Notice of Hearing: Reconsideration of Disapproval of Alaska State Plan Amendment 05-06, 41448-41450 [E6-11577]
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41448
Federal Register / Vol. 71, No. 140 / Friday, July 21, 2006 / Notices
Public: Business or other for-profit, Notfor-profit institutions, and State, local or
tribal governments; Number of
Respondents: 100,000; Total Annual
Responses: 100,000; Total Annual
Hours: 100,000.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS Web site
address at https://www.cms.hhs.gov/
PaperworkReductionActof1995, or
e-mail your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov, or call the
Reports Clearance Office on (410) 786–
1326.
Written comments and
recommendations for the proposed
information collections must be mailed
or faxed within 30 days of this notice
directly to the OMB desk officer: OMB
Human Resources and Housing Branch,
Attention: Carolyn Lovett, New
Executive Office Building, Room 10235,
Washington, DC 20503. Fax Number:
(202) 395–6974.
Dated: July 14, 2006.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E6–11576 Filed 7–20–06; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10179]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, HHS.
In compliance with the requirement
of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Centers for Medicare & Medicaid
Services (CMS) is publishing the
following summary of proposed
collections for public comment.
Interested persons are invited to send
comments regarding this burden
estimate or any other aspect of this
collection of information, including any
of the following subjects: (1) The
necessity and utility of the proposed
information collection for the proper
performance of the agency’s functions;
(2) the accuracy of the estimated
burden; (3) ways to enhance the quality,
utility, and clarity of the information to
be collected; and (4) the use of
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AGENCY:
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automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
1. Type of Information Collection
Request: New Collection; Title of
Information Collection: Requests by
Hospitals for an Alternative Cost-toCharge Ration Instead of the Statewide
Average Cost-to-Charge Ratio; Use:
Because of the extensive gaming of
outlier payments, CMS implemented
new regulations in 42 CFR 412.84(i)(2)
for inpatient hospitals and 42 CFR
412.525(a)(4)(ii) and 412.529(c)(5)(ii) for
Long Term Care Hospitals (LTCH) to
allow a hospital to contact its fiscal
intermediaries to request that its cost-tocharge ratio (CCR) (operating and/or
capital CCR for inpatient hospitals or
the total (combined operating and
capital) CCR for LTCHs), otherwise
applicable, be changed if the hospital
presents substantial evidence that the
ratios are inaccurate for inpatient
hospitals. Any such requests would
have to be approved by the CMS
Regional Office with jurisdiction over
that FI. Form Number: CMS–10179
(OMB#: 0938–NEW); Frequency:
Reporting—On occasion; Affected
Public: Individuals or Households and
Federal Government; Number of
Respondents: 18; Total Annual
Responses: 18; Total Annual Hours:
144.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS’ Web site
address at https://www.cms.hhs.gov/
PaperworkReductionActof1995, or email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov, or call the
Reports Clearance Office on (410) 786–
1326.
To be assured consideration,
comments and recommendations for the
proposed information collections must
be received at the address below, no
later than 5 p.m. on September 19, 2006.
CMS, Office of Strategic Operations
and Regulatory Affairs, Division of
Regulations Development—B, Attention:
William N. Parham, III, Room C4–26–
05, 7500 Security Boulevard, Baltimore,
Maryland 21244–1850.
Dated: July 14, 2006.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E6–11582 Filed 7–20–06; 8:45 am]
BILLING CODE 4120–01–P
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
Notice of Hearing: Reconsideration of
Disapproval of Alaska State Plan
Amendment 05–06
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice of hearing.
AGENCY:
SUMMARY: This notice announces an
administrative hearing to be held on
August 29, 2006, at the Blanchard Plaza
Building, 2201 Sixth Avenue, 11th Floor
Conference Room, Seattle, WA 98121, to
reconsider CMS’ decision to disapprove
Alaska State plan amendment 05–06.
Closing Date: Requests to participate
in the hearing as a party must be
received by the presiding officer by
August 7, 2006.
