Grants to States for Operation of Qualified High-Risk Pools (93.780)

 

Program

93.780 Grants to States for Operation of Qualified High-Risk Pools

 

Federal Agency

CENTERS FOR MEDICARE AND MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

Authorization

Trade Act of 2002; Public Law 107-210.

 

Program Number

93.780

 

Last Known Status

Active

 

Objectives

To assist States in the operation of a qualified high- risk health insurance pool by providing Federal funding for up to 50 percent of losses incurred by the pool for a given State fiscal year.

 

Types of Assistance

Formula Grants.

 

Uses and Use Restrictions

A State must have a qualified high-risk pool (as defined in section 2744(c)(2) of the Public Health Service Act) that has incurred a loss in order to be eligible for a grant.

 

Eligibility Requirements

Applicant Eligibility

A State must meet all of the following requirements to be eligible for a grant: 1) the State is operating a qualified high-risk pool as defined in section 2744(c)(2)of the Public Health Service Act; 2) the pool restricts premium charged under the pool to no more than 150 percent for applicable standard risk rates for the State; 3) the pool offers a choice of two or more coverage options through the pool; 4) the pool has in effect a mechanism reasonable designed to ensure continued funding of losses incurred by the State after the end of fiscal year 2004 in connection with the operation of the pool; and 5) the pool has incurred a loss in the State's fiscal year 2002, 2003, or 2004.

Beneficiary Eligibility

State Agency.

Credentials/Documentation

Federal funds must go to a designated State Agency or its partner agencies. Individuals must meet State requirements.

 

Application and Award Process

Preapplication Coordination

A notice of intent to apply is not required. This program is excluded from coverage under E.O. 12372.

Application Procedure

The standard application form SF-424 and related forms, as furnished by CMS, must be used for this program. These forms may be downloaded from the following Web site- www.cms.hhs.gov/researchers/priorities/grants.asp. In addition to the standard forms some additional information regarding the history and description of the qualifies high-risk pool, accounting of risk pool losses, and contact person information is also required. Please refer to the following Web site for additional information: www.cms.hhs.gov/riskpool. Applicants are required to submit an original and two copies of the application to the Acquisition and Grants Group, CMS, Mailstop C2-21-15, 7500 Security Boulevard, Baltimore, MD 21244- 1850. Facsimile (fax) transmissions will not be accepted. This program is subject to the provisions of OMB Circular No. A-102.

Award Procedure

The Centers for Medicare and Medicaid Services (CMS) will make a decision for each application received. Each applicant will receive written notification of CMS's decision. Applicants approved for a grant award must submit a letter of acceptance to CMS within 30 days of the date of the award, agreeing to the terms and conditions of the award letter.

Deadlines

Applications for State fiscal year 2002 losses must be submitted no later than September 30, 2003. Applications for State fiscal year 2003 losses must be submitted no later than June 30, 2004. Applications for the State fiscal year 2004 losses must be submitted no later than June 30, 2005.

 

Range of Approval/Disapproval Time

Appeals

If an application is disapproved, the reasons for disapproval will be fully stated.

Renewals

Not applicable.

 

Assistance Considerations

Formula and Matching Requirements

A State must have a qualified high-risk pool that incurred a loss in order to be eligible for a grant. States may apply for a grant in relation to losses incurred in the fiscal year 2002, 2003, and 2004. As directed by the statute, funds will be allocated using a formula based on the number of uninsured individuals in each eligible State. The formula was further defined through the rulemaking process with a regulation with a 60-day comment period. See the website: www.cms.hhs.gov/riskpool for additional information.

Length and Time Phasing of Assistance

A total of $80,000,000 has been made available for the qualified high-risk pool operation grant program with $40,000,000 being made available for obligation from FY 2003-FY 2004 and another $40,000,000 being made for obligation from FY 2004-FY 2005.

 

Post Assistance Requirements

Reports

Grant awardees may be required to submit quarterly progress and financial reports to CMS. At a maximum, a grantee would have to complete 8 reports per year if requested. It is anticipated that grantes may only need to file semi-annually, thus 4 reports per year. Refer to 45 CFR part 92.

Audits

All fiscal transactions identifiable to Federal financial assistance are subject to audit by DHHS audit agency.

Records

Proper accounting records, identifiable by project number and including all receipts and expenditures, must be maintained for 3 years. Subsequent to audit, they must be maintained until all questions are resolved.

 

Program Accomplishments

None.

 

Financial Information

Account Identification

75-0516-0-1-551.

Obligations

FY 02 $0; FY 03 est $0; and FY 04 est $60,000,000.

Range and Average of Financial Assistance

None. This is a new program.

 

Regulations, Guidelines and Literature

Grants Administration policies (45 CFR 74 and 92) application kits may be obtained from the Acquisition and Grants Group, CMS, Mailstop C2-21-15, 7500 Security Boulevard, Baltimore, MD 21244-1850. The grant application kit may be downloaded from the following web site- www.cms.hhs.gov/researchers/priorities/grants.asp.

 

Related Programs

None.

 

Information Contacts

Regional or Local Office

Contact the appropriate CMS Regional Administrator. (See appendix IV for Regional Offices).

Headquarters Office

CMS,Centers for Medicare and State Operations, Mailstop S3-16-16 (Jim Mayhew), 7500 Security Boulevard, Baltimore, MD 21244-1850. Telephone (410)786-9244. Email: jmayhew@cms.hhs.gov.

Web Site Address

http://www.cms.hhs.gov/riskpool

 

Examples of Funded Projects

Not applicable.

 

Criteria for Selecting Proposals

Each application will be reviewed to ensure it meets the eligibility criteria (as stated above). If eligible, the State will be awarded the lesser 50 percent of losses incurred by its qualified risk pool for the fiscal year in question or its allotment under the formula for the grants.