[Federal Register: August 27, 2004 (Volume 69, Number 166)]
[Notices]
[Page 52700-52706]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27au04-48]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-2201-N]
RIN 0938-ZA17
State Children's Health Insurance Program; Final Allotments to
States, the District of Columbia, and U.S. Territories and
Commonwealths for Fiscal Year 2005
AGENCY: Centers for Medicare & Medicaid Services (CMS),HHS.
ACTION: Notice.
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SUMMARY: Title XXI of the Social Security Act (the Act) authorizes
payment of Federal matching funds to States, the District of Columbia,
and U.S. Territories and Commonwealths to initiate and expand health
insurance coverage to uninsured, low-income children under the State
Children's Health Insurance Program (SCHIP). This notice sets forth the
final allotments of Federal funding available to each State, the
District of Columbia, and each U.S. Territory and Commonwealth for
fiscal year 2005.
States may implement SCHIP through a separate State program under
title XXI of the Act, an expansion of a State Medicaid program under
title XIX of the Act, or a combination of both.
DATES: This notice is effective on September 27, 2004. Final allotments
are available for expenditures after October 1, 2004.
FOR FURTHER INFORMATION CONTACT: Richard Strauss, (410) 786-2019.
SUPPLEMENTARY INFORMATION:
I. Purpose of This Notice
This notice sets forth the allotments available to each State, the
District of Columbia, and each U.S. Territory and Commonwealth for
fiscal year (FY) 2005 under title XXI of the Social Security Act (the
Act). Final allotments for a fiscal year are available to match
expenditures under an approved State child health plan for 3 fiscal
years, including the year for which the final allotment was provided.
The FY 2005 allotments will be available to States for FY 2005, and
unexpended amounts may be carried over to 2006 and 2007. Federal funds
appropriated for title XXI are limited, and the law specifies a formula
to divide the total annual appropriation into individual allotments
available for each State, the District of Columbia, and each U.S.
Territory and Commonwealth with an approved child health plan.
Section 2104(b) of the Act requires States, the District of
Columbia, and U.S. Territories and Commonwealths to have an approved
child health plan for the fiscal year in order for the Secretary to
provide an allotment for that fiscal year. All States, the District of
Columbia, and U.S. Territories and Commonwealths have approved plans
for FY 2005. Therefore, the FY 2005 allotments contained in this notice
pertain to all States, the District of Columbia, and U.S. Territories
and Commonwealths.
II. Methodology for Determining Final Allotments for States, the
District of Columbia, and U.S. Territories and Commonwealths
This notice specifies, in the Table under section III, the final FY
2005
[[Page 52701]]
allotments available to individual States, the District of Columbia,
and U.S. Territories and Commonwealths for either child health
assistance expenditures under approved State child health plans or for
claiming an enhanced Federal medical assistance percentage rate for
certain SCHIP-related Medicaid expenditures. As discussed below, the FY
2005 final allotments have been calculated to reflect the methodology
for determining an allotment amount for each State, the District of
Columbia, and each U.S. Territory and Commonwealth as prescribed by
section 2104(b) of the Act.
Section 2104(a) of the Act provides that, for purposes of providing
allotments to the 50 States and the District of Columbia, the following
amounts are appropriated: $4,295,000,000 for FY 1998; $4,275,000,000
for each FY 1999 through FY 2001; $3,150,000,000 for each FY 2002
throughFY 2004; $4,050,000,000 for each FY 2005 through FY 2006; and
$5,000,000,000 for FY 2007. However, under section 2104(c) of the Act,
0.25 percent of the total amount appropriated each year is available
for allotment to the U.S. Territories and Commonwealths of Puerto Rico,
Guam, the Virgin Islands, American Samoa, and the Northern Mariana
Islands. The total amounts are allotted to the U.S. Territories and
Commonwealths according to the following percentages: Puerto Rico, 91.6
percent; Guam, 3.5 percent; the Virgin Islands, 2.6 percent; American
Samoa, 1.2 percent; and the Northern Mariana Islands, 1.1 percent.
