81_FR_29361 81 FR 29270 - New Funding Formula

81 FR 29270 - New Funding Formula

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Community Living

Federal Register Volume 81, Issue 91 (May 11, 2016)

Page Range29270-29271
FR Document2016-11108

The Administration on Intellectual and Developmental Disabilities (AIDD) within the Administration on Disabilities (AoD), located within the Administration for Community Living (ACL) at the United States Department of Health and Human Services (HHS), has developed a new funding formula for the State Councils on Developmental Disabilities (SCDD) and Protection and Advocacy Systems (P&A) located in each State and Territory.

Federal Register, Volume 81 Issue 91 (Wednesday, May 11, 2016)
[Federal Register Volume 81, Number 91 (Wednesday, May 11, 2016)]
[Notices]
[Pages 29270-29271]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-11108]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Administration for Community Living


New Funding Formula

AGENCIES: Administration on Intellectual and Developmental Disabilities 
(AIDD), Administration on Disabilities (AoD), Administration for 
Community Living (ACL), Department of Health and Human Services (HHS).

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Administration on Intellectual and Developmental 
Disabilities (AIDD) within the Administration on Disabilities (AoD), 
located within the Administration for Community Living (ACL) at the 
United States Department of Health and Human Services (HHS), has 
developed a new funding formula for the State Councils on Developmental 
Disabilities (SCDD) and Protection and Advocacy Systems (P&A) located 
in each State and Territory.

DATES: Effective Date October 1, 2016.

ADDRESSES: The new formula is printed below and the estimated 
allotments for FY 2017 for each SCDD and P&A can be found at: http://www.acl.gov/About_ACL/Allocations/DD-Act.aspx.

FOR FURTHER INFORMATION CONTACT: Andrew Morris, Office of the 
Commissioner, Administration on Disabilities, 330 C St. SW., 
Washington, DC 20201. Telephone (202) 795-7408. Email 
[email protected]. Please note the telephone number is not toll 
free. This document will be made available in alternative formats upon 
request. Written correspondence can be sent to Administration for 
Community Living, U.S. Department of Health and Human Services, 330 C 
St. SW., Washington, DC 20201.

SUPPLEMENTARY INFORMATION:

Background

    The Developmental Disabilities Assistance and Bill of Rights Act of 
2000 (Pub. L. 106-402) provides, among other things, formula grants to 
States for the purpose of operating State Councils on Developmental 
Disabilities and Protection & Advocacy Systems for people with 
developmental disabilities. The Developmental Disabilities Assistance 
and Bill of Rights Act of 2000 (DD Act) provides authority and 
flexibility in Section 122 to determine the formula for distributing 
the annual grant awards as long as the three statutory factors are met. 
These factors are:

    1. Total population of the State/Territory
    2. Need for services for people with developmental disabilities in 
the State/Territory
    3. Financial need of the State/Territory

Responding to years of requests for a modernized funding formula and 
after a

[[Page 29271]]

comprehensive development process, AIDD published a notice in the 
Federal Register on February 18, 2016 seeking comments on a new funding 
formula (81 FR 8204). AIDD has reviewed the comments submitted and is 
moving forward with the proposed formula. AIDD believes that this 
formula is clear, concise, transparent, and consistent with Congress' 
intent to provide funds to States based on greatest need. For the P&A 
program, in response to the comments received, AIDD will adopt this new 
formula over a three year period.
    For complete details on methodology and development of the new 
formula please see the Federal Register, February 18, 2016, Vol 81, 
Number 32, Pages 8204-8205.

New Formula

    Beginning in FY 2017, AIDD will use a new formula to distribute 
funds to SCDD and P&A programs after meeting statutory minimums and 
hold-harmless requirements for the SCDD. Funding will be allocated to 
States and Territories based on the following criteria:
    1. State/Territory Population (30%): Based on July Census figures 
released in August of each year.
    2. Need for services (30%): Based on a 1.58 percent prevalence rate 
for developmental disabilities in each State and Territory from the HHS 
National Health Interview Survey on Disability (NHIS-D).
    3. Financial need (40%): Based on a combination of poverty (20%) 
and seasonally adjusted unemployment rates (20%) from July of each 
calendar year.

