[Federal Register: October 6, 2004 (Volume 69, Number 193)]
[Notices]
[Page 59930-59931]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr06oc04-92]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of New
Hampshire State Plan Amendment (04-001A)
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of hearing.
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SUMMARY: This notice announces an administrative hearing on November
19, 2004, at 10 a.m., JFK Federal Building, Room E275A, Boston,
Massachusetts 02203-0003, to reconsider the decision to disapprove New
Hampshire State Plan Amendment (SPA) 04-001A.
DATES: Requests to participate in the hearing as a party must be
received by the presiding officer by October 21, 2004.
FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Presiding
Officer, CMS, LB-23-20, Lord Baltimore Drive, Baltimore, Maryland
21244, telephone: (410) 786-2055.
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider the decision to disapprove New Hampshire State
Plan Amendment (SPA) 04-001A, which New Hampshire submitted on March
31, 2004. SPA 04-001A sought to reduce the Estimated Acquisition Cost
(EAC) for prescription drugs from Average Wholesale Price (AWP) minus
12 percent to AWP minus 16 percent and the dispensing fee from $2.50 to
$1.75 per prescription, effective for the period from January 12, 2004,
to March 11, 2004. The CMS reviewed this proposal and for the reasons
set forth below, was unable to approve SPA 04-001A as submitted.
At issue is whether the requested effective date of January 12,
2004, is consistent with statutory and regulatory requirements. In a
separate action, CMS approved SPA 04-001B, which made the same changes
in the EAC and dispensing fee calculations, effective March 12, 2004.
Section 1902(a)(30) of the Social Security Act (the Act) requires a
state's Medicaid state plan to provide such methods and procedures as
may be necessary to ensure that payments are consistent with
efficiency, economy, and quality of care. Under that authority, the
Secretary has issued regulations prescribing state rate-setting
procedures. Federal regulations at 42 CFR 447.205(d) require public
notice to be issued prior to the effective date of a significant change
in any methods and standards for setting payment rates for services.
The state did not issue a public notice for the proposed changes in
payment methodology until March 11, 2004. Therefore, the earliest that
such changes could be effective is March 12, 2004.
Based on the above, and after consultation with the Secretary as
required under 42 CFR 430.15(c)(2), CMS disapproved New Hampshire SPA
04-001A.
Section 1116 of the Act and 42 CFR part 430 establish Departmental
procedures that provide an administrative hearing for reconsideration
of a disapproval of a State plan or plan amendment. The 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 also will publish that
notice.
Any interested 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 person or organization that wants
to participate as amicus
[[Page 59931]]
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 New Hampshire announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows: Mr. John A.
Stephen, Commissioner, Department of Health and Human Services, 129
Pleasant Street, Concord, NH 03301-3857
Dear Mr. Stephen: I am responding to your request for
reconsideration of the decision to disapprove New Hampshire State Plan
Amendment (SPA) 04-001A, which the State submitted on March 31, 2004.
The SPA 04-001A sought to reduce the Estimated Acquisition Cost (EAC)
for prescription drugs from Average Wholesale Price (AWP) minus 12
percent to AWP minus 16 percent and the dispensing fee from $2.50 to
$1.75 per prescription, effective for the period from January 12, 2004,
to March 11, 2004. The Centers for Medicare & Medicaid Services (CMS)
reviewed this proposal, and for the reasons set forth below, was unable
to approve SPA 04-001A as submitted.
At issue is whether the requested effective date of January 12,
2004, is consistent with statutory and regulatory requirements. In a
separate action, CMS approved SPA 04-001B, which made the same changes
in the EAC and dispensing fee calculations, effective March 12, 2004.
Section 1902(a)(30) of the Social Security Act (the Act) requires a
state's Medicaid state plan to provide such methods and procedures as
may be necessary to ensure that payments are consistent with
efficiency, economy, and quality of care. Under that authority, the
Secretary has issued regulations prescribing state rate-setting
procedures. Federal regulations at 42 CFR 447.205(d) require public
notice to be issued prior to the effective date of a significant change
in any methods and standards for setting payment rates for services.
The State did not issue a public notice for the proposed changes in
payment methodology until March 11, 2004. Therefore, the earliest that
such changes could be effective is March 12, 2004. Based on the above,
and after consultation with the Secretary as required under 42 CFR
430.15(c)(2), CMS disapproved New Hampshire SPA 04-001A.
I am scheduling a hearing for November 19, 2004, at 10 a.m., JFK
Federal Building, Room E275A, Boston, Massachusetts 02203-0003, to
reconsider the decision to disapprove SPA 04-001A. 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 that 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.
The presiding officer may be reached at (410) 786-2055.
Sincerely,
Mark B. McClellan, M.D., PhD.
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)
Dated: September 27, 2004.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 04-22419 Filed 10-5-04; 8:45 am]
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