[Federal Register: December 30, 2008 (Volume 73, Number 250)]
[Notices]
[Page 79884-79885]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr30de08-89]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of Washington
State Plan Amendment (SPA) 08-002
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
February 5, 2009, at the CMS Seattle Regional Office, 2201 Sixth
Avenue, MS/RX-43, Seattle, Washington 98121 to reconsider CMS' decision
to disapprove Washington SPA 08-002.
Closing Date: Requests to participate in the hearing as a party
must be received by the presiding officer by January 14, 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 Washington SPA 08-002
which was submitted on January 7, 2007, and disapproved on September
26, 2008. The SPA proposed to add a methodology to the State plan that
would be used in the event that a contract with Regional Support
Network to provide mental health services under a managed care delivery
system to the State of Washington was not continued.
Federal regulations at 42 CFR 430.20 and 447.205, are issued under
the authority of general statutory requirements concerning methods of
administration at section 1902(a)(4)(A) of the Social Security Act (the
Act) and specific requirements at section 1902(a)(30)(A) concerning
methods and procedures relating to payments to providers. These
regulations require that public notice of changes in statewide methods
and standards for setting payment rates be published in either a State
register or the newspaper of widest circulation in the State (if there
is not a city with a population of at least 50,000). In addition, they
specify that the notice must be published before the effective date of
the State plan.
Washington did not provide public notice which complied with
Federal regulations at 42 CFR 447.205. Although, beginning in December
of 2007, the State held meetings with providers to inform them of what
would be proposed via SPA 08-002, it did not provide the notice
required by Federal regulations at 42 CFR 447.205 until February 20,
2008. As a result, the State was informed the effective date of this
plan could be no earlier than February 21, 2008. However, Washington
failed to make this required change.
Pursuant to Federal regulations at 42 CFR 430.10, which is
authorized by section 1902(a)(4) of the Act and implements the general
requirements of section 1902(a) of the Act for a State plan, a State
plan must provide sufficient information to describe the nature and
scope of the State program and to provide a basis for Federal financial
participation. And, Federal regulations at 42 CFR 441.252(b), which
implement in part provider payment provisions under section
1902(a)(30)(A) of the Act, require that the State plan include a
comprehensive description of the methods and standards used to set
payment rates. The proposed SPA did not meet these requirements because
the payment methodologies were not understandable and auditable. CMS
requested further information about the factors Washington used to set
its rates, and how the payment methodologies would be administered, but
the State failed to provide sufficient responsive information to assure
us that providers and auditors could determine whether correct payments
had been made. Absent this information, CMS cannot determine that the
requirements under section 1902(a) of the Act have been met.
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 Washington SPA 08-
002.
The hearing will involve the following issues:
Whether the proposed effective date for the SPA was
consistent with the limitations authorized under the requirements of
sections 1902(a)(4)(A) and 1902(a)(30)(A) of the Act relating to
methods of administration generally and methods and procedures for
payment rates specifically, and the implementing regulations at 42
CFR 430.20 and 42 CFR 447.205, which require advance public notice
of changes in payment rates before a State plan amendment can become
effective. The State's proposed effective date for the SPA was
earlier than the date of the publication of the public notice that
the State submitted in support of the SPA.
Whether Washington provided adequate documentation to
document the proposed payment rates and to demonstrate that the
proposed rates were consistent with efficiency and economy as
required by section 1902(a)(30)(A) of the Act. Specifically, the
State proposed the use of actuarially developed rates that included
a range of rates as opposed to a single dollar amount. The State
indicated that the single dollar amount was developed from the above
mentioned rate range, however, they were not able to provide either
the dollar amount or the documentation regarding the construction of
the single rate.
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
[[Page 79885]]
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 the State of Washington announcing an administrative
hearing to reconsider the disapproval of its SPA reads as follows:
Ms. Robin Arnold-Williams, Secretary, Department of Social and
Health Services, P.O. Box 45010, Olympia, WA 98504-5010.
Dear Ms. Arnold-Williams:
I am responding to your request for reconsideration of the decision
to disapprove the Washington Medicaid State plan amendment (SPA) 08-
002, which was submitted on January 7, 2008, and disapproved on
September 26, 2008. The SPA proposed to add a methodology to the State
plan that would be used in the event that a contract with Regional
Support Network to provide mental health services under a managed care
delivery system to the State of Washington was not continued.
The issues to be considered at the hearing are:
Whether the proposed effective date for the SPA was
consistent with the limitations imposed by applicable appropriations
statutes on the availability of funding for SPAs, the requirements of
sections 1902(a)(4)(A) and 1902(a)(30)(A) of the Social Security Act
(the Act) relating to methods and procedures generally and for payment
rates specifically, and the implementing regulations at 42 CFR 430.20
and 42 CFR 447.205--which require advance public notice of changes in
payment rates. The State's proposed effective date for the SPA was
earlier than the date of the publication of the public notice that the
State submitted in support of the SPA.
Whether Washington provided adequate documentation to
document the proposed payment rates and demonstrate that the proposed
rates were consistent with efficiency and economy as required by
section 1902(a)(30)(A) of the Act. Specifically, the State proposed the
use of actuarially developed rates that included a range of rates as
opposed to a single dollar amount. The State indicated that the single
dollar amount was developed from the above mentioned rate range,
however, they were not able to provide either the dollar amount or the
documentation regarding the construction of the single rate.
I am scheduling a hearing on your request for reconsideration to be
held on February 5, 2009, at the Centers for Medicare & Medicaid
Services Seattle Regional Office, 2201 Sixth Avenue, MS/RX-43, Seattle,
Washington 98121, in order to reconsider the decision to disapprove SPA
08-002. 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. section 1316; 42
CFR section 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. E8-31019 Filed 12-29-08; 8:45 am]
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