New Formula Phase-In

    In their comments to AIDD, numerous P&A programs requested to phase 
in the new formula as a way of offsetting losses some grantees would 
experience if AIDD were to begin using the new formula immediately in 
FY 2017. AIDD concurs with this requested approach, and the new formula 
will be phased in for the P&A programs only with funds allotted in the 
following manner:

FY 2017: 75 percent previous formula and 25 percent new formula
FY 2018: 50 percent previous formula and 50 percent new formula
FY 2019: 100 percent new formula

The new formula will be in full effect for the SCDD programs on October 
1, 2016. SCDDs will likely not experience significant fluctuations in 
their annual allotment due to that program's hold-harmless requirement.

Response to Public Comments

General

    AIDD received 75 comments related to the new formula including 39 
comments from SCDDs and 18 from P&As. AIDD also received 18 comments 
from other entities including non-profits and State agencies. Comments 
were received on each of the three required formula factors and 
weighting of the factors. Comments on the new formula were generally 
favorable and supportive. Commenters acknowledged that the current 
formula is more than 35 years old and uses data sources that do not 
adequately take into account the needs of people with developmental 
disabilities. Generally, they found the new formula to be more 
transparent and easier to understand. Comments also reinforced the need 
for the new formula in order to ease the administrative burden on ACL. 
Commenters pointed out that the previous formula used the per capita 
income rate which was an inadequate way to measure financial need and 
AIDD concurs with this comment. Several commenters stated that the 
current minimum allotments are inadequate; however these minimum 
allotments are set in statute and therefore not subject to change by 
AIDD.

Population

    Some commenters requested that population have a higher weight in 
the formula. AIDD declined to raise the weighting as doing so could 
cause larger swings in the formula year-to-year and thereby make it 
more difficult for States to plan for their operating needs. Some 
commenters asked for the population of people with developmental 
disabilities to be considered rather than the total population. 
However, the DD Act requires that the entire State population must be 
taken into consideration.

Need for Services

    As the formula workgroup and AIDD determined, the most clear and 
concise way to determine the need for services was to use the most 
current federal data for prevalence of people with developmental 
disabilities. Some commenters asked that AIDD use the Centers for 
Disease Control (CDC) prevalence rates for people with developmental 
disabilities, however, CDC's definition of developmental disabilities 
does not match AIDD's statutory definition.
    Several commenters asked for different data to be used to determine 
the need for services in each State and Territory. There were varied 
opinions and suggestions, but none were clearly stronger than the 
sources proposed by AIDD.
    Commenters also asked for the use of prevalence rates by State. 
That data is not currently available. AIDD is working with its federal 
partners to identify future opportunities to better understand the 
prevalence of developmental disabilities.

Financial Need

    AIDD and the formula workgroup weighted financial need at 40 
percent, with 20 percent based on State/Territory poverty levels and 20 
percent based on seasonally adjusted unemployment data from July of 
each year. The workgroup felt that these measures were the best 
economic indicators to measure a State's financial need.
    Several commenters asked for additional measures such as cost of 
living adjustments, workforce participation rates, and supplemental 
measures of poverty. HHS data experts stated that these data were not 
as reliable as the ones proposed and that the use of any of these data, 
including workforce participation rates, would not make a significant 
difference in the distribution of funds. Further, use of several of the 
proposed data would make the formula more complicated. Other commenters 
stated the need to use different data sources but did not give 
alternatives as was requested in the request for public comments. 
Therefore, AIDD concluded that there was no compelling reason to change 
data used for financial need.

