Medicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying Individuals: Federal Fiscal Year 1999

[Federal Register Volume 64, Number 59 (Monday, March 29, 1999)]
[Notices]
[Pages 14931-14934]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-7078]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-2032-N]
RIN 0938-AJ28

Medicaid Program; State Allotments for Payment of Medicare Part B
Premiums for Qualifying Individuals: Federal Fiscal Year 1999

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice.

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SUMMARY: The Social Security Act provides for the Medicaid program to
pay all or part of the Medicare Part B premiums for beneficiaries
belonging to two specific eligibility groups of low-income Medicare
beneficiaries, referred to as Qualifying Individuals (QIs). This notice
announces the Federal fiscal year 1999 allotments that are available
for State agencies to pay Medicare Part B premiums for these two
eligibility groups.

EFFECTIVE DATE: This document is defined as a major rule under the
congressional review provisions of 5 U.S.C. section 804(2). As
indicated in the preamble of this notice, pursuant to section 5 U.S.C.
section 808(2), for good cause we find that prior notice and comment
procedures are unnecessary and impracticable. Pursuant to 5 U.S.C.
section 808(2), this notice is effective October 1, 1998, for
allotments for payment of Medicare Part B premiums for individuals in
calendar year 1999 from the allocation for fiscal year 1999.

FOR FURTHER INFORMATION CONTACT: Miles McDermott, (410) 786-3722.

SUPPLEMENTARY INFORMATION:

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I. Background

Section 1902 of the Social Security Act (the Act) sets forth the
requirements for State plans to provide medical assistance. Prior to
August 5, 1997, section 1902(a)(10)(E) of the Act specified that the
State Medicaid plan must provide for Medicare cost-sharing for three
eligibility groups of low-income Medicare beneficiaries. These three
groups included qualified Medicare beneficiaries (QMBs), specified 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 level 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 between a State
established level (at or below the Federal poverty level) and 120
percent of the Federal poverty level. A QDWI is an individual who is
entitled to enroll in Medicare Part A, whose income does not exceed 200
percent of the Federal poverty level for a family of the size involved,
whose resources do not exceed twice the amount allowed under the
Supplementary Security Income (SSI) program, and who is not otherwise
eligible for Medicaid. The definition of Medicare cost-sharing at
section 1905(p)(3) of the Act includes payment for premiums for
Medicare Part B.
Section 1902(a)(10)(E) of the Act requires 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).
Under section 1902(a)(10)(E)(iv)(I) of the Act, State agencies are
required to pay the full amount of the Medicare Part B premium for
selected QIs who would be QMBs except that their income level is at
least 120 percent but less than 135 percent of the Federal poverty
level for a family of the size involved. These individuals cannot
otherwise be eligible for medical assistance under the approved State
Medicaid plan.
The second group of QIs, under section 1902(a)(10)(E)(iv)(II) of
the Act, includes Medicare beneficiaries who would be QMBs except that
their income is between 135 percent and 175 percent of the Federal
poverty level for a family of the size involved. These QIs may not be
otherwise eligible for Medicaid under the approved State plan, but are
eligible for a portion of Medicare cost-sharing consisting only of a
percentage of the increase in the Medicare Part B premium attributable
to the shift of Medicare home health coverage from Part A to Part B (as
provided in section 4611 of the Balanced Budget Act of 1997 (BBA).
Section 1933(a) specifies that a State agency must provide, through
a State plan amendment, for medical assistance to pay for the cost of
Medicare cost-sharing on behalf of QIs who are selected to receive
assistance.
Section 1933(b) of the Act sets forth the rules that State agencies
must follow in selecting QIs and providing payment for Medicare Part B
premiums. Specifically, the State agency must permit all QIs to apply
for assistance and must select individuals on a first-come, first-
served basis selecting QIs in the order in which they apply. Under
section 1933(b)(2)(B) of the Act, when selecting persons who will
receive assistance in the years after 1998, State agencies must give
preference to those individuals who received assistance as QIs, QMBs,
SLMBs, or QDWIs in the last month of the previous year and who continue
to be (or become) QIs. Under section 1933(b)(4), persons selected to
receive assistance in a calendar year are entitled to receive
assistance for the remainder of the year, but not beyond, as long as
they continue to qualify. The fact that an individual is selected to
receive assistance at any time during the year does not entitle the
individual to continued assistance for any succeeding year. Because the
State's allotment is limited by law, section 1933(b)(3) of the Act
provides that the State agency must limit the number of QIs so that the
amount of assistance provided during

