[Federal Register Volume 65, Number 249 (Wednesday, December 27, 2000)]
[Notices]
[Pages 81877-81878]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-32922]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration


Notice of Hearing: Reconsideration of Disapproval of Rhode Island 
State Plan Amendment (SPA) 00-003

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

ACTION: Notice of hearing.

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SUMMARY: This notice announces an administrative hearing on January 25, 
2001; 10:00 a.m.; Twenty-second Floor; Room 2255; JFK Federal Building; 
Boston, Massachusetts 02203-0003, to reconsider our decision to 
disapprove Rhode Island (SPA) 00-003.

DATES: Closing Date: Requests to participate in the hearing as a party 
must be received by the presiding officer by January 10, 2001.

FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Presiding 
Officer, HCFA, C1-09-13, 7500 Security Boulevard, Baltimore, Maryland 
21244, Telephone: (410) 786-2055.

SUPPLEMENTARY INFORMATION: This notice announces an administrative 
hearing to reconsider our decision to disapprove Rhode Island's State 
Plan Amendment (SPA) 00-003. Rhode Island submitted SPA 00-003 on March 
29, 2000. This amendment proposed to include under the State plan 
disproportionate share (DSH) payments to non-government hospitals to 
cover the costs of providing inpatient hospital services to inmates in 
the custody of the Department of Corrections (DOC) or the Department of 
Children, Youth and Families (DCYF). As explained below, HCFA could not 
approve Rhode Island's SPA 00-003.
    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 issue in Rhode Island SPA 00-003 is whether the payments at 
issue are consistent with the statutory requirements for DSH payments 
at section 1923 of the Act. The payments are for specific services 
furnished to individuals not eligible for Medicaid, and are not 
generally available for the costs to ``serve a disproportionate share

[[Page 81878]]

of low income patients with special needs.'' Moreover, since inmates in 
the custody of the DOC or the DCYF, have a source of third party 
coverage, because of the legal obligation of those entities to furnish 
food, housing and medical care to wards of the State, DSH payments for 
those services would be contrary to the applicable hospital-specific 
limits. HCFA contends that these inmates are neither eligible for 
Medicaid nor are they uninsured.
    Section 1923 of the Act establishes Federal requirements for DSH 
payments to qualifying hospitals. DSH payments may be reasonably 
related to the costs, volume or proportion of services provided to 
patients eligible for medical assistance under a State plan or to low-
income patients. Unlike other Medicaid payments, DSH payments are not 
payments for specific services, but are made to recognize that DSH 
facilities ``serve a disproportionate share of low income patients with 
special needs.'' The payments described in this State plan are payments 
for specific services to specified inmates in the custody of the DOC or 
DCYF, rather than payments available for the overall costs of serving a 
disproportionate share of low-income patients. It is important to note 
that, while States may use DSH payments generally to assist facilities 
that have high levels of uncompensated care, the DSH provisions do not 
authorize payments for specific services to non-Medicaid eligible 
individuals.
    Furthermore, under section 1923(g) of the Act there is a hospital-
specific limit on DSH payments under Medicaid. Such payments cannot 
exceed the hospital's uncompensated costs of furnishing hospital 
services to individuals who either are eligible for medical assistance 
under the State plan or have no health insurance or other source of 
third party coverage for services provided during the year. Individuals 
in the custody of the DOC and the DCYF are wards of the State. As such, 
the State is obligated to cover their basic economic needs (food, 
housing, and medical care) because failure to do so would be in 
violation of the Eighth amendment of the Constitution. Because State 
obligations outside of the Medicaid program provide these individuals a 
source of third party coverage, the individuals are neither eligible 
for medical assistance nor are they uninsured. Therefore, the State 
cannot make DSH payments to cover the costs of their care.
    Therefore, based on the above, and after consultation with the 
Secretary as required under 42 CFR 430.15(c)(2), HCFA disapproved Rhode 
Island SPA 00-003.
    The notice to Rhode Island announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Christine C. Ferguson
Director
Department of Human Services
600 New London Avenue
Cranston, Rhode Island 02920
    Dear Ms. Ferguson: I am responding to your request for 
reconsideration of the decision to disapprove Rhode Island State 
Plan Amendment (SPA) 00-003.
    The issue in Rhode Island SPA 00-003 is whether the payments at 
issue are consistent with the statutory requirements for 
disproportionate share hospital (DSH) payments at section 1923 of 
the Social Security Act (the Act). The payments are for specific 
services furnished to individuals not eligible for Medicaid, and are 
not generally available for the costs to ``serve a disproportionate 
share of low income patients with special needs.'' Moreover, since 
inmates in the custody of the Department of Corrections (DOC) or the 
Department of Children and Youth (DCYF), have a source of third 
party coverage, because of the legal obligation of those entities to 
furnish food, housing and medical care to wards of the State, DSH 
payments for those services would be contrary to the applicable 
hospital-specific limits. HCFA contends that these inmates are 
neither eligible for Medicaid nor are they uninsured.
    Section 1923 of the Act establishes Federal requirements for DSH 
payments to qualifying hospitals. DSH payments may be reasonably 
related to the costs, volume or proportion of services provided to 
patients eligible for medical assistance under a State plan or to 
low-income patients. Unlike other Medicaid payments, DSH payments 
are not payments for specific services, but are made to recognize 
that DSH facilities ``serve a disproportionate share of low income 
patients with special needs.'' The payments described in this State 
plan are payments for specific services to specified inmates in the 
custody of the DOC or DCYF, rather than payments available for the 
overall costs of serving a disproportionate share of low-income 
patients. It is important to note that, while States may use DSH 
payments generally to assist facilities that have high levels of 
uncompensated care, the DSH provisions do not authorize payments for 
specific services to non-Medicaid eligible individuals.
    Furthermore, under section 1923(g) of the Act there is a 
hospital-specific limit on DSH payments under Medicaid. Such 
payments cannot exceed the hospital's uncompensated costs of 
furnishing hospital services to individuals who either are eligible 
for medical assistance under the State plan or have no health 
insurance or other source of third party coverage for services 
provided during the year. Individuals in the custody of the DOC and 
the DCYF are wards of the State. As such, the State is obligated to 
cover their basic economic needs (food, housing, and medical care) 
because failure to do so would be in violation of the Eighth 
amendment of the Constitution. Because State obligations outside of 
the Medicaid program provide these individuals a source of third 
party coverage, the individuals are neither eligible for medical 
assistance nor are they uninsured. Therefore, the State cannot make 
DSH payments to cover the costs of their care.
    Therefore, based on the above, and after consultation with the 
Secretary as required under 42 CFR430.15(c)(2), HCFA disapproved 
Rhode Island SPA 00-003.
    I am scheduling a hearing on your request for reconsideration to 
be held on January 25, 2001, Twenty-second Floor: Room 2255; JFK 
Federal Building; Boston, Massachusetts 02203-0003. 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 Ms. Kathleen Scully-Hayes 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) 786-2055.
        Sincerely,

Robert A. Berenson, M.D.
Acting Deputy 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 20, 2000.
Robert A. Berenson,
Acting Deputy Administrator, Health Care Financing Administration.
[FR Doc. 00-32922 Filed 12-26-00; 8:45 am]
BILLING CODE 4120-03-P