Implementation of section 403(a)(2) of Social Security Act; bonus to reward decrease in illegitimacy ratio. Administration for Children and Families, HHS. Final rule

The Administration for Children and Families is issuing a final rule describing how we will award a bonus to those States that experience the largest decreases in out-of-wedlock childbearing and also reduce their abortion rates. The total amount of the bonus will be up to $100 million in each of fiscal years 1999 through 2002, and the award for each eligible State in a given year will be $25 million or less. This incentive provision is a part of the welfare reform block grant program enacted in 1996--the Temporary Assistance for Needy Families, or TANF, program.     

Notice inviting applications for new award for fiscal year 1999. The Office of the Assistant Secretary for Planning and Evaluation (ASPE), DHHS

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) announces the availability of funds and invites applications for research into the status of applicants and potential applicants to the Temporary Assistance to Needy Families (TANF) program, individuals and families entering the TANF caseload, and individuals and families who leave TANF. Approximately four to six States or large counties will receive funding that will enable them to monitor and conduct research into the progress of individuals who apply for TANF benefits and their families. ASPE is particularly interested in targeting those applicants who apply for cash assistance but are never enrolled because of non-financial eligibility requirements, participation in up-front job search or other diversion programs, or failure to complete the application process. Proposed studies of new entrants onto the TANF program and of individuals leaving welfare also will be given consideration. Research topics could fall into the broad categories of employment and earnings, participation in government assistance programs, and child and family well-being. Grant applicants may choose any method for their proposed studies, including the linking of administrative data, surveys, or other methods as appropriate. The funds could either support a newly designed project or could be used to add new data sources and analyses to an existing project.     

Reauthorization of the Temporary Assistance for Needy Families (TANF) program. Final rule

This final rule implements changes to the Temporary Assistance for Needy Families (TANF) program required by the Deficit Reduction Act of 2005 (DRA) (Pub. L. 109-171). The DRA reauthorized the TANF program through fiscal year (FY) 2010 with a renewed focus on work, program integrity, and strengthening families through healthy marriage promotion and responsible fatherhood. On June 29, 2006, ACF published an interim final rule implementing the required statutory changes with a 60-day comment period that ended on August 28, 2006. We have considered all comments received during this period and made necessary changes as reflected in this final rule.     

Temporary Assistance for Needy Families program (TANF). Administration for Children and Families, HHS. Final rule

The Administration for Children and Families (ACF) issues regulations governing key provisions of the new welfare block grant program enacted in 1996--the Temporary Assistance for Needy Families, or TANF, program. It replaces the national welfare program know as Aid to Families with Dependent Children (AFDC) and the related programs known as the Job Opportunities and Basic Skills Training Program (JOBS) and the Emergency Assistance (EA) program. These rules reflect new Federal, State, and Tribal relationships in the administration of welfare programs; a new focus on moving recipients into work; and a new emphasis on program information, measurement, and performance. They also reflect the Administration's commitment to regulatory reform.     

Methodology for determining whether an increase in a state's child poverty rate is the result of the TANF program--Administration for Children and Families, HHS. Proposed rule

The Administration for Children and Families is proposing a methodology to determine the child poverty rate in each State. If a State experiences an increase in its child poverty rate of 5 percent or more as a result of its Temporary Assistance for Needy Families (TANF) program, the State must submit and implement a corrective action plan. This requirement is a part of the new welfare reform block grant program enacted in 1996.     

State child health; State Children's Health Insurance Program allotments and payments to states. Health Care Financing Administration (HCFA), HHS. Final rule

This rule sets forth the methodologies and procedures to determine the allotments of Federal funds for each Federal fiscal year (FY) available to individual States, Commonwealths and Territories under title XXI of the Social Security Act. This rule also specifies the allotment, payment, and grant award process that will be used for the States, the Commonwealths and Territories to claim and receive Federal financial participation (FFP) for expenditures under the State Children's Health Insurance Program (SCHIP) and related Medicaid program provisions. Established by section 4901 of the Balanced Budget Act of 1997 (Public Law 105-33), amended by technical amendments (made by Public Law 105-100), and most recently amended by the Medicare, Medicaid and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 (Public Law 106-113, enacted November 29, 1999), the State Children's Health Insurance Program provides Federal matching funds to States to initiate and expand health insurance coverage to uninsured, low-income children. Aggregate Federal funding is limited to a fixed amount for each Federal fiscal year. This aggregate amount is divided into allotments for each State. State allotments are determined based on a statutory formula that divides the total available appropriation among all States with approved child health plans. Once determined, the amount of a State's allotment for a fiscal year is available for 3 years. We are publishing this final rule in accordance with the provisions of sections 2104 and 2105 of the Act that relate to allotments and payments to States under title XXI.     

