Notice of Hearing: Reconsideration of Disapproval of Minnesota State Plan Amendment 05-10, 16793-16794 [E7-6312]
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Federal Register / Vol. 72, No. 65 / Thursday, April 5, 2007 / Notices
Dated: March 29, 2007.
Joan F. Karr,
Acting Reports Clearance Officer, Centers for
Disease Control and Prevention.
[FR Doc. E7–6344 Filed 4–4–07; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
Notice of Hearing: Reconsideration of
Disapproval of Minnesota State Plan
Amendment 05–10
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice of hearing.
jlentini on PROD1PC65 with NOTICES
AGENCY:
SUMMARY: This notice announces an
administrative hearing to be held on
May 30, 2007, at 233 N. Michigan
Avenue, Suite 600, the Indiana Room,
Chicago, IL 60601, to reconsider CMS’
decision to disapprove Minnesota State
plan amendment 05–10.
CLOSING DATE: Requests to participate in
the hearing as a party must be received
by the presiding officer by (15 days after
publication).
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 Minnesota State plan
amendment (SPA) 05–10 which was
submitted on September 21, 2005. This
SPA was disapproved on December 29,
2006.
Under this SPA, the State proposed to
revise coverage and reimbursement
methodology for Early and Periodic
Screening, Diagnosis, and Treatment
services related to children’s mental
health rehabilitative services and
rehabilitative services pursuant to an
Individualized Education Plan or
Individual Family Service Plan.
The amendment was disapproved
because CMS found that the amendment
violated the statute for reasons set forth
in the disapproval letter.
The issues to be decided at the
hearing are:
• Whether the per diem (bundled)
payment methodologies for mental
health rehabilitative services described
in Minnesota’s SPA 05–10 accurately
reflect true costs or reasonable fees for
the services included in the bundles;
VerDate Aug<31>2005
17:37 Apr 04, 2007
Jkt 211001
• Whether the amount or scope of
services reimbursed through the
bundled rate is sufficiently constant so
that the proposed methodologies would
be an economic and efficient method of
payment;
• Whether all of the component parts
of the service are delivered as
recommended within the scope of
practice of the physician or licensed
practitioner of the healing arts;
• Whether the actual practitioners
who will be furnishing services can be
readily identified; and
• Whether the bundled rates provide
for direct payment to the actual
practitioners who provide the service.
Section 1116 of the Social Security
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 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 at 42 CFR
430.76(c). If the hearing is later
rescheduled, the presiding officer will
notify all participants.
The Notice to Minnesota Announcing
an Administrative Hearing To
Reconsider the Disapproval of Its SPA
Reads as Follows
Ms. Christine Bronson,
Medicaid Director,
Minnesota Department of Human Services,
P.O. Box 64998,
St. Paul, MN 55164–0998
Dear Ms. Bronson: I am responding to your
request for reconsideration of the decision to
disapprove the Minnesota State plan
amendment (SPA) 05–10, which was
submitted on September 21, 2005, and
disapproved on December 29, 2006.
Under this SPA, the State proposed to
revise coverage and reimbursement
methodology for Early and Periodic
Screening, Diagnosis, and Treatment services
related to children’s mental health
rehabilitative services and rehabilitative
services pursuant to an Individualized
PO 00000
Frm 00032
Fmt 4703
Sfmt 4703
16793
Education Plan or Individual Family Service
Plan. The Centers for Medicare & Medicaid
Services (CMS) disapproved the SPA because
the State did not document that its proposed
reimbursement methodology meets the
conditions specified in sections 1902(a)(10),
1902(a)(30), and 1902(a)(32) of the Social
Security Act (the Act).
At issue in this reconsideration is whether
Minnesota has demonstrated that the
bundled rate methodology proposed in SPA
05–10 is consistent with the requirements of
section 1902(a)(30)(A) of the Act, which
requires that States have methods and
procedures to assure that payments to
providers are consistent with efficiency,
economy, and quality of care. A second issue
is whether the State has shown that the
payment methodology is for care and services
that are within the scope, and meet the
requirements, of section 1902(a)(10)(A) to
make available ‘‘medical assistance,’’ which
is defined at section 1905(a) and
implementing requirements. Also at issue is
whether the proposed payment methodology
complies with the direct payment
requirements of section 1902(a)(32) of the
Act, which precludes payment to anyone
other than the individual, person, or
institution providing the care and service
(with specified exceptions). We discuss each
of these issues in more detail below in
relation to SPA 05–10.
