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pdfState: Amer. Samoa
Quarter/Year: Qtr 1st 2024
Quarter Ended: 12/31/2023
CMS 64.10 BASE Expenditures for State and Local Administration For the Medical
Assistance Program Expenditures in this Quarter
Federal Share
Payment Lines
Total Computable
FFP Rate
(a)
Federal Share
*
Other
Percent
Total Federal Share
Federal Share
(b)
(c)
(d)
1 Family Planning
2A MMIS - Inhouse Activities
2B MMIS - Private Sector
3A Skilled Professional Medical Personnel - Single State Agency
3B Skilled Professional Medical Personnel - Other Agency
4A Approved MMIS: Inhouse
4B Approved MMIS: Private
5A Mechanized Systems - In-House
5B Mechanized Systems: Private Sector
5C Mechanized Systems - Not Approved under MMIS Procedures:
Interagency
6 Quality Improvement Organizations (QIO)
7A TPL - Recovery Procedure
7B TPL - Assignment Of Rights
8 Immigration Status
9 Nurse Aide Training Costs
10 Preadmission Screening
11 Resident Review
12 Drug Use Review
13 Outstationed Eligibility
14 TANF Base
15 TANF Secondary 90%
16 TANF Secondary 75%
17 External Review
18 Enrollment Brokers
19 School Based Administration
20 Program Integrity/Fraud, Waste, and Abuse Activities
21 County/Local ADM Costs
22 Interagency Costs (State Level)
23 Translation and Interpretation
24 Health Information Technology Administration
24A HIT: Planning: Cost of In-house Activities
24B HIT: Planning: Cost of Private Contractors
24C HIT: Implementation and Operation: Cost of In-house Activities
24D HIT: Implementation and Operation: Cost of Private Contractors
24E HIT Incentive Payments: Eligible Professionals
24F HIT Incentive Payments: Eligible Hospitals
25 Citizenship Verification Technology - CHIPRA
25A CVT Development - CHIPRA
25B CVT Operation - CHIPRA
26 Planning for Health Homes for Enrollees with Chronic Conditions
27 Recovery Audit Contractors State Administration
28A Design Development/Installation of Medicaid Elig. Determ. Sys. –
Cost of In-house Activities
28B Design Development/Installation of Medicaid Elig. Determ. Sys. –
Cost of Private Sec. Contractors
28C Operation of an Approved Medicaid Eligibility Determination
Systems – Cost of In-house Activities
28D Operation of an Approved Medicaid Eligibility Determination Sys.
– Cost of Private Sec. Contractors
28E Eligibility Determination Staff – Cost of In-house Activities
0
0
0
0
0
0
0
0
0
90%
0%
0%
75%
75%
75%
75%
50%
50%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50%
75%
50%
50%
100%
50%
75%
75%
50%
50%
90%
90%
75%
50%
50%
50%
50%
50%
75%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
90%
90%
90%
90%
100%
100%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
90%
75%
88.00%
50%
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0%
0
0
0
0
0
0%
0
0
0
0
0
75%
0
0
0
0
0
0
75%
75%
0
0
0
0
0
0
0
0
28F Eligibility Determination Staff – Cost of Private Sector Contractors
28G Eligibility Determination Staff – Cost of In-house Activities –
50% FFP
28H Eligibility Determination Staff – Cost of Private Sector Contractors
– 50% FFP
29 Non-Emergency Medical Transportation
30 Design Development/Implementation of Prescription Drug
Monitoring Program Systems
31 CAA 2023 Section 5101
49 Other Financial Participation
50 Total
0
75%
0
0
0
0
0
50%
0
0
0
0
0
0
50%
50%
0
0
0
0
0
0
0
0
0
100
401,806
401,906
100%
100%
50%
0
0
200,903
200,903
0
0
0
0
0
0
0
0
0
100
200,903
201,003
| File Type | application/pdf |
| File Title | CMS 64.10 BASE with Line 31 Added |
| Author | Christopher Kessler |
| File Modified | 2023-10-16 |
| File Created | 2023-10-05 |