[Federal Register: September 27, 2006 (Volume 71, Number 187)]
[Notices]
[Page 56538-56539]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27se06-110]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of Missouri
State Plan Amendment 05-11
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
November 15, 2006, at the Richard Bolling Federal Building, 601 E. 12th
Street, Kansas City, MO 64106-2898, the Kansas City Room, to reconsider
CMS' decision to disapprove Missouri State plan amendment 05-11.
Closing Date: Requests to participate in the hearing as a party
must be received by the presiding officer by October 12, 2006.
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 CMS' decision to disapprove Missouri State plan
amendment (SPA) 05-11 which was submitted on September 27, 2005. This
SPA was disapproved on June 16, 2006. Under SPA 05-11, Missouri
proposed to alter the provider qualifications and payment methodology
for personal care assistance services by transferring administrative
responsibility for such providers from one State agency to another.
At issue is: (1) Whether SPA 05-11 complied with the requirements
of section 1902(a) of the Social Security Act (the Act) generally, and
1902(a)(30) of the Act specifically, in providing for coverage of
services for which the State plan did not contain a clear payment
methodology that the State had shown was consistent with efficiency and
economy; (2) whether the proposed coverage of personal care services in
SPA 05-11 was consistent with the definition of personal care services
in section 1905(a)(24) of the Act (which is integral to the definition
of ``medical assistance'' in sections 1905(a) and 1902(a)(10)(A) of the
Act), and applicable regulations, including services of registered
nurses.
This amendment was disapproved because the resulting plan would not
have comported with the requirements of section 1902(a)(30)(A) and
section 1905(a)(24) of the Act and implementing regulations.
Section 1902(a)(30)(A) of the Act requires that State plans have
methods and procedures to assure that payments are consistent with
economy, efficiency, and quality of care. While this SPA would have
provided for coverage of personal care services, the methodology for
paying for such services was not clearly set forth in the State plan.
Moreover, Missouri provided information that personal care services,
and personal care assistance services, are reimbursed based on a 15-
minute service unit. However, the State did not provide to CMS the rate
for the 15-minute service unit, or any rate derivation information, to
conclude that this payment is economic or efficient. In light of this,
CMS cannot conclude that the coverage of the proposed services would
have been accomplished through an efficient and economical payment
methodology in compliance with the requirements of section
1902(a)(30)(A).
Further, the overall requirement in section 1902(a) for a State
plan, and the specific requirement at section 1902(a)(30)(A) for
methods and procedures related to payment, as implemented by Federal
regulations at 42 CFR 430.10 and 42 CFR 447.252(b) require that the
State plan include a comprehensive description of the methods and
standards used to set payment rates. Payment methodologies should be
understandable and auditable. In addition, since the plan is the basis
for Federal financial participation, it is important that the plan
language be clear and unambiguous. The proposed methodology does not
provide sufficient information for providers to determine the payment
amount to which they are entitled.
Additionally, the Medicaid personal care services benefit does not
include registered nurse services in the definitions at section
1905(a)(24) of the Act and Federal regulations at 42 CFR 440.167 and
thus such coverage is not within the scope of ``medical assistance''
under sections 1905(a) and 1902(a)(10) of the Act. As CMS had indicated
in the State Medicaid Manual Part 4, section 4480(C), although personal
care services may be similar to, or overlap, some services furnished by
home health aides, ``skilled services that may be performed only by a
health professional are not considered personal care services.'' It
would not be consistent with efficiency and economy for a State to pay
higher rates to attract overqualified individuals (registered nurses)
to provide personal care services. Registered nurse services may
instead be furnished as a home health service under 42 CFR
440.70(b)(1), or as private duty nursing services as defined at 42 CFR
440.80(a). Furthermore, there is no provision in Medicaid for payment
for training of personal care providers, including the ``training and
supervision'' of the ``qualified staff licensed by the Department of
Mental Health'' or supervision visits by a registered nurse.
For these reasons, and after consulting with the Secretary as
required by Federal regulations at 42 CFR section 430.15(c)(2), I
disapproved this SPA on June 16, 2006.
Section 1116 of the Act and Federal regulations at 42 CFR Part 430,
establish Department procedures that provide an administrative hearing
for reconsideration of a disapproval of a State plan or plan amendment.
CMS is required to publish a copy of the notice to a State Medicaid
agency that informs the agency of the time and place of the hearing,
and the issues to be considered. If 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
[[Page 56539]]
430.76(c). If the hearing is later rescheduled, the presiding officer
will notify all participants.
