Medicaid Program; Cost Limit for Providers Operated by Units of Government and Provisions To Ensure the Integrity of Federal-State Financial Partnership, 73972-73976 [2010-30066]
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73972
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Federal Register / Vol. 75, No. 229 / Tuesday, November 30, 2010 / Rules and Regulations
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Dated: November 16, 2010.
Bill Luthans,
Acting Director, Multimedia Planning and
Permitting Division.
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[FR Doc. 2010–30104 Filed 11–29–10; 8:45 am]
BILLING CODE 6560–50–P
40 CFR part 261 is amended as
follows:
■
ENVIRONMENTAL PROTECTION
AGENCY
PART 261—IDENTIFICATION AND
LISTING OF HAZARDOUS WASTE
40 CFR Part 261
1. The authority citation for part 261
continues to read as follows:
■
[EPA–R06–RCRA–2009–0312; SW FRL–
9231–3]
Authority: 42 U.S.C. 6905, 6912(a), 6921,
6922, and 6938.
Hazardous Waste Management
System; Identification and Listing of
Hazardous Waste; Removal of Direct
Final Exclusion
2. In Tables 1, 2 and 3 of Appendix
IX of part 261 remove the following
facility’s waste streams: for Facility:
Eastman Chemical Company—Texas
Operations, Address: Longview, TX;
Waste Description: RKI bottom ash, RKI
fly ash and RKI scrubber water
blowdown.
■
Environmental Protection
Agency (EPA).
AGENCY:
Removal of Direct Final
Exclusion.
ACTION:
Because EPA received
adverse comment, we are removing the
direct final exclusion for Eastman
Chemical Company—Texas Operations,
published on September 24, 2010.
SUMMARY:
DATES:
Effective November 30, 2010.
FOR FURTHER INFORMATION CONTACT:
Michelle Peace, Environmental
Protection Agency, Multimedia
Planning and Permitting Division,
RCRA Branch, Mail Code: 6PD–C, 1445
Ross Avenue, Dallas, TX 75202, by
calling (214) 665–7430 or by e-mail at
peace.michelle@epa.gov.
Because
EPA received adverse comment, we are
removing the direct final exclusion for
Eastman Chemical Company—Texas
Operations, published on September 24,
2010, 75 FR 58315. We stated in that
direct final rule that if we received
adverse comment by October 25, 2010,
the direct final rule would not take
effect and we would publish a timely
removal in the Federal Register. We
subsequently received adverse comment
on that direct final rule. We will address
the comments submitted in a
subsequent final action which will be
based on the parallel proposed rule also
published on September 24, 2010, 75 FR
58346. As stated in the direct final rule
and the parallel proposed rule, we will
not institute a second comment period
on this action.
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SUPPLEMENTARY INFORMATION:
Lists of Subjects in 40 CFR Part 261
Environmental Protection, Hazardous
waste, Recycling, Reporting and
recordkeeping requirements.
Authority: Sec. 3001(f) RCRA, 42 U.S.C.
6921(f).
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[FR Doc. 2010–30109 Filed 11–29–10; 8:45 am]
BILLING CODE 6560–50–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 433, 447, and 457
[CMS–2361–F]
RIN 0938–AQ40
Medicaid Program; Cost Limit for
Providers Operated by Units of
Government and Provisions To Ensure
the Integrity of Federal-State Financial
Partnership
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final rule; implementation of
court orders.
AGENCY:
This final rule amends
Medicaid regulations to conform with
the decision by the United States
District Court for the District of
Columbia on May 23, 2008 in Alameda
County Medical Center, et al. v. Michael
O. Leavitt, Secretary, U.S. Department of
Health and Human Services, et al., 559
F. Supp. 2d (2008) that vacated a final
rule with comment period published in
the Federal Register in May 29, 2007.
This regulatory action takes ministerial
steps to remove the vacated provisions
from the Code of Federal Regulations
and reinstate the prior regulatory
language impacted by the May 29, 2007
final rule with comment period.
DATES: Effective Date: This regulation is
effective immediately on date of
publication November 30, 2010.
SUMMARY:
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FOR FURTHER INFORMATION CONTACT:
Rob
Weaver, (410) 786–5914.
SUPPLEMENTARY INFORMATION:
I. Background
A. Introduction
Title XIX of the Social Security Act
(the Act) authorizes Federal grants to
States for Medicaid programs that
provide medical assistance to lowincome families, the elderly and persons
with disabilities. Each State administers
the Medicaid program in accordance
with an approved Medicaid State plan.
States have considerable flexibility in
designing their programs, but must
comply with Federal requirements
specified in the Medicaid statute,
regulations, and program guidance.
Sections 1902(a)(2), 1903(a), and
1905(b) of the Act set forth requirements
that describe how the responsibility to
fund the Medicaid program will be
shared between the Federal and State
governments. Section 1905(b) of the Act
delineates a percentage referred to as the
Federal medical assistance percentage
(FMAP) that determines on a State-byState basis the Federal and non-Federal
share of program expenditures. Section
1903(a) of the Act requires Federal
reimbursement to the State of the
Federal share. Section 1902(a)(2) of the
Act and implementing regulations at 42
CFR 433.50(a)(1) permit a State to
delegate some responsibility for the
non-Federal share of medical assistance
expenditures to local units of
government sources under some
circumstances.
The U.S. Troop Readiness, Veterans
Care, Katrina Recovery and Iraq
Accountability Appropriations Act of
2007 prohibited the Secretary of Health
and Human Services from finalizing or
otherwise implement the provisions
contained in a proposed rule published
on January 18, 2007, titled ‘‘Medicaid
Program; Cost Limit for Providers
Operated by Units of Government and
Provisions To Ensure the Integrity of
Federal-State Financial Partnership’’ (72
FR 2236 through 2248).
B. Final Rule With Comment Period
Published May 29, 2007
On May 29, 2007, the Department of
Human and Human Services (DHHS)
published a final rule with comment
period titled, ‘‘Medicaid Program; Cost
Limit for Providers Operated by Units of
Government and Provisions To Ensure
the Integrity of Federal-State Financial
Partnership’’ in the Federal Register (72
FR 29747 through 29836).
That final rule eliminated, modified,
or implemented regulatory requirements
pertaining to the financial relationship
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between the Federal and State
governments. Specifically, this rule
consisted of the following:
• Clarified that entities involved in
the financing of the non-Federal share of
Medicaid payments must be a unit of
government.
• Clarified the documentation
necessary to support a Medicaid
certified public expenditure.
• Limited Medicaid reimbursement
for health care providers that are
operated by units of government to an
amount that does not exceed the health
care provider’s cost of providing
services to Medicaid individuals.
• Required all health care providers
to receive and retain the full amount of
total computable payments for services
furnished under the approved Medicaid
State plan.