Section 1902(a)(30)(A) of the Act requires
that States have methods and procedures to
assure that payments to providers are
consistent with efficiency, economy, and
quality of care. The per diem payment
methodologies for mental health
rehabilitative services described in SPA 05–
10 represent bundled payment
methodologies under which the State pays a
single rate for one or more of a group of
different services furnished to an eligible
individual during a fixed period of time. The
State has failed to demonstrate that its
methodologies are in compliance with
section 1902(a)(30)(A), in that it has not
shown: that these methodologies accurately
reflect true costs or reasonable fees for the
services included in the bundles; and that the
amount or scope of services reimbursed
through the bundled rate is sufficiently
constant so that the proposed methodologies
would be an economic and efficient method
of payment.
Section 1902(a)(10)(A) requires that State
plans make available medical assistance,
which is defined at section 1905(a) and in
implementing regulations. For a number of
categories of medical assistance, there are
provider standards applicable to different
types of care and services, and for
rehabilitative services there is a requirement
that rehabilitative services must be
recommended by a physician or other
licensed practitioner of the healing arts.
Minnesota did not provide evidence of a
method to identify that providers of the
component parts of the care and services
would meet all applicable provider
requirements. Nor did Minnesota
demonstrate a method to ensure that all of
the component parts of the care and services
furnished under the bundled payment
methodology proposed in SPA 05–10, would
E:\FR\FM\05APN1.SGM
05APN1
16794
Federal Register / Vol. 72, No. 65 / Thursday, April 5, 2007 / Notices
be delivered as recommended within the
scope of practice of the physician or licensed
practitioner of the healing arts.
Furthermore, the information provided by
the State did not demonstrate compliance
with section 1902(a)(32) of the Act, requiring
direct payment to the provider of care or
services. Under the State’s bundled payment
methodology, the entities which would
receive the proposed bundled rates for
mental health rehabilitation services are not
themselves providers of the service; they are
not billing agents for such providers; nor are
they recognized types of health care
providers under Federal law. The underlying
services represent different types of
individual services that are furnished by
individual practitioners. The State has failed
to show that the proposed payment
methodology is within one of the statutory
exceptions as implemented by Federal
regulations at 42 CFR 447.10. Indeed, the
State has not shown that, under its proposed
payment methodology, the actual
practitioners furnishing services can even be
readily identified. Thus, the State has not
demonstrated that the use of bundled rates
will comply with the requirement for direct
payment to the actual practitioners who
provide care or service.
I am scheduling a hearing on your request
for reconsideration to be held on May 30,
2007, at 233 N. Michigan Avenue, Suite 600,
the Indiana Room, 5th Floor, Chicago, IL,
60601, to reconsider the decision to
disapprove SPA 05–10. 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,
Leslie V. Norwalk, Esq.,
Acting Administrator.
Section 1116 of the Social Security
Act (42 U.S.C. section 1316); (42 CFR
section 430.18).
jlentini on PROD1PC65 with NOTICES
(Catalog of Federal Domestic Assistance
program No. 13.714, Medicaid Assistance
Program)
Dated: March 30, 2007.
Leslie V. Norwalk,
Acting Administrator, Centers for Medicare
& Medicaid Services.
[FR Doc. E7–6312 Filed 4–4–07; 8:45 am]
BILLING CODE 4120–01–P
VerDate Aug<31>2005
17:37 Apr 04, 2007
Jkt 211001
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–1270–RCN]
RIN 0938–AN14
Medicare Program; Competitive
Acquisition for Certain Durable
Medical Equipment, Prosthetics,
Orthotics, and Supplies; Extension of
Timeline for Publication of Final Rule
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Extension of timeline for
publication of final rule.
AGENCY:
SUMMARY: This notice announces an
extension of the timeline for publication
of a Medicare final rule in accordance
with section 1871(a)(3)(B) of the Social
Security Act, which allows us to extend
the timeline for publication of the final
rule.
EFFECTIVE DATE: This notice is effective
on March 30, 2007.
FURTHER INFORMATION CONTACT: Ralph
Goldberg, (410) 786–4870.
SUPPLEMENTARY INFORMATION: In the May
1, 2006 Federal Register (71 FR 25654),
we published a proposed rule that
would have implemented competitive
bidding programs for certain covered
items of durable medical equipment,
prosthetics, orthotics, and supplies
(DMEPOS) throughout the United States
in accordance with sections 1847(a) and
(b) of the Social Security Act (the Act).
These programs would change the way
that Medicare pays for these items
under Part B of the Medicare program
by utilizing bids submitted by DMEPOS
suppliers to establish applicable
payment amounts.