    Dated: May 5, 2016.
Jennifer Johnson,
Deputy Director, Administration on Intellectual and Developmental 
Disabilities.
[FR Doc. 2016-11108 Filed 5-10-16; 8:45 am]
 BILLING CODE 4154-04-P



                                                  29270                        Federal Register / Vol. 81, No. 91 / Wednesday, May 11, 2016 / Notices

                                                  along with a claim for reimbursement.                   sufficient to conclude that for Medicare              Disabilities (AIDD), Administration on
                                                  Form Number: CMS–484 (OMB control                       beneficiaries receiving NaF–18 PET scan               Disabilities (AoD), Administration for
                                                  number: 0938–0534); Frequency:                          to identify bone metastasis in cancer is              Community Living (ACL), Department
                                                  Occasionally; Affected Public: Private                  reasonable and necessary only when the                of Health and Human Services (HHS).
                                                  Sector (Business or other for-profits,                  provider is participating in and patients             ACTION: Notice.
                                                  Not-for-profits); Number of                             are enrolled in a clinical study designed
                                                  Respondents: 8,880; Total Annual                        to information at the time of the scan to             SUMMARY:   The Administration on
                                                  Responses: 1,632,000; Total Annual                      assist in initial antitumor treatment                 Intellectual and Developmental
                                                  Hours: 326,500; (For policy questions                   planning or to guide subsequent                       Disabilities (AIDD) within the
                                                  regarding this collection contact Paula                 treatment strategy by the identification,             Administration on Disabilities (AoD),
                                                  Smith at 410–786–4709.)                                 location and quantification of bone                   located within the Administration for
                                                     2. Type of Information Collection                    metastases in beneficiaries in whom                   Community Living (ACL) at the United
                                                  Request: Revision of a currently                        bone metastases are strongly suspected                States Department of Health and Human
                                                  approved collection; Title of                           based on clinical symptoms or the                     Services (HHS), has developed a new
                                                  Information Collection: Durable Medical                 results of other diagnostic studies.                  funding formula for the State Councils
                                                  Equipment Medicare Administrative                       Qualifying clinical studies must ensure               on Developmental Disabilities (SCDD)
                                                  Contractors (MAC) Regional Carrier,                     that specific hypotheses are addressed;               and Protection and Advocacy Systems
                                                  Certificate of Medical Necessity and                    appropriate data elements are collected;              (P&A) located in each State and
                                                  Supporting Documentation; Use: The                      hospitals and providers are qualified to              Territory.
                                                  certificates of medical necessity (CMNs)                provide the PET scan and interpret the
                                                  collect information required to help                                                                          DATES:   Effective Date October 1, 2016.
                                                                                                          results; participating hospitals and
                                                  determine the medical necessity of                      providers accurately report data on all               ADDRESSES:    The new formula is printed
                                                  certain items. CMS requires CMNs                        Medicare enrolled patients; and all                   below and the estimated allotments for
                                                  where there may be a vulnerability to                   patient confidentiality, privacy, and                 FY 2017 for each SCDD and P&A can be
                                                  the Medicare program. Each initial                      other Federal laws must be followed.                  found at: http://www.acl.gov/About_
                                                  claim for these items must have an                      Consistent with section 1142 of the                   ACL/Allocations/DD-Act.aspx.
                                                  associated CMN for the beneficiary.                     Social Security Act (the Act), the                    FOR FURTHER INFORMATION CONTACT:
                                                  Suppliers (those who bill for the items)                Agency for Healthcare Research and                    Andrew Morris, Office of the
                                                  complete the administrative information                 Quality (AHRQ) supports clinical                      Commissioner, Administration on
                                                  (e.g., patient’s name and address, items                research studies that CMS determines                  Disabilities, 330 C St. SW., Washington,
                                                  ordered, etc.) on each CMN. The 1994                    meets specified standards and address                 DC 20201. Telephone (202) 795–7408.
                                                  Amendments to the Social Security Act                   the specified research questions. To                  Email andrew.morris@acl.hhs.gov.
                                                  require that the supplier also provide a                qualify for payment, providers must                   Please note the telephone number is not
                                                  narrative description of the items                      prescribe certain NaF–18 PET scans for                toll free. This document will be made
                                                  ordered and all related accessories, their              beneficiaries with a set of clinical                  available in alternative formats upon
                                                  charge for each of these items, and the                 criteria specific to each solid tumor. The            request. Written correspondence can be