Section 2104(c)(4)(B) of the Act provides for additional amounts
for allotment to the Territories and Commonwealths: $34,200,000 for
each FY 2000 through FY 2001; $25,200,000 for each FY 2002 through FY
2004; $32,400,000 for each FY 2005 through FY 2006; and $40,000,000 for
FY 2007. Since, for FY 2005, title XXI of the Act provides an
additional $32,400,000 for allotment to the U.S. Territories and
Commonwealths, the total amount available for allotment to the U.S.
Territories and Commonwealths in FY 2005 is $42,525,000; that is,
$32,400,000 plus $10,125,000 (0.25 percent of the FY 2005 appropriation
of $4,050,000,000).
Therefore, the total amount available nationally for allotment for
the 50 States and the District of Columbia for FY 2005 was determined
in accordance with the following formula:
AT = S2104(a)-T2104(c)
AT = Total amount available for allotment to the 50 States
and the District of Columbia for the fiscal year.
S2104(a) = Total appropriation for the fiscal year indicated
in section 2104(a) of the Act. For FY 2005, this is $4,050,000,000.
T2104(c) = Total amount available for allotment for the U.S.
Territories and Commonwealths; determined under section 2104(c) of the
Act as 0.25 percent of the total appropriation for the 50 States and
the District of Columbia. For FY 2005, this is: .0025 x $4,050,000,000
= $10,125,000.
Therefore, for FY 2005, the total amount available for allotment to the
50 States and the District of Columbia is $4,039,875,000. This was
determined as follows:
AT ($4,039,875,000) = S2104(a) ($4,050,000,000)-
T2104(c) ($10,125,000)
For purposes of the following discussion, the term ``State,'' as
defined in section 2104(b)(1)(D)(ii) of the Act, ``means one of the 50
States or the District of Columbia.''
Under section 2104(b) of the Act, the States' SCHIP allotments for
a particular fiscal year are determined based on two factors: The
``number of children'' and the ``State cost factor.'' The number of
children is based on the three most recent March supplements to the
Current Population Survey (CPS) of the Bureau of the Census officially
available before the beginning of the calendar year in which the fiscal
year begins. The State cost factor is based on the annual average wages
per employee in the health services industry, which is determined using
the most recent 3 years of such wage data as reported and determined as
final by the Bureau of Labor Statistics (BLS) of the Department of
Labor to be officially available before the beginning of the calendar
year in which the fiscal year begins. Since FY 2005 begins on October
1, 2004 (that is, in calendar year 2004), in determining the FY 2005
SCHIP allotments, we are using the most recent official data from the
Bureau of the Census and the BLS, respectively, available before
January 1 of calendar year 2004 (that is, through the end of December
31, 2003).
Number of Children
For FY 2005, as specified by section 2104(b)(2)(A)(iii) of the Act,
the number of children is calculated as the sum of 50 percent of the
number of low-income, uninsured children in the State, and 50 percent
of the number of low-income children in the State. The number of
children factor for each State is developed from data provided by the
Bureau of the Census based on the standard methodology used to
determine official poverty status and uninsured status in the annual
CPS on these topics. As part of a continuing formal process between the
Centers for Medicare & Medicaid Services (CMS) and the Bureau of the
Census, each fiscal year we obtain the number of children data
officially from the Bureau of the Census.
Under section 2104(b)(2)(B) of the Act, the number of children for
each State (provided in thousands) was determined and provided by the
Bureau of the Census based on the arithmetic average of the number of
low-income children and low-income children with no health insurance as
calculated from the three most recent March supplements to the CPS
officially available from the Bureau of the Census before the beginning
of the 2004 calendar year. In particular, through December 31, 2003,
the most recent official data available from the Bureau of the Census
on the numbers of children were data from the three March CPSs
conducted in March 2001, 2002, and 2003 (representing data for years
2000, 2001, and 2002, respectively).
State Cost Factor
The State cost factor is based on annual average wages in the
health services industry in the State. The State cost factor for a
State is equal to the sum of: 0.15 and 0.85 multiplied by the ratio of
the annual average wages in the health industry per employee for the
State to the annual wages per employee in the health industry for the
50 States and the District of Columbia.
Under section 2104(b)(3)(B) of the Act, the State cost factor for
each State for a fiscal year is calculated based on the average of the
annual wages for employees in the health industry for each State using
data for each of the most recent three years as reported and determined
as final by the BLS in the Department of Labor and available before the
beginning of the calendar year in which the fiscal year begins.