• Made conforming changes to
provisions governing the Child Health
Insurance Program (CHIP) to make the
same requirements applicable, with the
exception of the cost limit on
reimbursement.
On May 23, 2008, the United States
District Court for the District of
Columbia, in Alameda County Medical
Center, et al. v. Michael O. Leavitt,
Secretary, U.S. Department of Health
and Human Services, et al., 559 F.
Supp. 2d, found that DHHS had
improperly promulgated these
regulations. The court stated that DHHS
violated the Congressional moratorium
on finalization of this regulation in the
Troop Readiness, Veteran’s Care,
Katrina Recovery and Iraq
Accountability Appropriation Act of
2007 (UTRA), (Pub. L. 110–28) and
vacated the rule and remanded the
matter to DHHS. Accordingly, DHHS is
removing the vacated rule from the
Code of Federal Regulations.
Section 7001 of the Supplemental
Appropriations Act of 2008 Public Law
110–252 extended the moratorium on
finalizing the Cost rule to April 1, 2009.
The Congress considered this matter
again in the passage of the American
Recovery and Reinvestment Act (ARRA)
of 2009. Section 5003(d) of ARRA
expressed the sense of Congress that the
Cost rule should not be adopted as a
final rule.
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II. Provisions of the Final Regulations
In this final rule, DHHS is removing
all of the provisions that were issued in
the May 29, 2007 final rule with
comment period. Concurrently, DHHS is
restoring regulation text so that the
regulatory language impacted by the
May 2007 final rule will appear in the
Code of Federal Regulations as it did
prior to issuance of that rule.
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Part 433—State Fiscal Administration
(Sec. 433.50) Basis, Scope, and
Applicability
In § 433.50(a)(1), DHHS is removing
the language that states ‘‘and section
1903(w)(7)(G).’’ DHHS is also removing
‘‘units of.’’ DHHS is also adding ‘‘s’’ to
the word ‘‘government’’ and adding the
word ‘‘both’’ before the words ‘‘State and
local governments.’’ In addition, DHHS
is removing paragraphs (a)(1)(i) and
(a)(1)(ii) of this regulation.
(Sec. 433.51) Funds From Units of
Government as the State Share of
Financial Participation
In § 433.51, DHHS is revising the
section heading to read ‘‘§ 433.51 Public
funds as the State share of financial
participation.’’
In § 433.51(a), DHHS is adding the
word ‘‘Public’’ before the word ‘‘funds.’’
DHHS is also removing the words ‘‘from
units of government’’ of this regulation.
In § 433.51(b), DHHS is revising the
paragraph to read ‘‘The public funds are
appropriated directly to the State or
local Medicaid agency, or are
transferred from other public agencies
(including Indian tribes) to the State or
local agency and under its
administrative control, or certified by
the contributing public agency as
representing expenditures eligible for
FFP under this section.’’
In § 433.51(c), DHHS is adding the
word ‘‘Public’’ before the word ‘‘funds.’’
DHHS is also removing the words ‘‘from
units of government’’ of this regulation.
Part 447—Payments For Services
(Sec. 447.206) Cost Limit for Providers
Operated by Units of Government
In part 447, DHHS is removing the
entire provisions of § 447.206 of this
regulation. (§ 447.207) Retention of
payments.
In part 447, DHHS is removing the
entire provisions of § 447.207 of this
regulation.
(Sec. 447.271) Upper Limits Based on
Customary Charges
In § 447.271(a), DHHS is adding an
introductory phrase to read ‘‘Except as
provided in paragraph (b) of this
section,’’.
In § 447.271(b), DHHS is removing the
word ‘‘Reserved’’ and replacing it with
‘‘The agency may pay a public provider
that provides services free or at a
nominal charge at the same rate that
would be used if the provider charges
were equal to or greater than its costs.’’
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(Sec. 447.272) Inpatient Services:
Application of Upper Payment Limits
In § 447.272(a), DHHS is removing the
word ‘‘nursing facilities’’ replacing it
with ‘‘NFs.’’
In § 447.272(a)(1), DHHS is revising
the paragraph to read ‘‘State
government-owned or operated facilities
(that is, all facilities that are either
owned or operated by the State).’’
In § 447.272(a)(2), DHHS is revising
the paragraph to read ‘‘Non-State
government-owned or operated facilities
(that is, all government facilities that are
neither owned nor operated by the
State).’’
In § 447.272(a)(3), DHHS is revising
the paragraph to read ‘‘Privately-owned
and operated facilities.’’
In § 447.272(b)(1), DHHS is removing
the words ‘‘For privately operated
facilities.’’
In § 447.272(b)(2), DHHS is revising
the paragraph to read ‘‘Except as
provided for in paragraph (c) of this
section, aggregate Medicaid payments to
a group of facilities within one of the
categories described in paragraph (a) of
this section may not exceed the upper
payment limit described in paragraph
(b)(1) of this section.’’
In § 447.272(b)(3), DHHS is removing
entire provision of this regulation.
In § 447.272(b)(4), DHHS is removing
entire provision of this regulation.
In § 447.272(c), DHHS is removing
symbol ‘‘—’’ and replacing it with ‘‘.’’.
In § 447.272, DHHS is removing
paragraph (c)(3) of this regulation.
In § 447.272(d)(1), DHHS is revising
the paragraph to read ‘‘For non-State
government owned or operated
hospitals—March 19, 2002.’’
(Sec. 447.321) Outpatient Hospital and
Clinic Services: Application of Upper
Payment Limits
In § 447.321(a)(1), DHHS is revising
the paragraph to read ‘‘State
government-owned or operated facilities
(that is, all facilities that are owned or
operated by the State).’’
In § 447.321(a)(2), DHHS is revising
the paragraph to read ‘‘Non-State
government owned or operated facilities
(that is, all government operated
facilities that are neither owned nor
operated by the State).’’
In § 447.321(a)(3), DHHS is revising
the paragraph to read ‘‘Privately-owned
and operated facilities.’’
In § 447.321(b)(1), DHHS is removing
the words ‘‘For privately operated
facilities,’’.
In § 447.321(b)(2), DHHS is revising
the provision to read ‘‘Except as
provided for in paragraph (c) of this
section, aggregate Medicaid payments to
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a group of facilities within one of the
categories described in paragraph (a) of
this section may not exceed the upper
payment limit described in paragraph
(b)(1) of this section.’’
In § 447.321, DHHS is removing
paragraph (b)(3) of this regulation.
In § 447.321, DHHS is removing
pargraph (b)(4) of this regulation.
In § 447.321(c)(1), DHHS is removing
the designated number ‘‘(1)’’ of this
regulation.
In § 447.321, DHHS is removing
paragraph (c)(2) of this regulation.
In § 447.321, DHHS is removing
paragraph (c)(3) of this regulation.
In § 447.321(d), DHHS is removing
reference to paragraph ‘‘(b)’’ and
replacing it with a reference to
paragraph ‘‘(b)(1).’’
In § 447.321(d)(1), DHHS is revising
the paragraph to read ‘‘For non-State
government-owned or operated
hospitals—March 19, 2002.’’
In § 447.321, DHHS is removing
paragraph (d)(2) and redesignating
paragraph (d)(3) as paragraph (d)(2) of
this regulation.
Sec. 457.220 Funds From Units of
Government as the State Share of
Financial Participation
In § 457.220(a), DHHS is adding the
word ‘‘Public’’ before the word ‘‘Funds.’’
DHHS is also removing the words ‘‘from
units of government.’’
In § 457.220(b), DHHS is revising the
paragraph to read ‘‘The public funds are
appropriated directly to the State or
local SCHIP agency, or are transferred
from other public agencies (including
Indian tribes) to the State or local
agency and are under its administrative
control, or are certified by the
contributing public agency as
representing expenditures eligible for
FFP under this section.’’
In § 457.220(c), DHHS is adding the
word ‘‘public’’ after the word ‘‘The’’
before the word ‘‘funds.’’ DHHS is also
removing the words ‘‘from units of
government.’’
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Sec. 457.628
Regulations
Other Applicable Federal
In § 457.628(a), DHHS is removing the
parenthesis ‘‘(’’ before the word
‘‘sources’’ and removing the parenthesis
‘‘)’’ after the word ‘‘Donations’’ and
adding a semicolon and the word
‘‘Donations.’’ In addition, DHHS is
removing the words ‘‘and § 447.207 of
this chapter (Retention of payments).’’
III. Collection of Information
This document does not impose
information collection and
recordkeeping requirements.
Consequently, it need not be reviewed
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by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995.
IV. Waiver of Proposed Rulemaking
and Delayed Effective Date
DHHS ordinarily publish a notice of
proposed rulemaking in the Federal
Register and invite public comment on
the proposed rule. The notice of
proposed rulemaking includes a
reference to the legal authority under
which the rule is proposed, and the
terms and substances of the proposed
rule or a description of the subjects and
issues involved. This procedure can be
waived, however, if an agency finds
good cause that a notice-and-comment
procedure is impractical, unnecessary,
or contrary to the public interest and
incorporates a statement of the finding
and its reasons in the rule issued. DHHS
has determined that providing prior
notice and opportunity for comment on
the amending regulations is
unnecessary. This final rule merely
removes regulatory language relating to
CMS–2258–FC, which was vacated by
the United States District Court for the
District of Columbia. As a result of this
decision, the regulatory language related
to CMS–2258–FC has no force or effect,
and public comment would not affect
that status. The presence of that
language in the Code of Federal
Regulations can be confusing, and thus
the public interest would be served by
removal of that language. Furthermore,
removing this language from the Code of
Federal Regulations and reinstating the
prior regulatory language has no legal
impact but simply reflects this final
judicial determination.
For the same reasons, DHHS believes
there is good cause for waiving any
delay in the effective date, making the
reinstated regulatory provisions
immediately effective. See 5 U.S.C.
553(d).
V. Regulatory Impact Statement
DHHS has examined the impact of
this rule as required by Executive Order
12866 on Regulatory Planning and
Review (September 30, 1993), the
Regulatory Flexibility Act (RFA)
(September 19, 1980, Pub. L. 96–354),
section 1102(b) of the Social Security
Act, section 202 of the Unfunded
Mandates Reform Act of 1995 (March
22, 1995; Pub. L. 104–4), Executive
Order 13132 on Federalism (August 4,
1999) and the Congressional Review Act
(5 U.S.C. 804(2)).
Executive Order 12866 directs
agencies to assess all costs and benefits
of available regulatory alternatives and,
if regulation is necessary, to select
regulatory approaches that maximize
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net benefits (including potential
economic, environmental, public health
and safety effects, distributive impacts,
and equity). A regulatory impact
analysis (RIA) must be prepared for
major rules with economically
significant effects ($100 million or more
in any 1 year). This regulatory action
only removes those regulations vacated
by the United States District Court for
the District of Columbia. Therefore, this
action is not a ‘‘significant’’ regulatory
action as defined by E.O. 12866. This
rule also does not reach the economic
threshold and thus is not considered a
major rule.
The RFA requires agencies to analyze
options for regulatory relief of small
businesses. For purposes of the RFA,
small entities include small businesses,
nonprofit organizations, and small
governmental jurisdictions. Most
hospitals and most other providers and
suppliers are small entities, either by
nonprofit status or by having revenues
of $7 million to $34.5 million in any one
year. Individuals and States are not
included in the definition of a small
entity. DHHS is not preparing an
analysis for the RFA because DHHS has
determined, and the Secretary certifies,
that this final rule will not have a
significant economic impact on a
substantial number of small entities.
In addition, section 1102(b) of the Act
requires us to prepare a regulatory
impact analysis if a rule may have a
significant impact on the operations of
a substantial number of small rural
hospitals. This analysis must conform to
the provisions of section 604 of the
RFA. For purposes of section 1102(b) of
the Act, we define a small rural hospital
as a hospital that is located outside of
a Core-Based Statistical Area (for
Medicaid) and outside a Metropolitan
Statistical Area for Medicare) and has
fewer than 100 beds. DHHS is not
preparing an analysis for section 1102(b)
of the Act because we have determined,
and the Secretary certifies, that this final
rule will not have a significant impact
on the operations of a substantial
number of small rural hospitals.
Section 202 of the Unfunded
Mandates Reform Act of 1995 also
requires that agencies assess anticipated
costs and benefits before issuing any
rule whose mandates require spending
in any 1 year of $100 million in 1995
dollars, updated annually for inflation.
In 2010, that threshold is approximately
$135 million. This rule will have no
consequential effect on State, local, or
tribal governments or on the private
sector.
Executive Order 13132 establishes
certain requirements that an agency
must meet when it promulgates
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regulations that imposes substantial
direct requirement costs on State and
local governments, preempts State law,
or otherwise has Federalism
implications. Since this regulation does
not impose any costs on State or local
governments, the requirements of
Executive Order 13132 are not
applicable.
In accordance with the provisions of
Executive Order 12866, this regulation
was reviewed by the Office of
Management and Budget.
List of Subjects
42 CFR Part 433
Administrative practice and
procedure, Child support, Claims, Grant
programs—health, Medicaid, Reporting
and recordkeeping requirements.
42 CFR Part 447
Accounting, Administrative practice
and procedure, Drugs, Grant programs—
health, Health facilities, Health
professions, Medicaid, Reporting and
recordkeeping requirements, Rural
areas.
