Notice of Opportunity for Hearing on Compliance of Arkansas State Plan Provisions Concerning Provision of Benefits During a Reasonable Opportunity Period With Titles XI and XIX (Medicaid) of the Social Security Act, 49660-49662 [2016-17923]
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[FR Doc. 2016–17799 Filed 7–27–16; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES (HHS)
Centers for Medicare & Medicaid
Services
Notice of Opportunity for Hearing on
Compliance of Arkansas State Plan
Provisions Concerning Provision of
Benefits During a Reasonable
Opportunity Period With Titles XI and
XIX (Medicaid) of the Social Security
Act
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice of Opportunity for a
Hearing Compliance of Arkansas
Medicaid State Plan—Provision of
Benefits During a Reasonable
Opportunity Period.
AGENCY:
Requests to participate in
the hearing as a party must be received
by the presiding officer by August 29,
2016.
FOR FURTHER INFORMATION CONTACT:
Benjamin R. Cohen, Hearing Officer,
Centers for Medicare & Medicaid
Services, 2520 Lord Baltimore Drive,
Suite L, Baltimore, MD 21244.
SUPPLEMENTARY INFORMATION: This
notice announces the opportunity for an
administrative hearing concerning the
finding of the Administrator of the
Centers for Medicare & Medicaid
Services (CMS) that the State of
Arkansas is not providing Medicaid
benefits during a reasonable opportunity
period.
Section 1902(a)(46) of the Social
Security Act (the Act) requires state
plans for medical assistance to provide
‘‘that information is requested and
exchanged for purposes of income and
eligibility verification in accordance
with a State system which meets the
requirements of section 1137 of this
Act.’’ Section 1137(d) of the Act and
regulations at 42 CFR 435.911(c) require
that the state agency provide a
reasonable opportunity period to
individuals who are determined
otherwise eligible for Medicaid but for
whom the state agency is unable to
promptly verify satisfactory immigration
status. In its approved State Plan
Amendment (SPA) 13–0018, the
Arkansas Department of Human
Services (DHS) provides assurance that
it provides Medicaid to citizens and
nationals of the United States and to
certain non-citizens, including during a
reasonable opportunity period pending
verification of their citizenship, national
status or satisfactory immigration status,
in accordance with the requirements of
sections 1902(a)(46), 1902(ee), 1903(x)
and 1137(d) of the Act. Despite such
CLOSING DATE:
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assurance in the Medicaid state plan, it
is CMS’ understanding based on
numerous discussions and interactions
with the state that Arkansas is not
providing Medicaid benefits to
individuals who declared under penalty
of perjury that they are in a satisfactory
immigration status, have met all other
eligibility requirements for Medicaid in
the state, and are pending verification of
their immigration status.
With a formal determination by the
CMS Administrator that the Arkansas
DHS has failed to comply substantially
with these requirements, made after a
hearing or absent a hearing request,
CMS will begin this FFP withholding
and it will continue until the Arkansas
DHS comes into compliance with the
requirement to provide Medicaid
benefits during a reasonable opportunity
period for otherwise eligible noncitizens who have declared under
penalty of perjury that they are in a
satisfactory immigration status.
Arkansas submitted state plan
amendment (SPA) Transmittal Number
13–0018 on September 23, 2013, which
described the Arkansas DHS’s policies
and practices related to citizenship and
non-citizen eligibility, including the
assurance that the Arkansas DHS
provides Medicaid benefits during the
reasonable opportunity period to
individuals who have declared under
penalty of perjury that they are in a
satisfactory immigration status pending
verification of such status. During the
review of this SPA, CMS learned that
the Arkansas DHS was not providing
Medicaid benefits during a reasonable
opportunity period to individuals who
have declared under penalty of perjury
that they are in a satisfactory
immigration status and who meet all
other eligibility requirements in the
state, pending verification of such
status. Throughout 2014 and 2015, CMS
and Arkansas engaged in extensive
technical assistance discussions. CMS
sent a letter to the Arkansas DHS on
April 1, 2015, reiterating the
requirement for Arkansas to comply
with the statute and regulations. During
this time, CMS received multiple draft
corrective action plans (CAPs) from
Arkansas that set out schedules to come
into compliance with section 1137(d) of
the Act by July 1, 2014, October 2015,
April 2016, and, most recently, August
2016.