Therefore, the State cost factor for FY 2005 is based on the most
recent 3 years of BLS data officially available as final before January
1, 2004 (the beginning of the calendar year in which FY 2005 begins);
that is, the State cost factor is based on the BLS data available as
final through December 31, 2003. In accordance with these requirements,
we used the final State cost factor data available from BLS for 2000,
2001, and 2002 in calculating the FY 2005 final allotments.
The State cost factor is determined based on the calculation of the
ratio of each State's average annual wages in the health industry to
the national average
[[Page 52702]]
annual wages in the health care industry. Since BLS is required to
suppress certain State-specific data in providing us with the State-
specific average wages per health services industry employee due to the
Privacy Act, we calculated the national average wages directly from the
State-specific data provided by BLS. As part of a continuing formal
process between CMS and the BLS, each fiscal year, CMS obtains these
wage data officially from the BLS.
Section 2104(b)(3)(B) of the Act, as amended by the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, refers to
wage data as reported by BLS under the ``Standard Industrial
Classification'' (SIC) system. However, in calendar year 2002, BLS
phased-out the SIC wage and employment reporting system and replaced it
with the ``North American Industry Classification System'' (NAICS). In
accordance with section 2104(b)(3)(B) of the Act, for purposes of
calculating the FY 2005 allotments, BLS would need to provide wage data
for the 3 most recent years as available through December 31, 2003; in
this case, the three years of wage data are 2000, 2001, and 2002.
However, because of the change from the SIC system to NAICS, wage data
for 2001 and 2002 are not available under the SIC reporting system.
Wage data for 2000 under the SIC reporting system is available from
BLS. Therefore, the BLS wage data used in calculating the FY 2005 SCHIP
allotments necessarily reflect 1 year of SIC system data (2000) and 2
years of NAICS data (2001 and 2002) to obtain the 3-year average
required for the allotments.
Under the SIC system, BLS provided CMS with wage data for each
State under the SIC Code 80 for year 2000. However, the wage data codes
under the SIC system do not map exactly to the wage data codes under
the NAICS. As a result, for the years 2001 and 2002, BLS provided us
with wage data using three NAICS wage data codes that represent
approximately 98 percent of the wage data that would have been provided
under the related SIC Code 80. Specifically, in lieu of SIC Code 80
data, for the years 2001 and 2002, BLS provided CMS data that are based
on the following three NAICS codes: NAICS Code 621 (Ambulatory health
care services), Code 622 (Hospitals), and Code 623 (Nursing and
residential care facilities).
Under section 2104(b)(4) of the Act, each State and the District of
Columbia is allotted a ``proportion'' of the total amount available
nationally for allotment to the States. The term ``proportion'' is
defined in section 2104(b)(4)(D)(i) of the Act and refers to a State's
share of the total amount available for allotment for any given fiscal
year. In order for the entire total amount available to be allotted to
the States, the sum of the proportions for all States must exactly
equal one. Under the statutory definition, a State's proportion for a
fiscal year is equal to the State's allotment for the fiscal year
divided by the total amount available nationally for allotment for the
fiscal year. In general, a State's allotment for a fiscal year is
calculated by multiplying the State's proportion for the fiscal year by
the national total amount available for allotment for that fiscal year
in accordance with the following formula:
SAi = Pi x AT
SAi = Allotment for a State or District of Columbia for a
fiscal year.
Pi = Proportion for a State or District of Columbia for a
fiscal year.
AT = Total amount available for allotment to the 50 States
and the District of Columbia for the fiscal year. For FY 2005, this is
$4,039,875,000.
In accordance with the statutory formula for determining
allotments, the State proportions are determined under two steps, which
are described in detail below.
Determination of Preadjusted Proportion
Under the first step, each State's proportion is calculated by
multiplying the State's Number of Children and the State Cost Factor to
determine a ``product'' for each State. The products for all States are
then summed. Finally, the product for a State is divided by the sum of
the products for all States, thereby yielding the State's preadjusted
proportion.