Section 1871(a)(3)(A) of the Act
requires us to establish and publish a
regular timeline for the publication of
final regulations based on the previous
publication of a proposed regulation. In
accordance with section 1871(a)(3)(B) of
the Act, the timeline may vary among
different regulations based on
differences in the complexity of the
regulation, the number and scope of
comments received, and other relevant
factors, but may not be longer than 3
years except under exceptional
circumstances. In addition, in
accordance with section 1871(a)(3)(B) of
the Act, the Secretary may extend the
initial targeted publication date of the
final regulation, if the Secretary, no later
than the regulation’s previously
established proposed publication date,
causes to have published a notice with
the new target date, and such notice
PO 00000
Frm 00033
Fmt 4703
Sfmt 4703
includes a brief explanation of the
justification for the variation.
We announced in the December 2006
Unified Agenda (December 11, 2006, 71
FR 72734) that we would issue the final
rule in March 2007. However, we are
not able to meet the announced
publication target date due to the
number of extensive comments received
on the proposed rule and interagency
coordination. We received over 2,000
timely comments on the proposed rule.
The commenters presented extremely
complex policy and legal issues, which
require extensive consultation and
analysis.
This final rule also is extremely
complex because it will establish an
entirely new program that will affect the
DMEPOS industry as well as Medicare
beneficiaries who use DMEPOS. This
final rule will establish a new concept
for Medicare payment for DMEPOS,
which necessitates the development of
new regulations and a competitive
bidding process in addition to extensive
payment system changes.
This notice extends the timeline for
publication of the final rule until April
30, 2007.
Authority: Section 1871 of the Social
Security Act (42 U.S.C. 201395hh).
(Catalog of Federal Domestic Assistance
Program No. 093.774, Medicare—
Supplementary Medical Insurance Program)
Dated: March 30, 2007.
Ann Agnew,
Executive Secretary to the Department.
[FR Doc. 07–1658 Filed 3–30–07; 4:01 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Public Education Study on Public
Knowledge of Abstinence and
Abstinence Education
OMB No.: New Collection.
Description: In support of the goal to
prevent unwed childbearing, pregnancy,
and sexually transmitted diseases,
Congress has recently authorized
funding increases to support abstinence
education.
To learn more about the public’s
views, the Administration for Children
and Families (ACF) will conduct a
public opinion survey of a nationally
representative sample of adolescents
(age 12 to 18) and their parents to
examine current attitudes on abstinence
and knowledge of abstinence education.
The survey data will be used to inform
current and future public education
E:\FR\FM\05APN1.SGM
05APN1
]]>Agencies
[Federal Register Volume 72, Number 65 (Thursday, April 5, 2007)]
[Notices]
[Pages 16793-16794]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-6312]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of Minnesota
State Plan Amendment 05-10
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of hearing.
-----------------------------------------------------------------------
SUMMARY: This notice announces an administrative hearing to be held on
May 30, 2007, at 233 N. Michigan Avenue, Suite 600, the Indiana Room,
Chicago, IL 60601, to reconsider CMS' decision to disapprove Minnesota
State plan amendment 05-10.
Closing Date: Requests to participate in the hearing as a party must be
received by the presiding officer by (15 days after publication).
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 Minnesota State plan
amendment (SPA) 05-10 which was submitted on September 21, 2005. This
SPA was disapproved on December 29, 2006.
Under this SPA, the State proposed to revise coverage and
reimbursement methodology for Early and Periodic Screening, Diagnosis,
and Treatment services related to children's mental health
rehabilitative services and rehabilitative services pursuant to an
Individualized Education Plan or Individual Family Service Plan.
The amendment was disapproved because CMS found that the amendment
violated the statute for reasons set forth in the disapproval letter.
The issues to be decided at the hearing are:
Whether the per diem (bundled) payment methodologies for
mental health rehabilitative services described in Minnesota's SPA 05-
10 accurately reflect true costs or reasonable fees for the services
included in the bundles;
Whether the amount or scope of services reimbursed through
the bundled rate is sufficiently constant so that the proposed
methodologies would be an economic and efficient method of payment;
Whether all of the component parts of the service are
delivered as recommended within the scope of practice of the physician
or licensed practitioner of the healing arts;
Whether the actual practitioners who will be furnishing
services can be readily identified; and
Whether the bundled rates provide for direct payment to
the actual practitioners who provide the service.
Section 1116 of the Social Security 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 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 at 42 CFR 430.76(c). If the hearing is later rescheduled, the
presiding officer will notify all participants.
