T h i s d o c u m e n t i s s c h e d u l e d t o b e p u b l i s h e d i n t h e F e d e r a l R e g i s t e r o n 0 7 / 2 6 / 2 0 1 3 a n d a v a i l a b l e o n l i n e a t h t t p : / / f e d e r a l r e g i s t e r

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, a n d o n F D s y s

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## CMS-2387-N 2

for the first quarter of FY 2012 (that is, through December 31, 2011) by providing $280 million

available for the first quarter of FY 2012. Section 310 of the Temporary Payroll Tax Cut

Continuation Act of 2011 (Pub. L. 112-78, enac ted on December 23, 2011) (TPTCA) provided
temporary continued authority and an additiona l $150 million in funding for the QI program for

the period January 1, 2012 through February 29, 2 012. With the enactment of TPTCA, the QI
program was authorized and funded at a tota l amount nationally of $430 million ($280 million
plus $150 million) for FY 2012 through February 29, 2012. Section 3101 of the Middle Class
Tax Relief and Job Creation Act of 2012 (Pub. L. 112-96, enacted on February 22, 2012)
(MCTRJCA) extended the authority and funding fo r the QI program for FY 2012; in particular,
authority for the QI program was extended for all of FY 2012 and funding for the program for
the period January 1, 2012 through September 30, 2012 was increased to $450 million.

Therefore, the total funding available for the QI program for FY 2012 is $730 million ($280
million plus $450 million).

B. QI Allotments for FY 2013 and Thereafter

Section 3101 of the MCTRJCA extended the au thority and funding for the QI program by
providing $280 million, available for the peri od October 1, 2012 through December 31, 2012, the

first quarter of FY 2013. Most recently, section 621 of the Amer ican Taxpayer Relief Act of
2012 (Pub. L. 112-240, enacted on January 2, 2013) (A TRA), extended the authority for the QI
program for all of FY 2013 and provided $485 milli on in additional funding for the program for
the period January 1, 2013 through September 30, 2013. Therefore the total funding available
for the QI program for FY 2013 is $765 million ($280 million plus $485 million).

Finally, section 621 of ATRA further exte nded the authority a nd funding for the QI
program by providing $300 million, availabl e for the period October 1, 2013 through

## CMS-2387-N 3

December 31, 2013, the firs t quarter of FY 2014.
C. Methodology for Calculating th e Fiscal Year QI Allotments.

The amounts of the states’ final FY 2012 and preliminary FY 2013 QI allotments,

contained in this notice, were determined in accordance with the methodology set forth in
existing regulations at 42 CFR 433.10(c)(5) an d reflect funding for the QI program made
available under the legi slation discussed above.

II. Charts

The final QI allotments for FY 2012 and the preliminary QI allotments for FY 2013 are
shown by state in Chart 1 and Chart 2 below, respectively:

Chart 1 - Final Qualifying Individuals A llotments for October 1, 2011 through

September 30, 2012.

Chart 2 – Preliminary Qualifying Individuals Allotments for October 1, 2012 through