42 CFR Part 457
Authority: Sec. 1102 of the Social Security
Act (42 U.S.C. 1302).
Subpart B—Payment Methods: General
Provisions
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[Removed]
5. Section 447.206 is removed.
[Removed]
6. Section 447.207 is removed.
Subpart C—Payment for Inpatient
Hospital and Long-Term Care Facility
Services
Upper Limits
7. Section § 447.271 is revised to read
as follows:
■
1. The authority citation for part 433
continues to read as follows:
Authority: Sec. 1102 of the Social Security
Act (42 U.S.C. 1302).
Subpart B—General Administrative
Requirements State Financial
Participation
2. Section § 433.50 is amended by
revising paragraph (a)(1) to read as
follows:
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4. The authority citation for part 447
continues to read as follows:
■
§ 447.207
■
Basis, scope, and applicability.
(a) * * *
(1) Section 1902(a)(2) of the Act
which requires States to share in the
cost of medical assistance expenditures
and permit both State and local
governments to participate in the
financing of the non-Federal portion of
medical assistance expenditures.
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■ 3. Section 433.51 is revised to read as
follows:
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PART 447—PAYMENTS FOR
SERVICES
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PART 433—STATE FISCAL
ADMINISTRATION
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(a) Public Funds may be considered as
the State’s share in claiming FFP if they
meet the conditions specified in
paragraphs (b) and (c) of this section.
(b) The public funds are appropriated
directly to the State or local Medicaid
agency, or are transferred from other
public agencies (including Indian tribes)
to the State or local agency and under
its administrative control, or certified by
the contributing public agency as
representing expenditures eligible for
FFP under this section.
(c) The public funds are not Federal
funds, or are Federal funds authorized
by Federal law to be used to match other
Federal funds.
§ 447.206
Administrative practice and
procedure, Grant programs—health,
Health insurance, Reporting and
recordkeeping requirements.
■ For the reasons set forth in the
preamble, the Centers for Medicare &
Medicaid Services amends 42 CFR
chapter IV as set forth below:
§ 433.50
§ 433.51 Public Funds as the State share
of financial participation.
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§ 447.271 Upper limits based on
customary charges.
(a) Except as provided in paragraph
(b) of this section, the agency may not
pay a provider more for inpatient
hospital services under Medicaid than
the provider’s customary charges to the
general public for the services.
(b) The agency may pay a public
provider that provides services free or at
a nominal charge at the same rate that
would be used if the provider charges
were equal to or greater than its costs.
■ 8. Section 447.272 is amended by—
■ A. Revising paragraphs (a), (b), and
(d)(1).
■ B. Revising the heading for paragraph
(c).
■ C. Removing paragraph (c)(3).
The revisions read as follows:
§ 447.272 Inpatient services: Application
of upper payment limits.
(a) Scope. This section applies to rates
set by the agency to pay for inpatient
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services furnished by hospitals, NFs,
and ICFs/MR within one of the
following categories:
(1) State government-owned or
operated facilities (that is, all facilities
that are either owned or operated by the
State).
(2) Non-State government-owned or
operated facilities (that is, all
government facilities that are neither
owned nor operated by the State).
(3) Privately-owned and operated
facilities.
(b) General rules.
(1) Upper payment limit refers to a
reasonable estimate of the amount that
would be paid for the services furnished
by the group of facilities under
Medicare payment principles in
subchapter B of this chapter.
(2) Except as provided for in
paragraph (c) of this section, aggregate
Medicaid payments to a group of
facilities within one of the categories
described in paragraph (a) of this
section may not exceed the upper
payment limit described in paragraph
(b)(1) of this section.
(c) Exceptions.
*
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*
*
(d) * * *
(1) For non-State government owned
or operated hospitals,—March 19, 2002.
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Subpart F—Payment Methods for
Other Institutional and Noninstitutional
Services
Outpatient Hospital and Clinic Services
9. Section 447.321 is amended by—
A. Revising paragraphs (a), (b), (c) and
(d)(1).
■ B. Revising introductory text of
paragraph (d) by removing the phrase
‘‘paragraph (b)’’ and adding in its place
the phrase ‘‘paragraph (b)(1).’’
■ C. Removing paragraphs (d)(2).
■ D. Redesignating paragraph (d)(3)as
paragraph (d)(2).
The revisions read as follows:
■
■
§ 447.321 Outpatient hospital and clinic
services: Application of upper payment
limits.
(a) Scope. This section applies to rates
set by the agency to pay for outpatient
services furnished by hospitals and
clinics within one of the following
categories:
(1) State government-owned or
operated facilities (that is, all facilities
that are owned or operated by the State.)
(2) Non-State government owned or
operated facilities (that is, all
government operated facilities that are
neither owned nor operated by the
State).
(3) Privately-owned and operated
facilities.
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(b) General rules. (1) Upper payment
limit refers to a reasonable estimate of
the amount that would be paid for the
services furnished by the group of
facilities under Medicare payment
principles in subchapter B of this
chapter.
(2) Except as provided in paragraph
(c) of this section, aggregate Medicaid
payments to a group of facilities within
one of the categories described in
paragraph (a) of this section may not
exceed the upper payment limit
described in paragraph (b)(1) of this
section.
(c) Exceptions. Indian Health Services
and tribal facilities. The limitation in
paragraph (b) of this section does not
apply to Indian Health Services
facilities and tribal facilities that are
funded through the Indian SelfDetermination and Education
Assistance Act (Pub. L. 93–638).
(d) * * *
(1) For non-State government-owned
or operated hospitals—March 19, 2002.
*
*
*
*
*
Subpart B—General Administration—
Reviews and Audits; Withholding for
Failure To Comply; Deferral and
Disallowance of Claims; Reduction of
Federal Medical Payments
11. Section 457.220 is revised to read
as follows:
■
jdjones on DSK8KYBLC1PROD with RULES
§ 457.220 Funds from units of government
as the State share of financial participation.
(a) Public funds may be considered as
the State’s share in claiming FFP if they
meet the conditions specified in
paragraphs (b) and (c) of this section.
(b) The public funds are appropriated
directly to the State or local SCHIP
agency, or are transferred from other
public agencies (including Indian tribes)
to the State or local agency and are
under its administrative control, or are
certified by the contributing public
agency as representing expenditures
eligible for FFP under this section.
(c) The public funds are not Federal
funds, or are Federal funds authorized
by Federal law to be used to match other
Federal funds.
VerDate Mar<15>2010
15:07 Nov 29, 2010
Jkt 223001
Dated: July 28, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare &
Medicaid Services.
Approved: August 20, 2010.
Kathleen Sebelius
Secretary.
