Medicaid Program; State Flexibility for Medicaid Benefit Packages, 15221-15222 [E9-7505]
Download as PDF
Federal Register / Vol. 74, No. 63 / Friday, April 3, 2009 / Rules and Regulations
(66) * * *
(i) * * *
(A) * * *
(4) Nevada Revised Statutes (NRS)
(2003), chapter 445B, section 445B.310
(‘‘Limitations on enforcement of federal
and state regulations concerning
indirect sources’’).
*
*
*
*
*
[FR Doc. E9–7428 Filed 4–2–09; 8:45 am]
BILLING CODE 6560–50–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 440
[CMS–2232–F2]
RIN 0938–AP72
Medicaid Program; State Flexibility for
Medicaid Benefit Packages
tjames on PRODPC75 with RULES
AGENCY: Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final rule; delay of effective
date and reopening of comment period.
SUMMARY: This action temporarily
delays the effective date of the
December 3, 2008 final rule entitled,
‘‘Medicaid Program: State Flexibility for
Medicaid Benefit Packages’’ (73 FR
73694) until December 31, 2009. In
addition, this action reopens the
comment period on the policies set out
in the December 3, 2008 final rule, and
specifically solicits comments on the
effect of certain provisions of the
Children’s Health Insurance Program
Reauthorization Act of 2009.
DATES: Effective Date: This action is
effective April 2, 2009. The effective
date of the rule amending 42 CFR part
440 published in the December 3, 2008,
Federal Register (73 FR 73694), delayed
February 2, 2009 (74 FR 5808), is further
delayed until December 31, 2009.
Comment Period: To be assured
consideration, comments must be
received at one of the addresses
provided below, no later than 5 p.m. on
May 4, 2009.
ADDRESSES: In commenting, please refer
to file code CMS–2232–F2. Because of
staff and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.
You may submit comments in one of
four ways (please choose only one of the
ways listed):
1. Electronically. You may submit
electronic comments on this regulation
to https://www.regulations.gov. Follow
VerDate Nov<24>2008
14:15 Apr 02, 2009
Jkt 217001
the instructions for ‘‘Comment or
Submission’’ and enter the file code to
find the document accepting comments.
2. By regular mail. You may mail
written comments (one original and two
copies) to the following address ONLY:
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, Attention: CMS–2232–
F2, P.O. Box 8016, Baltimore, MD
21244–8016.
Please allow sufficient time for mailed
comments to be received before the
close of the comment period.
3. By express or overnight mail. You
may send written comments (one
original and two copies) to the following
address ONLY: Centers for Medicare &
Medicaid Services, Department of
Health and Human Services, Attention:
CMS–2232–F2, Mail Stop C4–26–05,
7500 Security Boulevard, Baltimore, MD
21244–8010.
4. By hand or courier. If you prefer,
you may deliver (by hand or courier)
your written comments (one original
and two copies) before the close of the
comment period to either of the
following addresses: a. Room 445–G,
Hubert H. Humphrey Building, 200
Independence Avenue, SW.,
Washington, DC 20201.
(Because access to the interior of the
HHH Building is not readily available to
persons without Federal Government
identification, commenters are
encouraged to leave their comments in
the CMS drop slots located in the main
lobby of the building. A stamp-in clock
is available for persons wishing to retain
a proof of filing by stamping in and
retaining an extra copy of the comments
being filed.) b. 7500 Security Boulevard,
Baltimore, MD 21244–1850.
If you intend to deliver your
comments to the Baltimore address,
please call telephone number (410) 786–
7195 in advance to schedule your
arrival with one of our staff members.
Comments mailed to the addresses
indicated as appropriate for hand or
courier delivery may be delayed and
received after the comment period.
FOR FURTHER INFORMATION CONTACT:
Christine Gerhardt, (410) 786–0693.