Application of Floors and Ceilings
Under the second step, the preadjusted proportions are subject to
the application of proportion floors, ceilings, and a reconciliation
process, as appropriate. The SCHIP statute specifies three proportion
floors, or minimum proportions, that apply in determining States'
allotments. The first proportion floor is equal to $2,000,000 divided
by the total of the amount available nationally for the fiscal year.
This proportion ensures that a State's minimum allotment would be
$2,000,000. For FY 2005, no State's preadjusted proportion is below
this floor. The second proportion floor is equal to 90 percent of the
allotment proportion for the State for the previous fiscal year; that
is, a State's proportion for a fiscal year must not be lower than 10
percent below the previous fiscal year's proportion. The third
proportion floor is equal to 70 percent of the allotment proportion for
the State for FY 1999; that is, the proportion for a fiscal year must
not be lower than 30 percent below the FY 1999 proportion.
Each State's allotment proportion for a fiscal year is also limited
by a maximum ceiling amount, equal to 145 percent of the State's
proportion for FY 1999, that is, a State's proportion for a fiscal year
must be no higher than 45 percent above the State's proportion for FY
1999. The floors and ceilings are intended to minimize the fluctuation
of State allotments from year to year and over the life of the program
as compared to FY 1999. The floors and ceilings on proportions are not
applicable in determining the allotments of the U.S. Territories and
Commonwealths; they receive a fixed percentage specified in the statute
of the total allotment available to the U.S. Territories and
Commonwealths.
As determined under the first step for determining the States'
preadjusted proportions, which is applied before the application of any
floors or ceilings, the sum of the proportions for all the States and
the District of Columbia will be equal to exactly one. However, the
application of the floors and ceilings under the second step may change
the proportions for certain States; that is, some States' proportions
may need to be raised to the floors, while other States' proportions
may need to be lowered to the maximum ceiling. If this occurs, the sum
of the proportions for all States and the District of Columbia may not
exactly equal one. In that case, the statute requires the proportions
to be adjusted, under a method that is determined by whether the sum of
the proportions is greater or less than one.
The sum of the proportions would be greater than one if the
application of the floors and ceilings resulted in raising the
proportions of some States (due to the application of the floors) to a
greater degree than the proportions of other States were lowered (due
to the application of the ceiling). If, after application of the floors
and ceiling, the sum of the proportions is greater than one, the
statute requires the Secretary to determine a maximum percentage
increase limit, which, when applied to the State proportions, would
result in the sum of the proportions being exactly one.
If, after the application of the floors and ceiling, the sum of the
proportions is less than one, the statute requires the States'
proportions to be increased in a ``pro rata'' manner so that the sum of
the
[[Page 52703]]
proportions again equals one. Finally, it is also possible, although
unlikely, that the sum of the proportions (after the application of the
floors and ceiling) will be exactly one; in that case, the proportions
would require no further adjustment.
Determination of Preadjusted Proportions
The following is an explanation of how we applied the two State-
related factors specified in the statute to determine the States'
``preadjusted'' proportions for FY 2005. The term ``preadjusted,'' as
used here, refers to the States' proportions before the application of
the floors and ceiling and adjustments, as specified in the SCHIP
statute. The determination of each State and the District of Columbia's
preadjusted proportion for FY 2005 is in accordance with the following
formula:
PPi = (Ci x SCFi)/
[Sigma](Ci x SCFi)
PPi = Preadjusted proportion for a State or District of
Columbia for a fiscal year.
Ci = Number of children in a State (section 2104(b)(1)(A)(i)
of the Act) for a fiscal year. This number is based on the number of
low-income children for a State for a fiscal year and the number of
low-income uninsured children for a State for a fiscal year determined
on the basis of the arithmetic average of the number of such children
as reported and defined in the three most recent March supplements to
the CPS of the Bureau of the Census, officially available before the
beginning of the calendar year in which the fiscal year begins. (See
section 2104(b)(2)(B) of the Act.)
For fiscal year 2005, the number of children is equal to the sum
of 50 percent of the number of low-income uninsured children in the
State for the fiscal year and 50 percent of the number of low-income
children in the State for the fiscal year. (See section
2104(b)(2)(A)(iii) of the Act.)