[FR Doc. 2010–30066 Filed 11–29–10; 8:45 am]
BILLING CODE 4120–01–P
[MB Docket No. 09–52; FCC 10–24]
Authority: Sec. 1102 of the Social Security
Act (42 U.S.C. 1302).
12. Section 457.628 is amended by
revising the introductory text and
paragraph (a) to read as follows:
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program)
47 CFR Part 73
10. The authority for part 457
continues to read as follows:
■
■
Other regulations applicable to SCHIP
programs include the following:
(a) HHS regulations in 42 Subpart B—
433.51–433.74 sources of non-Federal
share and Health Care-Related Taxes
and Provider-Related Donations; apply
to States’ SCHIP programs in the same
manner as they apply to States’
Medicaid programs.
*
*
*
*
*
FEDERAL COMMUNICATIONS
COMMISSION
PART 457—ALLOTMENTS AND
GRANTS TO STATES
Subpart F—Payments to States
§ 457.628 Other applicable Federal
regulations.
Policies To Promote Rural Radio
Service and To Streamline Allotment
and Assignment Procedures
Federal Communications
Commission.
ACTION: Final rule; announcement of
compliance date.
AGENCY:
In this document, the
Commission announces that the Office
of Management and Budget (OMB) has
approved, for a period of three years, the
information collection requirements
associated with the Commission’s rules
and FCC Forms 301, 314, 315, 316 and
340. These rules and form changes were
approved on May 27, 2010 and June 4,
2010 and the compliance date will be
November 30, 2010.
DATES: The compliance date for
§§ 73.3571(k), 73.7000, 73.7002(b), and
73.7002(c) and FCC Forms 301, 314,
315, 316 and 340 published at 75 FR
9797, March 4, 2010 is November 30,
2010.
FOR FURTHER INFORMATION CONTACT:
Cathy Williams on (202) 418–2918 or
send an e-mail to:
Cathy.Williams@fcc.gov.
SUPPLEMENTARY INFORMATION: As
required by the Paperwork Reduction
Act of 1995 (44 U.S.C. 3507), the
Commission is notifying the public that
it received OMB approval on May 27,
SUMMARY:
PO 00000
Frm 00042
Fmt 4700
Sfmt 4700
2010, and June 4, 2010, for a period of
three years, for the information
collection requirements contained in
Sections 73.3571(k), 73.7000,
73.7002(b), and 73.7002(c) of the
Commission’s rules and FCC Forms 301,
314, 315, 316 and 340 and that the
compliance date for these rules and
forms published at 75 FR 9797, March
4, 2010, is November 30, 2010. If you
have any comments on the burden
estimates, or how the Commission can
improve the collections and reduce any
burdens caused thereby, please contact
Cathy Williams, Federal
Communications Commission, Room 1–
C823, 445 12th Street, SW., Washington,
DC 20554. Please include OMB Control
Numbers 3060–0029, 3060–0027, 3060–
0996, 3060–0031 and/or 3060–0009 in
your correspondence. The Commission
also will accept your comments via the
Internet if you send them to
PRA@fcc.gov. To request materials in
accessible formats for people with
disabilities (Braille, large print,
electronic files, audio format), send an
e-mail to fcc504@fcc.gov or call the
Consumer & Governmental Affairs
Bureau at (202)418–0530 (voice), (202)
418–0432 (TTY).
Under 5 CFR 1320, an agency may not
conduct or sponsor a collection of
information unless it displays a current,
valid OMB Control Number.
No person shall be subject to any
penalty for failing to comply with a
collection of information subject to the
Paperwork Reduction Act that does not
display a valid OMB Control Number.
The OMB Control Numbers are 3060–
0027, 3060–0029, 3060–0996, 3060–
0031 and 3060–0009 and the total
annual reporting burdens and costs for
respondents are as follows:
OMB Control Number: 3060–0029.
OMB Approval Date: June 4, 2010.
Expiration Date: June 30, 2013.
Title: Application for Construction
Permit for Reserved Channel
Noncommercial Educational Broadcast
Station.
Form Number: FCC Form 340.
Respondents: Business or other forprofit entities; Not-for-profit
institutions; State, local or tribal
government.
Number of Respondents and
Responses: 2,710 respondents and 2,710
responses.
Estimated Time per Response: 2 to 5
hours.
Frequency of Response: On occasion
reporting requirement; Third party
disclosure requirement.
Obligation to Respond: Required to
obtain or retain benefits. Statutory
authority for this collection of
information is contained in Sections
E:\FR\FM\30NOR1.SGM
30NOR1
]]>Agencies
[Federal Register Volume 75, Number 229 (Tuesday, November 30, 2010)]
[Rules and Regulations]
[Pages 73972-73976]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-30066]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 433, 447, and 457
[CMS-2361-F]
RIN 0938-AQ40
Medicaid Program; Cost Limit for Providers Operated by Units of
Government and Provisions To Ensure the Integrity of Federal-State
Financial Partnership
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule; implementation of court orders.
-----------------------------------------------------------------------
SUMMARY: This final rule amends Medicaid regulations to conform with
the decision by the United States District Court for the District of
Columbia on May 23, 2008 in Alameda County Medical Center, et al. v.
Michael O. Leavitt, Secretary, U.S. Department of Health and Human
Services, et al., 559 F. Supp. 2d (2008) that vacated a final rule with
comment period published in the Federal Register in May 29, 2007. This
regulatory action takes ministerial steps to remove the vacated
provisions from the Code of Federal Regulations and reinstate the prior
regulatory language impacted by the May 29, 2007 final rule with
comment period.
DATES: Effective Date: This regulation is effective immediately on date
of publication November 30, 2010.
FOR FURTHER INFORMATION CONTACT: Rob Weaver, (410) 786-5914.
SUPPLEMENTARY INFORMATION:
I. Background
A. Introduction
Title XIX of the Social Security Act (the Act) authorizes Federal
grants to States for Medicaid programs that provide medical assistance
to low-income families, the elderly and persons with disabilities. Each
State administers the Medicaid program in accordance with an approved
Medicaid State plan. States have considerable flexibility in designing
their programs, but must comply with Federal requirements specified in
the Medicaid statute, regulations, and program guidance. Sections
1902(a)(2), 1903(a), and 1905(b) of the Act set forth requirements that
describe how the responsibility to fund the Medicaid program will be
shared between the Federal and State governments. Section 1905(b) of
the Act delineates a percentage referred to as the Federal medical
assistance percentage (FMAP) that determines on a State-by-State basis
the Federal and non-Federal share of program expenditures. Section
1903(a) of the Act requires Federal reimbursement to the State of the
Federal share. Section 1902(a)(2) of the Act and implementing
regulations at 42 CFR 433.50(a)(1) permit a State to delegate some
responsibility for the non-Federal share of medical assistance
expenditures to local units of government sources under some
circumstances.
