CMS-64.21U ARP Section 9821 (Line 26)

CMS 64.21U

State: Amer. Samoa
Agency: CMS

Quarterly Medical Assistance Expenditures
By Children's Health Insurance Program
Expenditures Categories

Total Computable
Type of Eligibility: U2 *

(A)
1A) Premiums: Up To 150% - Gross
Premiums Paid
1B) Premiums: Up To 150% - Cost Sharing
Offset
1C) Premiums: Over 150% - Gross Premiums
Paid
1D) Premiums: Over 150% - Cost Sharing
Offset
2) Inpatient Hospital Services - Reg.
Payments
2A) Inpatient Hospital Services - DSH
3) Inpatient Mental Health - Reg. Payment
3A) Inpatient Mental Health - DSH
3B) Certified Community Behavior Health
Clinic Payments
4) Nursing Care Services
5) Physician/Surgical
6) Outpatient Hospital Services
7) Outpatient Mental Health
8) Prescribed Drugs
8A1) Drug Rebate - National
8A2) Drug Rebate - State
8A3) MCO - National Agreement
8A4) MCO - State Sidebar Agreement
8A5) Increased ACA OFFSET - Fee for Service 100%
8A6) Increased ACA OFFSET - MCO - 100%
9) Dental Services
10) Vision Services
11) Other Practitioners

Quarter/Year: Qtr 4th 2021
Quarter Ended: 09/30/2021
Federal Share
FMAP
CHIP
83%
85%
COVID FMAP
89.2% **
(B)

(C)

Total Federal Share

(D)

12) Clinic Services
13) Therapy Services
14) Laboratory/Radiological
15) Medical Equipment
16) Family Planning
17) Abortions No. 0
18) Screening Services
19) Home Health
20) Medicare Payments
21) Home And Community
21A) Home and Community-Based Services Regular Payment (WAIVER)
22) Hospice
23) Medical Transport
24) Case Management
26) ARP Section 9821 COVID
Vaccine/Vaccine Administration
49) Other Services
50) Total
** Lines are calculated at the COVID FMAP rate of 89.2%