September 30, 2013.CMS-2387-N 4TABLE 1: Final Qualifying Individuals Allotments for October 1, 2011 through September 30, 2012Initial QI Allotments for FY 2012 FY 2012 Need Pct of Tot. Reduction Pool Pct of Tot. Reduction Adj. For Increase Adj. For FinalSTATE Number of Percentage Initial QI Allotment Estimated QI (Difference) Need States for Non-Need Non-Need Non-Need States Need States FY 2012Individuals /3 of Total Col C x Expenditures /1States States Col. I x Col. G x QI Allotment /2(000s) Col B/Tot. Col B $730,000,000 If E>D, E-D F/(Tot. of F) If D >= E, D- E H/(Tot. of H) $82,487,822 $82,487,822A B C D E F G H I J K LAlabama43 3.22% $23,513,109 $21,324,574 NA NA $2,188,535 1.2003% $990,139 NA $22,522,970Alaska2 0.15% $1,093,633 $283,429 NA NA $810,204 0.4444% $366,553 NA $727,080Arizona14 1.05% $7,655,431 $16,592,682 $8,937,252 10.8346% Need Need Need $8,937,252 $16,592,682Arkansas21 1.57% $11,483,146 $12,996,962 $1,513,816 1.8352% Need Need Need $1,513,816 $12,996,962California89 6.67% $48,666,667 $27,247,615 NA NA $21,419,052 11.7477% $9,690,422 NA $38,976,244Colorado16 1.20% $8,749,064 $5,418,415 NA NA $3,330,649 1.8268% $1,506,854 NA $7,242,209Connecticut15 1.12% $8,202,247 $2,292,128 NA NA $5,910,119 3.2415% $2,673,860 NA $5,528,387Delaware4 0.30% $2,187,266 $3,030,541 $843,275 1.0223% Need Need Need $843,275 $3,030,541District of Columbia2 0.15% $1,093,633 $0 NA NA $1,093,633 0.5998% $494,782 NA $598,851Florida83 6.22% $45,385,768 $66,783,222 $21,397,454 25.9401% Need Need Need $21,397,454 $66,783,222Georgia35 2.62% $19,138,577 $35,076,093 $15,937,516 19.3211% Need Need Need $15,937,516 $35,076,093Hawaii5 0.37% $2,734,082 $1,308,325 NA NA $1,425,758 0.7820% $645,042 NA $2,089,040Idaho6 0.45% $3,280,899 $2,501,976 NA NA $778,923 0.4272% $352,401 NA $2,928,498Illinois64 4.79% $34,996,255 $23,748,898 NA NA $11,247,356 6.1688% $5,088,537 NA $29,907,718Indiana39 2.92% $21,325,843 $6,522,130 NA NA $14,803,712 8.1194% $6,697,506 NA $14,628,336Iowa16 1.20% $8,749,064 $4,338,994 NA NA $4,410,070 2.4188% $1,995,207 NA $6,753,857Kansas19 1.42% $10,389,513 $4,613,481 NA NA $5,776,032 3.1680% $2,613,196 NA $7,776,317Kentucky32 2.40% $17,498,127 $15,249,091 NA NA $2,249,037 1.2335% $1,017,511 NA $16,480,617Louisiana28 2.10% $15,310,861 $19,883,851 $4,572,989 5.5438% Need Need Need $4,572,989 $19,883,851Maine6 0.45% $3,280,899 $5,308,878 $2,027,979 2.4585% Need Need Need $2,027,979 $5,308,878Maryland19 1.42% $10,389,513 $7,562,402 NA NA $2,827,111 1.5506% $1,279,044 NA $9,110,470Massachusetts34 2.55% $18,591,760 $10,276,939 NA NA $8,314,821 4.5604% $3,761,797 NA $14,829,963Michigan39 2.92% $21,325,843 $16,321,547 NA NA $5,004,296 2.7447% $2,264,047 NA $19,061,796Minnesota21 1.57% $11,483,146 $5,943,209 NA NA $5,539,937 3.0385% $2,506,382 NA $8,976,764Mississippi19 1.42% $10,389,513 $14,400,900 $4,011,386 4.8630% Need Need Need $4,011,386 $14,400,900Missouri35 2.62% $19,138,577 $4,570,341 NA NA $14,568,235 7.9902% $6,590,971 NA $12,547,606Montana7 0.52% $3,827,715 $1,425,081 NA NA $2,402,634 1.3178% $1,087,001 NA $2,740,714CMS-2387-N 5Initial QI Allotments for FY 2012 FY 2012 Need Pct of Tot. Reduction Pool Pct of Tot. Reduction Adj. For Increase Adj. For FinalSTATE Number of Percentage Initial QI Allotment Estimated QI (Difference) Need States for Non-Need Non-Need Non-Need States Need States FY 2012Individuals /3 of Total Col C x Expenditures /1States States Col. I x Col. G x QI Allotment /2(000s) Col B/Tot. Col B $730,000,000 If E>D, E-D F/(Tot. of F) If D >= E, D- E H/(Tot. of H) $82,487,822 $82,487,822A B C D E F G H I J K LNebraska7 0.52% $3,827,715 $2,313,332 NA NA $1,514,383 0.8306% $685,138 NA $3,142,577Nevada9 0.67% $4,921,348 $4,662,209 NA NA $259,140 0.1421% $117,240 NA $4,804,108New Hampshire5 0.37% $2,734,082 $2,212,296 NA NA $521,787 0.2862% $236,067 NA $2,498,015New Jersey29 2.17% $15,857,678 $9,166,126 NA NA $6,691,552 3.6701% $3,027,397 NA $12,830,281New Mexico10 0.75% $5,468,165 $4,058,656 NA NA $1,409,509 0.7731% $637,691 NA $4,830,474New York78 5.84% $42,651,685 $44,692,419 $2,040,734 2.4740% Need Need Need $2,040,734 $44,692,419North Carolina47 3.52% $25,700,375 $28,365,556 $2,665,181 3.2310% Need Need Need $2,665,181 $28,365,556North Dakota3 0.22% $1,640,449 $629,590 NA NA $1,010,859 0.5544% $457,334 NA $1,183,116Ohio58 4.34% $31,715,356 $24,831,767 NA NA $6,883,589 3.7754% $3,114,278 NA $28,601,078Oklahoma17 1.27% $9,295,880 $10,241,906 $946,026 1.1469% Need Need Need $946,026 $10,241,906Oregon17 1.27% $9,295,880 $13,072,852 $3,776,972 4.5788% Need Need Need $3,776,972 $13,072,852Pennsylvania66 4.94% $36,089,888 $32,079,327 NA NA $4,010,560 2.1997% $1,814,460 NA $34,275,427Rhode Island5 0.37% $2,734,082 $2,388,025 NA NA $346,058 0.1898% $156,564 NA $2,577,519South Carolina26 1.95% $14,217,228 $13,359,233 NA NA $857,995 0.4706% $388,175 NA $13,829,054South Dakota4 0.30% $2,187,266 $1,915,993 NA NA $271,273 0.1488% $122,729 NA $2,064,536Tennessee32 2.40% $17,498,127 $29,077,199 $11,579,072 14.0373% Need Need Need $11,579,072 $29,077,199Texas105 7.87% $57,415,730 $34,868,400 NA NA $22,547,330 12.3665% $10,200,879 NA $47,214,851Utah5 0.37% $2,734,082 $2,429,445 NA NA $304,638 0.1671% $137,824 NA $2,596,258Vermont2 0.15% $1,093,633 $3,331,803 $2,238,170 2.7133% Need Need Need $2,238,170 $3,331,803Virginia25 1.87% $13,670,412 $13,050,355 NA NA $620,057 0.3401% $280,526 NA $13,389,886Washington26 1.95% $14,217,228 $6,502,266 NA NA $7,714,963 4.2314% $3,490,409 NA $10,726,820West Virginia16 1.20% $8,749,064 $6,165,223 NA NA $2,583,841 1.4172% $1,168,983 NA $7,580,080Wisconsin27 2.02% $14,764,045 $4,954,841 NA NA $9,809,204 5.3801% $4,437,887 NA $10,326,158Wyoming3 0.22% $1,640,449 $771,814 NA NA $868,636 0.4764% $392,989 NA $1,247,461Total 1,335 100.00% $730,000,000 $630,162,333 $82,487,822 100.0000% $182,325,489 100.0000% $82,487,822 $82,487,822 $730,000,000Footnotes:/1 FY 2012 Estimates from July 2012 CMS Survey of States; Estimates Are For Months October 2011 Through September 2012/2 For Need States, Final FY 2012 QI Allotment is equal to Initial QI Allotment in Column D increased by amount in Column KFor Non-Need States, Final FY 2012 QI Allotment is equal to Initial QI Allotment in Column D reduced by amount in Column JCMS-2387-N 6Initial QI Allotments for FY 2012 FY 2012 Need Pct of Tot. Reduction Pool Pct of Tot. Reduction Adj. For Increase Adj. For FinalSTATE Number of Percentage Initial QI Allotment Estimated QI (Difference) Need States for Non-Need Non-Need Non-Need States Need States FY 2012Individuals /3 of Total Col C x Expenditures /1States States Col. I x Col. G x QI Allotment /2(000s) Col B/Tot. Col B $730,000,000 If E>D, E-D F/(Tot. of F) If D >= E, D- E H/(Tot. of H) $82,487,822 $82,487,822A B C D E F G H I J K L/3 Three-year average (2008-2010) ofnumber (000) of Medicare beneficiaries in State who are not enrolled in Medicaid but whose incomes are at least 120% but lessthan 135% of federal poverty levelSource: Census Bureau Annual Social and Economic Supplement (ASEC) to the 2011 Current Population Survey (CPS)CMS-2387-N 7TABLE 2 - Preliminary QualifyingIndividuals Allotments for October 1, 2012 through September 30, 2013Initial QI Allotments for FY 2013 FY 2013 Need Pct of Tot. Reduction Pool Pct of Tot. Reduction Adj. For Increase Adj. For PreliminarySTATE Number of Percentage Initial QI Allotment Estimated QI (Difference) Need States for Non-Need Non-Need Non-Need States Need States FY 2013Individuals /3 of Total Col C x Expenditures /1States States Col. I x Col. G x QI Allotment /2(000s) Col B/Tot. Col B $765,000,000 If E>D, E-D F/(Tot. of F) If D >= E, D- E H/(Tot. of H) $103,554,487 $103,554,487A B C D E F G H I J K LAlabama38 2.64% $20,159,501 $24,188,697 $4,029,197 3.8909% Need Need Need $4,029,197 $24,188,697Alaska2 0.14% $1,061,026 $378,052 NA NA $682,974 0.4239% $438,933 NA $622,093Arizona21 1.46% $11,140,777 $20,302,279 $9,161,503 8.8470% Need Need Need $9,161,503 $20,302,279Arkansas27 1.87% $14,323,856 $14,968,578 $644,722 0.6226% Need Need Need $644,722 $14,968,578California107 7.42% $56,764,910 $30,667,238 NA NA $26,097,672 16.1967% $16,772,428 NA $39,992,482Colorado16 1.11% $8,488,211 $6,261,250 NA NA $2,226,960 1.3821% $1,431,221 NA $7,056,990Connecticut15 1.04% $7,957,698 $4,295,522 NA NA $3,662,176 2.2728% $2,353,604 NA $5,604,094Delaware4 0.28% $2,122,053 $3,516,899 $1,394,847 1.3470% Need Need Need $1,394,847 $3,516,899District of Columbia2 0.14% $1,061,026 $0 NA NA $1,061,026 0.6585% $681,899 NA $379,127Florida96 6.66% $50,929,265 $75,922,288 $24,993,023 24.1351% Need Need Need $24,993,023 $75,922,288Georgia45 3.12% $23,873,093 $37,187,452 $13,314,359 12.8573% Need Need Need $13,314,359 $37,187,452Hawaii6 0.42% $3,183,079 $1,502,678 NA NA $1,680,401 1.0429% $1,079,959 NA $2,103,120Idaho7 0.49% $3,713,592 $2,746,709 NA NA $966,883 0.6001% $621,396 NA $3,092,197Illinois68 4.72% $36,074,896 $28,872,870 NA NA $7,202,026 4.4697% $4,628,592 NA $31,446,304Indiana43 2.98% $22,812,067 $6,951,308 NA NA $15,860,759 9.8435% $10,193,378 NA $12,618,688Iowa16 1.11% $8,488,211 $4,940,141 NA NA $3,548,070 2.2020% $2,280,271 NA $6,207,940Kansas18 1.25% $9,549,237 $5,443,274 NA NA $4,105,963 2.5482% $2,638,817 NA $6,910,420Kentucky34 2.36% $18,037,448 $18,127,195 $89,747 0.0867% Need Need Need $89,747 $18,127,195Louisiana29 2.01% $15,384,882 $22,144,578 $6,759,696 6.5277% Need Need Need $6,759,696 $22,144,578Maine7 0.49% $3,713,592 $7,045,460 $3,331,867 3.2175% Need Need Need $3,331,867 $7,045,460Maryland24 1.66% $12,732,316 $8,602,875 NA NA $4,129,441 2.5628% $2,653,906 NA $10,078,411Massachusetts28 1.94% $14,854,369 $10,893,600 NA NA $3,960,769 2.4581% $2,545,503 NA $12,308,866Michigan38 2.64% $20,159,501 $20,967,835 $808,334 0.7806% Need Need Need $808,334 $20,967,835Minnesota22 1.53% $11,671,290 $6,559,682 NA NA $5,111,608 3.1724% $3,285,124 NA $8,386,166Mississippi18 1.25% $9,549,237 $16,529,838 $6,980,601 6.7410% Need Need Need $6,980,601 $16,529,838Missouri39 2.70% $20,690,014 $4,700,909 NA NA $15,989,105 9.9231% $10,275,864 NA $10,414,150Montana6 0.42% $3,183,079 $1,512,121 NA NA $1,670,958 1.0370% $1,073,890 NA $2,109,189CMS-2387-N 8Initial QI Allotments for FY 2013 FY 2013 Need Pct of Tot. Reduction Pool Pct of Tot. Reduction Adj. For Increase Adj. For PreliminarySTATE Number of Percentage Initial QI Allotment Estimated QI (Difference) Need States for Non-Need Non-Need Non-Need States Need States FY 2013Individuals /3 of Total Col C x Expenditures /1States States Col. I x Col. G x QI Allotment /2(000s) Col B/Tot. Col B $765,000,000 If E>D, E-D F/(Tot. of F) If D >= E, D- E H/(Tot. of H) $103,554,487 $103,554,487A B C D E F G H I J K LNebraska6 0.42% $3,183,079 $2,506,770 NA NA $676,309 0.4197% $434,650 NA $2,748,429Nevada10 0.69% $5,305,132 $5,177,080 NA NA $128,052 0.0795% $82,296 NA $5,222,836New Hampshire6 0.42% $3,183,079 $2,861,766 NA NA $321,313 0.1994% $206,501 NA $2,976,578New Jersey40 2.77% $21,220,527 $9,901,642 NA NA $11,318,885 7.0247% $7,274,411 NA $13,946,116New Mexico9 0.62% $4,774,619 $4,787,611 $12,993 0.0125% Need Need Need $12,993 $4,787,611New York85 5.89% $45,093,620 $50,481,630 $5,388,010 5.2031% Need Need Need $5,388,010 $50,481,630North Carolina38 2.64% $20,159,501 $28,897,791 $8,738,290 8.4383% Need Need Need $8,738,290 $28,897,791North Dakota3 0.21% $1,591,540 $692,912 NA NA $898,628 0.5577% $577,529 NA $1,014,010Ohio54 3.74% $28,647,712 $28,435,844 NA NA $211,867 0.1315% $136,163 NA $28,511,549Oklahoma27 1.87% $14,323,856 $11,348,409 NA NA $2,975,446 1.8466% $1,912,257 NA $12,411,598Oregon17 1.18% $9,018,724 $16,832,070 $7,813,346 7.5452% Need Need Need $7,813,346 $16,832,070Pennsylvania78 5.41% $41,380,028 $34,628,979 NA NA $6,751,049 4.1898% $4,338,758 NA $37,041,270Rhode Island6 0.42% $3,183,079 $2,625,070 NA NA $558,009 0.3463% $358,621 NA $2,824,458South Carolina33 2.29% $17,506,935 $13,456,800 NA NA $4,050,135 2.5136% $2,602,937 NA $14,903,998South Dakota4 0.28% $2,122,053 $2,344,945 $222,892 0.2152% Need Need Need $222,892 $2,344,945Tennessee48 3.33% $25,464,632 $30,163,578 $4,698,945 4.5377% Need Need Need $4,698,945 $30,163,578Texas106 7.35% $56,234,397 $35,884,800 NA NA $20,349,597 12.6294% $13,078,261 NA $43,156,136Utah6 0.42% $3,183,079 $2,680,802 NA NA $502,277 0.3117% $322,803 NA $2,860,276Vermont2 0.14% $1,061,026 $4,047,877 $2,986,851 2.8843% Need Need Need $2,986,851 $4,047,877Virginia23 1.60% $12,201,803 $14,387,068 $2,185,265 2.1103% Need Need Need $2,185,265 $14,387,068Washington23 1.60% $12,201,803 $7,274,362 NA NA $4,927,441 3.0581% $3,166,764 NA $9,035,039West Virginia17 1.18% $9,018,724 $6,550,585 NA NA $2,468,139 1.5318% $1,586,221 NA $7,432,503Wisconsin22 1.53% $11,671,290 $5,416,651 NA NA $6,254,639 3.8817% $4,019,726 NA $7,651,564Wyoming3 0.21% $1,591,540 $810,736 NA NA $780,803 0.4846% $501,806 NA $1,089,734Total 1,442 100.00% $765,000,000 $707,425,105 $103,554,487 100.0000% $161,129,382 100.0000% $103,554,487 $103,554,487 $765,000,000Footnotes:/1 FY 2013 Estimates from July 2012 CMS Survey of States; Estimates Are For Months October 2012 Through September 2013/2 For Need States, Preliminary FY 2013 QI Allotment is equalto Initial QI Allotment in Column D increased by amount in Column KFor Non-Need States, Preliminary FY 2013 QI Allotment is equal toInitial QI Allotment in Column D reduced by amount in ColumnJCMS-2387-N 9Initial QI Allotments for FY 2013 FY 2013 Need Pct of Tot. Reduction Pool Pct of Tot. Reduction Adj. For Increase Adj. For PreliminarySTATE Number of Percentage Initial QI Allotment Estimated QI (Difference) Need States for Non-Need Non-Need Non-Need States Need States FY 2013Individuals /3 of Total Col C x Expenditures /1States States Col. I x Col. G x QI Allotment /2(000s) Col B/Tot. Col B $765,000,000 If E>D, E-D F/(Tot. of F) If D >= E, D- E H/(Tot. of H) $103,554,487 $103,554,487A B C D E F G H I J K L/3 Three-year average (2009-2011) ofnumber (000) of Medicare beneficiaries in State who are not enrolled in Medicaid but whose incomes are at least 120% but lessthan 135% of federal poverty levelSource: Census Bureau Annual Social and Economic Supplement (ASEC) to the 2012 Current Population Survey (CPS)

