 of the Act. This interim final rule 

would attempt to compensate for this 

imprecision and enable States to enroll 

those QIs whom they would have been 

able to enroll had the data been more 

precise. 

II. Provisions of the Interim Final Rule 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘PROVISIONS’’ at the beginning of your 

comments.] 

This interim final rule amends 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 fiscal year for 

the Medicaid payment of Medicare Part 

B premiums for qualifying individuals 

identified under section 

1902(a)(10)(E)(iv) of the Act. 

The FY 2005 allotments were derived 

by applying 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 

fiscal year allotment be based upon a 

ratio of the amount of ‘‘total number of 

individuals described in section 

1902(a)(10)(E)(iv) 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 was a rough proxy 

to attain the statutory number. Actual 

expenditure data recently received, 

however, reveal that the Census Bureau 

data yielded an inappropriate 

distribution of the total appropriated 

fund as evidenced by the fact that 

several States have projected significant 

shortfalls in their allotments, while 

many other States project a significant 

surplus by the end of the fiscal year 

2005. Census Bureau data may not have 

been 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 does 

not preclude a subsequent readjustment 

of that allocation, when it becomes clear 

that the data used for that estimate did 

not effectuate the statutory objective. 

This interim final rule permits, in this 

specific circumstance, a redistribution 

of surplus funds, as it has been 

demonstrated that the projections and 

estimates resulted in an inequitable 

initial allocation, 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 this interim final rule, we are 

codifying the methodology we have 

been using to approximate the statutory 

formula for determining State 

allotments. However, since certain 

States project a deficit in their allotment 

before the end of fiscal year 2005, this 

rule permits fiscal year 2005 funds to be 

reallocated from the surplus States to 

the need States. The regulation specifies 

the methodology for computing the 

annual allotments, and for reallocating 

funds in this circumstance. The formula 

used to reallocate funds is intended to 

minimize impact on surplus States, to 

equitably distribute the total needed 

amount among those surplus States, and 

to meet the immediate needs for those 

States projecting deficits. Since the 

authorization for the QI benefit expires 

at the end of calendar year 2005 and 

currently no funds have been 

appropriated for the QI benefit beyond 

September 30, 2005, this regulation will 

sunset at the end of calendar year 2005. 

Should the Congress authorize an 

extension of the QI benefit and 

appropriate additional funds for 

allocation among the States, we will 

Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Rules and Regulations 50217 

amend the sunset date in this regulation 

to take into account any extension. 

The resulting allotments are shown by 

State in the table below. In this table 

each column contains data defined as 

follows: 

Chart—Revised FY 2005 Qualified 

Individuals Allotments 

Column A—State. Column A shows 

the name of each State. Columns B 

through D shows the calculation of the 

prior FY 2005 QI Allotments. 

Column B—Number of Individuals. 

Column B contains the estimated 

number of eligibles for each State, in 

thousands, as obtained from the Census 

Bureau. 

Column C—State Share of Column B. 

Column C provides the percentage of 

total eligibles for each State, determined 

as the number of individuals for the 

State in Column B divided by the Total 

Number of Individuals for all States in 

Column B. 

Column D—Prior FY 2005 QI 

Allotments. Column D contains each 

State’s prior FY 2005 QI allotments, 

calculated as the State’s percentage of 

total eligibles in Column C multiplied 

by the total amount available for FY 

2005 for all States ($400,000,000). 

Columns E through J shows the 

determination of the States’ revised FY 

2005 QI allotments. 

Column E—FY 2005 Estimated QI 

Expenditures. Column E contains the 

States’ most recent estimates of their 

total QI expenditures for FY 2005. 

Column F—Need (Difference). 

Column F contains the additional 

amount of QI allotment needed for those 

States whose estimated expenditures in 

Column E exceed their original FY 2005 

QI allotment in Column D; for such 

States Column E shows the difference of 

Column E minus Column D. For other 

States, Column F shows ‘‘NA’’. 

Column G—Reduction Pool for NonNeed States. Column G contains the 

amount of the pool of surplus FY 2005 

QI allotments for those States that 

project they will not need all of their FY 

2005 QI allotment. For States whose 

estimates of QI expenditures for FY 

2005 in Column E are equal to or less 

than their original FY 2005 QI allotment 

in Column D (referred to as non-need 

States), Column G shows the difference 

of Column D minus Column E. 

Column H—Percent of Total NonNeed States. Column H shows the 

percentage of the total excess FY 2005 

allotments for each Non-Need State, 

determined as the amount for each NonNeed State in Column G divided by the 

sum of the amounts for all states in 

Column G. 