FOR FURTHER INFORMATION CONTACT:
Kathleen Scully-Hayes, Presiding
Officer, CMS, Lord Baltimore Drive,
Mail Stop LB–23–20, Baltimore,
Maryland 21244. Telephone: (410) 786–
2055.
SUPPLEMENTARY INFORMATION: This
notice announces an administrative
hearing to reconsider CMS’ decision to
disapprove Alaska State plan
amendment (SPA) 05–06, which was
submitted on August 1, 2005. This SPA
was disapproved on April 21, 2006.
Under SPA 05–06, Alaska proposed to
add certain school-based behavioral
health services under the rehabilitation
services benefit.
This amendment was disapproved
because it did not comport with the
requirements of section 1902(a) of the
Social Security Act (the Act) and
implementing regulations. Specifically,
the following issues will be considered
on reconsideration: (1) Whether the
State demonstrated that the proposed
services would be within the scope of
‘‘medical assistance’’ under the State
plan pursuant to section 1902(a)(10) of
the Act, as defined at section 1905(a) of
the Act; (2) whether the State has
assured that there is non-Federal
funding as required under section
1902(a)(2) to support expenditures that
would be claimed under the State plan
as the basis for Federal matching
funding in light of financial
arrangements that do not appear to
result in net expenditures; (3) whether
the proposed payment rates meet the
requirements of section 1902(a)(30)(A)
of the Act to be consistent with
efficiency, economy, and quality of care,
in light of financial arrangements under
which the providers do not retain
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Federal Register / Vol. 71, No. 140 / Friday, July 21, 2006 / Notices
Medicaid payments; and (4) whether the
State plan complied with the
requirements of section 1902(a)
generally, and implementing Federal
regulations at 42 CFR 430.10, to include
all information necessary to serve as the
basis for Federal financial participation.
We describe each of these issues in
detail below.
Section 1902(a)(10) of the Act requires
that the State plan provide for making
medical assistance available to eligible
beneficiaries. The State did not establish
that the proposed ‘‘school-based
rehabilitative services’’ are within the
scope of ‘‘medical assistance,’’ which is
defined in section 1905(a) of the Act.
While we understand the State has
placed the proposed services under the
rehabilitative services benefit in the
State plan, the State has provided no
clear definition of the proposed services
so that CMS can determine whether
they are, indeed, within the scope of the
rehabilitation benefit. After repeated
requests for further information, the
State did not provide any description of
what elements the ‘‘behavioral health
services (including medication
services)’’ encompass, and how they are
different (or the same) as services in the
currently approved State plan. It is not
clear whether this is an expansion of
coverage or a different payment
methodology for school providers.
Absent such information, SPA 05–06
did not comply with the requirements of
section 1902(a)(10) of the Act to provide
for medical assistance as defined in
section 1905(a) of the Act.
Section 1902(a)(2) of the Act provides
that the State plan must assure adequate
funding for the non-Federal share of
expenditures from State or local sources
for the amount, duration, scope, or
quality of care and services available
under the plan. Section 1902(a)(30)(A)
of the Act requires that State plans
provide for payment for care and
services available under the plan that is
‘‘consistent with economy, efficiency,
and quality of care.’’ In order to assess
compliance with these provisions, State
officials were asked to provide
information related to Alaska’s funding
mechanisms for payments, and the net
State and local expenditures that are
incurred. Nor did Alaska respond to
requests for descriptions of any transfers
of funds between providers and State or
local governments, and information as
to whether the providers keep 100
percent of the total computable funds
given as Medicaid payments.