Cost allocation methodology applicable to the temporary assistance for needy families program. Final rule

This final rule applies to the Temporary Assistance for Needy Families (TANF) program and requires States, the District of Columbia and the Territories (hereinafter referred to as the "States") to use the "benefiting program" cost allocation methodology in U.S. Office of Management and Budget (OMB) Circular A-87 (2 CFR part 225). It is the judgment and determination of HHS/ACF that the "benefiting program" cost allocation methodology is the appropriate methodology for the proper use of Federal TANF funds. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 gave federally-recognized Tribes the opportunity to operate their own Tribal TANF programs. Federally-recognized Indian tribes operating approved Tribal TANF programs have always followed the "benefiting program" cost allocation methodology in accordance with OMB Circular A-87 (2 CFR part 225) and the applicable regulatory provisions at 45 CFR 286.45(c) and (d). This final rule contains no substantive changes to the proposed rule published on September 27, 2006.     

Medicaid and Title IV-E programs; revision to the definition of an unemployed parent--Administration for Children and Families (ACF) and HCFA. Final rule with comment period

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) transformed the nation's welfare system into one that requires work in exchange for time-limited assistance. The law eliminated the Aid to Families with Dependent Children (AFDC) program and replaced it with the Temporary Assistance for Needy Families (TANF) program. The law provides States flexibility to design their TANF programs in ways that strengthen families and promote work, responsibility, and self-sufficiency while holding them accountable for results. Many States are using this flexibility to provide welfare to work assistance to two parent families, which was more difficult to do under the old welfare rules. However, pre-existing regulations regarding the definition of "unemployed parent" prevent some States from providing intact families with health insurance to help them stay employed. This rule will eliminate this vestige of the old welfare system in order to promote work, strengthen families, and simplify State program administration. In general under PRWORA, States must ensure that families who would have qualified for Medicaid health benefits under the prior welfare law are still eligible. While under the previous law receipt of AFDC qualified families for Medicaid, the new statute does not tie receipt of TANF to Medicaid. Instead, subject to some exceptions, Medicaid eligibility for families and children now depends upon whether a family would have qualified for AFDC under the rules in effect on July 16, 1996. Similarly, Federal foster care eligibility depends on whether the child would have qualified for AFDC under the rules in effect on July 16, 1996. In order for a family to qualify for assistance under the pre-PRWORA AFDC rules, its child had to be deprived of parental support or care due to the death, absence, incapacity, or unemployment of a parent. Two parent families generally qualified only under the "unemployment" criterion which was narrowly defined in the AFDC regulations. In this final rule with comment, we are amending these regulations to provide States with additional flexibility to provide Medicaid coverage to two parent families, facilitate coordination among the TANF, Medicaid and foster care programs, increase incentives for fulltime work, and allow States to eliminate inequitable rules that are a disincentive to family unity.     

Announcement of anticipated availability of funds for family planning services grants. Office of Population Affairs, OPHS, HHS. Notice

The Office of Population Affairs announces the anticipated allocation of funds for FY 2000 family planning services grant projects under the authority of Title X of the Public Health Service Act and solicits applications for competing grant awards to serve the areas and/or populations set out below. Only applications which propose to serve the populations and/or areas listed in Table I will be accepted for review and possible funding. In addition, general program information is included to provide potential grantees with information about future funding opportunities.     

Supplemental grant to continue cooperative agreements with 10 predictor variables grantees and their research coordinating center. CSAP, SAMHSA, HHS. Supplement to support an additional year of intervention follow-up and data collection among the Predictor Variables by Developmental Stage grantees and their Research Coordinating Center

