Grants to States for Operation of Qualified High-Risk Pools

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.



Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.

Office - Contact the appropriate CMS Regional Administrator.

(See appendix IV for Regional Offices).


Program Accomplishments

None.

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.

Aplication 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 Procedures

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 Procedures

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

Please contact program office for application deadline.

Authorization

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

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

Under the original legislation, 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. A State can be awarded a maximum of two grants. 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

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.

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 grantees 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.

Financial Information

Account Identification

75-0516-0-1-551.

Obigations

FY 07 $0; FY 08 est not available; and FY 09 est not available.

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.

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, Paul Youket, Health Insurance Specialist, Mailstop S2-01-16, 7500 Security Boulevard, Baltimore, MD 21244-1850. Telephone: (410) 786-0264. Email: paul.youket@cms.hhs.gov.

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.



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