According to a flow chart provided by
the State, the Medicaid agency pays the
schools 100 percent of the claimed
amount. A quarterly bill for the State
match is then submitted to school
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17:59 Jul 20, 2006
Jkt 208001
providers who transfer to the Medicaid
agency the State share of the services
provided. This transfer of funds is made
after the schools have been reimbursed
for the services they provide, and is
effectively a refund by the schools for
part of their Medicaid payments. As a
result of this refund, the net expenditure
by the State Medicaid agency is wholly
federally funded. In light of this refund
arrangement, we cannot conclude that
the proposed payment rate reflects the
net expenditure by the State for
Medicaid services provided by schools,
and that the net non-Federal share
meets the requirements of section
1902(a)(2) of the Act. Moreover, the
refund is an indication that the full
payment amount is not required to
ensure Medicaid beneficiaries’ access to
the providers’ services. The result is that
proposed payments under this section
of the plan would not be in compliance
with the requirement under section
1902(a)(30)(A) of the Act that payment
rates must be consistent with economy,
efficiency, and quality of care.
Finally, the proposed SPA does not
comply with the general provisions of
section 1902(a), including section
1902(a)(4) of the Act, as implemented in
part by Federal regulations at 42 CFR
430.10. This regulation requires that
States include in their State plans all
information necessary for CMS to
determine whether the plan can be
approved to serve as a basis for Federal
financial participation. There is absent
information that would more precisely
identify the covered services. Therefore,
the proposed SPA does not comply with
this requirement.
For the reasons cited above, and after
consultation with the Secretary, as
required by Federal regulations at 42
CFR 430.15(c)(2), Alaska SPA 05–06
was disapproved.
Section 1116 of the Act, and Federal
regulations at 42 CFR part 430, establish
Department procedures that provide an
administrative hearing for
reconsideration of a disapproval of a
State plan or plan amendment. CMS is
required to publish a copy of the notice
to a State Medicaid agency that informs
the agency of the time and place of the
hearing, and the issues to be considered.
If we subsequently notify the agency of
additional issues that will be considered
at the hearing, we will also publish that
notice.
Any individual or group that wants to
participate in the hearing as a party
must petition the presiding officer
within 15 days after publication of this
notice, in accordance with the
requirements contained in Federal
regulations at 42 CFR 430.76(b)(2). Any
interested person or organization that
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41449
wants to participate as amicus curiae
must petition the presiding officer
before the hearing begins in accordance
with the requirements contained in
Federal regulations at 42 CFR 430.76(c).
If the hearing is later rescheduled, the
presiding officer will notify all
participants.
The notice to Alaska announcing an
administrative hearing to reconsider the
disapproval of its SPA reads as follows:
Mr. Jerry Fuller, Medicaid Director, State of
Alaska, Department of Health and Social
Services, Office of the Commissioner, P.O.
Box 110601, Juneau, AK 99811–0601.
Dear Mr. Fuller: I am responding to your
request for reconsideration of the decision to
disapprove the Alaska State plan amendment
(SPA) 05–06, which was submitted on
August 1, 2005, and disapproved on April 21,
2006. Under SPA 05–06, Alaska was
proposing to add certain school-based
behavioral health services under the
rehabilitation services benefit. This
amendment was disapproved because it did
not comport with the requirements of section
1902(a) of the Social Security Act (the Act)
and implementing regulations, as discussed
in more detail below.
Specifically, the following issues will be
considered on reconsideration: (1) Whether
the State demonstrated that the proposed
services would be within the scope of
‘‘medical assistance’’ under the State plan
pursuant to section 1902(a)(10) of the Act, as
defined at section 1905(a) of the Act; (2)
whether the State has assured that there is
non-Federal funding as required under
section 1902(a)(2) of the Act to support
expenditures that would be claimed under
the State plan as the basis for Federal
matching funding in light of financial
arrangements that do not appear to result in
net expenditures; (3) whether the proposed
payment rates meet the requirements of
section 1902(a)(30)(A) of the Act to be
consistent with efficiency, economy, and
quality of care, in light of financial
arrangements under which the providers do
not retain Medicaid payments; and (4)
whether the State plan complied with the
requirements of section 1902(a) of the Act
generally, and implementing Federal
regulations at 42 CFR 430.10, to include all
information necessary to serve as the basis
for Federal financial participation. We
describe each of these issues in detail below.
Section 1902(a)(10) of the Act requires that
the State plan provide for making medical
assistance available to eligible beneficiaries.