SUPPLEMENTARY INFORMATION:
I. Background
A. Regulatory History
On December 3, 2008, we published
a final rule in the Federal Register
entitled ‘‘Medicaid Program; State
Flexibility for Medicaid Benefit’’ (73 FR
73694). The December 2008 final rule
implements provisions of section 6044
of the Deficit Reduction Act (DRA) of
2005, (Pub. L. 109–171), enacted on
February 8, 2006, which amends the
PO 00000
Frm 00007
Fmt 4700
Sfmt 4700
15221
Social Security Act by adding a new
section 1937 related to the coverage of
medical assistance under approved
State plans. The final rule also provides
States increased flexibility under an
approved State plan to define the scope
of covered medical assistance by
offering coverage of benchmark or
benchmark-equivalent benefit packages
to certain Medicaid recipients. In
addition, the final rule responds to
public comments on the February 22,
2008, proposed rule that pertain to the
State Medicaid benefit package
provisions.
Subsequent to the publication of the
December 3, 2008 final rule, in
accordance with the memorandum of
January 20, 2009 from the Assistant to
the President and the Chief of Staff,
entitled ‘‘Regulatory Review,’’ we
published an interim final rule with
comment period in the Federal Register
to temporarily delay for 60 days the
effective date of the December 3, 2008
final rule entitled, ‘‘Medicaid Program;
State Flexibility for Medicaid Benefit
Packages’’ (February 2, 2009, 74 FR
5808). The interim final rule also
reopened the comment period on the
policies set out in the December 3, 2008
final rule. We received nine public
comments in response to the February 2,
2009 interim final rule.
B. New Legislation
On February 4, 2009, the Children’s
Health Insurance Program
Reauthorization Act (CHIPRA) of 2009
(Pub. L. 111–3) was enacted. Certain
provisions of the CHIPRA affect current
regulations regarding State Flexibility
for Medicaid Benefit Packages,
including the December 3, 2008 final
rule. Specifically, section 611(a)(1)(C)
and section 611(a)(3) of CHIPRA
amends section 1937 of the Act, to
require States to assure that children
under the age of 21, rather than those
under 19 as specified in the DRA of
2005, who are included in benchmark or
benchmark-equivalent plans, have
access to the Early Periodic Screening,
Diagnosis, and Treatment (EPSDT)
services. EPSDT services may be
provided through a benchmark or
benchmark-equivalent plan or as a
wrap-around benefit to those plans.
Section 611(a)(1)(A)(i) of CHIPRA
amends section 1937 of the Act by
changing the language
‘‘Notwithstanding any other provision
of this title * * *’’ to read
‘‘Notwithstanding section 1902(a)(1)
(relating to statewideness), section
1902(a)(10)(B) (relating to
comparability), and any other provision
of this title which would be directly
contrary to the authority * * *’’
E:\FR\FM\03APR1.SGM
03APR1
15222
Federal Register / Vol. 74, No. 63 / Friday, April 3, 2009 / Rules and Regulations
II. Provisions of the Final Rule
This action delays the effective date of
the December 3, 2008 final rule. The
effective date of that rule, which would
have been February 2, 2009, was
delayed until April 3, 2009 (74 FR 5808)
and is now delayed until December 31,
2009. Upon review and consideration of
the new provisions of CHIPRA and the
public comments we received during
the reopened comment period, we
believe that it may be necessary to
revise a substantial portion of the
December 3, 2008 final rule. Therefore,
to inform future rulemaking on this
issue, we are delaying the effective date
a second time to give the public an
additional opportunity to submit
additional comments on the policy set
forth in the December 3, 2008 final rule
as well as the provisions of CHIPRA,
discussed above. We anticipate that this
time period will allow sufficient time
for CMS to consider such comments and
develop appropriate revisions to the
delayed rule.
tjames on PRODPC75 with RULES
IV. Waiver of Proposed Rulemaking
and Delay in Effective Date
14:15 Apr 02, 2009
Jkt 217001
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program)
Dated: March 25, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare
& Medicaid Services.
Approved: March 30, 2009.
Charles E. Johnson,
Acting Secretary.
