[Federal Register Volume 66, Number 195 (Tuesday, October 9, 2001)]
[Notices]
[Pages 51439-51440]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-25227]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval of Iowa State 
Plan Amendment (SPA) 01-013

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice of hearing.

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

SUMMARY: This notice announces an administrative hearing on November 
14, 2001, 10 a.m., Room 281, Richard Bolling Federal Building, 601 E. 
Twelfth Street, Kansas City, Missouri 64106.

CLOSING DATE: Requests to participate in the hearing as a party must be 
received by the presiding officer by October 24, 2001.

FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Presiding 
Officer, CMS, 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 Iowa State Plan 
Amendment (SPA) 01-013. Iowa submitted Iowa SPA 01-013 on March 28, 
2001. The issue is whether Iowa can limit Medicaid eligibility to 
members of the Balanced Budget Act of 1997 (BBA) buy-in group for the 
working disabled who have not attained age 65.
    This amendment seeks to limit Medicaid eligibility under the 
optional categorically needy group at section 1902(a)(10)(A)(ii)(XIII) 
of the Social Security Act (the Act), to individuals under age 65. This 
group is more commonly known as the BBA buy-in group for the working 
disabled. Coverage of the group itself was approved via Iowa SPA 00-04. 
The SPA 01-013 seeks to add a limitation on the age of eligible 
individuals that was not included in SPA 00-04. For reasons explained 
below, the Centers for Medicare & Medicaid Services (CMS), formerly the 
Health Care Financing Administration, disapproved SPA 01-013.
    Iowa requested approval of an age limit under the BBA group because 
State legislation authorizing coverage of the group limits eligibility 
to those under the age of 65. However, the Federal statute at section 
1902(a)(10)(A)(ii)(XIII) of the Act does not provide for a limit on the 
age of individuals who can be eligible under this group, nor does that 
section include any authority for states to establish such a limit. 
Iowa argued that, while not stated explicitly, the intent of Congress 
in enacting the BBA group was that eligibility under the group be 
limited to individuals under age 65. The State bases its argument on a 
reference in subsection (XIII) to section 1905(q)(2)(B) of the Act as 
the authority for establishing the income limit for eligibility under 
the BBA group. Since eligibility in general under the group established 
at section 1905(q) of the Act (qualified severely impaired individuals) 
is limited to individuals under age 65, the State believes that age 
limit, through the subsection (XIII) reference to section 
1905(q)(2)(B), also applies to the BBA group.
    However, section 1902(a)(10)(A)(ii)(XIII) does not reference 
section 1905(q) in its entirety, but only subsection (2)(B), and then 
only in the specific context of the income limit set forth in that 
subsection. Accepting the argument that Congress intended, in referring 
to subsection (2)(B), that the age limit which applies to section 
1905(q) in general should apply to the BBA group, logically leads to 
the conclusion that all of the other requirements of section 1905(q) 
would apply to the BBA group as well. However, CMS believes that this 
is clearly not the case because Congress established separate 
requirements for eligibility under the BBA group, adopting section 
1905(q)(2)(B) only for purposes of establishing an income limit for 
that group.
    The CMS believes its position to be supported by Congress' action 
to establish two additional groups under the Ticket to Work and Work 
Incentives Improvement Act of 1999 through which states can elect to 
cover working disabled individuals under Medicaid. The statutory 
provisions for both groups (sections 1902(a)(10)(A)(ii)(XV) and (XVI)) 
specifically limit eligibility to individuals who are at least 16 but 
not more than 64 years of age. Had Congress intended to limit 
eligibility under the BBA group to individuals under age 65, it could 
have amended section 1902(a)(10)(A)(ii)(XV) and (XVI) specifically 
limiting eligibility to individuals who are at least 16 but not more 
than 64 years of age. Had Congress intended to limit eligibility under 
the BBA group to individuals under age 65, CMS believes it could have 
amended section 1902(a)(10)(A)(ii)(XIII) to provide such a limit.
    Therefore, after consulting with the Secretary as required by 42 
CFR 430.15(c), CMS informed Iowa of its decision to disapprove this 
amendment. The notice to Iowa announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:


[[Page 51440]]


Ms. Jessie K. Rasmussen,
Director, Iowa Department of Human Services, Hoover State Office 
Building, Des Moines, IA 50319-0114.

