Grants to States for Operation of Qualified High-Risk Pools
Published on AidPage by
IDILOGIC on Jun 24, 2005
Purpose of this program:
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.
Possible 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.
Who is eligible to apply...
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.
Credentials/Documentation
Federal funds must go to a designated State Agency or its partner agencies. Individuals must meet State requirements.
Note:This is a brief description of the credentials or documentation required prior to, or along with, an application for assistance.
About this section:
This section indicates who can apply to the Federal government for assistance and the criteria the potential applicant must satisfy.
For example, individuals may be eligible for research grants, and the criteria to be satisfied may be that they have a professional or scientific degree,
3 years of research experience, and be a citizen of the United States. Universities, medical schools, hospitals, or State and local governments may also be eligible.
Where State governments are eligible, the type of State agency will be indicated (State welfare agency or State agency on aging) and the criteria that they
must satisfy.
Certain federal programs (e.g., the Pell Grant program which provides grants to students) involve intermediate levels of application processing, i.e., applications
are transmitted through colleges or universities that are neither the direct applicant nor the ultimate beneficiary. For these programs,
the criteria that the intermediaries must satisfy are also indicated, along with intermediaries who are not eligible.
How to apply...
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.
Note: Each program will indicate whether applications are to be submitted to the Federal headquarters, regional or local office, or to a State or local government office.
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.
Note: Grant payments may be made by a letter of credit, advance by Treasury check, or reimbursement by Treasury check.
Awards may be made by the headquarters office directly to the applicant, an agency field office, a regional office,
or by an authorized county office. The assistance may pass through the initial applicant for further distribution by
intermediate level applicants to groups or individuals in the private sector.
Deadlines and process...
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.
Note:
When available, this section indicates the deadlines for applications to the funding agency which will
be stated in terms of the date(s) or between what dates the application should be received.
When not available, applicants should contact the funding agency for deadline information.
Range of Approval/Disapproval Time
60 to 120 days.
Preapplication Coordination
A notice of intent to apply is not required. This program is excluded from coverage under E.O. 12372.
Note:
This section indicates whether any prior coordination or approval is required with governmental or nongovernmental units
prior to the submission of a formal application to the federal funding agency.
Appeals
If an application is disapproved, the reasons for disapproval will be fully stated.
Note:
In some cases, there are no provisions for appeal. Where applicable, this section discusses appeal procedures or allowable rework time for resubmission
of applications to be processed by the funding agency. Appeal procedures vary with individual programs and are either listed in this section or
applicants are referred to appeal procedures documented in the relevant Code of Federal Regulations (CFR).
Renewals
Not applicable.
Note:
In some instances, renewal procedures may be the same as for the application procedure, e.g., for projects of a non-continuing nature renewals will be treated as new, competing applications; for projects of an ongoing nature, renewals may be given annually.
Who can benefit...
State Agency.
Beneficiaries
About this section:
This section lists the ultimate beneficiaries of a program, the criteria they must satisfy and who specifically is not eligible. The applicant and beneficiary will generally be the same for programs that provide assistance directly from a Federal agency. However, financial assistance that passes through State or local governments will have different applicants and beneficiaries since the assistance is transmitted to private sector beneficiaries who are not obligated to request or apply for the assistance.
What types of assistance...
Formula Grants
Allocations of money to States or their subdivisions in accordance with distribution formulas prescribed by law or administrative regulation, for activities of a continuing nature not confined to a specific project.
How much financial aid...
Range and Average of Financial Assistance
None.
Note:
This section lists the representative range (smallest to largest) of the amount of financial assistance available. These figures are based upon funds awarded in the past fiscal year and the current fiscal year to date. Also indicated is an approximate average amount of awards which were made in the past and current fiscal years.
Obligations
FY 03 $0; FY 04 est $40,000,000; and FY 05 est $40,000,000.
Note:
The dollar amounts listed in this section represent obligations for the past fiscal year (PY), estimates for the current fiscal year (CY), and estimates for the budget fiscal year (BY) as reported by the Federal agencies. Obligations for non-financial assistance programs indicate the administrative expenses involved in the operation of a program.
Account Identification
75-0516-0-1-551.
Note:
Note: This 11-digit budget account identification code represents the account which funds a particular program.
This code should be consistent with the code given for the program area as specified in Appendix III of the Budget of the United States Government.
Examples of funded projects...
Not applicable.
About this section
This section indicates the different types of projects which have been funded in the past. Only projects funded under Project Grants or Direct Payments for Specified Use should be listed here. The examples give potential applicants an idea of the types of projects that may be accepted for funding. The agency should list at least five examples of the most recently funded projects.
Program accomplishments...
None.
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.
Assistance considerations...
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. $40,000,000 was made available for obligation from FY 2003-FY 2004 and another $40,000,000 is being made available for obligation from FY 2004-FY 2005.
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. 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.
Note:
A formula may be based on population, per capita income, and other statistical factors. Applicants are informed whether there are any matching requirements to be met when participating in the cost of a project. In general, the matching share represents that portion of the project costs not borne by the Federal government. Attachment F of OMB Circular No. A-102 (Office of Management and Budget) sets forth the criteria and procedures for the evaluation of matching share requirements which may be cash or in-kind contributions made by State and local governments or other agencies, institutions, private organizations, or individuals to satisfy matching requirements of Federal grants or loans.
Cash contributions represent the grantees' cash outlay, including the outlay of money contributed to the grantee by other public agencies, institutions, private organizations, or individuals. When authorized by Federal regulation, Federal funds received from other grants may be considered as the grantees' cash contribution.
In-kind contributions represent the value of noncash contributions provided by the grantee, other public agencies and institutions, private organizations or individuals. In-kind contributions may consist of charges for real property and equipment, and value of goods and services directly benefiting and specifically identifiable to the grant program. When authorized by Federal legislation, property purchased with Federal funds may be considered as grantees' in-kind contribution.
Maintenance of effort (MOE) is a requirement contained in certain legislation, regulations, or administrative policies stating that a grantee must maintain a specified level of financial effort in a specific area in order to receive Federal grant funds, and that the Federal grant funds may be used only to supplement, not supplant, the level of grantee funds.
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.
Note:
This section indicates whether program reports, expenditure reports, cash reports or performance monitoring are required by the Federal funding agency, and specifies at what time intervals (monthly, annually, etc.) this must be accomplished.
Audits
All fiscal transactions identifiable to Federal financial assistance are subject to audit by DHHS audit agency.
Note:
This section discusses audits required by the Federal agency.
The procedures and requirements for State and local governments and nonprofit entities are set forth in OMB Circular No. A-133.
These requirements pertain to awards made within the respective State's fiscal year - not the Federal fiscal year,
as some State and local governments may use the calendar year or other variation of time span designated as the fiscal year period,
rather than that commonly known as the Federal fiscal year (from October 1st through September 30th).
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.
Note:
This section indicates the record retention requirements and the type of records the Federal agency may require.
Not included are the normally imposed requirements of the General Accounting Office.
For programs falling under the purview of OMB Circular No. A-102, record retention is set forth in Attachment C.
For other programs, record retention is governed by the funding agency's requirements.
Regulations...
Authorization
Trade Act of 2002; Public Law 107-210.
Note:
This section lists the legal authority upon which a program is based (acts, amendments to acts, Public Law numbers, titles, sections, Statute Codes, citations to the U.S. Code, Executive Orders, Presidential Reorganization Plans, and Memoranda from an agency head).
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.