[FR Doc. E9–7505 Filed 4–2–09; 8:45 am]
BILLING CODE 4120–01–P
We ordinarily publish a notice of
proposed rulemaking in the Federal
Register to provide a period for public
comment before the provisions of a
notice such as this take effect, in
accordance with section 553(b) of the
Administrative Procedure Act (APA) (5
U.S.C. 553(b)). We also ordinarily
provide a 30-day delay in the effective
date of the provisions of a notice in
accordance with section 553(d) of the
APA (5 U.S.C. 553(d)). However, we can
waive both the notice and comment
procedure and the 30-day delay in
effective date if the Secretary finds, for
good cause, that it is impracticable,
unnecessary or contrary to the public
interest to follow the notice and
comment procedure or to comply with
the 30-day delay in the effective date,
and incorporates a statement of the
finding and the reasons in the notice.
This final rule delays the effective
date of the December 3, 2008 final rule
that was promulgated through notice
and comment rulemaking, and does not
make substantive changes to that final
rule. Delay in the effective date and
reopening of the comment period is
necessary to ensure that the final rule,
when effective, fully takes into account
public comments, and conforms to
recently enacted legislation. We do not
believe that there will be any adverse
impact or effect on the public from this
delay in the effective date. Moreover, it
would not be in the public interest for
the underlying rule to go into effect, or
to have uncertainty about whether it is
VerDate Nov<24>2008
in effect, when the underlying rule does
not conform to statutory requirements.
In addition, it is not in the public
interest to put into effect a rule that we
intend to revise in a reasonable time
frame after fully taking into account
public comment and statutory changes.
For the reasons stated above, we find
that both notice and comment
procedures and the 30-day delay in
effective date for this final rule are
unnecessary and contrary to the public
interest. Therefore, we find there is good
cause to waive notice and comment
procedures and the 30-day delay in
effective date for this final rule.
DEPARTMENT OF TRANSPORTATION
Office of the Secretary
49 CFR Parts 23 and 26
[Docket No. DOT–OST–2009–0074]
RIN 2105–AD79
Disadvantaged Business Enterprise
Program; Inflationary Adjustment
Office of the Secretary, DOT.
Final rule.
AGENCY:
ACTION:
SUMMARY: Under the statutes governing
the Department’s Disadvantaged
Business Enterprise (DBE) Program,
firms are not considered small business
concerns and are therefore ineligible as
DBEs once their average annual receipts
over the preceding three fiscal years
reach specified dollar limits. The
Department of Transportation is
amending the size limits or gross
receipts caps to ensure that the
opportunity of small businesses to
participate in the Department’s DBE
programs remains unchanged after
taking inflation into account. This final
rule provides 2009 inflation adjustment
of size limits on small businesses
participating in the DOT’s
Disadvantaged Business Enterprise
programs.
DATES:
This rule is effective April 3,
2009.
PO 00000
Frm 00008
Fmt 4700
Sfmt 4700
FOR FURTHER INFORMATION CONTACT:
Robert C. Ashby, Deputy Assistant
General Counsel for Regulation and
Enforcement, Department of
Transportation, 1200 New Jersey
Avenue, SE., W94–302, Washington, DC
20590, phone numbers (202) 366–9310
(voice), (202) 366–9313 (fax), (202) 755–
7687 (TTY), bob.ashby@dot.gov (e-mail).
SUPPLEMENTARY INFORMATION:
Background
On April 2, 2007, the Department
published a final rule revising 49 CFR
part 23, the regulation governing the
airport concessions disadvantaged
business enterprise (ACDBE) program,
to require that the Department adjust the
general ACDBE gross receipts cap for
inflation. That rule also adjusted the
gross receipts cap for the Department’s
financial assistance programs in 49 CFR
part 26. This final rule updates the gross
receipts cap for the ACDBE program and
the Department’s financial assistance
program for 2009.
The DBE Airport Concession and
Contracting Programs
The DOT-assisted contracts DBE rule
and airport concessions DBE rule are
based on different statutes. Each statute
applies to a distinct type of business
that may seek DOT financial assistance.
The ACDBE program is designed to give
business opportunities to certain small
business concerns that operate at
airports and that are owned and
controlled by socially and economically
disadvantaged individuals. The ACDBE
program is mandated by 49 U.S.C.
47107(e), originally enacted in 1987 and
amended in 1992.
The DBE program for DOT-assisted
contracts is a statutory program
intended to ensure nondiscriminatory
contracting opportunities for small
business concerns owned and
controlled by socially and economically
disadvantaged individuals in the
Department’s highway, mass transit and
airport financial assistance programs.