## CMS-2387-N 10

The following describes the information co ntained 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 Initia l QI Allotment for FY 2012 (Chart 1) or

FY 2013 (Chart 2) for each state, based only on the indicated Census Bureau data.

Column B -- Number of Individuals

. Column B contains the estimated
average number of Medicare beneficiaries for each state that are not covered by
Medicaid whose family income is at least 120 but less than 135 pe rcent of the federal
poverty level. With respect to the final FY 2012 QI allotment (Chart 1) , Column B

contains the number of such individu als for the years 2008 through 2010, as obtained

from the Census Bureau’s Annual Soci al and Economic Supplement to the 2011
Current Population Survey. With respect to the preliminary FY 2013 QI allotment

(Chart 2) , Column B contains the number of su ch individuals for the years 2009 through
2012, as obtained from the Census Bureau’s Annual Social and Economic Supplement
to the Current Population Survey.

Column C -- Percentage of Total

. Column C provides the percentage of the

total number of individuals for each state, th at is, the Number of Individuals for the
state in Column B divided by the sum total of the Number of Indivi duals for all States

in Column B.

Column D -- Initial QI Allotment

. Column D contains each state’s Initial QI

Allotment for FY 2012 (Chart 1) or FY 2013 (Chart 2), calculated as the state’s
Percentage of Total in Column C multiplied by the total amount available nationally for
QI allotments for the fiscal year. The total amount available nationally for QI

## CMS-2387-N 11

allotments each fiscal year is $730,000,000 for FY 2012 (Chart 1) and $765,000,000 for

FY 2013 (Chart 2).
Columns E through L show the determinati on of the States’ Final QI Allotments
for FY 2012 (Chart 1) or Preliminary QI Allotments for FY 2013 (Chart 2).

Column E --FY 2012 or FY 2013 Estimated QI Expenditures

. Column E

contains the states’ estimates of their total QI expenditures for FY 2012 (Chart 1) or FY

2013 (Chart 2) based on informa tion obtained from states in the summer of 2012 and as

updated.

