Need for Additional Title XVIII and Title XIX Funds

4640 - Need for Additional Title XVIII and Title XIX Funds (Rev. 1, 05-21-04) At the end of each quarter, the SA should analyze current rate of expenditures for the title XVIII non-LTC and LTC survey activities. The SA advises the CMS-RO as soon as possible if a supplemental budget may be necessary. State Agencies should take full advantage of line-item flexibility (see §4630) to stay within their approved budget before requesting additional funding. Supplemental budget requests are not necessary for title XIX survey and certification activities. The SA will be paid at the appropriate FFP rate for the necessary and reasonable costs incurred during the FY for survey and certification activities relating to Medicaid title XIX.