The statutory provision governing the
DBE program in the highway and mass
transit financial assistance programs is
1101(b) of the Safe, Accountable,
Flexible, Efficient Transportation Equity
Act: A Legacy for Users (SAFETEA–LU),
Public Law 109–59, August 10, 2005.
The statutory provision governing the
DBE program as it relates to the airport
financial assistance programs is 49
U.S.C. 47113.
ACDBE Gross Receipts Size Standards
Under the current DOT rule, if the
airport concessions firm’s annual gross
receipts average over the preceding
three fiscal years exceed $47,780,000,
E:\FR\FM\03APR1.SGM
03APR1
Agencies
[Federal Register Volume 74, Number 63 (Friday, April 3, 2009)]
[Rules and Regulations]
[Pages 15221-15222]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-7505]
=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 440
[CMS-2232-F2]
RIN 0938-AP72
Medicaid Program; State Flexibility for Medicaid Benefit Packages
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule; delay of effective date and reopening of comment
period.
-----------------------------------------------------------------------
SUMMARY: This action temporarily delays the effective date of the
December 3, 2008 final rule entitled, ``Medicaid Program: State
Flexibility for Medicaid Benefit Packages'' (73 FR 73694) until
December 31, 2009. In addition, this action reopens the comment period
on the policies set out in the December 3, 2008 final rule, and
specifically solicits comments on the effect of certain provisions of
the Children's Health Insurance Program Reauthorization Act of 2009.
DATES: Effective Date: This action is effective April 2, 2009. The
effective date of the rule amending 42 CFR part 440 published in the
December 3, 2008, Federal Register (73 FR 73694), delayed February 2,
2009 (74 FR 5808), is further delayed until December 31, 2009.
Comment Period: To be assured consideration, comments must be
received at one of the addresses provided below, no later than 5 p.m.
on May 4, 2009.
ADDRESSES: In commenting, please refer to file code CMS-2232-F2.
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one
of the ways listed):
1. Electronically. You may submit electronic comments on this
regulation to https://www.regulations.gov. Follow the instructions for
``Comment or Submission'' and enter the file code to find the document
accepting comments.
2. By regular mail. You may mail written comments (one original and
two copies) to the following address ONLY: Centers for Medicare &
Medicaid Services, Department of Health and Human Services, Attention:
CMS-2232-F2, P.O. Box 8016, Baltimore, MD 21244-8016.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments (one
original and two copies) to the following address ONLY: Centers for
Medicare & Medicaid Services, Department of Health and Human Services,
Attention: CMS-2232-F2, Mail Stop C4-26-05, 7500 Security Boulevard,
Baltimore, MD 21244-8010.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to either of the following addresses: a.
Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW.,
Washington, DC 20201.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.) b. 7500
Security Boulevard, Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address,
please call telephone number (410) 786-7195 in advance to schedule your
arrival with one of our staff members.
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
FOR FURTHER INFORMATION CONTACT: Christine Gerhardt, (410) 786-0693.
SUPPLEMENTARY INFORMATION:
I. Background
A. Regulatory History
On December 3, 2008, we published a final rule in the Federal
Register entitled ``Medicaid Program; State Flexibility for Medicaid
Benefit'' (73 FR 73694). The December 2008 final rule implements
provisions of section 6044 of the Deficit Reduction Act (DRA) of 2005,
(Pub. L. 109-171), enacted on February 8, 2006, which amends the Social
Security Act by adding a new section 1937 related to the coverage of
medical assistance under approved State plans. The final rule also
provides States increased flexibility under an approved State plan to
define the scope of covered medical assistance by offering coverage of
benchmark or benchmark-equivalent benefit packages to certain Medicaid
recipients. In addition, the final rule responds to public comments on
the February 22, 2008, proposed rule that pertain to the State Medicaid
benefit package provisions.