On November 3, 2015, CMS approved
Arkansas’ SPA 13–0018. At the same
time, CMS issued a companion letter
informing Arkansas that, if it did not
demonstrate compliance with these
requirements within 30 days of the date
of the letter, CMS would initiate formal
compliance proceedings. To date, CMS
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has not received evidence of compliance
with the requirement to provide
Medicaid benefits to non-citizens during
a reasonable opportunity period.
The notice to Arkansas containing the
details concerning this compliance
issue, the proposed withholding of FFP,
opportunity for a hearing, and
possibility of postponing and ultimately
avoiding withholding by coming into
compliance, reads as follows:
Dear Ms. Stehle:
This letter provides notice that the
Centers for Medicare & Medicaid
Services (CMS) has found a serious
issue of noncompliance because the
Arkansas Department of Human
Services (DHS) is not providing
Medicaid benefits during a reasonable
opportunity period as required by
section 1137(d) of the Social Security
Act (the Act) and regulations at 42 CFR.
§ 435.911(c).
Pursuant to section 1904 of the Act
and 42 CFR 430.35, a portion of the
federal financial participation (FFP) of
the administrative costs associated with
the operation of the Arkansas Medicaid
program will be withheld. However,
CMS is first providing the Arkansas
DHS with an opportunity for a hearing
on this withholding decision. With a
formal determination by the CMS
Administrator that the Arkansas DHS
has failed to comply substantially with
these requirements, made after a hearing
or absent a hearing request, CMS will
begin this FFP withholding and it will
continue until the Arkansas DHS comes
into compliance with the requirement to
provide Medicaid benefits during a
reasonable opportunity period for
otherwise eligible non-citizens who
have declared under penalty of perjury
that they are in a satisfactory
immigration status. The details of the
finding, proposed withholding,
opportunity for the Arkansas DHS to
request a hearing on the finding, and
possibility of postponing, and
ultimately avoiding, withholding by
coming into compliance are described
below.
CMS learned of the Arkansas DHS’
non-compliance with section 1137(d) of
the Act and regulations at 42 CFR
435.911(c) during the review of State
Plan Amendment (SPA) Transmittal
Number 13–0018. Section 1902(a)(46) of
the Act requires state plans for medical
assistance to provide ‘‘that information
is requested and exchanged for purposes
of income and eligibility verification in
accordance with a State system which
meets the requirements of section 1137
of this Act.’’ Section 1137(d) of the Act
requires that the state agency provide a
reasonable opportunity period to
individuals who are determined
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otherwise eligible for Medicaid but for
whom the state agency is unable to
promptly verify satisfactory immigration
status. See also, 42 CFR. § 435.911(c). In
the approved SPA 13–0018, the
Arkansas DHS provides assurance that it
provides Medicaid to citizens and
nationals of the United States and to
certain non-citizens, including during a
reasonable opportunity period pending
verification of their citizenship, national
status or satisfactory immigration status,
in accordance with the requirements of
sections 1902(a)(46), 1902(ee), 1903(x)
and 1137(d) of the Act. Despite such
assurance in the Medicaid state plan, it
is our understanding that the Arkansas
DHS is not providing Medicaid benefits
to individuals who declare under
penalty of perjury that they are in a
satisfactory immigration status, meet all
other eligibility requirements for
Medicaid in the state, and are pending
verification of such status.
In processing SPA 13–0018, CMS and
the Arkansas DHS discussed this issue
on October 10, 2013, and again on
December 9, 2013, and the Arkansas
DHS acknowledged that it is not
furnishing benefits during the
reasonable opportunity period to
individuals who declare under penalty
of perjury that they are in a satisfactory
immigration status. A formal Request for
Additional Information (RAI) was
issued on December 20, 2013, which
requested a description of the steps the
Arkansas DHS would take to implement
the change, a timeline by which the
steps would be accomplished and a date
by which the changes will be completed
to be in compliance with section
1137(d) of the Act. CMS also sent a
letter to the Arkansas DHS on April 1,
2015, reiterating the requirement for the
Arkansas DHS to comply with the
statute and regulations.