                                                  Medicare fee schedule allowance (where                  statuary authority for this policy is                 sent to Administration for Community
                                                  applicable). The supplier then sends the                section 1862 (a)(1)(E) of the Act. The                Living, U.S. Department of Health and
                                                  CMN to the treating physician or other                  need to prospectively collect                         Human Services, 330 C St. SW.,
                                                  clinicians (e.g., physician assistant,                  information at the time of the scan is to             Washington, DC 20201.
                                                  LPN, etc.) who completes questions                      assist the provider in decision making                SUPPLEMENTARY INFORMATION:
                                                  pertaining to the beneficiary’s medical                 for patient management. Form Number:
                                                  condition and signs the CMN. The                                                                              Background
                                                                                                          CMS–10152 (OCN: 0938–0968);
                                                  physician or other clinician returns the                Frequency: Annually; Affected Public:                    The Developmental Disabilities
                                                  CMN to the supplier who has the option                  Private Sector (Business or other for-                Assistance and Bill of Rights Act of
                                                  to maintain a copy and then submits the                 profits); Number of Respondents:                      2000 (Pub. L. 106–402) provides, among
                                                  CMN (paper or electronic) to CMS,                       25,000; Total Annual Responses:                       other things, formula grants to States for
                                                  along with a claim for reimbursement.                   25,000; Total Annual Hours: 2,084                     the purpose of operating State Councils
                                                  Form Number: CMS–846–849, 854,                          hours. (For policy questions regarding                on Developmental Disabilities and
                                                  10125 and 10126 (OMB control number:                    this collection contact Stuart Caplan at              Protection & Advocacy Systems for
                                                  0938–0679); Frequency: Occasionally;                                                                          people with developmental disabilities.
                                                                                                          410–786–8564.)
                                                  Affected Public: Private Sector (Business                                                                     The Developmental Disabilities
                                                  or other for-profits, Not-for-profits);                    Dated: May 6, 2016.
                                                                                                                                                                Assistance and Bill of Rights Act of
                                                  Number of Respondents: 462,000; Total                   William N. Parham, III,
                                                                                                                                                                2000 (DD Act) provides authority and
                                                  Annual Responses: 462,000; Total                        Director, Paperwork Reduction Staff, Office
                                                                                                                                                                flexibility in Section 122 to determine
                                                  Annual Hours: 418,563; (For policy                      of Strategic Operations and Regulatory
                                                                                                          Affairs.                                              the formula for distributing the annual
                                                  questions regarding this collection                                                                           grant awards as long as the three
                                                  contact Paula Smith at 410–786–4709.)                   [FR Doc. 2016–11080 Filed 5–10–16; 8:45 am]
                                                                                                                                                                statutory factors are met. These factors
                                                     3. Type of Information Collection                    BILLING CODE 4120–01–P
                                                                                                                                                                are:
                                                  Request: Extension of a previously
                                                  approved collection; Title: Data                                                                                 1. Total population of the State/
                                                  Collection for Medicare Beneficiaries                   DEPARTMENT OF HEALTH AND                              Territory
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                                                  Receiving NaF–18 Positron Emission                      HUMAN SERVICES                                           2. Need for services for people with
                                                  Tomography (PET) to Identify Bone                                                                             developmental disabilities in the State/
                                                  Metastasis in Cancer; Use: In Decision                  Administration for Community Living                   Territory
                                                  Memorandum #CAG–00065R, issued on                                                                                3. Financial need of the State/
                                                                                                          New Funding Formula                                   Territory
                                                  February 26, 2010, the Centers for
                                                  Medicare and Medicaid Services (CMS)                    AGENCIES:  Administration on                          Responding to years of requests for a
                                                  determined that the evidence is                         Intellectual and Developmental                        modernized funding formula and after a


