Federal Register / Vol. 77, No. 142 / Tuesday, July 24, 2012 / Notices 43329 

[FR Doc. 2012–17954 Filed 7–20–12; 11:15 am] 

BILLING CODE C 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2385–N] 

RIN 0938–AR47 

Medicaid Program; State Allotments 

for Payment of Medicare Part B 

Premiums for Qualifying Individuals 

(QIs) for FY 2012 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice sets forth the 

States’ final allotments available to pay 

the Medicare Part B premiums for 

Qualifying Individuals (QIs) for the 

Federal fiscal year (FY) 2011 and the 

preliminary QI allotments for FY 2012. 

The amounts of these QI allotments 

were determined in accordance with the 

methodology set forth in regulations and 

reflect funding for the QI program made 

available under recent legislation as 

described in this notice. 

DATES: The final QI allotments for 

payment of Medicare Part B premiums 

for FY 2011 are effective October 1, 

2010. The preliminary QI allotments for 

FY 2012 are effective October 1, 2011. 

FOR FURTHER INFORMATION CONTACT: 

Richard Strauss, (410) 786–2019. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. QI Allotments for FY 2011 and 

Thereafter 

Section 5005 of the American 

Recovery and Reinvestment Act of 2009 

(Pub. L. 111–5, enacted on February 17, 

2009) (Recovery Act) extended the 

authority and funding for the QI 

program by providing $150 million in 

additional funds for the first quarter of 

FY 2011 (that is, through December 31, 

2010). Section 3 of the Emergency Aid 

to American Survivors of the Haiti 

Earthquake Act (Pub. L. 111–127, 

enacted on January 27, 2010) (Haiti 

Earthquake Act) provided an additional 

$15 million for States’ FY 2011 QI 

allotments; that brought the total funds 

available for the QI program for FY 2011 

through December 31, 2010 to $165 

million. Section 110 of the Medicare 

and Medicaid Extenders Act of 2010 

(Pub. L. 111–309, enacted on December 

15, 2010) (MMEA) extended authority 

and funding for the QI program for FY 

2011 by providing an additional $720 

million for the QI program for the last 

3 quarters of FY 2011 in addition to the 

previously available $165 million; 

which brought the total funding 

available for the QI program for FY 2011 

to $885 million. 

B. QI Allotments for FY 2012 and 

Thereafter 

Section 110 of the MMEA also 

extended the authority and funding for 

the QI program 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, enacted on December 23, 

2011) (TPTCA) provided temporary 

continued authority and an additional 

$150 million in funding for the QI 

program for the period January 1, 2012 

through February 29, 2012. With the 

enactment of TPTCA, the QI program 

was authorized and funded at a total 

amount nationally of $430 million ($280 

million plus $150 million) for FY 2012 

through February 29, 2012. Most 

recently, section 3101 of the Middle 

Class Tax Relief and Job Creation Act of 

2012 (Pub. L. 112–96, enacted on 

February 22, 2012) extended the 

authority and funding for the QI 

program for FY 2012 by increasing the 

amount of funding previously made 

available under TPTCA for FY 2012 

from $150 million to $450 million, and 

extending the period in FY 2012 this 

funding is available to September 30, 

2012 (that is, to the end of FY 2012). 

Therefore the total funding available for 

the QI program for FY 2012 is $730 

million ($280 million plus $450 

million). 

Finally, section 3101 of Middle Class 

Tax Relief and Job Creation Act also 

extended the authority and funding for 

the QI program by providing $280 

million to be available for the period 

October 1, 2012 through December 31, 

2012, the first quarter of FY 2013. 

C. Methodology for Calculating the 

Fiscal Year QI Allotments 

The amounts of the final FY 2011 and 

preliminary FY 2012 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) and 

reflect funding for the QI program made 

available under the legislation discussed 

above. 

II. Charts 

The final QI allotments for FY 2011 

and the preliminary QI allotments for 

FY 2011 are shown by State in Chart 1 

and Chart 2 below, respectively: 

Chart 1—Final Qualifying Individuals 

Allotments for October 1, 2010 through 

September 30, 2011. 

Chart 2—Preliminary Qualifying 

Individuals Allotments for October 1, 

2011 through September 30, 2012. 