SCFi = State Cost Factor for a State (section
2104(b)(1)(A)(ii) of the Act). For a fiscal year, this is equal to:
0.15 + 0.85 x (Wi/WN)
Wi = The annual average wages per employee for a State for
such year (section 2104(b)(3)(A)(ii)(I) of the Act).
WN = The annual average wages per employee for the 50 States
and the District of Columbia (section 2104(b)(3)(A)(ii)(II) of the
Act).
The annual average wages per employee for a State or for all
States and the District of Columbia for a fiscal year is equal to the
average of such wages for employees in the health services industry, as
reported and determined as final by the BLS of the Department of Labor
for each of the most recent 3 years officially available before the
beginning of the calendar year in which the fiscal year begins. (See
section 2104(b)(3)(B) of the Act).
[Sigma](Ci x SCFi) = The sum of the products of
(Ci x SCFi) for each State (section 2104(b)(1)(B)
of the Act).
The resulting proportions would then be subject to the application
of the floors and ceilings specified in the SCHIP statute and
reconciled, as necessary, to eliminate any deficit or surplus of the
allotments because the sum of the proportions was either greater than
or less than one.
Section 2104(e) of the Act requires that the amounts allotted to a
State for a fiscal year be available to the State for a total of 3
years; the fiscal year for which the amounts are allotted, and the 2
following fiscal years.
III. Table of State Children's Health Insurance Program Final
Allotments for FY 2005
Key to Table
Column/Description
Column A = State. Name of State, District of Columbia, U.S.
Commonwealth or Territory.
Column B = Number of Children. The number of children for each
State (provided in thousands) was determined and provided by the Bureau
of the Census based on the arithmetic average of the number of low-
income children and low-income uninsured children, and is based on the
three most recent March supplements to the CPS of the Bureau of the
Census officially available before the beginning of the calendar year
in which the fiscal year begins. The FY 2005 allotments were based on
the 2001, 2002, and 2003 March supplements to the CPS. These data
represent the number of people in each State under 19 years of age
whose family income is at or below 200 percent of the poverty threshold
appropriate for that family, and who are reported to be without health
insurance coverage. The number of children for each State was developed
by the Bureau of the Census based on the standard methodology used to
determine official poverty status and uninsured status in its annual
March CPS on these topics.
For FY 2005, the number of children is equal to the sum of 50
percent of the number of low-income uninsured children in the State and
50 percent of the number of low-income children in the State.
Column C = State Cost Factor. The State cost factor for a State is
equal to the sum of: 0.15, and 0.85 multiplied by the ratio of the
annual average wages in the health industry per employee for the State
to the annual wages per employee in the health industry for the 50
States and the District of Columbia. The State cost factor for each
State was calculated based on such wage data for each State as reported
and determined as final by the BLS in the Department of Labor for each
of the most recent 3 years and available before the beginning of the
calendar year in which the fiscal year begins. The FY 2005 allotments
were based on final BLS wage data for 2000, 2001, and 2002.
Column D = Product. The Product for each State was calculated by
multiplying the Number of Children in Column B by the State Cost Factor
in Column C. The sum of the Products for all 50 States and the District
of Columbia is below the Products for each State in Column D. The
Product for each State and the sum of the Products for all States
provides the basis for allotment to States and the District of
Columbia.
Column E = Proportion of Total. This is the calculated percentage
share for each State of the total allotment available to the 50 States
and the District of Columbia. The Percent Share of Total is calculated
as the ratio of the Product for each State in Column D to the sum of
the Products for all 50 States and the District of Columbia below the
Products for each State in Column D.
Column F = Adjusted Proportion of Total. This is the calculated
percentage share for each State of the total allotment available after
the application of the floors and ceilings and after any further
reconciliation needed to ensure that the sum of the State proportions
is equal to one. The three floors specified in the statute are: (1) The
percentage calculated by dividing $2,000,000 by the total of the amount
available for all allotments for the fiscal year; (2) an annual floor
of 90 percent of (that is, 10 percent below) the preceding fiscal
year's allotment proportion; and (3) a cumulative floor of 70 percent
of (that is, 30 percent below) the FY 1999 allotment proportion. There
is also a cumulative ceiling of 145 percent of (that is, 45 percent
above) the FY 1999 allotment proportion.