Column I—Reduction for Non-Need 

States. Column I shows the amount of 

reduction to Non-Need States’ prior FY 

2005 QI allotments in Column D in 

order provide for the total need shown 

in Column F (due to rounding 

adjustments, this total need is 

$8,914,634). The amount in Column I is 

determined as the percentage in Column 

H for Non-Need States multiplied by the 

total in Column F. 

Column J—Revised FY 2005 QI 

Allotments. Column J contains the 

revised FY 2005 QI allotments for each 

State. For States that needed additional 

amounts based on their estimates, 

Column J is equal to the amount in 

Column D plus the additional need in 

Column F. For Non-Need States, 

Column J is equal to the amount in 

Column D minus the amount in Column 

I. 

BILLING CODE 4120–01–P 

50218 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Rules and Regulations 

BILLING CODE 4120–01–C 


ER26AU05.000</GPH>
Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Rules and Regulations 50219 

III. 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). 

IV. Waiver of Notice With Comment 

and 30-Day Delay in Effective Date 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘WAIVER OF ADVANCE PUBLIC 

COMMENT’’ at the beginning of your 

comments.] 

We ordinarily publish an advance 

notice in the Federal Register for 

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 

public interest, we may waive the delay 

in the effective date. 

We are publishing this rule as an 

interim final rule 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 rule 

permits redistribution of funds and will 

allow all eligible applicants to receive 

QI benefits during this calendar year. 

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. 

Also, 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 which will have 

access to additional funds to enroll QIs 

need to know that these funds are 

available as soon as possible, so they 

can begin enrolling QIs. While we 

believe those States which will have 

diminished amounts available for this 

fiscal year 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 fiscal year. 

We are publishing this interim final 

rule, with a 60-day period for public 

comment. However, if we decide that 

changes are necessary as a result of our 

consideration of timely comments, we 

will issue a final rule and respond to the 

comments in that rule. 

V. Regulatory Impact Statement 

We have examined the impact of this 

rule 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. 

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 rule 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 $6 million to $29 million in any 1 

year. Individuals and States are not 

included in the definition of a small 

entity. 

This interim final rule with comment 

period 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 rule 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 interim 

final rule with comment period 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. In no 

States will the changes in allotments 

result in fewer individuals receiving the 

QI benefit. The FY 2005 cost for this 

provision has been included in the FY 

2006 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 a Core-Based 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 interim final rule with 

comment period will not have a 

significant economic impact on a 

substantial number of small entities or 

a significant impact on the operations of 

a substantial number of small rural 

hospitals. 

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 1 year by State, local, or tribal 

governments, in the aggregate, or by the 

private sector, of $110 million. This rule 

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 

proposed rule (and subsequent final 

rule) 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 E.O. 13132 are not 

applicable. 

50220 Federal Register / Vol. 70, No. 165 / Friday, August 26, 2005 / Rules and Regulations 

In accordance with the provisions of 

Executive Order 12866, this interim 

final rule with comment period was 

reviewed by the Office of Management 

and Budget. 

List of Subjects in 42 CFR Part 433 

Administrative practice and 

procedure, Child support, Claims, Grant 

programs—health, Medicaid, Reporting 

and recordkeeping requirements. 

■ For the reasons set forth in the 

preamble, the Centers for Medicare & 

Medicaid Services amends 42 CFR 

Chapter IV as set forth below: 

PART 433—STATE FISCAL 

ADMINISTRATION 

■ 1. The authority citation for part 433 

continues to read as follows: 

Authority: Sec. 1102 of the Social Security 

Act (42 U.S.C. 1302). 

■ 2. Section 433.10 is amended by 

adding new paragraph (c)(5) to read as 

follows: 

§ 433.10 Rates of FFP for program 

services. 

* * * * * 

(c) * * * 

(5) (i) Under section 1933(d) of the 

Act, the Federal share of State 

expenditures for Medicare Part B 

premiums described in section 

1905(p)(3)(A)(ii) of the Act on behalf of 

Qualifying Individuals described in 

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

100 percent, to the extent that the 

assistance does not exceed the State’s 

allocation under paragraph (c)(5)(ii) of 

this section. To the extent that the 

assistance exceeds that allocation, the 

Federal share is 0 percent. 