The State did not establish that the proposed
‘‘school-based rehabilitative services’’ are
within the scope of ‘‘medical assistance,’’
which is defined in section 1905(a) of the
Act. While we understand the State has
placed the proposed services under the
rehabilitative services benefit in the State
plan, the State has provided no clear
definition of the proposed services so that the
Centers for Medicare & Medicaid Services
(CMS) can determine whether they are,
indeed, within the scope of the rehabilitation
benefit. After repeated requests for further
information, the State provided no
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21JYN1
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41450
Federal Register / Vol. 71, No. 140 / Friday, July 21, 2006 / Notices
description of what elements the ‘‘behavioral
health services (including medication
services)’’ encompass, and how they are
different (or the same) as services in the
currently approved State plan. It is not clear
whether this is an expansion of coverage or
a different payment methodology for school
providers. Absent such information, SPA 05–
06 did not comply with the requirements of
section 1902(a)(10) of the Act to provide for
medical assistance as defined in section
1905(a) of the Act.
Section 1902(a)(2) of the Act provides that
the State plan must assure adequate funding
for the non-Federal share of expenditures
from State or local sources for the amount,
duration, scope, or quality of care and
services available under the plan. Section
1902(a)(30)(A) of the Act requires that State
plans provide for payment for care and
services available under the plan that is
‘‘consistent with economy, efficiency, and
quality of care.’’ In order to assess
compliance with these provisions, State
officials were asked to provide information
related to Alaska’s funding mechanisms for
payments, and the net State and local
expenditures that are incurred. Nor did
Alaska respond to requests for any transfers
of funds between providers and State or local
governments, and information as to whether
the providers keep 100 percent of the total
computable funds given as Medicaid
payments.
According to a flow chart provided by the
State, the Medicaid agency pays the schools
100 percent of the claimed amount. A
quarterly bill for the State match is then
submitted to school providers who transfer to
the Medicaid agency the State share of the
services provided. This transfer of funds is
made after the schools have been reimbursed
for the services they provide, and is
effectively a refund by the schools for part of
their Medicaid payments. As a result of this
refund, the net expenditure by the State
Medicaid agency is wholly federally funded.
In light of this refund arrangement, we
cannot conclude that the proposed payment
rate reflects the net expenditure by the State
for Medicaid services provided by schools,
and that the net non-Federal share meets the
requirements of section 1902(a)(2) of the Act.
Moreover, the refund is an indication that the
full payment amount is not required to
ensure Medicaid beneficiaries’ access to the
providers’ services. The result is that
proposed payments under this section of the
plan would not be in compliance with the
requirement under section 1902(a)(30)(A) of
the Act that payment rates must be consistent
with economy, efficiency, and quality of care.
Finally, the proposed SPA does not comply
with the general provisions of section
1902(a), including section 1902(a)(4) of the
Act, as implemented in part by Federal
regulations at 42 CFR section 430.10. This
regulation requires that States include in
their State plans all information necessary for
CMS to determine whether the plan can be
approved to serve as a basis for Federal
financial participation. As discussed above,
Alaska did not provide information that
would more precisely identify the covered
services or the non-Federal funding source.
Therefore the proposed SPA does not comply
with this requirement.
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17:59 Jul 20, 2006
Jkt 208001
For the reasons cited above, and after
consultation with the Secretary, as required
by Federal regulations at 42 CFR 430.15(c)(2),
Alaska SPA 05–06 was disapproved.
I am scheduling a hearing on your request
for reconsideration to be held on August 29,
2006, at the Blanchard Plaza Building, 2201
Sixth Avenue, 11th Floor Conference Room,
Seattle, WA 98121, to reconsider the decision
to disapprove SPA 05–06. If this date is not
acceptable, we would be glad to set another
date that is mutually agreeable to the parties.
The hearing will be governed by the
procedures prescribed by Federal regulations
at 42 CFR part 430.