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The following describes the 

information contained in the columns of 

Chart 1 and Chart 2: 

Column A—State. Column A shows 

the name of each State. Columns B 

through D show the determination of an 

Initial QI Allotment for FY 2011 (Chart 

1) or FY 2012 (Chart 2) for each State, 

based only on the indicated Census 

Bureau data. 

Column B—Number of Individuals. 

Column B contains the estimated 

average number of Medicare 

beneficiaries for each State that are not 

covered by Medicaid whose family 

income is at least 120 but less than 135 

percent of the federal poverty level. 

With respect to the final FY 2011 QI 

allotment (Chart 1), Column B contains 

the number of such individuals for the 

years 2007 through 2009, as obtained 

from the Census Bureau’s Annual Social 

and Economic Supplement to the 2010 

Current Population Survey. With 

respect to the preliminary FY 2012 QI 

allotment (Chart 2), Column B contains 

the number of such individuals for the 

years 2008 through 2010, as obtained 

from the Census Bureau’s Annual Social 

and Economic Supplement to the 2011 

Current Population Survey. 

Column C—Percentage of Total. 

Column C provides the percentage of 

the total number of individuals for each 

State, that is, the Number of Individuals 

for the State in Column B divided by the 

sum total of the Number of Individuals 

for all States in Column B. 

Column D—Initial QI Allotment. 

Column D contains each State’s Initial 

QI Allotment for FY 2011 (Chart 1) or 

FY 2012 (Chart 2), calculated as the 

State’s Percentage of Total in Column C 

multiplied by the total amount available 

nationally for QI allotments for the 

fiscal year. The total amount available 

nationally for QI allotments each fiscal 

year is $885,000,000 for FY 2011 (Chart 

1) and $730,000,000 for FY 2012 (Chart 

2). 

Columns E through L show the 

determination of the States’ Final QI 

Allotments for FY 2011 (Chart 1) or 

Preliminary QI Allotments for FY 2012 

(Chart 2). 

Column E—FY 2011 Estimated QI 

Expenditures. Column E contains the 

States’ estimates of their total QI 

expenditures for FY 2011 (Chart 1) or 

FY 2012 (Chart 2) based on information 

obtained from States in the summer of 

2011. The projected QI expenditures for 

FY 2012 were updated in January 2012 

to reflect the extended funding and 

authority for the QI program for FY 

2012. 

Column F—Need (Difference). 

Column F contains the additional 

amount of QI allotment needed for those 

States whose estimated expenditures in 

Column E exceeded their Initial QI 

allotments in Column D for FY 2011 

(Chart 1) or for FY 2012 (Chart 2) for 

such States, Column F shows the 

amount in Column E minus the amount 

in Column D. For other ‘‘Non-Need’’ 

States, Column F shows ‘‘NA’’. 

Column G—Percent of Total Need 

States. For States whose projected QI 

expenditures in Column E are greater 

than their initial QI allotment in 

Column D for FY 2011 (Chart 1) or FY 

2012 (Chart 2), respectively, Column G 

shows the percentage of total need, 

determined as the amount for each Need 

State in Column F divided by the sum 

of the amounts for all States in Column 

F. For Non-Need States, the entry in 

Column G is ‘‘NA’’. 

Column H—Reduction Pool for NonNeed States. Column H shows the 

amount of the pool of surplus QI 

allotments for FY 2011 (Chart 1) or FY 

2012 (Chart 2), respectively, for those 

States that project QI expenditures for 

the fiscal year that are less than the 

Initial QI allotment for the fiscal year 

(referred to as non-need States). For 

States whose estimates of QI 

expenditures for FY 2011 or FY 2012, 

respectively, in Column E are equal to 

or less than their Initial FY 2011 or FY 

2012 QI allotments in Column D for FY 

2011 or FY 2012, Column H shows the 

amount in Column D minus the amount 

in Column E. For the States with a need, 

Column H shows ‘‘Need’’. The 

reduction pool of excess QI allotments 

is equal to the sum of the amounts in 

Column H. 

Column I—Percent of Total Non-Need 

States. For States whose projected QI 

expenditures in Column E are less than 

their Initial QI allotment in Column D 

for FY 2011 (Chart 1) or FY 2012 (Chart 

2), Column I shows the percentage of 

the total reduction pool in Column H, 

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

sum of the amounts for all States in 

Column H. For Need States, the entry in 

Column I is ‘‘Need’’. 

