Notice of Hearing: Reconsideration of Disapproval of Washington State Plan Amendment (SPA) 08-019, 33449-33450 [E9-16677]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 74, Number 132 (Monday, July 13, 2009)]
[Notices]
[Pages 33449-33450]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-16677]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval of Washington 
State Plan Amendment (SPA) 08-019

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice of hearing.

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SUMMARY: This notice announces an administrative hearing to be held on 
August 4, 2009 at the CMS Seattle Regional Office, 2201 Sixth Avenue, 
MS/RX-43, Seattle, Washington 98121, to reconsider CMS' decision to 
disapprove Washington SPA 08-019.
    Closing Date: Requests to participate in the hearing as a party 
must be received by the presiding officer by July 28, 2009.

FOR FURTHER INFORMATION CONTACT: Benjamin Cohen, Presiding Officer, 
CMS, 2520 Lord Baltimore Drive, Suite L, Baltimore, Maryland 21244, 
Telephone: (410) 786-3169.

SUPPLEMENTARY INFORMATION:
    This notice announces an administrative hearing to reconsider CMS' 
decision to disapprove Washington SPA 08-019 which was received by CMS 
on September 23, 2008, and disapproved on March 6, 2009. The SPA 
proposed to increase dispensing fees for pharmacies from $4.20 to $4.24 
for high-volume pharmacies, $4.51 to $4.56 for mid-volume pharmacies, 
$5.20 to $5.25 for low-volume pharmacies, and $5.20 to $5.25 for unit 
dose systems.
    As submitted, SPA 08-019 has raised concerns regarding compliance 
with section 1902(a)(30) of the Social Security Act (the Act) and 
implementing regulatory requirements. Section 1902(a)(30)(A) of the Act 
requires that States have methods and procedures in place to assure 
that payments are consistent with efficiency, economy, and quality of 
care. Under that authority, the Secretary has issued regulations 
prescribing State rate-setting procedures and requirements. 
Longstanding requirements (presently codified at 42 CFR 447.512 and 
447.514, and previously codified at 42 CFR 447.331 and 447.332) provide 
that the State is responsible for demonstrating that the dispensing 
fees are reasonable. The State has not provided that demonstration. In 
addition, Federal regulations at 42 CFR 447.205 require that a State 
provide public notice of any significant proposed change in its methods 
and standards for setting payment rates for services. In support of 
this amendment, the State believes that issuing a memorandum to 
providers online meets the public requirements. We believe that this 
does not meet the Federal standard. We believe public notice promotes 
transparency and openness in this process and allows the public to be 
fully aware of the State's actions.
    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), Washington SPA 08-019 was 
disapproved.
    The following issues will be considered at the hearing:
     Whether Washington provided adequate public notice for 
setting payment rates for services as required at 42 CFR 447.205.
     Whether Washington met the longstanding requirement 
(presently codified at 42 CFR 447.512 and 447.514, and previously 
codified in 42 CFR 447.331 and 447.332) that the State is responsible 
for demonstrating that the proposed increased dispensing fees are 
reasonable.
    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 CMS subsequently notifies 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 the State of Washington announcing an administrative 
hearing to reconsider the disapproval of its SPA reads as follows:

Ms. Susan Dreyfus, Secretary, Department of Social and Health 
Services, P.O. Box 45010, Olympia, WA 98504-5010.

    Dear Ms. Dreyfus: I am responding to your request for 
reconsideration of the decision to disapprove the Washington State 
plan amendment (SPA) 08-019, which was received by the Centers for 
Medicare & Medicaid Services on September 23, 2008, and disapproved 
on March 6, 2009. The SPA proposed to increase dispensing fees for 
pharmacies from $4.20 to $4.24 for high-volume pharmacies, $4.51 to 
$4.56 for mid-volume pharmacies, $5.20 to $5.25 for low-volume 
pharmacies, and $5.20 to $5.25 for unit dose systems.
    The following issues will be considered at the hearing:
     Whether Washington provided adequate public notice for 
setting payment rates for services as required at 42 CFR 447.205.
     Whether Washington met the longstanding requirement 
(presently codified at 42 CFR 447.512 and 447.514, and previously 
codified in 42 CFR 447.331 and 447.332) that the State is 
responsible for demonstrating that the proposed increased dispensing 
fees are reasonable.
    I am scheduling a hearing on your request for reconsideration to 
be held on August 4, 2009, at the Centers for Medicare & Medicaid 
Services', Seattle Regional Office, 2201 Sixth Avenue, MS/RX-43, 
Seattle, Washington 98121, in order to reconsider the decision to 
disapprove SPA 08-019. 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 Mr. Benjamin Cohen as the presiding officer. If 
these arrangements present any problems, please contact the 
presiding officer at (410) 786-3169. In order to facilitate any 
communication which may be necessary among 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,

Charlene Frizzera,
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)


[[Page 33450]]


    Dated: June 16, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare & Medicaid Services.
 [FR Doc. E9-16677 Filed 7-10-09; 8:45 am]
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