I am designating Ms. Kathleen ScullyHayes as the presiding officer. If these
arrangements present any problems, please
contact the presiding officer at (410) 786–
2055. In order to facilitate any
communication which may be necessary
between the parties to the hearing, please
notify the presiding officer to indicate
acceptability of the hearing date that has
been scheduled, and provide names of the
individuals who will represent the State at
the hearing.
Sincerely,
Mark B. McClellan, M.D., PhD.
Section 1116 of the Social Security Act
(42 U.S.C. 1316; 42 CFR 430.18)
(Catalog of Federal Domestic Assistance
Program No. 13.714, Medicaid Assistance
Program)
Dated: July 14, 2006.
Mark B. McClellan,
Administrator.
[FR Doc. E6–11577 Filed 7–20–06; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
Privacy Act of 1974; Report of a New
System of Records
Department of Health and
Human Services (HHS), Centers for
Medicare & Medicaid Services (CMS).
ACTION: Notice of a New System of
Records (SOR).
AGENCY:
SUMMARY: In accordance with the
requirements of the Privacy Act of 1974,
we are proposing to establish a new
system titled, ‘‘Medicare Chiropractic
Coverage Demonstration and Evaluation
(MCCDE), System No. 09–70–0577.’’
The demonstration entitled, ‘‘Expansion
of Coverage of Chiropractic Services
Demonstration’’ was established under
provisions of Section 651 (d) of the
Medicare Prescription Drug,
Improvement, and Modernization Act
(MMA) of 2003 (Public Law (Pub. L.)
108–173). The MCCDE will focus on
selected beneficiaries, residing within
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the four demonstration regions or their
respective control regions, who have
Medicare chiropractic-eligible diagnoses
[i.e., neuromusculoskeletal conditions
(NMS)]. The system will contain:
Demographic information from
Medicare enrollment files; Medicare
claims data on utilization of NMSrelated Medicare services with
associated costs, for demonstration
participants and their matched, nonparticipant controls; and participant
satisfaction survey data for the subset
randomly surveyed. The MCCDE has
four goals: (1) To determine whether
eligible beneficiaries who use
chiropractic services under the
demonstration use a lesser overall
amount of items and services for which
payment is made under the Medicare
program than eligible beneficiaries who
do not use such services; (2) to
determine the cost of providing
payment for chiropractic services under
the Medicare program; (3) to further
determine whether the demonstration
achieves budget neutrality, and if not,
the amount of any cost excess to be
recouped by Medicare from the
chiropractic profession; and (4) finally,
to ascertain the satisfaction of eligible
beneficiaries participating in the
demonstration projects and their
perceived quality of care received.
The primary purpose of the system is
to collect and maintain individually
identifiable information on
beneficiaries, physicians, participating
chiropractors, and providers of service
participating in the demonstration and
evaluation program. Information
retrieved from this system may be
disclosed to: (1) Support regulatory,
reimbursement, and policy functions
performed within the agency or by a
contractor, consultant or grantee; (2)
assist another Federal or state agency
with information to contribute to the
accuracy of CMS’s proper payment of
Medicare benefits, enable such agency
to administer a Federal health benefits
program, or to enable such agency to
fulfill a requirement of Federal statute
or regulation that implements a health
benefits program funded in whole or in
part with Federal funds; (3) support an
individual or organization for a research
project or in support of an evaluation
project related to the prevention of
disease or disability, the restoration or
maintenance of health, or payment
related projects; (4) support litigation
involving the agency; and (5) combat
fraud and abuse in certain Federallyfunded health benefits programs. We
have provided background information
about the new system in the
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]]>Agencies
[Federal Register Volume 71, Number 140 (Friday, July 21, 2006)]
[Notices]
[Pages 41448-41450]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E6-11577]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of Alaska State
Plan Amendment 05-06
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of hearing.
-----------------------------------------------------------------------
SUMMARY: This notice announces an administrative hearing to be held on
August 29, 2006, at the Blanchard Plaza Building, 2201 Sixth Avenue,
11th Floor Conference Room, Seattle, WA 98121, to reconsider CMS'
decision to disapprove Alaska State plan amendment 05-06.