Column F -- Need (Difference)

. Column F contains the additional amount of

QI allotment needed for those states w hose estimated expenditures in Column E

exceeded their Initial QI allotments in Colu mn D for FY 2012 (Chart 1) or for FY 2013

(Chart 2) for such states, Column F show s 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 th eir initial QI allotment in Column D for

FY 2012 (Chart 1) or FY 2013 (Chart 2), respectively, Column G shows the percentage

of total need, determined as the amount for each Need State in Co lumn F divided by the

sum of the amounts for all states in Column F. For Non-Need States, the entry in

Column G is “NA”.

Column H — Reduction Pool for Non-Need States

. Column H shows the

amount of the pool of surplus QI allotments for FY 2012 (Chart 1) or FY 2013
(Chart 2), respectively, for those states that project QI expenditures for the fiscal year

that are less than the Initial QI allotment fo r the fiscal year (referred to as non-need

## CMS-2387-N 12

States). For states for which the estimates in Column E of QI expenditures for FY 2012
or FY 2013, respectively, are equa l to or less than th eir Initial QI allo tments in Column
D for FY 2012 or FY 2013, respectively, Column H shows the amount in Column D

minus the amount in Column E. For the stat es 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 thei r Initial QI allotment in Column D for

FY 2012 (Chart 1) or FY 2013 (Chart 2), Colu mn I shows the percentage of the total

reduction pool in Column H, determined as the amount for each Non-Need State in
Column H divided by the sum of the amounts for all States in Column H. For Need
States, the entry in Column I is “Need”.

Column J -- Reduction Adjustment for Non-Need States

. Column J shows
the amount of adjustment needed to reduce th e Initial QI allotments in Column D for

FY 2012 (Chart 1) or FY 2013 (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 Co lumn F) or the total Reduction Pool in

Column H (equal to the sum of the Non-Need amounts in Column H). For Need States,
the entry in Column J is “Need”.

Column K -- Increase Adju stment for Need States

. Column K shows the
amount of adjustment to increase the Init ial QI Allotment in Column D for FY 2012

(Chart 1) or FY 2013 (Chart 2) for Need Stat es in order to addre ss the total need shown

## CMS-2387-N 13

for the fiscal year in Column F. The amount in Column K is determined as the
percentage in Column G for Need States multiplied by the lesser of the total need in

Column F (equal to the sum of Needs in Co lumn F) or the total Reduction Pool in

Column H (equal to the sum of the Non-N eed amounts in Column H). For Non-Need
States, the entry in Column K is “NA”.

Column L -- Final FY 2012 QI Allotment (Chart 1) or Preliminary FY 2013

QI Allotment (Chart 2)

. Column L contains the Final QI Allotment for each state for
FY 2012 (Chart 1) or the Preliminary QI A llotment for FY 2013 (Chart 2). For states

that need additional QI allotment amounts fo r the fiscal year based on Estimated QI

Expenditures in Column E as compared to th eir Initial QI allotments in Column D for
the fiscal year (states with a projected need amount are shown in Column F), Column L

is equal to the Initial QI allotment in Column D for FY 2012 (Chart 1) or FY 2013

(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 Re duction Adjustment amount in Column J.

III. Collection of Information Requirements
This notice does not impose any inform ation collection or recordkeeping
requirements. Consequently, it does not need Office of Management and Budget review
under the authority of the Paperwork Reduc tion Act of 1995 (44 U.S.C. 3501 et seq. ).

## CMS-2387-N

Authority : (Section 1102 of the Social S ecurity Act (42 U.S.C. 1302))
(Catalog of Federal Domestic Assistance Pr ogram No. 93.778, Medical Assistance Program)

Dated: May 15, 2013

________________________________ Marilyn Tavenner
,
Administrator
,
Centers for Medicare & Medicaid

Services

.

Dated: June 28, 2013

________________________________ Kathleen Sebelius,

Secretary.
Department of Health and Human Services

BILLING CODE 4120-01-P

## CMS-2387-N 15

[FR Doc. 2013-17962 Filed 07/25/2013 at 8: 45 am; Publication Date: 07/26/2013]