[Federal Register Volume 59, Number 214 (Monday, November 7, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-27495]


[[Page Unknown]]

[Federal Register: November 7, 1994]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration

 

Hearing: Reconsideration of Disapproval of Kansas State Plan 
Amendment (SPA)

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice of hearing.

-----------------------------------------------------------------------

SUMMARY: This notice announces an administrative hearing on November 
30, 1994, in Room 111, New Federal Office Building, 601 East 12th 
Street, Kansas City, Missouri 64106-2808, to reconsider our decision to 
disapprove Kansas SPA 93-25.

CLOSING DATES: 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: Stan Katz, Presiding Officer, 
Groundfloor, Meadowwood East Building, 1849 Gwynn Oak Avenue, 
Baltimore, Maryland 21207, Telephone: (410) 597-3013.

SUPPLEMENTARY INFORMATION:
    This notice announces an administrative hearing to reconsider our 
decision to disapprove Kansas State plan amendment (SPA) number 93-25.
    Section 1116 of the Social Security Act (the Act) and 42 CFR, Part 
430 establish Department procedures that provide an administrative 
hearing for reconsideration of a disapproval of a State plan or plan 
amendment. The Health Care Financing Administration (HCFA) 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 State of Kansas submitted SPA 93-25 to increase the copayment 
amount for general hospital inpatient services and inpatient free 
standing psychiatric facility services from $25 to $325 per admission.
    The issues are whether Kansas SPA 93-25 adheres to the Federal law 
at section 1902(a)(14) of the Act (referencing section 1916 of the 
Act), as implemented in the regulations at 42 CFR section 447.54(c) and 
section 1902(a)(19) of the Act.
    Section 1902(a)(14) of the Act requires a Medicaid State plan to 
provide that premiums, deductions, cost sharing or similar charges be 
imposed only as provided in section 1916 of the Act. Pursuant to 
section 1916 of the Act, a State may impose nominal cost-sharing 
payments, such as deductibles, coinsurance, copayments, or similar 
cost-sharing charges on certain Medicaid recipients for some services. 
Current Medicaid regulations at 42 CFR section 447.54(c) define 
``nominal'' for institutional services, as the maximum deductible, 
coinsurance, or copayment charge for each admission that does not 
exceed 50 percent of the payment the State makes for the first day of 
care in the institution.
    HCFA believes the State's proposed copayment does not conform to 
the regulation because the copayment is not institution and admission 
specific. Furthermore, the proposed $325 copayment amount is a fixed 
Statewide amount. The regulation limits the State plan to the maximum 
copayment amount per admission. Kansas believes that the regulations do 
not require institution and admission specific copayments. In addition, 
Kansas indicates that Federal regulations at 42 CFR 447.55(a) 
specifically allow the State to set a standard, or fixed, copayment 
amount for any service.
    Section 1902(a)(19) of the Act provides that the State plan must 
include safeguards to assure that services will be provided in a manner 
consistent with the best interests of the recipients. HCFA believes the 
State has neglected to include any analysis or data which determines 
whether any Medicaid recipients were dissuaded from even seeking the 
services because of the proposed copayment. Further, if recipients are 
deterred from seeking necessary medical services because they are 
unable to pay the copayment amount, regardless of the fact that such 
services could not be denied, a copayment amount such as Kansas 
proposed cannot be in the best interests of the Medicaid recipients. 
Kansas believes there is no regulatory requirement that a State 
undertake studies or surveys of the recipient population before it 
implements a copayment.
    The notice to Kansas announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Ms. Donna L. Whiteman,
Secretary, Kansas Department of Social and Rehabilitation Services,
6th Floor, North Wing,
915 S.W. Harrison St.,
Topeka, KS 66612

    Dear Ms. Whiteman: I am responding to your request for 
reconsideration of the decision to disapprove Kansas State Plan 
Amendment (SPA) 93-25.
    Kansas submitted SPA 93-25 which would increase the copayment 
amount for the general hospital inpatient services and inpatient 
free standing psychiatric facility services from $25 to $325 per 
admission.
    The issues are whether Kansas SPA 93-25 adheres to the Federal 
law at section 1902(a)(14) of the Social Security Act (the Act) 
(referencing section 1916 of the Act), as implemented in the 
regulations at 42 C.F.R. section 447.54(c), and section 1902(a)(19) 
of the Act.
    I am scheduling a hearing on your request for reconsideration to 
be held on November 30, 1994, in Room 111, New Federal Office 
Building, 601 East 12th Street, Kansas City, Missouri, 64106-2808. 
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 Mr. Stanley Katz as the presiding officer. If 
these arrangements present any problems, please contact the 
presiding officer. 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. The presiding officer may 
be reached at (410) 597-3013.

    Sincerely,
Bruce C. Vladeck,
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: October 31, 1994.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 94-27495 Filed 11-4-94; 8:45 am]
BILLING CODE 4120-01-P