[Federal Register: June 23, 2009 (Volume 74, Number 119)]
[Notices]
[Page 29703-29704]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr23jn09-60]
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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) 08-019
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of Hearing.
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[[Page 29704]]
SUMMARY: This notice announces an administrative hearing to be held on
August 4, 2009, at the CMS Seattle Regional Office, 2201 Sixth Avenue,
MS/RX-43, Seattle, Washington 98121, to reconsider CMS' decision to
disapprove Washington SPA 08-019.
Closing Date: Requests to participate in the hearing as a party must be
received by the presiding officer by 15 days after publication.
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 08-019
which was received by CMS on September 23, 2008, and disapproved on
March 6, 2009. The SPA proposed to increase dispensing fees for
pharmacies from $4.20 to $4.24 for high-volume pharmacies, $4.51 to
$4.56 for mid-volume pharmacies, $5.20 to $5.25 for low-volume
pharmacies, and $5.20 to $5.25 for unit dose systems.
As submitted, SPA 08-019 has raised concerns regarding compliance
with section 1902(a)(30) of the Social Security Act (the Act) and
implementing regulatory requirements. Section 1902(a)(30)(A) of the Act
requires that States have methods and procedures in place to assure
that payments are consistent with efficiency, economy, and quality of
care.
Under that authority, the Secretary has issued regulations
prescribing State rate-setting procedures and requirements.
Longstanding requirements (presently codified at 42 CFR 447.512 and
447.514, and previously codified at 42 CFR 447.331 and 447.332) provide
that the State is responsible for demonstrating that the dispensing
fees are reasonable. The State has not provided that demonstration. In
addition, Federal regulations at 42 CFR 447.205 require that a State
provide public notice of any significant proposed change in its methods
and standards for setting payment rates for services. In support of
this amendment, the State believes that issuing a memorandum to
providers online meets the public requirements. We believe that this
does not meet the Federal standard. We believe public notice promotes
transparency and openness in this process and allows the public to be
fully aware of the State's actions.
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), Washington SPA 08-019 was
disapproved.
The following issues will be considered at the hearing:
Whether Washington provided adequate public notice for
setting payment rates for services as required at 42 CFR 447.205.
Whether Washington met the longstanding requirement
(presently codified at 42 CFR 447.512 and 447.514, and previously
codified in 42 CFR 447.331 and 447.332) that the State is responsible
for demonstrating that the proposed increased dispensing fees are
reasonable.
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 CMS subsequently notifies 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 the State of Washington announcing an administrative
hearing to reconsider the disapproval of its SPA reads as follows:
Ms. Susan Dreyfus
Secretary
Department of Social and Health Services
P.O. Box 45010
Olympia, WA 98504-5010
Dear Ms. Dreyfus:
I am responding to your request for reconsideration of the decision
to disapprove the Washington State plan amendment (SPA) 08-019, which
was received by the Centers for Medicare & Medicaid Services on
September 23, 2008, and disapproved on March 6, 2009. The SPA proposed
to increase dispensing fees for pharmacies from $4.20 to $4.24 for
high-volume pharmacies, $4.51 to $4.56 for mid-volume pharmacies, $5.20
to $5.25 for low-volume pharmacies, and $5.20 to $5.25 for unit dose
systems.
The following issues will be considered at the hearing:
Whether Washington provided adequate public notice for
setting payment rates for services as required at 42 CFR 447.205.
Whether Washington met the longstanding requirement
(presently codified at 42 CFR 447.512 and 447.514, and previously
codified in 42 CFR 447.331 and 447.332) that the State is responsible
for demonstrating that the proposed increased dispensing fees are
reasonable.
I am scheduling a hearing on your request for reconsideration to be
held on August 4, 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 08-019. 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 among 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,
Charlene Frizzera
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: June 16, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E9-14776 Filed 6-22-09; 8:45 am]