[[Page 14932]]

the year is approximately equal to the State's allotment for that year.
Section 1933(c) of the Act limits the total amount of Federal funds
available for payment of Part B premiums each fiscal year and specifies
the formula to be used to determine an allotment for each State from
this total amount. For State agencies that execute a State plan
amendment in accordance with section 1933(a) of the Act, a total of
$1.5 billion was allocated over 5 years as follows: $200 million in FY
1998; $250 million in FY 1999; $300 million in FY 2000; $350 million in
FY 2001; and $400 million in FY 2002.
The Federal matching rate for Medicaid payment of Medicare Part B
premiums for QIs is 100 percent for expenditures up to the amount of
the State's allotment. No Federal matching funds are available for
expenditures in excess of the State's allotment amount. Administrative
expenses associated with the payment of Medicare Part B premiums for
QIs remain at the 50 percent matching level and may not be taken from
the State's allotment.
The amount available for each fiscal year is to be allocated among
States according to the formula set forth in section 1933(c)(2) of the
Act. The formula provides for an amount to each State agency that is to
be based on each State's share of the Secretary's estimate of the ratio
of--
(1) An amount equal to the sum of the following:
(a) Twice the total number of individuals who meet all but the
income requirements for QMBs, whose incomes are at least 120 percent
but less than 135 percent of the Federal poverty level, and who are not
otherwise eligible for Medicaid; and
(b) The total number of individuals in the State who meet all but
the income requirements for QMBs, whose incomes are at least 135
percent but less than 175 percent of the Federal poverty level, and who
are not otherwise eligible for Medicaid; to
(2) The sum of all of these individuals under item (1) for all
eligible States.

II. Provisions of This Notice

This notice announces the availability of individual State
allotments for Federal fiscal year 1999 for the Medicaid payment of
Medicare Part B premiums for QIs identified under sections
1902(a)(10)(E)(iv)(I) and (II) of the Act. The formula used to
calculate these allotments was described in detail in the announcement
of the Federal fiscal year 1998 allotments (63 FR 3754, January 26,
1998), and, except for the incorporation of the latest data, has been
used here without changes.

FY 1999 State Allotments for Payment of Part B Premiums Under Sec. 4732 of the BBA of 1997
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State FY99
State (a) M1¹ (b) M2 ² (c) 2 x State share of allocation
(a)+(b) (c) (percent) ($000)
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AK.............................. 0 3 3 0.05 116
AL.............................. 33 75 141 2.18 5,548
AR.............................. 25 37 87 1.35 3,368
AZ.............................. 16 62 94 1.46 3,639
CA.............................. 93 309 495 7.66 19,162
CO.............................. 15 27 57 0.88 2,207
CT.............................. 8 60 76 1.18 2,942
DC.............................. 2 4 8 0.12 310
DE.............................. 4 10 18 0.28 697
FL.............................. 98 262 458 7.09 17,730
GA.............................. 41 96 178 2.76 6,891
HI.............................. 4 10 18 0.28 697
IA.............................. 17 47 81 1.25 3,136
ID.............................. 4 17 25 0.39 968
IL.............................. 70 173 313 4.85 12,117
IN.............................. 28 107 163 2.52 6,310
KS.............................. 14 50 78 1.21 3,020
LA.............................. 32 57 121 1.87 4,684
MA.............................. 35 82 152 2.35 5,884
MD.............................. 21 71 113 1.75 4,374
ME.............................. 8 29 45 0.70 1,742
MI.............................. 52 127 231 3.58 8,942
MN.............................. 25 54 104 1.61 4,026
MO.............................. 26 88 140 2.17 5,420
MS.............................. 27 39 93 1.44 3,600
MT.............................. 6 16 28 0.43 1,084
NC.............................. 51 122 224 3.47 8,671
ND.............................. 6 13 26 0.39 968
NE.............................. 11 29 51 0.79 1,974
NH.............................. 8 19 35 0.54 1,355
NJ.............................. 48 129 225 3.48 8,710
NM.............................. 9 22 40 0.62 1,548
NV.............................. 7 18 32 0.50 1,239
NY.............................. 94 241 429 6.64 16,607
OH.............................. 62 180 304 4.71 11,768
OK.............................. 27 52 106 1.64 4,103
OR.............................. 20 55 95 1.47 3,678
PA.............................. 80 202 362 5.61 14,014
RI.............................. 7 20 34 0.53 1,316
SC.............................. 26 67 119 1.84 4,607
SD.............................. 5 10 20 0.31 774
TN.............................. 36 55 127 1.97 4,916
TX.............................. 80 208 368 5.70 14,246
UT.............................. 5 21 31 0.48 1,200

[[Page 14933]]

VA.............................. 12 73 97 1.50 3,755
VT.............................. 5 7 17 0.26 658
WA.............................. 12 54 78 1.21 3,020
WI.............................. 18 58 94 1.46 3,639
WV.............................. 20 40 80 1.24 3,097
WY.............................. 2 5 9 0.14 348
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Total....................... 1378 3702 6458 100.00 250,000
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¹ Three-year average (1995-7) of number (000) of Medicare beneficiaries in State who are not enrolled in
Medicaid but whose incomes are at least 120% but less than 135% of FPL.
² Three-year average (1995-7) of number (000) of Medicare beneficiaries in State who are not enrolled in
Medicaid but whose incomes are least 135% but less than 175% of FPL.