Throughout 2014 and 2015, CMS and
the Arkansas DHS engaged in extensive
technical assistance discussions. During
this time, CMS received multiple draft
corrective action plans (CAPs) from the
Arkansas DHS that set out schedules for
compliance with section 1137(d) of the
Act, including dates of compliance by
July 1, 2014, October 2015, and April
2016. The Arkansas DHS formally
responded to the December 20, 2013,
RAI on October 7, 2015. The RAI
response included a revised schedule
for compliance with section 1137(d) of
the Act by April of 2016. On November
3, 2015, CMS approved Arkansas’ SPA
13–0018, which describes the Arkansas
DHS’s policies and practices related to
citizenship and non-citizen eligibility,
including the assurance that the
Arkansas DHS is providing Medicaid
benefits during the reasonable
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49661
opportunity period to individuals who
have declared under penalty of perjury
that they are in a satisfactory
immigration status pending verification
of such status. At the same time, CMS
issued a companion letter informing the
Arkansas DHS that, if it did not
demonstrate compliance with these
requirements within 30 days of the date
of the letter, CMS would initiate formal
compliance proceedings. The Arkansas
DHS did not come into compliance by
the specified date and on February 23,
2016, submitted a revised timeline for
compliance with section 1137(d) of the
Act, with a compliance date of August
2016.
The Arkansas DHS’ submission of its
quarterly expenditure reports through
the CMS–64 includes a certification that
the Arkansas DHS is operating under
the authority of its approved Medicaid
state plan. However, at this time, CMS
has not received information from the
Arkansas DHS providing evidence of
compliance with its approved state
plan, section 1137(d) of the Act and
regulations at 42 CFR 435.911(c).
In light of the Arkansas DHS’ noncompliance with section 1137(d) of the
Act, CMS is moving forward with a
formal determination of substantial
noncompliance with federal
requirements described in section
1137(d) of the Act and the regulations
at 42 CFR 435.911(c) to provide
Medicaid coverage to otherwise eligible
non-citizens pending verification of
their satisfactory immigration status
during a reasonable opportunity period
if the individual meets all other
eligibility criteria for Medicaid. Subject
to the state’s opportunity for a hearing,
CMS will withhold a portion of federal
financial participation (FFP) from the
Arkansas DHS’ quarterly claim of
expenditures for administrative costs
until such time as the Arkansas DHS is
and continues to be in compliance with
the federal requirements. The
withholding will initially be three
percent of the federal share of the
Arkansas DHS’ quarterly claim for
administrative expenditures, an amount
that was developed based on the
proportion of total state Medicaid
expenditures that are used for
expenditures for eligibility
determinations, as reported on Form
CMS–64.10 Line 50. The withholding
percentage will increase by two
percentage points (i.e. 5 percent, 7
percent, etc.) for every quarter in which
the Arkansas DHS remains out of
compliance, up to a maximum
withholding percentage of 100 percent
(of total administrative expenditures).
The withholding will end when the
Arkansas DHS fully and satisfactorily
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implements a corrective action plan to
bring its procedures to process
eligibility determinations under its
Medicaid program into compliance with
the federal requirements.
The state has 30 days from the date of
this letter to request a hearing. As
specified in the accompanying Federal
Register notice, the Arkansas DHS has
an opportunity for an administrative
hearing prior to this determination
becoming final. However, the Arkansas
DHS must request a hearing. If a request
for a hearing is submitted timely, the
hearing will be convened by the Hearing
Officer designated below no later than
60 days after the date of the Federal
Register notice, or a later date by
agreement of the parties and the Hearing
Officer, at the CMS Regional Office in
Dallas, Texas, in accordance with the
procedures set forth in federal
regulations at 42 CFR part 430, subpart
D. The issue in any such hearing will be
whether benefits are being provided
during a reasonable opportunity period
to individuals who have declared under
penalty of perjury that they are in a to
a satisfactory immigration status
pending verification of such status, if
they meet all other eligibility
requirements, in accordance with the
state plan and 42 CFR 435.911(c). Any
request for such a hearing should be
sent to the designated Hearing Officer.
The Hearing Officer also should be
notified if the Arkansas DHS requests a
hearing but cannot meet the timeframe
expressed in this notice. The Hearing
Officer designated for this matter is:
Benjamin R. Cohen, Hearing Officer,
Centers for Medicare & Medicaid
Services, 2520 Lord Baltimore Drive,
Suite L, Baltimore, MD 21244.