Column G = Allotment. This is the SCHIP allotment for each State,
Commonwealth, or Territory for the fiscal year. For each of the 50
States and the District of Columbia, this is determined as the Adjusted
Proportion of Total in Column F for the State multiplied by the total
amount available
[[Page 52704]]
for allotment for the 50 States and the District of Columbia for the
fiscal year.
For each of the U.S. Territory and Commonwealths, the allotment is
determined as the Proportion of Total in Column E multiplied by the
total amount available for allotment to the U.S. Territories and
Commonwealths. For the U.S. Territories and Commonwealths, the
Proportion of Total in Column E is specified in section 2104(c) of the
Act. The total amount is then allotted to the U.S. Territories and
Commonwealths according to the percentages specified in section 2104 of
the Act. There is no adjustment made to the allotments of the U.S.
Territories and Commonwealths as they are not subject to the
application of the floors and ceiling. As a result, Column F in the
table, the Adjusted Proportion of Total, is empty for the U.S.
Territories and Commonwealths.
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[[Page 52705]]
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IV. Impact Statement
We have examined the impact of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-354),
section 1102(b) of the Social Security Act, the Unfunded Mandates
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
We have examined the impact of this notice as required by Executive
Order 12866. Executive Order 12866 directs
[[Page 52706]]
agencies to assess all costs and benefits of available regulatory
alternatives and, when rules are necessary, to select regulatory
approaches that maximize net benefits (including potential economic
environments, public health and safety, other advantages, distributive
impacts, and equity). We believe that this notice is consistent with
the regulatory philosophy and principles identified in the Executive
Order. The formula for the allotments is specified in the statute.
Since the formula is specified in the statute, we have no discretion in
determining the allotments. This notice merely announces the results of
our application of this formula, and therefore does not reach the
economic significance threshold of $100 million in any one year.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and government agencies.
Most hospitals and most other providers and suppliers are small
entities, either by nonprofit status or by having revenues of $6
million to $29 million in any one year. Individuals and States are not
included in the definition of a small entity; therefore, this
requirement does not apply.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 604 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a Metropolitan
Statistical Area and has fewer than 100 beds.
The Unfunded Mandates Reform Act of 1995 requires that agencies
prepare an assessment of anticipated costs and benefits before
publishing any notice that may result in an annual expenditure by
State, local, and tribal governments, in the aggregate, or by the
private sector, of $110 million or more (adjusted each year for
inflation) in any one year. Since participation in the SCHIP program on
the part of States is voluntary, any payments and expenditures States
make or incur on behalf of the program that are not reimbursed by the
Federal government are made voluntarily. This notice will not create an
unfunded mandate on States, tribal, or local governments because it
merely notifies States of their SCHIP allotment for FY 2005. Therefore,
we are not required to perform an assessment of the costs and benefits
of this notice.
Low-income children will benefit from payments under SCHIP through
increased opportunities for health insurance coverage. We believe this
notice will have an overall positive impact by informing States, the
District of Columbia, and U.S. Territories and Commonwealths of the
extent to which they are permitted to expend funds under their child
health plans using their FY 2005 allotments.
Under Executive Order 13132, we are required to adhere to certain
criteria regarding Federalism. We have reviewed this notice and
determined that it does not significantly affect States' rights, roles,
and responsibilities because it does not set forth any new policies.
For these reasons, we are not preparing analyses for either the RFA
or section 1102(b) of the Act because we have determined, and we
certify, that this notice will not have a significant economic impact
on a substantial number of small entities or a significant impact on
the operations of a substantial number of small rural hospitals.
In accordance with the provisions of Executive Order 12866, this
notice was reviewed by the Office of Management and Budget.
(Section 1102 of the Social Security Act (42 U.S.C. 1302).)
(Catalog of Federal Domestic Assistance Program No. 93.767, State
Children's Health Insurance Program)
Dated: May 17, 2004.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
Dated: June 14, 2004.
Tommy G. Thompson,
Secretary.
[FR Doc. 04-19573 Filed 8-26-04; 8:45 am]
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