[Federal Register Volume 60, Number 67 (Friday, April 7, 1995)]
[Notices]
[Pages 17791-17792]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-8524]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration


Notice of Hearing: Reconsideration of Disapproval of Utah State 
Plan Amendment (SPA)

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

ACTION: Notice of hearing.

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SUMMARY: This notice announces an administrative hearing on May 17, 
1995 in Room 578, 1961 Stout Street, Denver, Colorado to reconsider our 
decision to disapprove Utah SPA 93-033.

CLOSING DATE: Requests to participate in the hearing as a party must be 
received by the presiding officer by April 24, 1995.

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 Utah State plan 
amendment (SPA) number 93-033.
    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 Utah submitted SPA 93-033 which proposed changes in an 
asset test for poverty level pregnant women. Specifically, Utah's 
amendment required certain poverty level pregnant women who did not 
meet the resource test to make a one-time payment equal to 4 percent of 
the individual's total non-exempt resources. In addition, Utah's 
amendment would waive this requirement for high risk pregnant women.
    The issues in this matter are whether Utah SPA 93-033 adheres to 
the Federal law at section 1902(a)(14) of the Act (referencing section 
1916 of the Act) section 1902(l) and section 1902(a)(17).
    Section 1902(a)(14) of the Act specifies that enrollment fees, 
premiums, deductions, cost sharing, or similar charges may be imposed 
only as provided in section 1916. Section 1916(a)(1) prohibits the 
application of any enrollment fee with respect to the categorically 
needy. It restricts States from charging a premium for Medicaid for the 
categorically needy. An exception is made regarding poverty level 
pregnant women with income at or above 150 percent of the Federal 
Poverty Level. For these women, the amount of that premium is 
restricted to 10 percent of the amount by which the family income (less 
expense for care of a dependent child) exceeds 150 percent of the 
poverty level. In addition, section 1916(a)(2)(B) prohibits States from 
imposing any deduction, cost sharing or similar charge with respect to 
services furnished to pregnant women, provided the services relate to 
the pregnancy or a complicating condition. HCFA disapproved Utah's 
amendment finding contrary to the statute's prohibition on imposing 
premiums (other than those authorized in section 1916(c) of the Act) 
enrollment fees, or similar charges on categorically needy individuals.
    Utah believes its proposed policy to waive the resource spenddown 
for pregnant women determined to be in the high risk category is 
supported by section 1902(1)(3) of the Act. Utah believes this is the 
only statutory authority over resource standards and methodologies for 
poverty level pregnant women. Utah also claims that section 1902(a)(17) 
explicitly exempts pregnant women from all requirements in that 
section. HCFA did not agree with Utah's interpretation of the statute 
that section 1902(l) exempts this group from the comparability 
requirements in section 1902(a)(17).
    While HCFA acknowledges that subsection (l)(3) exempts the States 
from using a resource test for high-risk pregnant women, this exemption 
does not override the remainder of section 1902 (a)(17) which requires 
comparability of services to all such women. Utah cites the phrase, 
``except as provided in subsections (l)(3), (m)(3), and (m)(4) include 
reasonable standards (which shall be comparable for all groups * * *)'' 
as a rationale for this assertion. However, section 1902(1)(3) applies 
only in cases in which its application would be inconsistent with the 
requirements of subsection (a)(17). HCFA believed that subsection 
(l)(3) authorizes States to establish a more liberal resource standard 
or to drop the resource test for all section 1902(l)(A) pregnant women, 
but not to adopt either of these approaches for a specific segment of 
that group. While the goal of removing barriers to ensure positive 
birth outcomes is a shared one, HCFA did not approve foregoing a 
resource test exclusively for high-risk pregnant women because they are 
not a separate group described in section 1902(l).
    Utah points out that subsection (l)(3) prescribes that a resource 
standard or methodology may not be more restrictive than applied under 
Title XVI. Utah also believes that exclusion of all resources based 
upon the level of medical risk factors is less restrictive than Title 
XVI, and is also reasonable. However, HCFA believed that section 
1902(a)(17) is explicitly meant to be inclusive of whole eligibility 
groups and not portions of groups. HCFA contended it cannot authorize a 
State to single out any part of an eligibility group for preferential 
treatment. HCFA's position was, in order to drop the resource test for 
high risk pregnant women, the State must do so for the entire poverty 
level group of pregnant women.
    The notice to Utah announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Mr. Rod L. Betit,
Executive Director, Utah Department of Health, 288 North 1460 West, 
P.O. Box 16700, Salt Lake City, Utah 84116-0700.

    Dear Mr. Betit: I am responding to your request for 
reconsideration of the decision to disapprove Utah State Plan 
Amendment (SPA) 93-033.
    The State of Utah submitted SPA 93-33 which proposed changes in 
an asset test for poverty level pregnant women. Specifically, Utah 
proposed policy regarding a one-time payment equal to 4 percent of 
the individual's total non-exempt resources if [[Page 17792]] they 
are equal to or exceed $5,000. In addition, Utah proposed to waive 
this payment requirement for high risk pregnant women.
    The issues in this matter are whether Utah SPA 93-033 adheres to 
the Federal law at section 1902(a)(14) of the Act (referencing 
section 1916 of the Act), section 1902(l) and section 1902(a)(17).
    I am scheduling a hearing on your request for reconsideration to 
be held on May 17, 1995, in Room 578, 1961 Stout Street, Denver, 
Colorado. 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 residing 
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. 1316); 42 CFR 
section 430.18)

(Catalog of Federal Domestic Assistance Program No. 13.714, Medicaid 
Assistance Program)

    Dated: March 30, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 95-8524 Filed 4-6-95; 8:45 am]
BILLING CODE 4120-01-P