Column J—Reduction Adjustment for 

Non-Need States. Column J shows the 

amount of adjustment needed to reduce 

the Initial QI allotments in Column D 

for FY 2011 (Chart 1) or FY 2012 (Chart 

2) for Non-Need States in order to 

address the total need shown in Column 

F. The amount in Column J is 

determined as the percentage in column 

I for Non-Need States multiplied by the 

lesser of the total need in Column F 

(equal to the sum of Needs in Column 

F) or the total Reduction Pool in 

Column H (equal to the sum of the NonNeed amounts in Column H). For Need 

States, the entry in Column J is ‘‘Need’’. 

Column K—Increase Adjustment for 

Need States. Column K shows the 

amount of adjustment to increase the 

Initial QI Allotment in Column D for FY 

2011 (Chart 1) or FY 2012 (Chart 2) for 

Need States in order to address the total 

need shown for the fiscal year in 

Column F. The amount in Column K is 

determined as the percentage in Column 

G for Need States multiplied by the 

lesser of the total need in Column F 

(equal to the sum of Needs in Column 

F) or the total Reduction Pool in 

Column H (equal to the sum of the NonNeed amounts in Column H). For NonNeed States, the entry in Column K is 

‘‘NA’’. 

Column L—Final FY 2011 QI 

Allotment (Chart 1) or Preliminary FY 

2012 QI Allotment (Chart 2). Column L 

contains the Final QI Allotment for each 

State for FY 2011 (Chart 1) or the 

Preliminary QI Allotment for FY 2012 

(Chart 2). For States that need additional 

QI allotment amounts for the fiscal year 

based on Estimated QI Expenditures in 

Column E as compared to their Initial QI 

allotments in Column D for the fiscal 

year (States with a projected need 

amount are shown in Column F), 

Column L is equal to the Initial QI 

allotment in Column D for FY 2011 

(Chart 1) or FY 2012 (Chart 2) plus the 

amount determined in Column K for 

Need States. For Non-Need States 

(States with a projected surplus in 

Column H), Column L is equal to the QI 

Allotment in Column D reduced by the 

Reduction Adjustment amount in 

Column J. 

III. Waiver of Notice With Comment 

and 30-Day Delay in Effective Date 

We ordinarily publish a notice with 

comment in the Federal Register and 

invite public comment. The notice with 

comment includes a reference to the 

legal authority under which the notice 

is proposed, and the terms and 

substance of the notice with comment, 

or a description of the subjects and 

issues involved. This procedure can be 

waived, however, if an agency finds 

good cause that a notice-and-comment 

procedure is impracticable, 

unnecessary, or contrary to the public 

interest, and incorporates a statement of 

the finding and its reasons in the notice 

issued. In addition, we also normally 

provide a delay of 30 days in the 

effective date. However, if adherence to 

this procedure would be impractical, 

unnecessary, or contrary to public 

interest, we may waive the delay in the 

effective date in accordance with the 

Administrative Procedure Act (5 U.S.C. 

551 et seq). 

We are publishing this notice without 

a comment period or delay in effective 


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date because of the need to notify 

individual States of the limitations on 

Federal funds for their Medicaid 

expenditures for payment of Medicare 

Part B premiums for qualifying 

individuals. Some States have 

experienced deficits in their current 

allotments that have caused them to 

consider denying benefits to eligible 

applicants, while other States project a 

surplus in their allotments. This notice 

adjusts the allocation of Federal funds, 

which will reduce the impact of States 

potentially denying coverage to eligible 

QIs when there is sufficient funding to 

cover all or some of these individuals. 

Because access to Medicare Part B 

coverage for QIs, who without this 

coverage would have difficulty paying 

for needed health care, is critically 

important, we believe that it is in the 

public interest to waive the usual notice 

and comment procedure which we 

undertake before making a notice final. 

Moreover, we are not making any 

changes to the process we use for 

allocating allotments. We are simply 

implementing a process already set forth 

in regulations. For these reasons, we 

also believe a notice and comment 

process would be unnecessary. 

Therefore, for the reasons discussed 

above, we find that good cause exists to 

dispense with the normal requirement 

that a notice cannot become effective 

any earlier than 30 days after its 

publication. States that will have access 

to additional funds for QIs need to know 

that these funds are available as soon as 

possible. While we believe the surplus 

States that will have diminished 

amounts available for this FY will have 

sufficient funds for enrolling all 

potential QIs in their States, they also 

need to know as soon as possible that 

a certain amount of their unused 

allocation will no longer be available to 

them for this FY. 