Closing Date: Requests to participate in the hearing as a party
must be received by the presiding officer by August 7, 2006.
FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Presiding
Officer, CMS, Lord Baltimore Drive, Mail Stop LB-23-20, Baltimore,
Maryland 21244. Telephone: (410) 786-2055.
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider CMS' decision to disapprove Alaska State plan
amendment (SPA) 05-06, which was submitted on August 1, 2005. This SPA
was disapproved on April 21, 2006. Under SPA 05-06, Alaska proposed to
add certain school-based behavioral health services under the
rehabilitation services benefit.
This amendment was disapproved because it did not comport with the
requirements of section 1902(a) of the Social Security Act (the Act)
and implementing regulations. Specifically, the following issues will
be considered on reconsideration: (1) Whether the State demonstrated
that the proposed services would be within the scope of ``medical
assistance'' under the State plan pursuant to section 1902(a)(10) of
the Act, as defined at section 1905(a) of the Act; (2) whether the
State has assured that there is non-Federal funding as required under
section 1902(a)(2) to support expenditures that would be claimed under
the State plan as the basis for Federal matching funding in light of
financial arrangements that do not appear to result in net
expenditures; (3) whether the proposed payment rates meet the
requirements of section 1902(a)(30)(A) of the Act to be consistent with
efficiency, economy, and quality of care, in light of financial
arrangements under which the providers do not retain
[[Page 41449]]
Medicaid payments; and (4) whether the State plan complied with the
requirements of section 1902(a) generally, and implementing Federal
regulations at 42 CFR 430.10, to include all information necessary to
serve as the basis for Federal financial participation. We describe
each of these issues in detail below.
Section 1902(a)(10) of the Act requires that the State plan provide
for making medical assistance available to eligible beneficiaries. The
State did not establish that the proposed ``school-based rehabilitative
services'' are within the scope of ``medical assistance,'' which is
defined in section 1905(a) of the Act. While we understand the State
has placed the proposed services under the rehabilitative services
benefit in the State plan, the State has provided no clear definition
of the proposed services so that CMS can determine whether they are,
indeed, within the scope of the rehabilitation benefit. After repeated
requests for further information, the State did not provide any
description of what elements the ``behavioral health services
(including medication services)'' encompass, and how they are different
(or the same) as services in the currently approved State plan. It is
not clear whether this is an expansion of coverage or a different
payment methodology for school providers. Absent such information, SPA
05-06 did not comply with the requirements of section 1902(a)(10) of
the Act to provide for medical assistance as defined in section 1905(a)
of the Act.
Section 1902(a)(2) of the Act provides that the State plan must
assure adequate funding for the non-Federal share of expenditures from
State or local sources for the amount, duration, scope, or quality of
care and services available under the plan. Section 1902(a)(30)(A) of
the Act requires that State plans provide for payment for care and
services available under the plan that is ``consistent with economy,
efficiency, and quality of care.'' In order to assess compliance with
these provisions, State officials were asked to provide information
related to Alaska's funding mechanisms for payments, and the net State
and local expenditures that are incurred. Nor did Alaska respond to
requests for descriptions of any transfers of funds between providers
and State or local governments, and information as to whether the
providers keep 100 percent of the total computable funds given as
Medicaid payments.
According to a flow chart provided by the State, the Medicaid
agency pays the schools 100 percent of the claimed amount. A quarterly
bill for the State match is then submitted to school providers who
transfer to the Medicaid agency the State share of the services
provided. This transfer of funds is made after the schools have been
reimbursed for the services they provide, and is effectively a refund
by the schools for part of their Medicaid payments. As a result of this
refund, the net expenditure by the State Medicaid agency is wholly
federally funded. In light of this refund arrangement, we cannot
conclude that the proposed payment rate reflects the net expenditure by
the State for Medicaid services provided by schools, and that the net
non-Federal share meets the requirements of section 1902(a)(2) of the
Act. Moreover, the refund is an indication that the full payment amount
is not required to ensure Medicaid beneficiaries' access to the
providers' services. The result is that proposed payments under this
section of the plan would not be in compliance with the requirement
under section 1902(a)(30)(A) of the Act that payment rates must be
consistent with economy, efficiency, and quality of care.