This notice is to inform the public that an estimated $1.65 million will be available to support up to 11 supplemental awards to 10 existing Predictor Variables Study Sites and one existing Research Coordinating Center in FY 1999. The purpose of the award is to support enhancement of current programs and allow the collection and analyses of additional follow-up data for children currently included in these studies. CSAP will make the awards based on the recommendations of the initial review group and the CSAP National Advisory Council. Supplemental awards will be made in Fiscal Year 1999, by September 30, 1999. The studies funded under this supplement are projected to end September 30, 2000. Eligibility is limited to existing SAMHSA/CSAP's Predictor Variables by Developmental Stage study sites, and their Research Coordinating Center. All currently active Predictor Variables grantees are eligible to apply for supplemental funds under this GFA. Given the short implementation time frame and limited funds available for this activity, as well as existing research protocols that limit the scope of new activities that could be introduced at this point in the study, the existing Predictor Variables projects are the only projects that can effectively implement the required booster sessions and follow-up data collection activities. These studies have already demonstrated that they can make a positive impact on children within selected developmental parameters. It is important to document that this impact on these same children can be maintained as they enter the next developmental stages. The Research Coordinating Center has put considerable effort into developing cross-site rapport and collecting process data from the individual sites; an effort that would be redundant and not cost-effective if attempted by another entity at this point in the project. Additionally, it is important to the continuity of the study that the Research Coordinating Center be able to continue its current analyses and be able to conduct secondary analyses based on the totality of the data submitted throughout the life of the study.     

Early and periodic screening, diagnosis, and treatment (EPSDT) program--HCFA. Final rule

This final rule modifies present regulations to conform to legislative changes enacted by section 2181 of Pub. L. 97-35, the Omnibus Budget Reconciliation Act of 1981. That section eliminates the penalty which reduces by one percent Federal funds for a State's Title IV-A program, Aid to Families with Dependent Children (AFDC), for any quarter during which a State fails to: (1) Inform all AFDC families of the availability of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), services; (2) provide or arrange for requested screening services; and (3) arrange for corrective treatment of health problems found as a result of screening. In addition, even though the penalty has been eliminated, section 2181 mandates that States incorporate these three requirements into their Medicaid State plan with respect to all EPSDT eligibles. Further, this rule modifies current regulations to reflect Congressional intent that while States should continue to develop fully effective EPSDT programs, the Federal government should work to reduce current reporting requirements which entail a large volume of paperwork.     

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2003 and inclusion of registered nurses in the personnel provision of the critical access hospital emergency services requirement for frontier areas and remote locations. Final rule with comment period

This final rule with comment period refines the resource-based practice expense relative value units (RVUs) and makes other changes to Medicare Part B payment policy. In addition, as required by statute, we are announcing the physician fee schedule update for CY 2003. The update to the physician fee schedule occurs as a result of a calculation methodology specified by law. That law required the Department to set annual updates based in part on estimates of several factors. Although subsequent after-the-fact data indicate that actual increases were different to some degree from earlier estimates, the law does not permit those estimates to be revised. A subsequent law required estimates to be revised for FY 2000 and beyond. Although we have exhaustively examined opportunities for a different interpretation of law that would allow us to correct the flaw in the formula administratively, current law does not permit such an interpretation. Accordingly, without Congressional action to address the current legal framework, the Department is compelled to announce herein a physician fee schedule update for CY 2003 of -4.4 percent. Because the Department would adopt a change in the formula that determines the physician update if the law permitted it, we have examined how proper adjustments to past data could result in a positive update. The Department believes that revisions of estimates used to establish the sustainable growth rates (SGR) for fiscal years (FY) 1998 and 1999 and Medicare volume performance standards (MVPS) for 1990-1996 would, under present calculations, result in a positive update. The Department intends to work closely with Congress to develop legislation that could permit a positive update, and hopes that such legislation can be passed before the negative update takes effect. Because the Department wishes to change the update promptly in the event that Congress provides the Department legal authority to do so, we are requesting comments regarding how physician fee schedule rates could and should be recalculated prospectively in the event that Congress provides the Department with legal authority to revise estimates used to establish the sustainable growth rates (SGR) and for 1998 and 1999 and the NVPS for 1990-1996. The other policy changes concern: the pricing of the technical component for positron emission tomography (PET) scans, Medicare qualifications for clinical nurse specialists, a process to add or delete services to the definition of telehealth, the definition for ZZZ global periods, global period for surface radiation, and an endoscopic base for urology codes. In addition, this rule updates the codes subject to physician self-referral prohibitions. We are expanding the definition of a screening fecal-occult blood test and are modifying our regulations to expand coverage for additional colorectal cancer screening tests through our national coverage determination process. We also make revisions to the sustainable growth rate, the anesthesia conversion factor, and the work values for some gastroenterologic services. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule also clarifies the enrollment of physical and occupational therapists as therapists in private practice and clarifies the policy regarding services and supplies incident to a physician's professional services. In addition, this final rule discusses physical and occupational therapy payment caps and makes technical changes to the definition of outpatient rehabilitation services. In addition, we are finalizing the calendar year (CY) 2002 interim RVUs and are issuing interim RVUs for new and revised procedure codes for calendar year (CY) 2003. As required by the statute, we are announcing that the physician fee schedule update for CY 2003 is -4.4 percent, the initial estimate of the sustainable growth rate for CY 2003 is 7.6 percent, and the conversion factor for CY 2003 is $34.5920. This final rule will also allow registered nurses (RNs) to provide emergency care in certain critical access hospitals (CAHs) in frontier areas (an area with fewer than six residents per square mile) or remote locations (locations designated in a State's rural health plan that we have approved.) This policy applies if the State, following consultation with the State Boards of Medicine and Nursing, and in accordance with State law, requests that RNs be included, along with a doctor of medicine or osteopathy, a physician's assistant, or a nurse practitioner with training or experience in emergency care, as personnel authorized to provide emergency services in CAHs in frontier areas or remote locations.     