III. Waiver of Advance Public Comment and 30-Day Delay in Effective
Date

We ordinarily publish an advance notice in the Federal Register for
a notice containing substantive determinations 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 find good cause to waive notice and comment procedure for this
final notice. The law sets out in detail the specific amounts available
for each Federal fiscal year for Medicare Part B premiums for QIs and
the formula that is used to determine individual State allotments. No
public comments were received as a result of the January 26, 1998,
Federal Register Notice of the FY 1998 State allotments. (63 FR 3754).
In addition, the latest data from the U.S. Census Bureau on the number
of possible QIs in the States used in the statutory formula, as
discussed in section V. of this notice, is not available until too late
in the calendar year. Therefore, it would be impracticable,
unnecessary, and contrary to the public interest to submit this notice
to the public for a notice and comment procedure.
Also, because States can begin making payments for Medicare Part B
premiums for QIs as early January 1, 1999, we are not making the
effective date of the notice the usual 30 days after publication. For
the reasons discussed above, we find good cause to waive the usual 30-
day delay.

IV. Effect of the Contract With America Advancement Act

Normally, under 5 U.S.C. section 801, as added by section 251 of
Public Law 104-121, the effective date of a major rule is delayed 60
days for congressional review. This notice has been determined to be a
major rule under 5 U.S.C. section 804(2) for purposes of congressional
review. However, as indicated in section III of this notice, we have
found that good cause exists to dispense with prior notice and comment
procedures since they are unnecessary and impracticable under the
circumstances. Pursuant to 5 U.S.C. section 808(2), a rule shall take
effect at such time as the Federal agency promulgating the rule
determines, if it finds, for good cause, that prior notice and comment
procedures are unnecessary or impracticable. Accordingly, under the
exemption provided in 5 U.S.C. section 808(2), this notice is effective
January 1, 1999, for allotments for payments of Medicare Part B
premiums for individuals in calendar year 1999 from the allotment for
fiscal year 1999.

V. Regulatory Impact Statement

We have examined the impact of this notice as required by Executive
Order 12866 and the Regulatory Flexibility Act (RFA) (Public Law 96-
354). Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, when regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects; distributive impacts; and equity). The RFA requires agencies
to analyze options for regulatory relief for small businesses. For
purposes of the RFA, States and individuals are not considered to be
small entities.
This notice allocates, among the States, Federal funds to provide
Medicaid payment for Medicare Part B premiums for two additional groups
of 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 except for the use of
specified data. Because the data specified in the law were not
currently available, we have used comparable data from the U.S. Census
Bureau on the number of possible QIs in the States, as described in
detail in the January 26, 1998, Federal Register Notice of the FY 1998
State allotments. (63 FR 3754). These new allotments for FY 1999
incorporate the latest data from the Census Bureau covering 1995
through 1997, as specified in the footnote to the table above.
We believe 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 QIs and a greater number of
low-income Medicare beneficiaries will be eligible to have their
Medicare Part B premiums paid under Medicaid.
Section 1102(b) of the Social Security Act requires us to prepare a
regulatory impact analysis for any notice that may have a significant
impact on the operations of a substantial number of small rural
hospitals. Such an analysis must conform to the provisions of section
603 of the RFA. For purposes of section 1102(b) of the Act, we define a
small rural hospital as a hospital that is located outside a
Metropolitan Statistical Area and has fewer than 50 beds.
We are not preparing analyses for either the RFA or section 1102(b)
of the Act, because we have determined and certify that this notice
will not have a significant economic impact on a

[[Page 14934]]

substantial number of small entities, or a significant impact on the
operations of a substantial number of small rural hospitals.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.

Authority: Sections 1902(a)(10)(E) and 1933 of the Social
Security Act (42 U.S.C. 1396a(a)(10)(E) and 1396x), and section 4732
of Public Law 105-33.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)

Dated: October 16, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.

Dated: December 10, 1998.
Donna E. Shalala,
Secretary.
[FR Doc. 99-7078 Filed 3-26-99; 8:45 am]
BILLING CODE 4120-01-P

Medicaid Program; State Allotments for Payment of Medicare Part B Premiums for Qualifying Individuals: Federal Fiscal Year 1999

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