[Federal Register: May 19, 2004 (Volume 69, Number 97)]
[Notices]
[Page 28895-28896]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr19my04-53]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of
Connecticut's Medicaid State Plan Amendment 03-002A
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of hearing.
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SUMMARY: This notice announces an administrative hearing to be held on
June 8, 2004, at 10 a.m., JFK Federal Building, Room 2325, Boston,
Massachusetts 02203-0003, to reconsider CMS' decision to disapprove
Connecticut's Medicaid State Plan Amendment (SPA) 03-002A.
DATES: Closing Date: Requests to participate in the hearing as a party
must be received by the presiding officer by June 3, 2004.
FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Presiding
Officer CMS, Lord Baltimore Drive, Mail Stop LB-23-20, Baltimore,
Maryland 21244, Telephone: (410) 786-2055.
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider the CMS' decision to disapprove Connecticut's
Medicaid State Plan Amendment (SPA) 03-002A.
Connecticut submitted SPA 03-002A on February 13, 2003, which
proposes to establish new pharmacy reimbursement rates for the period
January 1, 2003, through February 4, 2003. The CMS reviewed this
proposal and for the reasons set forth below, the Agency was unable to
approve SPA 03-002A as submitted.
The sole issue is whether the requested effective date is
consistent with statutory and regulatory requirements. In a separate
action, CMS approved SPA 03-002B, which made the requested changes to
pharmacy reimbursement rates for a subsequent period. Under section
1902(a)(30)(A) of the Social Security Act (the Act), states are
required to have methods and procedures to ensure that rates are
consistent with efficiency, economy, and quality of care. Under that
authority, the Secretary has issued regulations prescribing state rate-
setting procedures. One of those requirements, set forth at 42 CFR
447.205(d), is issuance of public notice prior to the effective date of
a significant change in any methods and standards for setting payment
rates for services. While the State indicated that a legislative
hearing was held in February 2002, and that other activities occurred
in the Connecticut General Assembly, the required public notice was not
published in the Connecticut Law Journal until February 4, 2003. The
regulations at 42 CFR 447.205(d) are quite specific that in order to
meet the public notice requirements, a notice must be published in one
of the following publications: (1) A state register similar to the
Federal Register; (2) the newspaper of widest circulation in each city
with a population of 50,000 or more; or (3) the newspaper of widest
circulation in the state, if there is not a city with a population of
50,00 or more. Hearings and activities before a state legislature are
not included in the regulation as meeting the requirements of public
notice. Therefore, the change in pharmacy reimbursement rates contained
in SPA 03-002A could not be effective until February 5, 2003.
Therefore, based on the reasoning set forth above, and after
consultation with the Secretary as required under 42 CFR 430.15(c)(2),
CMS disapproved Connecticut SPA 03-002A.
Section 1116 of the Act and 42 CFR part 430 establish Department
procedures that provide an administrative hearing for reconsideration
of a disapproval of a state plan or plan amendment. CMS is required to
publish a copy of the notice to a State Medicaid agency that informs
the agency of the time and place of the hearing and the issues to be
considered.
If we subsequently notify the agency of additional issues that will
be considered at the hearing, we will also publish that notice.
Any individual or group that wants to participate in the hearing as
a party must petition the presiding officer within 15 days after
publication of this notice, in accordance with the requirements
contained at 42 CFR 430.76(b)(2). Any interested person or organization
that wants to participate as amicus curiae must petition the presiding
officer before the hearing begins in accordance with the requirements
contained at 42 CFR 430.76(c). If the hearing is later rescheduled, the
presiding officer will notify all participants.
The notice to Connecticut announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows: Mr. Michael
Starkowski, Deputy Commissioner, State of Connecticut, Department of
Social Services, 25 Sigourney Street, Hartford, CT 06106-5033.
Dear Mr. Starkowski:
I am responding to your request for reconsideration of the
decision to disapprove State Plan Amendment (SPA) 03-002A.
Connecticut submitted SPA 03-002A on February 13, 2003, which
proposes to establish new pharmacy reimbursement rates for the
period January 1, 2003, through February 4, 2003. The Centers for
Medicare & Medicaid Services (CMS) reviewed this proposal and for
the reasons set forth below, the Agency was unable to approve SPA
03-002A as submitted.
The sole issue is whether the requested effective date is
consistent with statutory and regulatory requirements. In a separate
action, CMS approved SPA 03-002B, which made the requested changes
to pharmacy reimbursement rates for a subsequent period. Under
section 1902(a)(30)(A) of the Social Security Act, states are
required to have methods and procedures to ensure that rates are
consistent with efficiency, economy, and quality of care. Under that
authority, the Secretary has issued regulations prescribing state
rate-setting procedures. One of those requirements, set forth at 42
CFR 447.205(d), is issuance of public notice prior to the effective
date of a significant change in any methods and standards for
setting payment rates for services. While the State indicated that a
legislative hearing was held in February 2002, and that other
activities occurred in the Connecticut General Assembly, the
required public notice was not published in the Connecticut Law
Journal until February 4, 2003. The regulations at 42 CFR 447.205(d)
are quite specific that in order to meet the public notice
requirements, a notice must be published in one of the following
publications: (1) A state register similar to the Federal Register;
(2) the newspaper of widest circulation in each city with a
population of 50,000 or more; or (3) the newspaper of widest
circulation in the state, if there is not a city with a population
of 50,000 or more. Hearings and activities before a state
legislature are not included in the regulation as meeting the
requirements of public notice. Therefore, the change in pharmacy
reimbursement rates contained in SPA 03-002A could not be effective
until February 5, 2003.
[[Page 28896]]
Therefore, based on the reasoning set forth above, and after
consultation with the Secretary as required under 42 CFR
430.15(c)(2), CMS disapproved Connecticut SPA 02-003A.
I am scheduling a hearing on your request for reconsideration to
be held on June 8, 2004, at 10 a.m., JFK Federal Building, Room
2325, Boston, Massachusetts 02203-0003. If this date is not
acceptable, we would be glad to set another date that is mutually
agreeable to the parties. The hearing will be governed by the
procedures prescribed at 42 CFR part 430.
I am designating Ms. Kathleen Scully-Hayes as the presiding
officer. If these arrangements present any problems, please contact
the presiding officer. In order to facilitate any communication
which may be necessary between the parties to the hearing, please
notify the presiding officer to indicate acceptability of the
hearing date that has been scheduled and provide names of the
individuals who will represent the State at the hearing. Ms.
Kathleen Scully-Hayes may be reached at (410) 786-2055.
Sincerely,
Mark B. McClellan, M.D., Ph.D.
Authority: Section 1116 of the Social Security Act (42 U.S.C.
1316; 42 CFR 430.18).
(Catalog of Federal Domestic Assistance Program No. 13.714, Medicaid
Assistance Program)
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 04-11268 Filed 5-18-04; 8:45 am]
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