[Federal Register: October 18, 2006 (Volume 71, Number 201)]
[Notices]
[Page 61481-61482]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr18oc06-64]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of New York
State Plan Amendment 05-49
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 22, 2006, at 26 Federal Plaza, Room 38-110a, New York, NY,
10278, to reconsider CMS' decision to disapprove New York State plan
amendment 05-49.
Closing Date: Requests to participate in the hearing as a party must
be received by the presiding officer by November 2, 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 New York State plan
amendment (SPA) 05-49 which was submitted on September 29, 2005. This
SPA was disapproved on June 21, 2006.
Under SPA 05-49, New York proposed to extend previously approved
provisions that provide funding to home care agencies for the purpose
of maintaining or subsidizing health insurance coverage for employed
home care workers.
The amendment was disapproved because it did not comport with the
requirements of sections 1902(a)(4), 1902(a)(10)(A), 1902(a)(30)(A),
and 1905(a) of the Social Security Act (the Act) and implementing
regulations.
The issues in this reconsideration are whether:
(1) The proposed payments are for services to eligible individuals
within the scope of the eligibility provisions of section 1902(a)(10)
of the Act, as applied consistent with the limitations in the
definition of medical assistance at section 1905(a) of the Act;
(2) The proposed payments are for services that are within the
scope of covered medical assistance, as set forth in section 1905(a) of
the Act and incorporated by section 1902(a)(10) of the Act;
(3) It is necessary for the proper and efficient operation of the
plan for the State to include in the State plan a provision to provider
costs that are not within the statutory definition of medical
assistance; and
(4) The proposed payments are consistent with efficiency and
economy as required by section 1902(a)(30)(A) of the Act.
We discuss these issues in more detail below, as set forth in the
initial disapproval decision. The proposed payments under SPA 05-49 are
not for a group or category of individuals who are eligible under the
statute under either section 1902(a)(10) of the Act nor as medical
assistance for a covered benefit under 1905(a) of the Act. The proposed
methodology would directly compensate home health and personal care
employers for health insurance costs.
Under the Medicaid statute, Federal funding is only available for
medical assistance for Individuals eligible under the approved State
plan. Section 1902(a)(10) of the Act lists mandatory and optional
groups of individuals who may be eligible for medical assistance.
Section 1902(a)(10) of the Act must be read in concert with section
1905(a) of the Act, which defines medical assistance benefits
(including additional specification of the categories of eligible
individuals).
For the same reasons, SPA 05-49 is not consistent with the
requirements of section 1902(a)(4) of the Act. Section 1902(a)(4) of
the Act requires that State Medicaid plans provide for methods of
administration that are found by the Secretary to be necessary for the
proper and efficient operation of the plan. It is not considered
necessary for the proper and efficient operation of the plan for the
State to include in the State plan a provision which would pay for
provider
[[Page 61482]]
costs furnished to eligible individuals that are not within the
statutory definition of medical assistance. It will result in State
claims for FFP in expenditures as medical assistance which are not
within the statutory definition of medical assistance.
Furthermore, section 1902(a)(30)(A) of the Act requires that State
plan payment rates must be consistent with efficiency, economy, and
quality of care. The payments that would be made under SPA 05-49 are
for care or services that are not within the scope of medical
assistance, and are not furnished to Medicaid-eligible individuals.
Instead, the SPA would authorize a pool of funding, to subsidize health
insurance that would be furnished to home health and personal care
workers. The proposed payments would not be payment for identifiable
covered Medicaid services, as defined under section 1905(a)(30)(A) of
the Act.
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 430.76(c). If the hearing is later rescheduled, the
presiding officer will notify all participants.
The notice to New York announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows:
Mr. Gregor N. Macmillan, Director, State of New York, Department
of Health, Corning Tower, The Governor Nelson A. Rockefeller Empire
State Plaza, Albany, NY 12237.
Dear Mr. Macmillan:
I am responding to your request for reconsideration of the
decision to disapprove New York State plan amendment (SPA) 05-49,
which was submitted on September 29, 2005, and disapproved on June
21, 2006. Under SPA 05-49, New York was proposing to provide
supplemental funding to home care agencies for the purpose of
maintaining or subsidizing health insurance coverage for employed
home care workers.
The amendment was disapproved because it did not comport with
the requirements of section 1902(a)(4), 1902(a)(10)(A),
1902(a)(30)(A), and 1905(a) of the Social Security Act (the Act) and
implementing regulations.
The issues in this reconsideration are whether:
(1) The proposed payments are for services to eligible
individuals within the scope of the eligibility provisions of
section 1902(a)(10) of the Act, as applied consistent with the
limitations in the definition of medical assistance at section
1905(a) of the Act;
(2) The proposed payments are for services that are within the
scope of covered medical assistance, as set forth in section 1905(a)
of the Act and incorporated by section 1902(a)(10) of the Act;
(3) It is necessary for the proper and efficient operation of
the plan for the State to include in the State plan a provision to
provider costs that are not within the statutory definition of
medical assistance; and
(4) The proposed payments are consistent with efficiency and
economy as required by section 1902(a)(30)(A) of the Act.
We discuss these issues in more detail below, as set forth in
the initial disapproval decision.
The proposed payments under SPA 05-49 are not for a group or
category of individuals who are eligible under the statute under
either section 1902(a)(10) of the Act nor as medical assistance for
a covered benefit under 1905(a) of the Act. The proposed methodology
would directly compensate home health and personal care employers
for health insurance costs. Under the Medicaid statute, Federal
funding is only available for medical assistance for individuals
eligible under the approved State plan. Section 1902(a)(10) of the
Act lists mandatory and optional groups of individuals who may be
eligible for medical assistance. Section 1902(a)(10) must be read in
concert with section 1905(a) of the Act, which defines medical
assistance benefits (including additional specification of the
categories of eligible individuals). For the same reasons, SPA 05-49
is not consistent with the requirements of section 1902(a)(4) of the
Act. Section 1902(a)(4) of the Act requires that State Medicaid
plans provide for methods of administration that are found by the
Secretary to be necessary for the proper and efficient operation of
the plan. It is not considered necessary for the proper and
efficient operation of the plan for the State to include in the
State plan a provision which would pay for provider costs furnished
to eligible individuals that are not within the statutory definition
of medical assistance. It will result in State claims for Federal
financial participation in expenditures as medical assistance which
are not within the statutory definition of medical assistance.
Furthermore, section 1902(a)(30)(A) of the Act requires that
State plan payment rates must be consistent with efficiency,
economy, and quality of care. The payments that would be made under
SPA 05-49 are for care or services that are not within the scope of
medical assistance, and are not furnished to Medicaid-eligible
individuals. Instead, the SPA would authorize a pool of funding, to
subsidize health insurance that would be furnished to home health
and personal care workers. The proposed payments would not be
payment for identifiable covered Medicaid services, as defined under
section 1905(a)(30)(A) of the Act.
I am scheduling a hearing on your request for reconsideration to
be held on November 22, 2006, at 26 Federal Plaza, Room 38-110a, New
York, NY, 10278, to reconsider the decision to disapprove SPA 05-49.
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. 1316); 42 CFR
430.18)
(Catalog of Federal Domestic Assistance Program No. 13.714, Medicaid
Assistance Program)
Dated: September 29, 2006.
Mark B. McClellan,
Administrator.
[FR Doc. E6-17361 Filed 10-17-06; 8:45 am]
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