Subsequent to the publication of the December 3, 2008 final rule,
in accordance with the memorandum of January 20, 2009 from the
Assistant to the President and the Chief of Staff, entitled
``Regulatory Review,'' we published an interim final rule with comment
period in the Federal Register to temporarily delay for 60 days the
effective date of the December 3, 2008 final rule entitled, ``Medicaid
Program; State Flexibility for Medicaid Benefit Packages'' (February 2,
2009, 74 FR 5808). The interim final rule also reopened the comment
period on the policies set out in the December 3, 2008 final rule. We
received nine public comments in response to the February 2, 2009
interim final rule.
B. New Legislation
On February 4, 2009, the Children's Health Insurance Program
Reauthorization Act (CHIPRA) of 2009 (Pub. L. 111-3) was enacted.
Certain provisions of the CHIPRA affect current regulations regarding
State Flexibility for Medicaid Benefit Packages, including the December
3, 2008 final rule. Specifically, section 611(a)(1)(C) and section
611(a)(3) of CHIPRA amends section 1937 of the Act, to require States
to assure that children under the age of 21, rather than those under 19
as specified in the DRA of 2005, who are included in benchmark or
benchmark-equivalent plans, have access to the Early Periodic
Screening, Diagnosis, and Treatment (EPSDT) services. EPSDT services
may be provided through a benchmark or benchmark-equivalent plan or as
a wrap-around benefit to those plans.
Section 611(a)(1)(A)(i) of CHIPRA amends section 1937 of the Act by
changing the language ``Notwithstanding any other provision of this
title * * *'' to read ``Notwithstanding section 1902(a)(1) (relating to
statewideness), section 1902(a)(10)(B) (relating to comparability), and
any other provision of this title which would be directly contrary to
the authority * * *''
[[Page 15222]]
II. Provisions of the Final Rule
This action delays the effective date of the December 3, 2008 final
rule. The effective date of that rule, which would have been February
2, 2009, was delayed until April 3, 2009 (74 FR 5808) and is now
delayed until December 31, 2009. Upon review and consideration of the
new provisions of CHIPRA and the public comments we received during the
reopened comment period, we believe that it may be necessary to revise
a substantial portion of the December 3, 2008 final rule. Therefore, to
inform future rulemaking on this issue, we are delaying the effective
date a second time to give the public an additional opportunity to
submit additional comments on the policy set forth in the December 3,
2008 final rule as well as the provisions of CHIPRA, discussed above.
We anticipate that this time period will allow sufficient time for CMS
to consider such comments and develop appropriate revisions to the
delayed rule.
IV. Waiver of Proposed Rulemaking and Delay in Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a notice such as this take effect, in accordance with
section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C.
553(b)). We also ordinarily provide a 30-day delay in the effective
date of the provisions of a notice in accordance with section 553(d) of
the APA (5 U.S.C. 553(d)). However, we can waive both the notice and
comment procedure and the 30-day delay in effective date if the
Secretary finds, for good cause, that it is impracticable, unnecessary
or contrary to the public interest to follow the notice and comment
procedure or to comply with the 30-day delay in the effective date, and
incorporates a statement of the finding and the reasons in the notice.
This final rule delays the effective date of the December 3, 2008
final rule that was promulgated through notice and comment rulemaking,
and does not make substantive changes to that final rule. Delay in the
effective date and reopening of the comment period is necessary to
ensure that the final rule, when effective, fully takes into account
public comments, and conforms to recently enacted legislation. We do
not believe that there will be any adverse impact or effect on the
public from this delay in the effective date. Moreover, it would not be
in the public interest for the underlying rule to go into effect, or to
have uncertainty about whether it is in effect, when the underlying
rule does not conform to statutory requirements. In addition, it is not
in the public interest to put into effect a rule that we intend to
revise in a reasonable time frame after fully taking into account
public comment and statutory changes. For the reasons stated above, we
find that both notice and comment procedures and the 30-day delay in
effective date for this final rule are unnecessary and contrary to the
public interest. Therefore, we find there is good cause to waive notice
and comment procedures and the 30-day delay in effective date for this
final rule.
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)
Dated: March 25, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare & Medicaid Services.
Approved: March 30, 2009.
Charles E. Johnson,
Acting Secretary.
[FR Doc. E9-7505 Filed 4-2-09; 8:45 am]
BILLING CODE 4120-01-P