The U.S. Troop Readiness, Veterans Care, Katrina Recovery and Iraq
Accountability Appropriations Act of 2007 prohibited the Secretary of
Health and Human Services from finalizing or otherwise implement the
provisions contained in a proposed rule published on January 18, 2007,
titled ``Medicaid Program; Cost Limit for Providers Operated by Units
of Government and Provisions To Ensure the Integrity of Federal-State
Financial Partnership'' (72 FR 2236 through 2248).
B. Final Rule With Comment Period Published May 29, 2007
On May 29, 2007, the Department of Human and Human Services (DHHS)
published a final rule with comment period titled, ``Medicaid Program;
Cost Limit for Providers Operated by Units of Government and Provisions
To Ensure the Integrity of Federal-State Financial Partnership'' in the
Federal Register (72 FR 29747 through 29836).
That final rule eliminated, modified, or implemented regulatory
requirements pertaining to the financial relationship
[[Page 73973]]
between the Federal and State governments. Specifically, this rule
consisted of the following:
Clarified that entities involved in the financing of the
non-Federal share of Medicaid payments must be a unit of government.
Clarified the documentation necessary to support a
Medicaid certified public expenditure.
Limited Medicaid reimbursement for health care providers
that are operated by units of government to an amount that does not
exceed the health care provider's cost of providing services to
Medicaid individuals.
Required all health care providers to receive and retain
the full amount of total computable payments for services furnished
under the approved Medicaid State plan.
Made conforming changes to provisions governing the Child
Health Insurance Program (CHIP) to make the same requirements
applicable, with the exception of the cost limit on reimbursement.
On May 23, 2008, the United States District Court for the District
of Columbia, in Alameda County Medical Center, et al. v. Michael O.
Leavitt, Secretary, U.S. Department of Health and Human Services, et
al., 559 F. Supp. 2d, found that DHHS had improperly promulgated these
regulations. The court stated that DHHS violated the Congressional
moratorium on finalization of this regulation in the Troop Readiness,
Veteran's Care, Katrina Recovery and Iraq Accountability Appropriation
Act of 2007 (UTRA), (Pub. L. 110-28) and vacated the rule and remanded
the matter to DHHS. Accordingly, DHHS is removing the vacated rule from
the Code of Federal Regulations.
Section 7001 of the Supplemental Appropriations Act of 2008 Public
Law 110-252 extended the moratorium on finalizing the Cost rule to
April 1, 2009. The Congress considered this matter again in the passage
of the American Recovery and Reinvestment Act (ARRA) of 2009. Section
5003(d) of ARRA expressed the sense of Congress that the Cost rule
should not be adopted as a final rule.
II. Provisions of the Final Regulations
In this final rule, DHHS is removing all of the provisions that
were issued in the May 29, 2007 final rule with comment period.
Concurrently, DHHS is restoring regulation text so that the regulatory
language impacted by the May 2007 final rule will appear in the Code of
Federal Regulations as it did prior to issuance of that rule.
Part 433--State Fiscal Administration
(Sec. 433.50) Basis, Scope, and Applicability
In Sec. 433.50(a)(1), DHHS is removing the language that states
``and section 1903(w)(7)(G).'' DHHS is also removing ``units of.'' DHHS
is also adding ``s'' to the word ``government'' and adding the word
``both'' before the words ``State and local governments.'' In addition,
DHHS is removing paragraphs (a)(1)(i) and (a)(1)(ii) of this
regulation.
(Sec. 433.51) Funds From Units of Government as the State Share of
Financial Participation
In Sec. 433.51, DHHS is revising the section heading to read
``Sec. 433.51 Public funds as the State share of financial
participation.''
In Sec. 433.51(a), DHHS is adding the word ``Public'' before the
word ``funds.'' DHHS is also removing the words ``from units of
government'' of this regulation.
In Sec. 433.51(b), DHHS is revising the paragraph to read ``The
public funds are appropriated directly to the State or local Medicaid
agency, or are transferred from other public agencies (including Indian
tribes) to the State or local agency and under its administrative
control, or certified by the contributing public agency as representing
expenditures eligible for FFP under this section.''
In Sec. 433.51(c), DHHS is adding the word ``Public'' before the
word ``funds.'' DHHS is also removing the words ``from units of
government'' of this regulation.
Part 447--Payments For Services
(Sec. 447.206) Cost Limit for Providers Operated by Units of Government
In part 447, DHHS is removing the entire provisions of Sec.
447.206 of this regulation. (Sec. 447.207) Retention of payments.
In part 447, DHHS is removing the entire provisions of Sec.
447.207 of this regulation.
(Sec. 447.271) Upper Limits Based on Customary Charges
In Sec. 447.271(a), DHHS is adding an introductory phrase to read
``Except as provided in paragraph (b) of this section,''.
In Sec. 447.271(b), DHHS is removing the word ``Reserved'' and
replacing it with ``The agency may pay a public provider that provides
services free or at a nominal charge at the same rate that would be
used if the provider charges were equal to or greater than its costs.''
(Sec. 447.272) Inpatient Services: Application of Upper Payment Limits
In Sec. 447.272(a), DHHS is removing the word ``nursing
facilities'' replacing it with ``NFs.''
In Sec. 447.272(a)(1), DHHS is revising the paragraph to read
``State government-owned or operated facilities (that is, all
facilities that are either owned or operated by the State).''
In Sec. 447.272(a)(2), DHHS is revising the paragraph to read
``Non-State government-owned or operated facilities (that is, all
government facilities that are neither owned nor operated by the
State).''
In Sec. 447.272(a)(3), DHHS is revising the paragraph to read
``Privately-owned and operated facilities.''
In Sec. 447.272(b)(1), DHHS is removing the words ``For privately
operated facilities.''
In Sec. 447.272(b)(2), DHHS is revising the paragraph to read
``Except as provided for in paragraph (c) of this section, aggregate
Medicaid payments to a group of facilities within one of the categories
described in paragraph (a) of this section may not exceed the upper
payment limit described in paragraph (b)(1) of this section.''
In Sec. 447.272(b)(3), DHHS is removing entire provision of this
regulation.
In Sec. 447.272(b)(4), DHHS is removing entire provision of this
regulation.
In Sec. 447.272(c), DHHS is removing symbol ``--'' and replacing
it with ``.''.
In Sec. 447.272, DHHS is removing paragraph (c)(3) of this
regulation.
In Sec. 447.272(d)(1), DHHS is revising the paragraph to read
``For non-State government owned or operated hospitals--March 19,
2002.''
(Sec. 447.321) Outpatient Hospital and Clinic Services: Application of
Upper Payment Limits
In Sec. 447.321(a)(1), DHHS is revising the paragraph to read
``State government-owned or operated facilities (that is, all
facilities that are owned or operated by the State).''