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                                                                               Federal Register / Vol. 81, No. 91 / Wednesday, May 11, 2016 / Notices                                                   29271

                                                  comprehensive development process,                      Response to Public Comments                           stronger than the sources proposed by
                                                  AIDD published a notice in the Federal                                                                        AIDD.
                                                                                                          General                                                  Commenters also asked for the use of
                                                  Register on February 18, 2016 seeking
                                                  comments on a new funding formula (81                     AIDD received 75 comments related                   prevalence rates by State. That data is
                                                  FR 8204). AIDD has reviewed the                         to the new formula including 39                       not currently available. AIDD is working
                                                  comments submitted and is moving                        comments from SCDDs and 18 from                       with its federal partners to identify
                                                  forward with the proposed formula.                      P&As. AIDD also received 18 comments                  future opportunities to better
                                                  AIDD believes that this formula is clear,               from other entities including non-profits             understand the prevalence of
                                                  concise, transparent, and consistent                    and State agencies. Comments were                     developmental disabilities.
                                                  with Congress’ intent to provide funds                  received on each of the three required
                                                                                                          formula factors and weighting of the                  Financial Need
                                                  to States based on greatest need. For the
                                                  P&A program, in response to the                         factors. Comments on the new formula                     AIDD and the formula workgroup
                                                  comments received, AIDD will adopt                      were generally favorable and                          weighted financial need at 40 percent,
                                                  this new formula over a three year                      supportive. Commenters acknowledged                   with 20 percent based on State/Territory
                                                  period.                                                 that the current formula is more than 35              poverty levels and 20 percent based on
                                                                                                          years old and uses data sources that do               seasonally adjusted unemployment data
                                                    For complete details on methodology
                                                                                                          not adequately take into account the                  from July of each year. The workgroup
                                                  and development of the new formula
                                                                                                          needs of people with developmental                    felt that these measures were the best
                                                  please see the Federal Register,
                                                                                                          disabilities. Generally, they found the               economic indicators to measure a State’s
                                                  February 18, 2016, Vol 81, Number 32,
                                                                                                          new formula to be more transparent and                financial need.
                                                  Pages 8204–8205.                                                                                                 Several commenters asked for
                                                                                                          easier to understand. Comments also
                                                  New Formula                                             reinforced the need for the new formula               additional measures such as cost of
                                                                                                          in order to ease the administrative                   living adjustments, workforce
                                                    Beginning in FY 2017, AIDD will use                   burden on ACL. Commenters pointed                     participation rates, and supplemental
                                                  a new formula to distribute funds to                    out that the previous formula used the                measures of poverty. HHS data experts
                                                  SCDD and P&A programs after meeting                     per capita income rate which was an                   stated that these data were not as
                                                  statutory minimums and hold-harmless                    inadequate way to measure financial                   reliable as the ones proposed and that
                                                  requirements for the SCDD. Funding                      need and AIDD concurs with this                       the use of any of these data, including
                                                  will be allocated to States and                         comment. Several commenters stated                    workforce participation rates, would not
                                                  Territories based on the following                      that the current minimum allotments                   make a significant difference in the
                                                  criteria:                                               are inadequate; however these                         distribution of funds. Further, use of
                                                    1. State/Territory Population (30%):                  minimum allotments are set in statute                 several of the proposed data would
                                                  Based on July Census figures released in                and therefore not subject to change by                make the formula more complicated.
                                                  August of each year.                                    AIDD.                                                 Other commenters stated the need to
                                                    2. Need for services (30%): Based on                                                                        use different data sources but did not
                                                                                                          Population                                            give alternatives as was requested in the
                                                  a 1.58 percent prevalence rate for
                                                  developmental disabilities in each State                  Some commenters requested that                      request for public comments. Therefore,
