Recovery.gov - Track the Money

The regular actions taken for all QI extensions apply to this funding. Notice of State allotments are published in the Federal Register. As part of this process, CMS works with States to understand what each States’ projected funding needs for the QI program will be. CMS then bases the individual State allotments on this information.

All Recovery Act programs will be assessed for risk and to ensure that appropriate internal controls are in place throughout the entire funding cycle. These assessments will be done consistent with the statutory requirements of the Federal Manager’s Financial Integrity Act and the Improper Payments Information Act, as well as OMB’s circular A-123 “Management’s Responsibility for Internal Control.”

States’ expenditures will be monitored on a quarterly basis by both States and CMS. In accordance with the guidelines established by OMB, any funding to States related to continuation of the QI allotments will be issued in a separate account specifically designated by the Treasury for the Recovery funds and the States will have to draw these funds from that separate account. The handling of these grant awards will follow the processes CMS has established for issuance of regular Medicaid grant awards as well as reconciliation at the end of the quarter to actual expenditures. These processes are well documented in the Medicaid Cycle memo which documents the processes as well as details internal controls in place to mitigate risk.

CMS will continue to use its existing internal control infrastructure to implement these provisions, i.e., CMS will examine actual expenditures claimed for appropriateness within the Medicaid program requirements and will monitor State compliance with statutory requirements. To the extent CMS finds expenditures that are not allowable or in excess of the State’s specific allotment, CMS will initiate recovery of any unallowable funds. In addition, CMS will work on an ongoing basis with the Office of Inspector General (OIG) to coordinate oversight and audit activity.

CMS will be open and transparent in all of its grant making activities that involve spending of Recovery Act funding consistent with statutory and OMB guidance. The actual QI allotments for January 1, 2010 through December 31, 2010 will be published through a Federal Register notice, in accordance with its regular process. The actual amounts of funding made available to States as a result of the increased DSH allotments is also available on www.hhs.gov/recovery/.

Finally, States must report to CMS on a quarterly basis their Medicaid expenditures, including expenditures related to QI payments (note that QI is funded separately from the Medicaid program as a whole). In accordance with the guidelines established by OMB, any funding to States related to the QI allotment will be issued in a separate account specifically designated by the Treasury for the Recovery Act funds and the States will have to draw these funds from that separate account.

To ensure that managers are held to high standards of accountability in achieving program goals under the Recovery Act, CMS will build on and strengthen existing processes. Senior CMS Center for Medicaid and State Operations officials will meet regularly with senior Department officials to ensure that projects are meeting their program goals, assessing and mitigating risks, ensuring transparency, and incorporating corrective actions. The personnel performance appraisal system will also incorporate Recovery Act program stewardship responsibilities for program and business function managers. Although the specific factors for managers’ plans have not been developed, they will include responsibility for statutorily-required Recovery Act activities.

In addition, CMS will utilize its existing financial management oversight mechanisms to require the return of any Federal funds to which a State was not entitled. Such mechanisms include the disallowance of expenditures funded under the QI allotment. This disallowance action would involve formal notice to the State as well as provide the State an opportunity for a hearing to the Departmental Appeals Board.

Not applicable.