[Federal Register: December 29, 2008 (Volume 73, Number 249)]
[Notices]
[Page 79491-79492]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr29de08-72]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of Montana
State Plan Amendment (SPA) 08-003
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
January 27, 2009, at the CMS Denver Regional Office, 1600 Broadway,
Suite 700, Denver, Colorado 80202 to reconsider CMS' decision to
disapprove Montana SPA 08-003.
Closing Date: Requests to participate in the hearing as a party
must be received by the presiding officer by January 13, 2009.
FOR FURTHER INFORMATION CONTACT: Benjamin Cohen, Presiding Officer,
CMS, 2520 Lord Baltimore Drive, Suite L, Baltimore, Maryland 21244,
Telephone: (410) 786-3169.
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider CMS' decision to disapprove Montana SPA 08-003
which was submitted on December 27, 2007, and disapproved on September
23, 2008. The SPA proposed to modify the reimbursement methodology for
licensed denturist services and dental services effective October 1,
2007.
Section 1902(a)(30)(A) of the Social Security Act (the Act)
requires that States have methods and procedures to ensure payments are
consistent with economy, efficiency, and quality of care. The overall
requirement in section 1902(a) of the Act for a State plan, and the
specific requirement at section 1902(a)(30)(A) of the Act for methods
and procedures related to payment, are implemented by Federal
regulations at 42 CFR 430.10 and 42 CFR 447.252(b), which require that
the State plan include a comprehensive description of the methods and
standards used to set payment rates, and provide a basis for Federal
financial participation (FFP). To be comprehensive, payment
methodologies should be understandable, clear, and unambiguous. In
addition, since the plan is the basis for FFP, it is important that the
plan language provide an auditable basis for determining if payment was
appropriate.
Montana SPA 08-003 proposed to reimburse denturist and dental
services on a fee-for-service basis by multiplying a nationally
recognized relative value unit for each service by a State specific
conversion factor. CMS requested the State to include the exact
conversion factor in the reimbursement methodology in order to meet the
requirements of a comprehensive reimbursement methodology in accordance
with Federal regulations at 42 CFR 430.10 and 447.252(b). Including the
conversion rate would ensure that payment calculations were verifiable
and auditable. Absent that detail, CMS requested that the State include
sufficient information so that providers and CMS would know the initial
rate for each service (either directly or through reference to a fee
schedule) and have notice of any subsequent changes to each rate. The
State declined to include such information in the SPA. Therefore, CMS
was unable to approve the SPA because it does not comply with section
1902(a)(30)(A) of the Act as implemented by Federal regulations at 42
CFR 430.10 and 447.252(b).
Based on the above, and after consultation with the Secretary of
the Department of Health and Human Services as required under Federal
regulations at 42 CFR 430.15(c)(2), CMS disapproved Montana Medicaid
SPA 08-003.
The hearing will involve the following issues:
Whether Montana's proposed methodologies for payment of
dental and denturist services, meet the requirements of section
1902(a)(30)(A) of the Social Security Act and Federal regulations at 42
CFR 430.10 and 42 CFR 447.252(b), which require that the State plan
include a comprehensive description of the methods and
[[Page 79492]]
standards used to set payment rates, and provide a basis for FFP, when
the proposed plan did not specify the amount or methodology to
determine a key variable that would determine the rate (a ``conversion
factor''); and
Whether CMS incorrectly disapproved SPA 08-003 on
September 23, 2008, by means of a hardcopy, date-stamped, signed letter
from the CMS Acting Administrator, with a courtesy electronic copy of
the signed letter e-mailed to Montana on September 24, 2008.
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 Montana announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows:
Ms. Mary E. Dalton,
Acting Medicaid Director,
Montana DPHHS,
Helena, MT 59604-4210.
Dear Ms. Dalton:
I am responding to your request for reconsideration of the
decision to disapprove the Montana State plan amendment (SPA) 08-
003, which was submitted on December 27, 2007, and disapproved on
September 23, 2008. The SPA proposed to modify the reimbursement
methodology for licensed denturist services and dental services
effective October 1, 2007.
The issues to be considered at the hearing are:
Whether Montana's proposed methodologies for payment of
dental and denturist services, meet the requirements of section
1902(a)(30)(A) of the Social Security Act and Federal regulations at
42 CFR 430.10 and 42 CFR 447.252(b), which require that the State
plan include a comprehensive description of the methods and
standards used to set payment rates, and provide a basis for Federal
financial participation, when the proposed plan did not specify the
amount or methodology to determine a key variable that would
determine the rate (a ``conversion factor''); and
Whether CMS incorrectly disapproved SPA 08-003 on
September 23, 2008, by means of a hardcopy, date-stamped, signed
letter from the CMS Acting Administrator, with a courtesy electronic
copy of the signed letter e-mailed to Montana on September 24, 2008.
I am scheduling a hearing on your request for reconsideration to
be held on January 27, 2009, at the CMS Denver Regional Office, 1600
Broadway, Suite 700, Denver, Colorado 80202, in order to reconsider
the decision to disapprove SPA 08-003. 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 Mr. Benjamin Cohen as the presiding officer. If
these arrangements present any problems, please contact the
presiding officer at (410) 786-3169. 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,
Kerry Weems,
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: December 22, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E8-30820 Filed 12-24-08; 8:45 am]
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