                                                  and Territory from the HHS National                     population have a higher weight in the                AIDD concluded that there was no
                                                  Health Interview Survey on Disability                   formula. AIDD declined to raise the                   compelling reason to change data used
                                                  (NHIS–D).                                               weighting as doing so could cause larger              for financial need.
                                                    3. Financial need (40%): Based on a                   swings in the formula year-to-year and                  Dated: May 5, 2016.
                                                  combination of poverty (20%) and                        thereby make it more difficult for States
                                                                                                                                                                Jennifer Johnson,
                                                  seasonally adjusted unemployment rates                  to plan for their operating needs. Some
                                                                                                                                                                Deputy Director, Administration on
                                                  (20%) from July of each calendar year.                  commenters asked for the population of
                                                                                                                                                                Intellectual and Developmental Disabilities.
                                                                                                          people with developmental disabilities
                                                                                                                                                                [FR Doc. 2016–11108 Filed 5–10–16; 8:45 am]
                                                  New Formula Phase-In                                    to be considered rather than the total
                                                                                                                                                                BILLING CODE 4154–04–P
                                                                                                          population. However, the DD Act
                                                     In their comments to AIDD, numerous
                                                                                                          requires that the entire State population
                                                  P&A programs requested to phase in the
                                                                                                          must be taken into consideration.
                                                  new formula as a way of offsetting                                                                            DEPARTMENT OF HEALTH AND
                                                  losses some grantees would experience                   Need for Services                                     HUMAN SERVICES
                                                  if AIDD were to begin using the new                       As the formula workgroup and AIDD
                                                  formula immediately in FY 2017. AIDD                                                                          Food and Drug Administration
                                                                                                          determined, the most clear and concise
                                                  concurs with this requested approach,                   way to determine the need for services                [Docket No. FDA–2013–N–0730]
                                                  and the new formula will be phased in                   was to use the most current federal data
                                                  for the P&A programs only with funds                    for prevalence of people with                         Agency Information Collection
                                                  allotted in the following manner:                       developmental disabilities. Some                      Activities; Proposed Collection;
                                                                                                          commenters asked that AIDD use the                    Comment Request; Threshold of
                                                  FY 2017: 75 percent previous formula
                                                                                                          Centers for Disease Control (CDC)                     Regulation for Substances Used in
                                                    and 25 percent new formula
                                                                                                          prevalence rates for people with                      Food-Contact Articles
                                                  FY 2018: 50 percent previous formula
                                                    and 50 percent new formula                            developmental disabilities, however,                  AGENCY:   Food and Drug Administration,
                                                                                                          CDC’s definition of developmental
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                                                  FY 2019: 100 percent new formula                                                                              HHS.
                                                                                                          disabilities does not match AIDD’s                    ACTION:   Notice.
                                                  The new formula will be in full effect                  statutory definition.
                                                  for the SCDD programs on October 1,                       Several commenters asked for                        SUMMARY:   The Food and Drug
                                                  2016. SCDDs will likely not experience                  different data to be used to determine                Administration (FDA or we) is
                                                  significant fluctuations in their annual                the need for services in each State and               announcing an opportunity for public
                                                  allotment due to that program’s hold-                   Territory. There were varied opinions                 comment on the proposed collection of
                                                  harmless requirement.                                   and suggestions, but none were clearly                certain information by the Agency.


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Document Created: 2016-05-11 01:11:32
Document Modified: 2016-05-11 01:11:32
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesEffective Date October 1, 2016.
ContactAndrew Morris, Office of the Commissioner, Administration on Disabilities, 330 C St. SW., Washington, DC 20201. Telephone (202) 795-7408. Email [email protected] Please note the telephone number is not toll free. This document will be made available in alternative formats upon request. Written correspondence can be sent to Administration for Community Living, U.S. Department of Health and Human Services, 330 C St. SW., Washington, DC 20201.
FR Citation81 FR 29270 

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