In Sec. 447.321(a)(2), DHHS is revising the paragraph to read
``Non-State government owned or operated facilities (that is, all
government operated facilities that are neither owned nor operated by
the State).''
In Sec. 447.321(a)(3), DHHS is revising the paragraph to read
``Privately-owned and operated facilities.''
In Sec. 447.321(b)(1), DHHS is removing the words ``For privately
operated facilities,''.
In Sec. 447.321(b)(2), DHHS is revising the provision to read
``Except as provided for in paragraph (c) of this section, aggregate
Medicaid payments to
[[Page 73974]]
a group of facilities within one of the categories described in
paragraph (a) of this section may not exceed the upper payment limit
described in paragraph (b)(1) of this section.''
In Sec. 447.321, DHHS is removing paragraph (b)(3) of this
regulation.
In Sec. 447.321, DHHS is removing pargraph (b)(4) of this
regulation.
In Sec. 447.321(c)(1), DHHS is removing the designated number
``(1)'' of this regulation.
In Sec. 447.321, DHHS is removing paragraph (c)(2) of this
regulation.
In Sec. 447.321, DHHS is removing paragraph (c)(3) of this
regulation.
In Sec. 447.321(d), DHHS is removing reference to paragraph
``(b)'' and replacing it with a reference to paragraph ``(b)(1).''
In Sec. 447.321(d)(1), DHHS is revising the paragraph to read
``For non-State government-owned or operated hospitals--March 19,
2002.''
In Sec. 447.321, DHHS is removing paragraph (d)(2) and
redesignating paragraph (d)(3) as paragraph (d)(2) of this regulation.
Sec. 457.220 Funds From Units of Government as the State Share of
Financial Participation
In Sec. 457.220(a), DHHS is adding the word ``Public'' before the
word ``Funds.'' DHHS is also removing the words ``from units of
government.''
In Sec. 457.220(b), DHHS is revising the paragraph to read ``The
public funds are appropriated directly to the State or local SCHIP
agency, or are transferred from other public agencies (including Indian
tribes) to the State or local agency and are under its administrative
control, or are certified by the contributing public agency as
representing expenditures eligible for FFP under this section.''
In Sec. 457.220(c), DHHS is adding the word ``public'' after the
word ``The'' before the word ``funds.'' DHHS is also removing the words
``from units of government.''
Sec. 457.628 Other Applicable Federal Regulations
In Sec. 457.628(a), DHHS is removing the parenthesis ``('' before
the word ``sources'' and removing the parenthesis ``)'' after the word
``Donations'' and adding a semicolon and the word ``Donations.'' In
addition, DHHS is removing the words ``and Sec. 447.207 of this
chapter (Retention of payments).''
III. Collection of Information
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995.
IV. Waiver of Proposed Rulemaking and Delayed Effective Date
DHHS ordinarily publish a notice of proposed rulemaking in the
Federal Register and invite public comment on the proposed rule. The
notice of proposed rulemaking includes a reference to the legal
authority under which the rule is proposed, and the terms and
substances of the proposed rule or a description of the subjects and
issues involved. This procedure can be waived, however, if an agency
finds good cause that a notice-and-comment procedure is impractical,
unnecessary, or contrary to the public interest and incorporates a
statement of the finding and its reasons in the rule issued. DHHS has
determined that providing prior notice and opportunity for comment on
the amending regulations is unnecessary. This final rule merely removes
regulatory language relating to CMS-2258-FC, which was vacated by the
United States District Court for the District of Columbia. As a result
of this decision, the regulatory language related to CMS-2258-FC has no
force or effect, and public comment would not affect that status. The
presence of that language in the Code of Federal Regulations can be
confusing, and thus the public interest would be served by removal of
that language. Furthermore, removing this language from the Code of
Federal Regulations and reinstating the prior regulatory language has
no legal impact but simply reflects this final judicial determination.
For the same reasons, DHHS believes there is good cause for waiving
any delay in the effective date, making the reinstated regulatory
provisions immediately effective. See 5 U.S.C. 553(d).
V. Regulatory Impact Statement
DHHS has examined the impact of this rule as required by Executive
Order 12866 on Regulatory Planning and Review (September 30, 1993), the
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354),
section 1102(b) of the Social Security Act, section 202 of the Unfunded
Mandates Reform Act of 1995 (March 22, 1995; Pub. L. 104-4), Executive
Order 13132 on Federalism (August 4, 1999) and the Congressional Review
Act (5 U.S.C. 804(2)).
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, if regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity). A regulatory impact
analysis (RIA) must be prepared for major rules with economically
significant effects ($100 million or more in any 1 year). This
regulatory action only removes those regulations vacated by the United
States District Court for the District of Columbia. Therefore, this
action is not a ``significant'' regulatory action as defined by E.O.
12866. This rule also does not reach the economic threshold and thus is
not considered a major rule.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and small governmental
jurisdictions. Most hospitals and most other providers and suppliers
are small entities, either by nonprofit status or by having revenues of
$7 million to $34.5 million in any one year. Individuals and States are
not included in the definition of a small entity. DHHS is not preparing
an analysis for the RFA because DHHS has determined, and the Secretary
certifies, that this final rule will not have a significant economic
impact on a substantial number of small entities.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 604 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a Core-Based
Statistical Area (for Medicaid) and outside a Metropolitan Statistical
Area for Medicare) and has fewer than 100 beds. DHHS is not preparing
an analysis for section 1102(b) of the Act because we have determined,
and the Secretary certifies, that this final rule will not have a
significant impact on the operations of a substantial number of small
rural hospitals.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule whose mandates require spending in any 1 year of $100
million in 1995 dollars, updated annually for inflation. In 2010, that
threshold is approximately $135 million. This rule will have no
consequential effect on State, local, or tribal governments or on the
private sector.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates
[[Page 73975]]
regulations that imposes substantial direct requirement costs on State
and local governments, preempts State law, or otherwise has Federalism
implications. Since this regulation does not impose any costs on State
or local governments, the requirements of Executive Order 13132 are not
applicable.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
List of Subjects
42 CFR Part 433
Administrative practice and procedure, Child support, Claims, Grant
programs--health, Medicaid, Reporting and recordkeeping requirements.
42 CFR Part 447
Accounting, Administrative practice and procedure, Drugs, Grant
programs--health, Health facilities, Health professions, Medicaid,
Reporting and recordkeeping requirements, Rural areas.
42 CFR Part 457
Administrative practice and procedure, Grant programs--health,
Health insurance, Reporting and recordkeeping requirements.
0
For the reasons set forth in the preamble, the Centers for Medicare &
Medicaid Services amends 42 CFR chapter IV as set forth below:
PART 433--STATE FISCAL ADMINISTRATION
0
1. The authority citation for part 433 continues to read as follows:
Authority: Sec. 1102 of the Social Security Act (42 U.S.C.