If the Arkansas DHS plans to come
into compliance with the approved state
plan, the Arkansas DHS should submit,
within 30 days of the date of this letter,
an explanation of how the Arkansas
DHS plans to come into compliance
with federal requirements and the
timeframe for doing so. If that
explanation is satisfactory, CMS may
consider postponing any requested
hearing, which could also delay the
imposition of the withholding of funds
as described above. Our goal is to have
the Arkansas DHS come into
compliance, and CMS continues to be
available to provide technical assistance
to the Arkansas DHS in achieving this
outcome.
Should you not request a hearing
within 30 days, a notice of withholding
will be sent to you and the withholding
of federal funds will begin as described
above.
If you have any questions or wish to
discuss this determination further,
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please contact: Bill Brooks, Associate
Regional Administrator, Division of
Medicaid and Children’s Health
Operations, CMS Dallas Regional Office,
1301 Young Street, Suite 714, Dallas, TX
75202, 214–767–4461.
Sincerely,
Andrew M. Slavitt
Acting Administrator
(Catalog of Federal Domestic Assistance
Program No. 13.714, Medicaid Assistance
Program.)
Dated: July 22, 2016.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare
& Medicaid Services.
[FR Doc. 2016–17923 Filed 7–27–16; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–1667–PN]
Medicare Program; Request for an
Exception to the Prohibition on
Expansion of Facility Capacity Under
the Hospital Ownership and Rural
Provider Exceptions to the Physician
Self-Referral Prohibition
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Proposed notice.
AGENCY:
The Social Security Act
prohibits a physician-owned hospital
from expanding its facility capacity,
unless the Secretary of the Department
of Health and Human Services (the
Secretary) grants the hospital’s request
for an exception to that prohibition after
considering input on the hospital’s
request from individuals and entities in
the community where the hospital is
located. The Centers for Medicare &
Medicaid Services (CMS) has received a
request from a physician-owned
hospital for an exception to the
prohibition against expansion of facility
capacity. This notice solicits comments
on the request from individuals and
entities in the community in which the
physician-owned hospital is located.
Community input may inform our
determination regarding whether the
requesting hospital qualifies for an
exception to the prohibition against
expansion of facility capacity.
DATES: Comment Date: To be assured
consideration, comments must be
received at one of the addresses
provided below, no later than 5 p.m. on
August 29, 2016.
SUMMARY:
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In commenting, please refer
to file code CMS–1667–PN. Because of
staff and resource limitations, we cannot
accept comments by facsimile (FAX)
transmission.
You may submit comments in one of
three ways (please choose only one of
the ways listed):
1. Electronically. You may submit
electronic comments on this exception
request to https://www.regulations.gov.
Follow the instructions under the ‘‘More
Search Options’’ tab.
2. By regular mail. You may mail
written comments to the following
address ONLY: Centers for Medicare &
Medicaid Services, Department of
Health and Human Services, Attention:
CMS–1667–PN, P.O. Box 8010,
Baltimore, MD 21244–1850.
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 to the
following address ONLY: Department of
Health and Human Services, Attention:
CMS–1667–PN, Mail Stop C4–26–05,
7500 Security Boulevard, Baltimore, MD
21244–1850.
For information on viewing public
comments, see the beginning of the
SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
POH-ExceptionRequests@cms.hhs.gov.
ADDRESSES:
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments
All comments received before the
close of the comment period are
available for viewing by the public,
including any personally identifiable or
confidential business information that is
included in a comment. We post all
comments received before the close of
the comment period on the following
Web site as soon as possible after they
have been received: https://
www.regulations.gov. Follow the search
instructions on that Web site to view
public comments.
We will allow stakeholders 30 days
from the date of this notice to submit
written comments. Comments received
timely will be available for public
inspection as they are received,
generally beginning approximately 3
weeks after publication of this notice, at
the headquarters of the Centers for
Medicare & Medicaid Services, 7500
Security Boulevard, Baltimore,
Maryland 21244, Monday through
Friday of each week from 8:30 a.m. to
4 p.m. To schedule an appointment to
view public comments, please phone 1–
800–743–3951.
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]]>Agencies
[Federal Register Volume 81, Number 145 (Thursday, July 28, 2016)]
[Notices]
[Pages 49660-49662]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-17923]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Centers for Medicare & Medicaid Services
Notice of Opportunity for Hearing on Compliance of Arkansas State
Plan Provisions Concerning Provision of Benefits During a Reasonable
Opportunity Period With Titles XI and XIX (Medicaid) of the Social
Security Act
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of Opportunity for a Hearing Compliance of Arkansas
Medicaid State Plan--Provision of Benefits During a Reasonable
Opportunity Period.