Finally, the proposed SPA does not comply with the general
provisions of section 1902(a), including section 1902(a)(4) of the Act,
as implemented in part by Federal regulations at 42 CFR 430.10. This
regulation requires that States include in their State plans all
information necessary for CMS to determine whether the plan can be
approved to serve as a basis for Federal financial participation. There
is absent information that would more precisely identify the covered
services. Therefore, the proposed SPA does not comply with this
requirement.
For the reasons cited above, and after consultation with the
Secretary, as required by Federal regulations at 42 CFR 430.15(c)(2),
Alaska SPA 05-06 was disapproved.
Section 1116 of the Act, and Federal regulations at 42 CFR part
430, establish Department procedures that provide an administrative
hearing for reconsideration of a disapproval of a State plan or plan
amendment. CMS is required to publish a copy of the notice to a State
Medicaid agency that informs the agency of the time and place of the
hearing, and the issues to be considered. If we subsequently notify the
agency of additional issues that will be considered at the hearing, we
will also publish that notice.
Any individual or group that wants to participate in the hearing as
a party must petition the presiding officer within 15 days after
publication of this notice, in accordance with the requirements
contained in Federal regulations at 42 CFR 430.76(b)(2). Any interested
person or organization that wants to participate as amicus curiae must
petition the presiding officer before the hearing begins in accordance
with the requirements contained in Federal regulations at 42 CFR
430.76(c). If the hearing is later rescheduled, the presiding officer
will notify all participants.
The notice to Alaska announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows:
Mr. Jerry Fuller, Medicaid Director, State of Alaska, Department of
Health and Social Services, Office of the Commissioner, P.O. Box
110601, Juneau, AK 99811-0601.
Dear Mr. Fuller: I am responding to your request for
reconsideration of the decision to disapprove the Alaska State plan
amendment (SPA) 05-06, which was submitted on August 1, 2005, and
disapproved on April 21, 2006. Under SPA 05-06, Alaska was proposing
to add certain school-based behavioral health services under the
rehabilitation services benefit. This amendment was disapproved
because it did not comport with the requirements of section 1902(a)
of the Social Security Act (the Act) and implementing regulations,
as discussed in more detail below.
Specifically, the following issues will be considered on
reconsideration: (1) Whether the State demonstrated that the
proposed services would be within the scope of ``medical
assistance'' under the State plan pursuant to section 1902(a)(10) of
the Act, as defined at section 1905(a) of the Act; (2) whether the
State has assured that there is non-Federal funding as required
under section 1902(a)(2) of the Act to support expenditures that
would be claimed under the State plan as the basis for Federal
matching funding in light of financial arrangements that do not
appear to result in net expenditures; (3) whether the proposed
payment rates meet the requirements of section 1902(a)(30)(A) of the
Act to be consistent with efficiency, economy, and quality of care,
in light of financial arrangements under which the providers do not
retain Medicaid payments; and (4) whether the State plan complied
with the requirements of section 1902(a) of the Act generally, and
implementing Federal regulations at 42 CFR 430.10, to include all
information necessary to serve as the basis for Federal financial
participation. We describe each of these issues in detail below.
Section 1902(a)(10) of the Act requires that the State plan
provide for making medical assistance available to eligible
beneficiaries. The State did not establish that the proposed
``school-based rehabilitative services'' are within the scope of
``medical assistance,'' which is defined in section 1905(a) of the
Act. While we understand the State has placed the proposed services
under the rehabilitative services benefit in the State plan, the
State has provided no clear definition of the proposed services so
that the Centers for Medicare & Medicaid Services (CMS) can
determine whether they are, indeed, within the scope of the
rehabilitation benefit. After repeated requests for further
information, the State provided no
[[Page 41450]]
description of what elements the ``behavioral health services
(including medication services)'' encompass, and how they are
different (or the same) as services in the currently approved State
plan. It is not clear whether this is an expansion of coverage or a
different payment methodology for school providers. Absent such
information, SPA 05-06 did not comply with the requirements of
section 1902(a)(10) of the Act to provide for medical assistance as
defined in section 1905(a) of the Act.