1302).
Subpart B--General Administrative Requirements State Financial
Participation
0
2. Section Sec. 433.50 is amended by revising paragraph (a)(1) to read
as follows:
Sec. 433.50 Basis, scope, and applicability.
(a) * * *
(1) Section 1902(a)(2) of the Act which requires States to share in
the cost of medical assistance expenditures and permit both State and
local governments to participate in the financing of the non-Federal
portion of medical assistance expenditures.
* * * * *
0
3. Section 433.51 is revised to read as follows:
Sec. 433.51 Public Funds as the State share of financial
participation.
(a) Public Funds may be considered as the State's share in claiming
FFP if they meet the conditions specified in paragraphs (b) and (c) of
this section.
(b) The public funds are appropriated directly to the State or
local Medicaid agency, or are transferred from other public agencies
(including Indian tribes) to the State or local agency and under its
administrative control, or certified by the contributing public agency
as representing expenditures eligible for FFP under this section.
(c) The public funds are not Federal funds, or are Federal funds
authorized by Federal law to be used to match other Federal funds.
PART 447--PAYMENTS FOR SERVICES
0
4. The authority citation for part 447 continues to read as follows:
Authority: Sec. 1102 of the Social Security Act (42 U.S.C.
1302).
Subpart B--Payment Methods: General Provisions
Sec. 447.206 [Removed]
0
5. Section 447.206 is removed.
Sec. 447.207 [Removed]
0
6. Section 447.207 is removed.
Subpart C--Payment for Inpatient Hospital and Long-Term Care
Facility Services
Upper Limits
0
7. Section Sec. 447.271 is revised to read as follows:
Sec. 447.271 Upper limits based on customary charges.
(a) Except as provided in paragraph (b) of this section, the agency
may not pay a provider more for inpatient hospital services under
Medicaid than the provider's customary charges to the general public
for the services.
(b) The agency may pay a public provider that provides services
free or at a nominal charge at the same rate that would be used if the
provider charges were equal to or greater than its costs.
0
8. Section 447.272 is amended by--
0
A. Revising paragraphs (a), (b), and (d)(1).
0
B. Revising the heading for paragraph (c).
0
C. Removing paragraph (c)(3).
The revisions read as follows:
Sec. 447.272 Inpatient services: Application of upper payment limits.
(a) Scope. This section applies to rates set by the agency to pay
for inpatient services furnished by hospitals, NFs, and ICFs/MR within
one of the following categories:
(1) State government-owned or operated facilities (that is, all
facilities that are either owned or operated by the State).
(2) Non-State government-owned or operated facilities (that is, all
government facilities that are neither owned nor operated by the
State).
(3) Privately-owned and operated facilities.
(b) General rules.
(1) Upper payment limit refers to a reasonable estimate of the
amount that would be paid for the services furnished by the group of
facilities under Medicare payment principles in subchapter B of this
chapter.
(2) Except as provided for in paragraph (c) of this section,
aggregate Medicaid payments to a group of facilities within one of the
categories described in paragraph (a) of this section may not exceed
the upper payment limit described in paragraph (b)(1) of this section.
(c) Exceptions.
* * * * *
(d) * * *
(1) For non-State government owned or operated hospitals,--March
19, 2002.
* * * * *
Subpart F--Payment Methods for Other Institutional and
Noninstitutional Services
Outpatient Hospital and Clinic Services
0
9. Section 447.321 is amended by--
0
A. Revising paragraphs (a), (b), (c) and (d)(1).
0
B. Revising introductory text of paragraph (d) by removing the phrase
``paragraph (b)'' and adding in its place the phrase ``paragraph
(b)(1).''
0
C. Removing paragraphs (d)(2).
0
D. Redesignating paragraph (d)(3)as paragraph (d)(2).
The revisions read as follows:
Sec. 447.321 Outpatient hospital and clinic services: Application of
upper payment limits.
(a) Scope. This section applies to rates set by the agency to pay
for outpatient services furnished by hospitals and clinics within one
of the following categories:
(1) State government-owned or operated facilities (that is, all
facilities that are owned or operated by the State.)
(2) Non-State government owned or operated facilities (that is, all
government operated facilities that are neither owned nor operated by
the State).
(3) Privately-owned and operated facilities.
[[Page 73976]]
(b) General rules. (1) Upper payment limit refers to a reasonable
estimate of the amount that would be paid for the services furnished by
the group of facilities under Medicare payment principles in subchapter
B of this chapter.
(2) Except as provided in paragraph (c) of this section, aggregate
Medicaid payments to a group of facilities within one of the categories
described in paragraph (a) of this section may not exceed the upper
payment limit described in paragraph (b)(1) of this section.
(c) Exceptions. Indian Health Services and tribal facilities. The
limitation in paragraph (b) of this section does not apply to Indian
Health Services facilities and tribal facilities that are funded
through the Indian Self-Determination and Education Assistance Act
(Pub. L. 93-638).
(d) * * *
(1) For non-State government-owned or operated hospitals--March 19,
2002.
* * * * *
PART 457--ALLOTMENTS AND GRANTS TO STATES
0
10. The authority for part 457 continues to read as follows:
Authority: Sec. 1102 of the Social Security Act (42 U.S.C.
1302).
Subpart B--General Administration--Reviews and Audits; Withholding
for Failure To Comply; Deferral and Disallowance of Claims;
Reduction of Federal Medical Payments
0
11. Section 457.220 is revised to read as follows:
Sec. 457.220 Funds from units of government as the State share of
financial participation.
(a) Public funds may be considered as the State's share in claiming
FFP if they meet the conditions specified in paragraphs (b) and (c) of
this section.
(b) The public funds are appropriated directly to the State or
local SCHIP agency, or are transferred from other public agencies
(including Indian tribes) to the State or local agency and are under
its administrative control, or are certified by the contributing public
agency as representing expenditures eligible for FFP under this
section.
(c) The public funds are not Federal funds, or are Federal funds
authorized by Federal law to be used to match other Federal funds.
Subpart F--Payments to States
0
12. Section 457.628 is amended by revising the introductory text and
paragraph (a) to read as follows:
Sec. 457.628 Other applicable Federal regulations.
Other regulations applicable to SCHIP programs include the
following:
(a) HHS regulations in 42 Subpart B--433.51-433.74 sources of non-
Federal share and Health Care-Related Taxes and Provider-Related
Donations; apply to States' SCHIP programs in the same manner as they
apply to States' Medicaid programs.
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program)
Dated: July 28, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
Approved: August 20, 2010.
Kathleen Sebelius
Secretary.
[FR Doc. 2010-30066 Filed 11-29-10; 8:45 am]
BILLING CODE 4120-01-P