The Notice to Minnesota Announcing an Administrative Hearing To
Reconsider the Disapproval of Its SPA Reads as Follows
Ms. Christine Bronson,
Medicaid Director,
Minnesota Department of Human Services,
P.O. Box 64998,
St. Paul, MN 55164-0998
Dear Ms. Bronson: I am responding to your request for
reconsideration of the decision to disapprove the Minnesota State
plan amendment (SPA) 05-10, which was submitted on September 21,
2005, and disapproved on December 29, 2006.
Under this SPA, the State proposed to revise coverage and
reimbursement methodology for Early and Periodic Screening,
Diagnosis, and Treatment services related to children's mental
health rehabilitative services and rehabilitative services pursuant
to an Individualized Education Plan or Individual Family Service
Plan. The Centers for Medicare & Medicaid Services (CMS) disapproved
the SPA because the State did not document that its proposed
reimbursement methodology meets the conditions specified in sections
1902(a)(10), 1902(a)(30), and 1902(a)(32) of the Social Security Act
(the Act).
At issue in this reconsideration is whether Minnesota has
demonstrated that the bundled rate methodology proposed in SPA 05-10
is consistent with the requirements of section 1902(a)(30)(A) of the
Act, which requires that States have methods and procedures to
assure that payments to providers are consistent with efficiency,
economy, and quality of care. A second issue is whether the State
has shown that the payment methodology is for care and services that
are within the scope, and meet the requirements, of section
1902(a)(10)(A) to make available ``medical assistance,'' which is
defined at section 1905(a) and implementing requirements. Also at
issue is whether the proposed payment methodology complies with the
direct payment requirements of section 1902(a)(32) of the Act, which
precludes payment to anyone other than the individual, person, or
institution providing the care and service (with specified
exceptions). We discuss each of these issues in more detail below in
relation to SPA 05-10.
Section 1902(a)(30)(A) of the Act requires that States have
methods and procedures to assure that payments to providers are
consistent with efficiency, economy, and quality of care. The per
diem payment methodologies for mental health rehabilitative services
described in SPA 05-10 represent bundled payment methodologies under
which the State pays a single rate for one or more of a group of
different services furnished to an eligible individual during a
fixed period of time. The State has failed to demonstrate that its
methodologies are in compliance with section 1902(a)(30)(A), in that
it has not shown: that these methodologies accurately reflect true
costs or reasonable fees for the services included in the bundles;
and that the amount or scope of services reimbursed through the
bundled rate is sufficiently constant so that the proposed
methodologies would be an economic and efficient method of payment.
Section 1902(a)(10)(A) requires that State plans make available
medical assistance, which is defined at section 1905(a) and in
implementing regulations. For a number of categories of medical
assistance, there are provider standards applicable to different
types of care and services, and for rehabilitative services there is
a requirement that rehabilitative services must be recommended by a
physician or other licensed practitioner of the healing arts.
Minnesota did not provide evidence of a method to identify that
providers of the component parts of the care and services would meet
all applicable provider requirements. Nor did Minnesota demonstrate
a method to ensure that all of the component parts of the care and
services furnished under the bundled payment methodology proposed in
SPA 05-10, would
[[Page 16794]]
be delivered as recommended within the scope of practice of the
physician or licensed practitioner of the healing arts.
Furthermore, the information provided by the State did not
demonstrate compliance with section 1902(a)(32) of the Act,
requiring direct payment to the provider of care or services. Under
the State's bundled payment methodology, the entities which would
receive the proposed bundled rates for mental health rehabilitation
services are not themselves providers of the service; they are not
billing agents for such providers; nor are they recognized types of
health care providers under Federal law. The underlying services
represent different types of individual services that are furnished
by individual practitioners. The State has failed to show that the
proposed payment methodology is within one of the statutory
exceptions as implemented by Federal regulations at 42 CFR 447.10.
Indeed, the State has not shown that, under its proposed payment
methodology, the actual practitioners furnishing services can even
be readily identified. Thus, the State has not demonstrated that the
use of bundled rates will comply with the requirement for direct
payment to the actual practitioners who provide care or service.
I am scheduling a hearing on your request for reconsideration to
be held on May 30, 2007, at 233 N. Michigan Avenue, Suite 600, the
Indiana Room, 5th Floor, Chicago, IL, 60601, to reconsider the
decision to disapprove SPA 05-10. 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,
Leslie V. Norwalk, Esq.,
Acting Administrator.
Section 1116 of the Social Security Act (42 U.S.C. section 1316);
(42 CFR section 430.18).
(Catalog of Federal Domestic Assistance program No. 13.714, Medicaid
Assistance Program)
Dated: March 30, 2007.
Leslie V. Norwalk,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E7-6312 Filed 4-4-07; 8:45 am]
BILLING CODE 4120-01-P
