Anonymous -- DC

In Section V, Regulatory Impact Analysis, CMS states, "Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State or local government, preempts State law, or otherwise has Federalism implication, the requirements of E.O. 13132 are not applicable." Since this rule requires States to conduct new screening requirements without additional funding, I recommend that CMS provide its analysis showing that this proposed rule does not impose a substantial direct requirement costs on State or local government, preempt State law, or otherwise has Federalism implications, I recommend that CMS provide a State-by-State analysis of the direct requirement costs imposed on each State and the District of Columbia to implement this proposed rule for CY 2011, CY 2012 and CY 2013. I recommend that CMS explain if each State will receive funding in advance of implementing the provisions of the final rule or if States will receive reimbursement for the resources spent during a calendar year in which obligations are made.