Section 1902(a)(2) of the Act provides that the State plan must
assure adequate funding for the non-Federal share of expenditures
from State or local sources for the amount, duration, scope, or
quality of care and services available under the plan. Section
1902(a)(30)(A) of the Act requires that State plans provide for
payment for care and services available under the plan that is
``consistent with economy, efficiency, and quality of care.'' In
order to assess compliance with these provisions, State officials
were asked to provide information related to Alaska's funding
mechanisms for payments, and the net State and local expenditures
that are incurred. Nor did Alaska respond to requests for any
transfers of funds between providers and State or local governments,
and information as to whether the providers keep 100 percent of the
total computable funds given as Medicaid payments.
According to a flow chart provided by the State, the Medicaid
agency pays the schools 100 percent of the claimed amount. A
quarterly bill for the State match is then submitted to school
providers who transfer to the Medicaid agency the State share of the
services provided. This transfer of funds is made after the schools
have been reimbursed for the services they provide, and is
effectively a refund by the schools for part of their Medicaid
payments. As a result of this refund, the net expenditure by the
State Medicaid agency is wholly federally funded. In light of this
refund arrangement, we cannot conclude that the proposed payment
rate reflects the net expenditure by the State for Medicaid services
provided by schools, and that the net non-Federal share meets the
requirements of section 1902(a)(2) of the Act. Moreover, the refund
is an indication that the full payment amount is not required to
ensure Medicaid beneficiaries' access to the providers' services.
The result is that proposed payments under this section of the plan
would not be in compliance with the requirement under section
1902(a)(30)(A) of the Act that payment rates must be consistent with
economy, efficiency, and quality of care.
Finally, the proposed SPA does not comply with the general
provisions of section 1902(a), including section 1902(a)(4) of the
Act, as implemented in part by Federal regulations at 42 CFR section
430.10. This regulation requires that States include in their State
plans all information necessary for CMS to determine whether the
plan can be approved to serve as a basis for Federal financial
participation. As discussed above, Alaska did not provide
information that would more precisely identify the covered services
or the non-Federal funding source. Therefore the proposed SPA does
not comply with this requirement.
For the reasons cited above, and after consultation with the
Secretary, as required by Federal regulations at 42 CFR
430.15(c)(2), Alaska SPA 05-06 was disapproved.
I am scheduling a hearing on your request for reconsideration to
be held on August 29, 2006, at the Blanchard Plaza Building, 2201
Sixth Avenue, 11th Floor Conference Room, Seattle, WA 98121, to
reconsider the decision to disapprove SPA 05-06. If this date is not
acceptable, we would be glad to set another date that is mutually
agreeable to the parties. The hearing will be governed by the
procedures prescribed by Federal regulations at 42 CFR part 430.
I am designating Ms. Kathleen Scully-Hayes as the presiding
officer. If these arrangements present any problems, please contact
the presiding officer at (410) 786-2055. In order to facilitate any
communication which may be necessary between the parties to the
hearing, please notify the presiding officer to indicate
acceptability of the hearing date that has been scheduled, and
provide names of the individuals who will represent the State at the
hearing.
Sincerely,
Mark B. McClellan, M.D., PhD.
Section 1116 of the Social Security Act (42 U.S.C. 1316; 42 CFR 430.18)
(Catalog of Federal Domestic Assistance Program No. 13.714, Medicaid
Assistance Program)
Dated: July 14, 2006.
Mark B. McClellan,
Administrator.
[FR Doc. E6-11577 Filed 7-20-06; 8:45 am]
BILLING CODE 4120-01-P
