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

Agency: Department of Health and Human Services
Office: Centers For Medicare And Medicaid Services

Authorization

Trade Act of 2002; Public Law 107-210; Deficit Reduction Act of 2005; Public Law 109-171.

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 reasonably 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. This program is excluded from coverage under OMB Circular No. A-87.

Application and Award Process

Preapplication Coordination

Preapplication coordination is required. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.

Application Procedure

OMB Circular No. A-102 applies to this program. This program is excluded from coverage under OMB Circular No. A-110. 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 qualified 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

Contact the headquarters or regional office, as appropriate, for application deadlines.

Range of Approval/Disapproval Time

60 to 120 days.

Appeals

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

Renewals

None.

Assistance Considerations

Formula and Matching Requirements

Statutory formulas are not applicable to this program.

This program has no matching requirements.

This program does not have MOE requirements.

Length and Time Phasing of Assistance

Under the original legislation, a total of $80,000,000 has been made available for the qualified high-risk pool operation grant program. $40,000,000 was made available for obligation from FY 2003-FY 2004 and another $40,000,000 was made available for obligation from FY 2004-FY 2005. Under the provisions of section 6202 of the Deficit Reduction Act, $75,000,000 is available in FY 2006 for this activity. Method of awarding/releasing assistance: lump sum.

Post Assistance Requirements

Reports

No program reports are required. No cash reports are required. No progress reports are required. 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 grantees may only need to file semi-annually, thus 4 reports per year. Refer to 45 CFR part 92. No performance monitoring is required.

Audits

This program is excluded from coverage under OMB Circular No. A-133. 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

Not Applicable.

Financial Information

Account Identification

75-0516-0-1-551.

Obligations

(Formula Grants (Apportionments)) FY 08 $50,000,000; FY 09 est $75,000,000; FY 10 est $0

Range and Average of Financial Assistance

None.

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

Not Applicable.

Information Contacts

Regional or Local Office

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

Headquarters Office

Timothy Love 7500 Security Boulevard, Baltimore, Maryland 21244 Email: timothy.love@cms.hhs.gov Phone: 410-786-0948

Web Site Address

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.