-----------------------------------------------------------------------
CLOSING DATE: Requests to participate in the hearing as a party must be
received by the presiding officer by August 29, 2016.
FOR FURTHER INFORMATION CONTACT: Benjamin R. Cohen, Hearing Officer,
Centers for Medicare & Medicaid Services, 2520 Lord Baltimore Drive,
Suite L, Baltimore, MD 21244.
SUPPLEMENTARY INFORMATION: This notice announces the opportunity for an
administrative hearing concerning the finding of the Administrator of
the Centers for Medicare & Medicaid Services (CMS) that the State of
Arkansas is not providing Medicaid benefits during a reasonable
opportunity period.
Section 1902(a)(46) of the Social Security Act (the Act) requires
state plans for medical assistance to provide ``that information is
requested and exchanged for purposes of income and eligibility
verification in accordance with a State system which meets the
requirements of section 1137 of this Act.'' Section 1137(d) of the Act
and regulations at 42 CFR 435.911(c) require that the state agency
provide a reasonable opportunity period to individuals who are
determined otherwise eligible for Medicaid but for whom the state
agency is unable to promptly verify satisfactory immigration status. In
its approved State Plan Amendment (SPA) 13-0018, the Arkansas
Department of Human Services (DHS) provides assurance that it provides
Medicaid to citizens and nationals of the United States and to certain
non-citizens, including during a reasonable opportunity period pending
verification of their citizenship, national status or satisfactory
immigration status, in accordance with the requirements of sections
1902(a)(46), 1902(ee), 1903(x) and 1137(d) of the Act. Despite such
assurance in the Medicaid state plan, it is CMS' understanding based on
numerous discussions and interactions with the state that Arkansas is
not providing Medicaid benefits to individuals who declared under
penalty of perjury that they are in a satisfactory immigration status,
have met all other eligibility requirements for Medicaid in the state,
and are pending verification of their immigration status.
With a formal determination by the CMS Administrator that the
Arkansas DHS has failed to comply substantially with these
requirements, made after a hearing or absent a hearing request, CMS
will begin this FFP withholding and it will continue until the Arkansas
DHS comes into compliance with the requirement to provide Medicaid
benefits during a reasonable opportunity period for otherwise eligible
non-citizens who have declared under penalty of perjury that they are
in a satisfactory immigration status.
Arkansas submitted state plan amendment (SPA) Transmittal Number
13-0018 on September 23, 2013, which described the Arkansas DHS's
policies and practices related to citizenship and non-citizen
eligibility, including the assurance that the Arkansas DHS provides
Medicaid benefits during the reasonable opportunity period to
individuals who have declared under penalty of perjury that they are in
a satisfactory immigration status pending verification of such status.
During the review of this SPA, CMS learned that the Arkansas DHS was
not providing Medicaid benefits during a reasonable opportunity period
to individuals who have declared under penalty of perjury that they are
in a satisfactory immigration status and who meet all other eligibility
requirements in the state, pending verification of such status.
Throughout 2014 and 2015, CMS and Arkansas engaged in extensive
technical assistance discussions. CMS sent a letter to the Arkansas DHS
on April 1, 2015, reiterating the requirement for Arkansas to comply
with the statute and regulations. During this time, CMS received
multiple draft corrective action plans (CAPs) from Arkansas that set
out schedules to come into compliance with section 1137(d) of the Act
by July 1, 2014, October 2015, April 2016, and, most recently, August
2016.
On November 3, 2015, CMS approved Arkansas' SPA 13-0018. At the
same time, CMS issued a companion letter informing Arkansas that, if it
did not demonstrate compliance with these requirements within 30 days
of the date of the letter, CMS would initiate formal compliance
proceedings. To date, CMS
[[Page 49661]]
has not received evidence of compliance with the requirement to provide
Medicaid benefits to non-citizens during a reasonable opportunity
period.
The notice to Arkansas containing the details concerning this
compliance issue, the proposed withholding of FFP, opportunity for a
hearing, and possibility of postponing and ultimately avoiding
withholding by coming into compliance, reads as follows:
Dear Ms. Stehle:
This letter provides notice that the Centers for Medicare &
Medicaid Services (CMS) has found a serious issue of noncompliance
because the Arkansas Department of Human Services (DHS) is not
providing Medicaid benefits during a reasonable opportunity period as
required by section 1137(d) of the Social Security Act (the Act) and
regulations at 42 CFR. Sec. 435.911(c).