Medicaid program; disproportionate share hospital payments-institutions for mental disease--HCFA. Notice

This notice announces the Federal share disproportionate share hospital (DSH) allotments for Federal fiscal years (FFYs) 1998 through 2002. This notice also describes the methodology for calculating the Federal share DSH allotments for FFY 2003 and thereafter, and announces the FFY 1998 and FFY 1999 limitations on aggregate DSH payments States may make to institutions for mental disease (IMD) and other mental health facilities. In addition, it clarifies the DSH reporting requirements required by the Balanced Budget Act of 1997 (BBA '97).     

Availability of additional HRSA competitive grants. Health Resources and Services Administration, HHS. Notice of availability of funds

The Health Resources and Services Administration (HRSA) announces the availability of funds for several HRSA programs. This Notice lists several programs that are announcing competitions for fiscal year (FY) 1999 funds but were not published in the fall 1998 HRSA Preview. This Notice includes funding for HRSA discretionary authorities and programs as follows: (1) Special Projects of National Significance, HIV/AIDS Bureau; (2) Extramural Support Program for Projects to Increase Organ and Tissue Donation, HIV/AIDS Bureau; (3) Cooperative Agreement for Emergency Medical Services for Children and Quality Improvement Center, Maternal and Child Health Bureau; and (4) Basic Nurse Education and Practice: Baccalaureate Nursing Education Using Distance Learning Methodologies for Rural RNs, Bureau of Health Professions. These programs were not published in the fall 1998 HRSA Preview and will only appear in the Federal Register and on the HRSA Home Page at: http://www.hrsa.dhhs.gov/. The next edition of the HRSA Preview is scheduled to be published by early summer 1999. The purpose of the HRSA Preview is to provide the general public with a single source of program and application information related to the Agency's competitive grant reviews. The HRSA Preview is designed to replace multiple Federal Register notices which traditionally advertised the availability of HRSA's discretionary funds for its various programs.     

Reducing Domestic Violence and Improving Outcomes for Children: Funding Civil Legal Aid to Maximize Impact

Domestic violence survivors and children in foster care often experience significant unmet civil legal needs. Legal aid services, when adequately funded, can help close the justice gap for these two populations while improving safety, stability, and court efficiencies. However, despite ample literature demonstrating how legal aid can improve outcomes, almost half of those seeking legal aid services are turned away due to lack of resources. This article reviews the research and data about how legal aid can improve outcomes for people in the domestic violence and child welfare contexts. It also discusses how several state‐administered federal funding opportunities—including the Victims of Crime Act (VOCA) Victim Assistance Formula Grant Program, Title IV‐D child support funds, and Temporary Assistance for Needy Families (TANF) basic block grants—can fund the needed civil legal help.     

Grants to states for construction or acquisition of state home facilities--VA. Final regulations

The Department of Veterans Affairs (VA) is amending its medical care regulations, Grants to States for Construction or Acquisition of State Home Facilities (38 CFR part 17), to implement section 206 of the Veterans' Benefits and Services Act of 1988 enacted on May 20, 1988. This section changes from July 1 to August 15, the date on which VA will determine the priority of applications for construction or acquisition grants for State Extended Care Facilities for purposes of the priority list. Section 206 also provides the Secretary authority to conditionally approve an application and obligate funds for a grant is the Secretary determines that the State can meet all remaining Federal requirements within 90 days. At the same time, VA is updating the States home grant standards and veteran population of the various States set forth in these regulations. These revisions will assist the States in meeting deadlines for the priority list and subsequent grant awards.