Cms-10529 Cms-37.9

Department of Health and Human Services
Centers for Medicare & Medicaid Services
Medicaid Program Budget Report
State And Local Administration
State: American Samoa
Submission Date: 08/15/2023

Type of Service

FFP Rate

Total Administration Costs

90% Total Computable
Federal Share
50% Total Computable
2A DDI-MMIS In-House Oth
Federal Share
75% Total Computable
Federal Share
90% Total Computable
Federal Share
50% Total Computable
2B DDI-MMIS PRI-SEC-CONT
Federal Share
75% Total Computable
Federal Share
90% Total Computable
Federal Share
90% Total Computable
2C Drug Claims System
Federal Share
75% Total Computable
3A Skilled Professional Medical Personnel - Single State Agency
Federal Share
75% Total Computable
3B Skilled Professional Medical Personnel - Other Agencies
Federal Share
75% Total Computable
4A OAA-MMIS In-House Oth
Federal Share
75% Total Computable
4B OAA-MMIS Prv-Contract
Federal Share
50%
5A Non-MMIS In-House Oth
Total Computable
Federal Share
50% Total Computable
5B Non-MMIS Prv-Contract
Federal Share
50% Total Computable
5C Mechanized Systems, not Approved under MMIS Procedures: Interagency
Federal Share
75% Total Computable
6 Quality Improvement Organizations (QIO)
Federal Share
50% Total Computable
7A TPL-Billing Offset
Federal Share
50% Total Computable
7B Asgn-Of-Rights-Bill-Of
Federal Share
100% Total Computable
8 Immigration Stat Syst
Federal Share
50% Total Computable
9 Nurse Aide Training
Federal Share
75% Total Computable
10 Pre-Admission Screen
Federal Share
75% Total Computable
11 Resident Review
Federal Share
50% Total Computable
12 Drug Use Review Prog
Federal Share
50% Total Computable
13 Outsta Elig Workers
Federal Share
90%
14 Tanf Base Allocation
90%
15 Tanf 2nd Alloc 90%
75%
16 Tanf 2nd Alloc 75%
50% Total Computable
17 Ext Qual Review
Federal Share
75% Total Computable
Federal Share
50% Total Computable
18 Enrollment Brokers
Federal Share
50% Total Computable
19 School Based Administration
Federal Share
50% Total Computable
20 Program Integrity/Fraud, Waste, and Abuse Activities
Federal Share
50% Total Computable
21 County/Local ADM Costs
Federal Share
50% Total Computable
22 Interagency Costs
Federal Share
75% Total Computable
23 Translation and Interpretation
Federal Share
24 Health Information Technology Administration
90%
24A HIT: Planning: Cost of In-house Activities
90%
24B HIT: Planning: Cost of Private Contractors
24C HIT: Implementation and Operation: Cost of In-house Activities 90% Total Computable
Federal Share
24D HIT: Implementation and Operation: Cost of Private Contractors90% Total Computable
Federal Share
1 Family Planning

Column1

Total of Total Computable

Total of Federal Share

24E HIT Incentive Payments: Eligible Professionals
24F HIT Incentive Payments: Eligible Hospitals
25 Citizenship Verification Technology - CHIPRA
25A CVT Development - CHIPRA

100%
100%

90% Total Computable
Federal Share
75% Total Computable
25B CVT Operation - CHIPRA
Federal Share
26 Planning for Health Homes for Enrollees with Chronic Conditions84.5% Total Computable
Federal Share
50% Total Computable
27 Recovery Audit Contractors State Administration
Federal Share
28A Design Development/Installation of Medicaid Elig. Determ. Sys. –50%
CostTotal
of In-house
Computable
Activities
Federal Share
75% Total Computable
Federal Share
90% Total Computable
Federal Share
28B Design Development/Installation of Medicaid Elig. Determ. Sys. –50%
CostTotal
of Private
Computable
Sec. Contractors
Federal Share
75% Total Computable
Federal Share
90% Total Computable
Federal Share
75% Total
28C Operation of an Approved Medicaid Eligibility Determination Systems
– Cost
Computable
of In-house Activities
Federal Share
75%
28D Operation of an Approved Medicaid Eligibility Determination Sys.
– Cost
Total
ofComputable
Private Sec. Contractors
Federal Share
75% Total Computable
28E Eligibility Determination Staff – Cost of In-house Activities
Federal Share
28F Eligibility Determination Staff – Cost of Private Sector Contractors75% Total Computable
Federal Share
28G Eligibility Determination Staff – Cost of In-house Activities – 50%50%
FFP Total Computable
Federal Share
50%
28H Eligibility Determination Staff – Cost of Private Sector Contractors
– 50%
Total
FFP
Computable
Federal Share
50% Total Computable
29 Non-Emergency Medical Transportation
Federal Share
100% Total Computable
31 CAA 2023 Section 5101
Federal Share
50%
49 Other Financial Participation
Total Computable
Federal Share
50 Sub-total (Line 1 - 49) excluding 24s
Total Computable
Federal Share
50% Total Computable
51 Collections
Federal Share
50% Total Computable
52 Prior Period Adjust
Federal Share
53 Total (excluding 24s)
Total Computable
Federal Share