Pursuant to section 1904 of the Act and 42 CFR 430.35, a portion of
the federal financial participation (FFP) of the administrative costs
associated with the operation of the Arkansas Medicaid program will be
withheld. However, CMS is first providing the Arkansas DHS with an
opportunity for a hearing on this withholding decision. With a formal
determination by the CMS Administrator that the Arkansas DHS has failed
to comply substantially with these requirements, made after a hearing
or absent a hearing request, CMS will begin this FFP withholding and it
will continue until the Arkansas DHS comes into compliance with the
requirement to provide Medicaid benefits during a reasonable
opportunity period for otherwise eligible non-citizens who have
declared under penalty of perjury that they are in a satisfactory
immigration status. The details of the finding, proposed withholding,
opportunity for the Arkansas DHS to request a hearing on the finding,
and possibility of postponing, and ultimately avoiding, withholding by
coming into compliance are described below.
CMS learned of the Arkansas DHS' non-compliance with section
1137(d) of the Act and regulations at 42 CFR 435.911(c) during the
review of State Plan Amendment (SPA) Transmittal Number 13-0018.
Section 1902(a)(46) of the Act requires state plans for medical
assistance to provide ``that information is requested and exchanged for
purposes of income and eligibility verification in accordance with a
State system which meets the requirements of section 1137 of this
Act.'' Section 1137(d) of the Act requires that the state agency
provide a reasonable opportunity period to individuals who are
determined otherwise eligible for Medicaid but for whom the state
agency is unable to promptly verify satisfactory immigration status.
See also, 42 CFR. Sec. 435.911(c). In the approved SPA 13-0018, the
Arkansas DHS provides assurance that it provides Medicaid to citizens
and nationals of the United States and to certain non-citizens,
including during a reasonable opportunity period pending verification
of their citizenship, national status or satisfactory immigration
status, in accordance with the requirements of sections 1902(a)(46),
1902(ee), 1903(x) and 1137(d) of the Act. Despite such assurance in the
Medicaid state plan, it is our understanding that the Arkansas DHS is
not providing Medicaid benefits to individuals who declare under
penalty of perjury that they are in a satisfactory immigration status,
meet all other eligibility requirements for Medicaid in the state, and
are pending verification of such status.
In processing SPA 13-0018, CMS and the Arkansas DHS discussed this
issue on October 10, 2013, and again on December 9, 2013, and the
Arkansas DHS acknowledged that it is not furnishing benefits during the
reasonable opportunity period to individuals who declare under penalty
of perjury that they are in a satisfactory immigration status. A formal
Request for Additional Information (RAI) was issued on December 20,
2013, which requested a description of the steps the Arkansas DHS would
take to implement the change, a timeline by which the steps would be
accomplished and a date by which the changes will be completed to be in
compliance with section 1137(d) of the Act. CMS also sent a letter to
the Arkansas DHS on April 1, 2015, reiterating the requirement for the
Arkansas DHS to comply with the statute and regulations.
Throughout 2014 and 2015, CMS and the Arkansas DHS engaged in
extensive technical assistance discussions. During this time, CMS
received multiple draft corrective action plans (CAPs) from the
Arkansas DHS that set out schedules for compliance with section 1137(d)
of the Act, including dates of compliance by July 1, 2014, October
2015, and April 2016. The Arkansas DHS formally responded to the
December 20, 2013, RAI on October 7, 2015. The RAI response included a
revised schedule for compliance with section 1137(d) of the Act by
April of 2016. On November 3, 2015, CMS approved Arkansas' SPA 13-0018,
which describes the Arkansas DHS's policies and practices related to
citizenship and non-citizen eligibility, including the assurance that
the Arkansas DHS is providing Medicaid benefits during the reasonable
opportunity period to individuals who have declared under penalty of
perjury that they are in a satisfactory immigration status pending
verification of such status. At the same time, CMS issued a companion
letter informing the Arkansas DHS that, if it did not demonstrate
compliance with these requirements within 30 days of the date of the
letter, CMS would initiate formal compliance proceedings. The Arkansas
DHS did not come into compliance by the specified date and on February
23, 2016, submitted a revised timeline for compliance with section
1137(d) of the Act, with a compliance date of August 2016.