(ii) Under section 1933(c)(2) of the 

Act and subject to paragraph (c)(5)(iii) of 

this section, the allocation to each State 

is equal to the total allocation specified 

in section 1933(c)(1) of the Act 

multiplied by the Secretary’s estimate of 

the ratio of the total number of 

individuals described in section 

1902(a)(10)(E)(iv) of the Act in the State 

to the total number of individuals 

described in section 1902(a)(10)(E)(iv) of 

the Act for all eligible States. In 

estimating that ratio, the Secretary will 

use data from the U.S. Census Bureau. 

(iii) If, based on projected 

expenditures for a fiscal year, the 

Secretary determines that the 

expenditures described in paragraph 

(c)(5)(i) of this section for one or more 

States are projected to exceed the 

allocation made to the State, the 

Secretary may adjust each State’s fiscal 

year 2005 allocation, as follows: 

(A) The Secretary will compare each 

State’s new projected total expenditures 

for the expenses described in paragraph 

(c)(5)(i) of this section to the State’s 

initial allocation, to determine the 

extent of each State’s projected surplus 

or deficit. 

(B) The surplus of each State with a 

projected surplus, as determined in 

accordance with paragraph (c)(5)(iii)(A) 

of this section will be added together to 

arrive at the Total Projected Surplus. 

(C) The deficit of each State with a 

projected deficit, as determined in 

accordance with paragraph (c)(5)(iii)(A) 

of this section will be added together to 

arrive at the Total Projected Deficit. 

(D) Each State with a projected deficit 

will receive an additional allocation 

equal to the amount of its projected 

deficit. The amount to be reallocated 

from each State with a projected surplus 

will be equal to A ×B, where A equals 

the Total Projected Deficit and B equals 

the amount of the State’s projected 

surplus as a percentage of the Total 

Projected Surplus. 

(iv) CMS will notify States of any 

changes in allotments resulting from 

any reallocations without opportunity 

for prior comment. CMS will follow 

applicable rulemaking procedures in 

publishing revisions to the allotments 

resulting from changes other those that 

specified above. 

(v) The provisions of this paragraph 

(c)(5) will be in effect though the end of 

calendar year 2005. 

Authority: Sections 1902(a)(10), 1933 of 

the Social Security Act (42 U.S.C. 1396a), 

and Pub. L. 105–33. 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

Dated: August 9, 2005. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: August 15, 2005. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. 05–16973 Filed 8–23–05; 9:19 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 648 

[Docket No. 040804229–4300–02; I.D. 

081705H] 

Magnuson-Stevens Fishery 

Conservation and Management Act 

Provisions; Fisheries of the 

Northeastern United States; Northeast 

Multispecies Fishery; Closure of the 

Eastern U.S./Canada Area and the 

Eastern U.S./Canada Haddock Special 

Access Program Pilot Program 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Temporary rule; closure. 

SUMMARY: NMFS announces the closure 

of the Eastern U.S./Canada Area, 

including the Eastern U.S./Canada 

Haddock Special Access Program (SAP) 

Pilot Program, to limited access 

Northeast (NE) multispecies days-at-sea 

(DAS) vessels for the remainder of the 

2005 fishing year (i.e., through April 30, 

2006), unless otherwise notified by the 

Administrator, Northeast Region, NMFS 

(Regional Administrator). This closure 

is based on a determination by the 

Regional Administrator that 90 percent 

of the total allowable catch (TAC) of 

Georges Bank (GB) cod allocated to be 

harvested from the Eastern U.S./Canada 

Area has already been harvested during 

the 2005 fishing year. This action is 

being taken to prevent the 2005 TAC for 

GB cod in the Eastern U.S./Canada Area 

from being exceeded during the 2005 

fishing year in accordance with the 

regulations implemented under 

Amendment 13 to the NE Multispecies 

Fishery Management Plan and the 

Magnuson-Stevens Fishery 

Conservation and Management Act. 

DATES: The closure of the Eastern U.S./ 

Canada Area to all limited access NE 

multispecies DAS vessels is effective 

0001 hr local time, August 26, 2005, 

through 2400 hr local time, April 30, 

2006. One exception to this prohibition 

is discussed in the SUPPLEMENTARY

INFORMATION section of this temporary 

rule. 

FOR FURTHER INFORMATION CONTACT: 

Douglas W. Christel, Fishery Policy 

Analyst, (978) 281–9141, fax (978) 281– 

9135. 

SUPPLEMENTARY INFORMATION: 

Regulations governing fishing activity in 

the U.S./Canada Management Areas are 

found at 50 CFR 648.85. In addition,