IV. Collection of Information 

Requirements 

This notice does not impose any 

information collection or recordkeeping 

requirements. Consequently, it does not 

need Office of Management and Budget 

review under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 3501 et seq.). 

V. Regulatory Impact Statement 

We have examined the impact of this 

notice as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review), the Regulatory 

Flexibility Act (RFA) (September 19, 

1980, Pub. L. 96–354), section 1102(b) of 

the Social Security Act (the Act), the 

Unfunded Mandates Reform Act of 1995 

(Pub. L. 104–4), and Executive Order 

13132 on Federalism and the 

Congressional Review Act (5 U.S.C. 

804(2)). 

Executive Order 12866 directs 

agencies to assess all costs and benefits 

of available regulatory alternatives and, 

if regulation is necessary, to select 

regulatory approaches that maximize 

net benefits (including potential 

economic, environmental, public health 

and safety effects, distributive impacts, 

and equity). A regulatory impact 

analysis (RIA) must be prepared for 

major rules with economically 

significant effects ($100 million or more 

in any one year). This notice does not 

reach the economic threshold and thus 

is not considered a major rule. 

The RFA requires agencies to analyze 

options for regulatory relief for small 

businesses. For purposes of the RFA, 

small entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of $7 million to $34.5 million in any one 

year. Individuals and States are not 

included in the definition of a small 

entity. 

This notice codifies our procedures 

for implementing provisions of the 

Balanced Budget Act of 1997 (Pub. L. 

105–33, enacted on August 5, 1997) to 

allocate, among the States, Federal 

funds to provide Medicaid payment for 

Medicare Part B premiums for lowincome Medicare beneficiaries. The 

total amount of Federal funds available 

during a Federal fiscal year and the 

formula for determining individual 

State allotments are specified in the law. 

We have applied the statutory formula 

for the State allotments. Because the 

data specified in the law were not 

initially available, we used comparable 

data from the U.S. Census Bureau on the 

number of possible qualifying 

individuals in the States. This notice 

also permits, in a specific circumstance, 

reallocation of funds to enable 

enrollment of all eligible individuals to 

the extent of the available funding. 

We believe that the statutory 

provisions implemented in this notice 

will have a positive effect on States and 

individuals. Federal funding at the 100 

percent matching rate is available for 

Medicare cost-sharing for Medicare Part 

B premium payments for qualifying 

individuals and, with the reallocation of 

the State allotments, a greater number of 

low-income Medicare beneficiaries will 

be eligible to have their Medicare Part 

B premiums paid under Medicaid. The 

changes in allotments will not result in 

fewer individuals receiving the QI 

benefit in any State. 

Section 1102(b) of the Act requires us 

to prepare a regulatory impact analysis 

for any rule that may have a significant 

impact on the operations of a substantial 

number of small rural hospitals. The 

analysis must conform to the provisions 

of section 604 of the RFA. For purposes 

of section 1102(b) of the Act, we define 

a small rural hospital as a hospital that 

is located outside of a metropolitan 

statistical area and has fewer than 100 

beds. 

We are not preparing analyses for 

either the RFA or section 1102(b) of the 

Act because we have determined and 

certify that this notice will not have a 

significant economic impact on a 

substantial number of small entities or 

a significant impact on the operations of 

a substantial number of small rural 

hospitals. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 (Pub. L. 

104–04, enacted on March 22, 1995), 

also requires that agencies assess 

anticipated costs and benefits before 

issuing any rule that may result in 

expenditure in any one year by State, 

local, or tribal governments, in the 

aggregate, or by the private sector, of 

$139 million. This notice will have no 

consequential effect on the governments 

mentioned or on the private sector. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a rule 

that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has federalism implications. 

Since this notice does not impose any 

costs on State or local governments, the 

requirements of E.O. 13132 are not 

applicable. 

In accordance with the provisions of 

Executive Order 12866, this notice was 

reviewed by the Office of Management 

and Budget. 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

Dated: May 14, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Dated: June 8, 2012. 

Kathleen Sebelius, 

Secretary. 

[FR Doc. 2012–17952 Filed 7–20–12; 11:15 am] 

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