The Arkansas DHS' submission of its quarterly expenditure reports
through the CMS-64 includes a certification that the Arkansas DHS is
operating under the authority of its approved Medicaid state plan.
However, at this time, CMS has not received information from the
Arkansas DHS providing evidence of compliance with its approved state
plan, section 1137(d) of the Act and regulations at 42 CFR 435.911(c).
In light of the Arkansas DHS' non-compliance with section 1137(d)
of the Act, CMS is moving forward with a formal determination of
substantial noncompliance with federal requirements described in
section 1137(d) of the Act and the regulations at 42 CFR 435.911(c) to
provide Medicaid coverage to otherwise eligible non-citizens pending
verification of their satisfactory immigration status during a
reasonable opportunity period if the individual meets all other
eligibility criteria for Medicaid. Subject to the state's opportunity
for a hearing, CMS will withhold a portion of federal financial
participation (FFP) from the Arkansas DHS' quarterly claim of
expenditures for administrative costs until such time as the Arkansas
DHS is and continues to be in compliance with the federal requirements.
The withholding will initially be three percent of the federal share of
the Arkansas DHS' quarterly claim for administrative expenditures, an
amount that was developed based on the proportion of total state
Medicaid expenditures that are used for expenditures for eligibility
determinations, as reported on Form CMS-64.10 Line 50. The withholding
percentage will increase by two percentage points (i.e. 5 percent, 7
percent, etc.) for every quarter in which the Arkansas DHS remains out
of compliance, up to a maximum withholding percentage of 100 percent
(of total administrative expenditures). The withholding will end when
the Arkansas DHS fully and satisfactorily
[[Page 49662]]
implements a corrective action plan to bring its procedures to process
eligibility determinations under its Medicaid program into compliance
with the federal requirements.
The state has 30 days from the date of this letter to request a
hearing. As specified in the accompanying Federal Register notice, the
Arkansas DHS has an opportunity for an administrative hearing prior to
this determination becoming final. However, the Arkansas DHS must
request a hearing. If a request for a hearing is submitted timely, the
hearing will be convened by the Hearing Officer designated below no
later than 60 days after the date of the Federal Register notice, or a
later date by agreement of the parties and the Hearing Officer, at the
CMS Regional Office in Dallas, Texas, in accordance with the procedures
set forth in federal regulations at 42 CFR part 430, subpart D. The
issue in any such hearing will be whether benefits are being provided
during a reasonable opportunity period to individuals who have declared
under penalty of perjury that they are in a to a satisfactory
immigration status pending verification of such status, if they meet
all other eligibility requirements, in accordance with the state plan
and 42 CFR 435.911(c). Any request for such a hearing should be sent to
the designated Hearing Officer. The Hearing Officer also should be
notified if the Arkansas DHS requests a hearing but cannot meet the
timeframe expressed in this notice. The Hearing Officer designated for
this matter is: Benjamin R. Cohen, Hearing Officer, Centers for
Medicare & Medicaid Services, 2520 Lord Baltimore Drive, Suite L,
Baltimore, MD 21244.
If the Arkansas DHS plans to come into compliance with the approved
state plan, the Arkansas DHS should submit, within 30 days of the date
of this letter, an explanation of how the Arkansas DHS plans to come
into compliance with federal requirements and the timeframe for doing
so. If that explanation is satisfactory, CMS may consider postponing
any requested hearing, which could also delay the imposition of the
withholding of funds as described above. Our goal is to have the
Arkansas DHS come into compliance, and CMS continues to be available to
provide technical assistance to the Arkansas DHS in achieving this
outcome.
Should you not request a hearing within 30 days, a notice of
withholding will be sent to you and the withholding of federal funds
will begin as described above.
If you have any questions or wish to discuss this determination
further, please contact: Bill Brooks, Associate Regional Administrator,
Division of Medicaid and Children's Health Operations, CMS Dallas
Regional Office, 1301 Young Street, Suite 714, Dallas, TX 75202, 214-
767-4461.
Sincerely,
Andrew M. Slavitt
Acting Administrator
(Catalog of Federal Domestic Assistance Program No. 13.714, Medicaid
Assistance Program.)
Dated: July 22, 2016.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2016-17923 Filed 7-27-16; 8:45 am]
BILLING CODE 4120-01-P
