[Code of Federal Regulations] [Title 42, Volume 4] [Revised as of October 1, 2006] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR430.48] [Page 13-14] TITLE 42--PUBLIC HEALTH CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PART 430_GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS--Table of Subpart C_Grants; Reviews and Audits; Withholding for Failure To Comply; Deferral and Disallowance of Claims; Reduction of Federal Medicaid Payments Sec. 430.48 Repayment of Federal funds by installments. (a) Basic conditions. When Federal payments have been made for claims that are later found to be unallowable, the State may repay the Federal Funds by installments if the following conditions are met: (1) The amount to be repaid exceeds 2\1/2\ percent of the estimated or actual annual State share for the Medicaid program; and (2) The State has given the Regional Administrator written notice, before total repayment was due, of its intent to repay by installments. (b) Annual State share determination. CMS determines whether the amount to be repaid exceeds 2\1/2\ percent of the annual State share as follows: (1) If the Medicaid program is ongoing, CMS uses the annual estimated [[Page 14]] State share of Medicaid expenditures. This is the sum of the estimated State shares for four consecutive quarters, beginning with the quarter in which the first installment is to be paid, as shown on the State's latest CMS-25 form. (2) If the Medicaid program has been terminated by Federal law or by the State, CMS uses the actual State share. The actual State share is that shown on the State's Statement of Expenditures reports for the last four quarters before the program was terminated. (c) Repayment amounts, schedules, and procedures--(1) Repayment amount. The repayment amount may not include any amount previously approved for installment repayment. (2) Repayment schedule. The number of quarters allowed for repayment is determined on the basis of the ratio of the repayment amount to the annual State share of Medicaid expenditures. The higher the ratio of the total repayment amount is to the annual State share, the greater the number of quarters allowed, as follows: ------------------------------------------------------------------------ Number of Total repayment amount as percentage of State share of quarters annual expenditures for Medicaid to make repayment ------------------------------------------------------------------------ 2.5 pct. or less............................................ 1 Greater than 2.5, but not greater than 5.................... 2 Greater than 5, but not greater than 7.5.................... 3 Greater than 7.5, but not greater than 10................... 4 Greater than 10, but not greater than 15.................... 5 Greater than 15, but not greater than 20.................... 6 Greater than 20, but not greater than 25.................... 7 Greater than 25, but not greater than 30.................... 8 Greater than 30, but not greater than 47.5.................. 9 Greater than 47.5, but not greater than 65.................. 10 Greater than 65, but not greater than 82.5.................. 11 Greater than 82.5, but not greater than 100................. 12 ------------------------------------------------------------------------ (3) Quarterly repayment amounts. The quarterly repayment amounts for each of the quarters in the repayment schedule may not be less than the following percentages of the estimated State share of the annual expenditures for Medicaid: ------------------------------------------------------------------------ Repayment installment may not be For each of the following quarters less than these percentages ------------------------------------------------------------------------ 1 to 4..................................................... 2.5 5 to 8..................................................... 5.0 9 to 12.................................................... 17.5 ------------------------------------------------------------------------ (4) Extended schedule. The repayment schedule may be extended beyond 12 quarterly installments if the total repayment amount exceeds 100% of the estimated State share of annual expenditures. In these circumstances, paragraph (c)(2) of this section is followed for repayment of the amount equal to 100 percent of the annual State share. The remaining amount of the repayment is in quarterly amounts equal to not less than 17.5 percent of the estimated State share of annual expenditures. (5) Repayment process. Repayment is accomplished through adjustment in the quarterly grants over the period covered by the repayment schedule. If the State chooses to repay amounts representing higher percentages during the early quarters, any corresponding reduction in required minimum percentages is applied first to the last scheduled payment, then to the next to the last payment, and so forth as neccessary. (6) Offsetting of retroactive claims. The amount of a retroactive claim to be paid a State will be offset against any amounts to be, or already being, repaid by the State in installments. Under this provision, the State may choose to: (i) Suspend payments until the retroactive claim due the State has, in fact, been offset; or (ii) Continue payments until the reduced amount of its debt (remaining after the offset), has been paid in full. This second option would result in a shorter payment period. A retroactive claim for the purpose of this regulation is a claim applicable to any period ending 12 months or more before the beginning of the quarter in which CMS would pay that claim.