The notice to Missouri announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows:
Mr. Steven E. Renne, Interim Director, Missouri, Department of
Social Services, P.O. Box 1527, Broadway State Office Building,
Jefferson City, MO 65102-1527.
Dear Mr. Renne: I am responding to your request for
reconsideration of the decision to disapprove the Missouri State
plan amendment (SPA) 05-11, which was submitted on September 27,
2005, and disapproved on June 16, 2006.
Under SPA 05-11, Missouri was proposing to alter the provider
qualifications and payment methodology for personal care assistance
services by transferring administrative responsibility for such
providers from one State agency to another.
At issue in this reconsideration is: (1) whether SPA 05-11
complied with the requirements of section 1902(a) of the Social
Security Act (the Act) generally, and 1902(a)(30) of the Act
specifically, in providing for coverage of services for which the
State plan did not contain a clear payment methodology that the
State had shown was consistent with efficiency and economy; (2)
whether the proposed coverage of personal care services in SPA 05-11
was consistent with the definition of personal care services in
section 1905(a)(24) of the Act (which is integral to the definition
of ``medical assistance'' at sections 1905(a) and 1902(a)(10) of the
Act), and applicable regulations, including services of registered
nurses.
This amendment was disapproved because it did not comport with
the requirements of section 1902(a) generally, section
1902(a)(30)(A) specifically, and section 1905(a)(24) of the Act and
implementing regulations.
Section 1902(a)(30)(A) of the Act requires that State plans have
methods and procedures to assure that payments are consistent with
economy, efficiency, and quality of care. While this SPA would have
provided for coverage of personal care services, the methodology for
paying for such services was not clearly set forth in the State
plan. Moreover, Missouri provided information that personal care
services and personal care assistance services are reimbursed based
on a 15-minute service unit. However, the State did not provide to
the Centers for Medicare & Medicaid Services (CMS) the rate for the
15-minute service unit or any rate derivation information to
conclude that this payment is economic or efficient. In light of
this, CMS cannot conclude that coverage of the proposed services
would be accomplished through an efficient and economical payment
methodology in compliance with the requirements of section
1902(a)(30)(A).
Further, the overall requirement in section 1902(a) for a State
plan, and the specific requirement at section 1902(a)(30)(A) for
methods and procedures related to payment, as implemented by Federal
regulations at 42 CFR Sec. Sec. 430.10 and 447.252(b) require that
the State plan include a comprehensive description of the methods
and standards used to set payment rates. Payment methodologies
should be understandable and auditable. In addition, since the plan
is the basis for Federal financial participation, it is important
that the plan language be clear and unambiguous. The proposed
methodology does not provide sufficient information for providers to
determine the payment amount to which they are entitled.
Additionally, the Medicaid personal care services benefit does
not include registered nurse services in the definitions at section
1905(a)(24) of the Act and Federal regulations at 42 CFR 440.167,
and thus such coverage is not within the scope of ``medical
assistance'' defined under section 1905(a) and 1902(a)(10) of the
Act. As CMS had indicated in the State Medicaid Manual Part 4,
section 4480(C), although personal care services may be similar to,
or overlap, some services furnished by home health aides, ``skilled
services that may be performed only by a health professional are not
considered personal care services.'' It would not be consistent with
efficiency and economy for a State to pay higher rates to attract
overqualified individuals (registered nurses) to provide personal
care services. Registered nurse services may instead be furnished as
a home health service under 42 CFR 440.70(b)(1), or as private duty
nursing services as defined at 42 CFR 440.80(a). Furthermore, there
is no provision in Medicaid for payment for training of personal
care providers, including the ``training and supervision'' of the
``qualified staff licensed by the Department of Mental Health'' or
supervision visits by a registered nurse.
For these reasons, and after consulting with the Secretary as
required by Federal regulations at 42 CFR section 430.15(c)(2), I
disapproved this SPA on June 16, 2006.
I am scheduling a hearing on your request for reconsideration to
be held on November 15, 2006, at the Richard Bolling Federal
Building, 601 E. 12th Street, Kansas City, MO 64106-2898, the Kansas
City Room, to reconsider the decision to disapprove SPA 05-11. 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 at (410) 786-2055. 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.
Sincerely,
Mark B. McClellan, M.D., PhD
(Section 1116 of the Social Security Act (42 U.S.C. section 1316);
42 CFR section 430.18)
(Catalog of Federal Domestic Assistance program No. 13.714, Medicaid
Assistance Program)
Dated: September 20, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E6-15780 Filed 9-26-06; 8:45 am]
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