CMS-37.10I Information - State and Local Administration

Department of Health and Human Services																		OMB No. 0938-0101
Centers for Medicare & Medicaid Services
Medicaid Program Budget Report
Information - State and Local Administration (In Thousands)
State:																		Submission Date:
										Fiscal Year	(1)					Fiscal Year	(2)
State and Local Administration								Salaries and Expenses			Other Administration			FTE's	Salaries and Expenses		Other Administration				FTE's
Program:						FFP		Total Comp.	Fed. Share		Total Comp.		Fed. Share		Total Comp.	Fed. Share	Total Comp.		Fed. Share
						Rates		A		B		C	D	E	F	G		H		I	J
1.	Family Planning					90
2.	Design Develop or Install MMIS:
	A. In-house and Other State Activities					90
	B. Private Sector Contractors					90
	C. Drug Claims System					90
3.	Skilled Professional Medical Personnel					75
4.	Operation of an Approved MMIS:
	A. In-house and Other State Activities					75
	B. Private Sector Contractors					75
5.	Non- MMIS Systems:
	A. In-house and Other State Activities					50
	B. Private Sector Contractors					50
6.	Peer Review Organization					75
7.	A. TPL-Billing Offset					50
	B. Assignment of Rights- Billing Offset					50
8.	Immigration Status System					100
9.	Nurse Aide Training and Competency Evaluation Programs					50
10.	Preadmission Screening Costs					75
11.	Resident Review Activities					75
12.	Drug Use Review Program					50
13.	Outstationed Eligibility Workers					50
14.	TANF Base Allocation					90
15.	TANF Secondary Allocation - 90%					90
16.	TANF Secondary Allocation - 75%					75
17.	External Quality Reviews					75
18.	Enrollment Brokers					50
19.	Other Financial Participation					50
20.	Subtotal (Sum of Lines 1 - 19)
21.	Collections
22.	Prior Period Adjustments
23.	Total Administration (Sum of Lines 20 - 22)
Form CMS-37.10I																			Report Date: