Notice of Hearing: Reconsideration of Disapproval of Pennsylvania State Plan Amendment (SPA) 06-007, 55221-55222 [E7-19141]
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Federal Register / Vol. 72, No. 188 / Friday, September 28, 2007 / Notices
status, such as a change from a regular
certificate to a certificate of waiver.
jlentini on PROD1PC65 with NOTICES
Required Administrative Actions
CLIA is a user-fee funded program.
The registration fee paid by laboratories
is intended to cover the cost of the
development and administration of the
program. However, when a State’s
application for exemption is approved,
we do not charge a fee to laboratories in
the State. The State’s share of the costs
associated with CLIA must be collected
from the State, as specified in § 493.645.
The State of Washington must pay for
the following:
• Costs of Federal inspection of
laboratories in the State to verify that
Washington State’s laboratory licensure
program requirements are enforced in
an appropriate manner. The average
Federal hourly rate is multiplied by the
total hours required to perform Federal
validation surveys within the State.
• Costs incurred for Federal
investigations and surveys triggered by
complaints that are substantiated. We
will bill the State of Washington on a
semiannual basis.
• The State of Washington’s
proportionate share of the costs
associated with establishing,
maintaining, and improving the CLIA
computer system, a portion of those
services from which the State of
Washington received direct benefit or
contributed to the CLIA program in the
State. Thus, the State of Washington is
being charged for a portion of CMS’
direct and indirect costs as well as a
portion of the costs incurred by the
Centers for Disease Control and
Prevention (CDC) and the Food and
Drug Administration (FDA).
In order to estimate the State of
Washington’s proportionate share of the
general overhead costs to develop and
implement CLIA, we determined the
ratio of laboratories in the State to the
total number of laboratories nationally.
Approximately 1.5 percent of the
registered laboratories are in the State of
Washington. We determined that a
corresponding percentage of the
applicable CDC, FDA, and CMS costs
should be borne by the State of
Washington.
The State of Washington has agreed to
pay us the State’s pro rata share of the
overhead costs and anticipated costs of
actual validation and complaint
investigation surveys. A final
reconciliation for all laboratories and all
expenses will be made. We will
reimburse the State for any overpayment
or bill it for any balance.
VerDate Aug<31>2005
17:12 Sep 27, 2007
Jkt 211001
II. Approval
In light of the foregoing, CMS grants
approval of the State of Washington’s
laboratory licensure program under
Subpart E. All laboratories located in
and licensed by the State of Washington
under the Medical Test Site Licensure
Law, Chapter 70.42 of the Revised Code
of Washington, are CLIA-exempt for all
specialties and subspecialties until
September 28, 2013.
Authority: Section 353(p) of the Public
Health Service Act (42 U.S.C. 263a).
Dated: July 20, 2007.
Leslie V. Norwalk,
Acting Administrator, Centers for Medicare
& Medicaid Services.
[FR Doc. E7–18731 Filed 9–27–07; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
Notice of Hearing: Reconsideration of
Disapproval of Pennsylvania State
Plan Amendment (SPA) 06–007
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice of Hearing.
AGENCY:
SUMMARY: This notice announces an
administrative hearing to be held on
November 16, 2007, at Suite 216, The
Public Ledger Building, 150 S.
Independence Mall West, Conference
Room 241, the Pennsylvania Room,
Philadelphia, PA 19106, to reconsider
CMS’s decision to disapprove
Pennsylvania SPA 06–007.
Closing Date: Requests to participate
in the hearing as a party must be
received by the presiding officer by
October 15, 2007.
FOR FURTHER INFORMATION CONTACT:
Kathleen Scully-Hayes, Presiding
Officer, CMS, Lord Baltimore Drive,
Mail Stop LB–23–20, Baltimore, MD
21244. Telephone: (410) 786–2055
SUPPLEMENTARY INFORMATION: This
notice announces an administrative
hearing to reconsider CMS’s decision to
disapprove Pennsylvania State plan
amendment (SPA) 06–007 which was
submitted on September 27, 2006. This
SPA was disapproved on June 29, 2007.
Under this SPA, the State requested
the addition of targeted case
management services to low-income,
first-time expectant mothers who have,
or are at risk of having, a high incidence
of medical or social problems. The new
targeted case management services were
to be provided through the Nurse
PO 00000
Frm 00050
Fmt 4703
Sfmt 4703
55221
Family Partnership Program. CMS made
a Request for Additional Information on
December 22, 2006, to which the State
responded on April 2, 2007. The
information provided confirmed that the
targeted case management services
proposed in SPA 06–007 are currently
provided to all individuals without
charge.
The amendment was disapproved
because CMS found that the amendment
violated the statute for reasons set forth
in the disapproval letter. CMS consulted
with the Secretary as required by
Federal regulations at 42 CFR
430.15(c)(2).
Section 1902(a)(10) of the Social
Security Act (the Act) requires that
States make available medical assistance
which is defined at section 1905(a) of
the Act, and is limited to payment of
medical costs for ‘‘individuals whose
income and resources are insufficient to
meet all of such costs.’’ The term
‘‘medical assistance’’ fundamentally
excludes payment for medical services
that are free to the general public, since
where a service is provided without
charge the individual is not in the
circumstance of having insufficient
income or resources to meet the cost of
care. Hence, such services do not meet
the definition of ‘‘medical assistance.’’
In addition, section 1902(a)(30) of the
Act requires States to have methods and
procedures in place to assure that
payments are consistent with efficiency,
economy, and quality of care. CMS did
not find that Medicaid payments for
case management for first-time
expectant mothers were consistent with
this requirement when these same
services are available to non-Medicaid
enrollees without charge. Furthermore,
the State failed to provide
documentation requested by CMS
demonstrating that the rate methodology
used to determine payments to service
providers was consistent with section
1902(a)(30). The State also failed to
provide documentation of the various
cost elements used to determine a feeschedule amount or to submit provider
surveys conducted by the State to
determine whether its proposed indirect
cost rate should be applied to direct
costs to calculate the final fee paid to
providers.
Based on the above, and after
consultation with the Secretary of the
Department of Health and Human
Services as required under Federal
regulations at 42 CFR 430.15(c)(2), CMS
disapproved Pennsylvania Medicaid
SPA 06–007.
The issues to be decided at the
hearing are:
• Whether Pennsylvania has
demonstrated that its SPA 06–007
E:\FR\FM\28SEN1.SGM
28SEN1
55222
Federal Register / Vol. 72, No. 188 / Friday, September 28, 2007 / Notices
jlentini on PROD1PC65 with NOTICES
complies with sections 1902(a)(10) and
1902(a)(30) of the Act by limiting
payment of medical assistance to
payment of medical costs for
individuals who lack sufficient income
and resources to meet the cost of care;
and
• Whether the State has provided
adequate documentation to demonstrate
that the State’s rate methodology is
consistent with the requirements of
section 1902(a)(30) of the Act;
specifically whether the rates paid to
service providers are consistent with
efficiency, economy, and quality of care.
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 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 Pennsylvania
announcing an administrative hearing to
reconsider the disapproval of its SPA
reads as follows:
Ms. Estelle B. Richman,
Secretary of Public Welfare, Commonwealth
of Pennsylvania, Department of Public
Welfare, Office of Medical Assistance
Programs, Bureau of Policy, Budget and
Planning,
P.O. Box 8046,
Harrisburg, PA 17105.
Dear Ms. Richman:
I am responding to your request for
reconsideration of the decision to disapprove
Pennsylvania State plan amendment (SPA)
06–007, which was submitted on September
27, 2006, and disapproved on June 29, 2007.
Under this SPA, the State requested the
addition of targeted case management
services for first-time, low-income expectant
mothers who have, or are at risk of having,
a high incidence of medical or social
problems. The Centers for Medicare &
Medicaid Services (CMS) disapproved the
SPA because CMS found that it violated the
VerDate Aug<31>2005
17:12 Sep 27, 2007
Jkt 211001
statute for reasons set forth in the
disapproval letter.
The CMS made a Request for Additional
Information on December 22, 2006, to which
the State responded on April 2, 2007. The
information provided confirmed that the
targeted case management services proposed
in SPA 06–007 are currently provided to
first-time expectant mothers without charge
through State grant funding and private
funds.
Section 1902(a)(10) of the Social Security
Act (the Act) requires that States make
available medical assistance, which is
defined at section 1905(a) of the Act, and is
limited to payment of medical costs for
‘‘individuals whose income and resources are
insufficient to meet all of such costs.’’ The
term ‘‘medical assistance’’ fundamentally
excludes payment for medical services that
are free to the general public, since where a
service is provided without charge the
individual is not in the circumstance of
having insufficient income or resources to
meet the cost of care. Hence, such services
do not meet the definition of ‘‘medical
assistance.’’
In addition, section 1902(a)(30) of the Act
requires States to have methods and
procedures in place to assure that payments
are consistent with efficiency, economy, and
quality of care. CMS did not find that
Medicaid payments for case management for
first-time expectant mothers were consistent
with this requirement when these same
services are available to non-Medicaid
enrollees without charge. Furthermore, the
State failed to provide documentation
requested by CMS demonstrating that the rate
methodology used to determine payments to
service providers was consistent with section
1902(a)(30). The State failed to provide
documentation of the various cost elements
used to determine a fee-schedule amount or
to submit provider surveys conducted by the
State to determine whether its proposed
indirect cost rate should be applied to direct
costs to calculate the final fee paid to
providers.
Based on the above, and after consultation
with the Secretary of the Department of
Health and Human Services as required
under Federal regulations at 42 CFR
430.15(c)(2), CMS disapproved Pennsylvania
Medicaid SPA 06–007.
The issues to be decided at the hearing are
• Whether Pennsylvania has demonstrated
that its SPA 06–007 complies with sections
1902(a)(10) and 1902(a)(30) of the Act by
limiting payment of medical assistance to
payment of medical costs for individuals
who lack sufficient income and resources to
meet the cost of care; and
• Whether the State has provided adequate
documentation to demonstrate that the
State’s rate methodology is consistent with
the requirements of section 1902(a)(30) of the
Act; specifically whether the rates paid to
service providers are consistent with
efficiency, economy, and quality of care.
I am scheduling a hearing on your request
for reconsideration to be held on November
16, 2007, at Suite 216, The Public Ledger
Building, 150 S. Independence Mall West,
Conference Room 241, the Pennsylvania
Room, Philadelphia, PA 19106, to reconsider
PO 00000
Frm 00051
Fmt 4703
Sfmt 4703
the decision to disapprove SPA 06–007. 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,
Kerry Weems,
Acting Administrator.
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.)
Kerry Weems,
Acting Administrator, Centers for Medicare
& Medicaid Services.
[FR Doc. E7–19141 Filed 9–27–07; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare and Medicaid
Services
[CMS–3186–PN]
Medicare and Medicaid Programs;
Application by the Indian Health
Service (IHS) for Continued
Recognition as a National
Accreditation Organization for
Accrediting American Indian and
Alaska Native Entities To Furnish
Outpatient Diabetes Self-Management
Training
Centers for Medicare and
Medicaid Services, HHS.
ACTION: Proposed notice.
AGENCY:
SUMMARY: This proposed notice
announces the receipt of an application
from the Indian Health Service for
continued recognition as a national
accreditation organization for
accrediting American Indian and Alaska
Native entities that wish to furnish
outpatient diabetes self-management
training to Medicare beneficiaries. This
notice also announces a 30-day public
comment period.
DATES: To be assured consideration,
comments must be received at one of
the addresses provided below, no later
than 5 p.m. October 29, 2007.
E:\FR\FM\28SEN1.SGM
28SEN1
]]>Agencies
[Federal Register Volume 72, Number 188 (Friday, September 28, 2007)]
[Notices]
[Pages 55221-55222]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-19141]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of Pennsylvania
State Plan Amendment (SPA) 06-007
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of Hearing.
-----------------------------------------------------------------------
SUMMARY: This notice announces an administrative hearing to be held on
November 16, 2007, at Suite 216, The Public Ledger Building, 150 S.
Independence Mall West, Conference Room 241, the Pennsylvania Room,
Philadelphia, PA 19106, to reconsider CMS's decision to disapprove
Pennsylvania SPA 06-007.
Closing Date: Requests to participate in the hearing as a party
must be received by the presiding officer by October 15, 2007.
FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Presiding
Officer, CMS, Lord Baltimore Drive, Mail Stop LB-23-20, Baltimore, MD
21244. Telephone: (410) 786-2055
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider CMS's decision to disapprove Pennsylvania State
plan amendment (SPA) 06-007 which was submitted on September 27, 2006.
This SPA was disapproved on June 29, 2007.
Under this SPA, the State requested the addition of targeted case
management services to low-income, first-time expectant mothers who
have, or are at risk of having, a high incidence of medical or social
problems. The new targeted case management services were to be provided
through the Nurse Family Partnership Program. CMS made a Request for
Additional Information on December 22, 2006, to which the State
responded on April 2, 2007. The information provided confirmed that the
targeted case management services proposed in SPA 06-007 are currently
provided to all individuals without charge.
The amendment was disapproved because CMS found that the amendment
violated the statute for reasons set forth in the disapproval letter.
CMS consulted with the Secretary as required by Federal regulations at
42 CFR 430.15(c)(2).
Section 1902(a)(10) of the Social Security Act (the Act) requires
that States make available medical assistance which is defined at
section 1905(a) of the Act, and is limited to payment of medical costs
for ``individuals whose income and resources are insufficient to meet
all of such costs.'' The term ``medical assistance'' fundamentally
excludes payment for medical services that are free to the general
public, since where a service is provided without charge the individual
is not in the circumstance of having insufficient income or resources
to meet the cost of care. Hence, such services do not meet the
definition of ``medical assistance.''
In addition, section 1902(a)(30) of the Act requires States to have
methods and procedures in place to assure that payments are consistent
with efficiency, economy, and quality of care. CMS did not find that
Medicaid payments for case management for first-time expectant mothers
were consistent with this requirement when these same services are
available to non-Medicaid enrollees without charge. Furthermore, the
State failed to provide documentation requested by CMS demonstrating
that the rate methodology used to determine payments to service
providers was consistent with section 1902(a)(30). The State also
failed to provide documentation of the various cost elements used to
determine a fee-schedule amount or to submit provider surveys conducted
by the State to determine whether its proposed indirect cost rate
should be applied to direct costs to calculate the final fee paid to
providers.
Based on the above, and after consultation with the Secretary of
the Department of Health and Human Services as required under Federal
regulations at 42 CFR 430.15(c)(2), CMS disapproved Pennsylvania
Medicaid SPA 06-007.
The issues to be decided at the hearing are:
Whether Pennsylvania has demonstrated that its SPA 06-007
[[Page 55222]]
complies with sections 1902(a)(10) and 1902(a)(30) of the Act by
limiting payment of medical assistance to payment of medical costs for
individuals who lack sufficient income and resources to meet the cost
of care; and
Whether the State has provided adequate documentation to
demonstrate that the State's rate methodology is consistent with the
requirements of section 1902(a)(30) of the Act; specifically whether
the rates paid to service providers are consistent with efficiency,
economy, and quality of care.
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 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 Pennsylvania announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows:
Ms. Estelle B. Richman,
Secretary of Public Welfare, Commonwealth of Pennsylvania,
Department of Public Welfare, Office of Medical Assistance Programs,
Bureau of Policy, Budget and Planning,
P.O. Box 8046,
Harrisburg, PA 17105.
Dear Ms. Richman:
I am responding to your request for reconsideration of the
decision to disapprove Pennsylvania State plan amendment (SPA) 06-
007, which was submitted on September 27, 2006, and disapproved on
June 29, 2007.
Under this SPA, the State requested the addition of targeted
case management services for first-time, low-income expectant
mothers who have, or are at risk of having, a high incidence of
medical or social problems. The Centers for Medicare & Medicaid
Services (CMS) disapproved the SPA because CMS found that it
violated the statute for reasons set forth in the disapproval
letter.
The CMS made a Request for Additional Information on December
22, 2006, to which the State responded on April 2, 2007. The
information provided confirmed that the targeted case management
services proposed in SPA 06-007 are currently provided to first-time
expectant mothers without charge through State grant funding and
private funds.
Section 1902(a)(10) of the Social Security Act (the Act)
requires that States make available medical assistance, which is
defined at section 1905(a) of the Act, and is limited to payment of
medical costs for ``individuals whose income and resources are
insufficient to meet all of such costs.'' The term ``medical
assistance'' fundamentally excludes payment for medical services
that are free to the general public, since where a service is
provided without charge the individual is not in the circumstance of
having insufficient income or resources to meet the cost of care.
Hence, such services do not meet the definition of ``medical
assistance.''
In addition, section 1902(a)(30) of the Act requires States to
have methods and procedures in place to assure that payments are
consistent with efficiency, economy, and quality of care. CMS did
not find that Medicaid payments for case management for first-time
expectant mothers were consistent with this requirement when these
same services are available to non-Medicaid enrollees without
charge. Furthermore, the State failed to provide documentation
requested by CMS demonstrating that the rate methodology used to
determine payments to service providers was consistent with section
1902(a)(30). The State failed to provide documentation of the
various cost elements used to determine a fee-schedule amount or to
submit provider surveys conducted by the State to determine whether
its proposed indirect cost rate should be applied to direct costs to
calculate the final fee paid to providers.
Based on the above, and after consultation with the Secretary of
the Department of Health and Human Services as required under
Federal regulations at 42 CFR 430.15(c)(2), CMS disapproved
Pennsylvania Medicaid SPA 06-007.
The issues to be decided at the hearing are
Whether Pennsylvania has demonstrated that its SPA 06-
007 complies with sections 1902(a)(10) and 1902(a)(30) of the Act by
limiting payment of medical assistance to payment of medical costs
for individuals who lack sufficient income and resources to meet the
cost of care; and
Whether the State has provided adequate documentation
to demonstrate that the State's rate methodology is consistent with
the requirements of section 1902(a)(30) of the Act; specifically
whether the rates paid to service providers are consistent with
efficiency, economy, and quality of care.
I am scheduling a hearing on your request for reconsideration to
be held on November 16, 2007, at Suite 216, The Public Ledger
Building, 150 S. Independence Mall West, Conference Room 241, the
Pennsylvania Room, Philadelphia, PA 19106, to reconsider the
decision to disapprove SPA 06-007. 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,
Kerry Weems,
Acting Administrator.
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.)
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E7-19141 Filed 9-27-07; 8:45 am]
BILLING CODE 4120-01-P