    Dear Ms. Rasmussen: I am responding to your request for 
reconsideration of the decision to disapprove Iowa State Plan 
Amendment (SPA) 01-013. Iowa submitted Iowa SPA 01-013 on March 28, 
2001. The issue is whether Iowa can limit Medicaid eligibility to 
members of the Balanced Budget Act of 1997 (BBA) buy-in group for 
the working disabled who have not attained age 65. This amendment 
seeks to limit Medicaid eligibility under the optional categorically 
needy group at section 1902 (a)(10)(A)(ii)(XIII) of the Social 
Security Act (the Act) to individuals under age 65. This group is 
more commonly known as the BBA buy-in group for the working 
disabled. Coverage of the group itself was approved via Iowa SPA 00-
04. The SPA 01-013 seeks to add a limitation on the age of eligible 
individuals that was not included in SPA 00-04. For reasons 
explained below, the Centers for Medicare & Medicaid Services (CMS), 
formerly the Health Care Financing Administration, disapproved SPA 
01-013.
    Iowa requested approval of an age limit under the BBA group 
because State legislation authorizing coverage of the group limits 
eligibility to those under the age of 65. However, the Federal 
statute at section 1902(a)(10)(A)(ii)(XIII) of the Act does not 
provide for a limit on the age of individuals who can be eligible 
under this group, nor does that section include any authority for 
states to establish such a limit. Iowa argued that, while not stated 
explicitly, the intent of Congress in enacting the BBA group was 
that eligibility under the group be limited to individuals under age 
65. The State bases its argument on a reference in subsection (XIII) 
to section 1905(q)(2)(B) of the Act as the authority for 
establishing the income limit for eligibility under the BBA group. 
Since eligibility in general under the group established at section 
1905(q) of the Act (qualified severely impaired individuals) is 
limited to individuals under age 65, the State believes that age 
limit, through the subsection (XIII) reference to section 
1905(q)(2)(B), also applies to the BBA group.
    However, section 1902(a)(10)(A)(ii)(XIII) does not reference 
section 1905(q) in its entirety, but only subsection (2)(B), and 
then only in the specific context of the income limit set forth in 
that subsection. Accepting the argument that Congress intended, in 
referring to subsection (2)(B), that the age limit which applies to 
section 1905(q) in general should apply to the BBA group, logically 
leads to the conclusion that all of the other requirements of 
section 1905(q) would apply to the BBA group as well. However, this 
is clearly not the case because Congress established separate 
requirements for eligibility under the BBA group, adopting section 
1905(q)(2)(B) only for purposes of establishing an income limit for 
that group.
    The CMS believes its position to be supported by Congress' 
action to establish two additional groups under the Ticket to Work 
and Work Incentives Improvement Act of 1999 through which states can 
elect to cover working disabled individuals under Medicaid. The 
statutory provisions for both groups (sections 
1902(a)(10)(A)(ii)(XV) and (XVI)) specifically limit eligibility to 
individuals who are at least 16 but not more than 64 years of age. 
Had Congress intended to limit eligibility under the BBA group to 
individuals under age 65, it could have amended section 
1902(a)(10)(A)(ii)(XV) and (XVI) specifically limiting eligibility 
to individuals who are at least 16 but not more than 64 years of 
age. Had Congress intended to limit eligibility under the BBA group 
to individuals under age 65, it could have amended section 
1902(a)(10)(A)(ii)(XIII) to provide such a limit.
    The CMS had offered Iowa an alternative that would have enabled 
the State to avoid covering most individuals age 65 and over under 
the BBA group. The State could define the group as consisting only 
of individuals who meet the definition of disability under the 
Supplemental Security Income (SSI) program. By defining the group in 
this way, the State would not have to cover anyone age 65 or over 
who did not also meet the SSI definition of disability. However, 
Iowa was not able to take advantage of this alternative because of 
the specific language of the State's enabling legislation.
    Therefore, after consulting with the Secretary as required by 42 
CFR 430.15(c), CMS informed Iowa of its decision to disapprove this 
amendment.
    I am scheduling a hearing on your request for reconsideration to 
be held on November 14, 2001, at 10:00 a.m. in Room 281, Richard 
Bolling Federal Building, 601 E. Twelfth Street, Kansas City, 
Missouri 64106. 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,

Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.

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: September 30, 2001.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 01-25227 Filed 10-3-01; 1:55 pm]
BILLING CODE 4120-03-P