[Federal Register: November 13, 2006 (Volume 71, Number 218)]
[Notices]
[Page 66174-66175]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr13no06-41]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of Colorado
State Plan Amendment 05-006
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
December 29, 2006, at the Colorado State Bank Building, 1600 Broadway,
Suite 700, Keystone Conference Room, Denver, CO 80202-4967, to
reconsider CMS' decision to disapprove Colorado State plan amendment
05-006.
Closing Date: Requests to participate in the hearing as a party
must be received by the presiding officer by November 28, 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 Colorado State plan
amendment (SPA) 05-006 which was submitted on July 26, 2005. This SPA
was disapproved on July 13, 2006.
In SPA 05-006, Colorado proposed to modify the reimbursement
methodology in the State plan for covered Medicaid Early and Periodic
Screening, Diagnostic and Treatment (EPSDT) services provided in
schools. Specifically, this amendment specified cost elements used to
determine reimbursement rates for school-based services and targeted
case management.
The amendment was disapproved because it did not comport with the
requirements of sections 1902(a)(2), 1902(a)(4), 1902(a)(23),
1902(a)(30)(A), 1902(a)(10)(B), and 1903(a)(1) of the Social Security
Act (the Act).
The issues to be decided in the hearing are:
Whether Colorado has established that the indirect cost
elements specified in Colorado SPA 05-006 would not duplicate direct
cost elements also specified, to ensure that the payment rate is
consistent with efficiency and economy as required by section
1902(a)(30)(A) of the Act.
Whether Colorado has shown that certified public
expenditures that will be used as the basis for claims under SPA 05-006
will be documented through auditable methods for determining or
documenting actual and non-duplicative Medicaid expenditures incurred
for school-based health services by a governmental entity, so that the
claims will be consistent with sections 1902(a)(2), 1902(a)(4) and
1903(a)(1) of the Act.
Whether the State has assured that the payment methodology
specified under SPA 05-006, when read together with the State plan
provisions authorizing the covered services that are the subject of SPA
05-006, would allow beneficiaries the ability to receive services from
any willing and qualified provider within the State, consistent with
the requirements of section 1902(a)(23) of the Act.
Whether the State has established that the covered EPSDT
services that are the subject of SPA 05-006 would be available in
comparable amount, duration, and scope to the EPSDT services available
to all eligible Medicaid beneficiaries, including those who do not
attend schools paid under SPA 05-006, consistent with the
[[Page 66175]]
requirements of section 1902(a)(10)(B) 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 in Federal regulations 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 in Federal regulations at 42 CFR
430.76(c). If the hearing is later rescheduled, the presiding officer
will notify all participants.
The notice to Colorado announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows:
Ms. Lisa M. Esgar, Senior Director,
Operations and Finance Office,
Department of Health Care Policy and Financing,
1570 Grant Street,
Denver, CO 80203-1818.
Dear Ms. Esgar: I am responding to your request for
reconsideration of the decision to disapprove the Colorado State
plan amendment (SPA) 05-006, which was submitted on July 26, 2005,
and disapproved on July 13, 2006.
In SPA 05-006, Colorado was proposed to modify the reimbursement
methodology in the State plan for covered Medicaid Early and
Periodic Screening, Diagnostic and Treatment (EPSDT) services
provided in schools. Specifically, this amendment specified cost
elements used to determine reimbursement rates for school-based
services and targeted case management.
The amendment was disapproved because it did not comport with
the requirements of sections 1902(a)(2), 1902(a)(4), 1902(a)(23),
1902(a)(30)(A), 1902(a)(10)(B), and 1903(a)(1) of the Social
Security Act (the Act).
The issues to be decided in the hearing are:
Whether Colorado has established that the indirect cost
elements specified in Colorado SPA 05-006 would not duplicate direct
cost elements also specified, to ensure that the payment rate is
consistent with efficiency and economy as required by section
1902(a)(30)(A) of the Act.
Whether Colorado has shown that certified public
expenditures that will be used as the basis for claims under SPA 05-
006 will be documented through auditable methods for determining or
documenting actual and non-duplicative Medicaid expenditures
incurred for school-based health services by a governmental entity,
so that the claims will be consistent with section 1902(a)(2),
1902(a)(4) and 1903(a)(1) of the Act.
Whether the State has assured that the payment
methodology specified under SPA 05-006, when read together with the
State plan provisions authorizing the covered services that are the
subject of SPA 05-006, would allow beneficiaries the ability to
receive services from any willing and qualified provider within the
State, consistent with the requirements of section 1902(a)(23) of
the Act.
Whether the State has established that the covered
EPSDT services that are the subject of SPA 05-006 would be available
in a comparable amount, duration and scope to the EPSDT services
available to all eligible Medicaid beneficiaries, including those
who do not attend schools paid under SPA 05-006, consistent with the
requirements of section 1902(a)(10)(B) of the Act.
I am scheduling a hearing on your request for reconsideration to
be held on December 29, 2006, at the Colorado State Bank Building,
1600 Broadway, Suite 700, Keystone Conference Room, Denver, CO,
80202-4967, to reconsider the decision to disapprove SPA 05-006. 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 by Federal regulations 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, Leslie V. Norwalk, Esq.,
Acting Administrator.
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: November 6, 2006.
Leslie V. Norwalk,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E6-19069 Filed 11-9-06; 8:45 am]
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