[Federal Register Volume 66, Number 218 (Friday, November 9, 2001)]
[Notices]
[Pages 56680-56681]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-28220]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval of Louisiana 
State Plan Amendment (SPA) 01-03

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice of hearing.

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SUMMARY: This notice announces an administrative hearing to reconsider 
our decision to disapprove Louisiana SPA 01-03 on December 19, 2001, at 
10 a.m.; at 1301 Young Street; Conference Room 1113; Dallas, Texas 
75202.

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: Kathleen Scully-Hayes, Office of 
Hearings, Centers for Medicare & Medicaid Services, Suite L, 2520 Lord 
Baltimore Drive, Baltimore, Maryland 21244-2670, Telephone: (410) 786-
2055.

SUPPLEMENTARY INFORMATION: This notice announces an administrative 
hearing to reconsider our decision to disapprove Louisiana SPA 01-03.
    Section 1116 of the Social Security Act (the Act) and 42 CFR part 
430 establish HHS procedures that provide an administrative hearing for 
reconsideration of a disapproval of a State plan or plan amendment. The 
Centers for Medicare & Medicaid Services (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 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.
    At issue is whether Louisiana may include in the calculation of 
disproportionate share hospital (DSH) payments the uncompensated costs 
of providing certain health care services that were not within the 
regulatory definition of hospital services and are not treated as 
hospital services for any other purpose. This amendment proposed 
including rural health clinic uncompensated care costs in a hospital's 
DSH payment calculation.
    Section 1923(g)(1) of the Act sets forth a hospital-specific limit 
on DSH payments and permits only the costs of ``hospital services'' 
furnished by a hospital to be included in calculating this limit. 
Medicaid outpatient hospital services are defined in Federal 
regulations at 42 CFR 440.20(a). This regulation requires the services 
to be provided by an institution that is licensed or formally approved 
as a hospital by an officially designated authority for state standard 
setting. The institution also must meet the

[[Page 56681]]

conditions of participation in the Medicaid program. This means that a 
state may not include costs or revenues in the DSH calculation which 
are attributable to services rendered in a separately licensed/
certified entity, even if that entity is owned by the same institution. 
Such health services are not ``hospital services.''
    Louisiana SPA 01-03 is not consistent with either section 
1923(g)(1) of the Act or 42 CFR 440.20, because it would include as 
hospital services (for purposes of the DSH calculations) health 
services that were not within the regulatory definition of hospital 
services or otherwise characterized as hospital services. Therefore, 
the CMS Administrator, after consulting with the Secretary as required 
by 42 CFR 430.15, informed Louisiana that Louisiana SPA 01-03 was 
disapproved.
    The notice to Louisiana announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:
Mr. David W. Hood,
Secretary, Louisiana Department of Health and Hospitals, 1201 
Capitol Access Road, P.O. Box 91030, Baton Rouge, LA 70821-9030

    Dear Mr. Hood: I am responding to your request for 
reconsideration of the decision to disapprove Louisiana State Plan 
Amendment (SPA) 01-03.
    At issue is whether Louisiana may include in the calculation of 
disproportionate share hospital (DSH) payments the uncompensated 
costs of providing certain health care services that were not within 
the regulatory definition of hospital services and are not treated 
as hospital services for any other purpose. This amendment proposed 
including rural health clinic uncompensated care costs in a 
hospital's DSH payment calculation.
    Section 1923(g)(1) of the Social Security Act (the Act) sets 
forth a hospital-specific limit on DSH payments and permits only the 
costs of ``hospital services'' furnished by a hospital to be 
included in calculating this limit. Medicaid outpatient hospital 
services are defined in Federal regulations at 42 CFR 440.20(a). 
This regulation requires the services to be provided by an 
institution that is licensed or formally approved as a hospital by 
an officially designated authority for state standard setting. The 
institution also must meet the conditions of participation in the 
Medicaid program. This means that a state may not include costs or 
revenues in the DSH calculation which are attributable to services 
rendered in a separately licensed/certified entity, even if that 
entity is owned by the same institution. Such health services are 
not ``hospital services.''
    Louisiana SPA 01-03 is not consistent with either section 
1923(g)(1) of the Act or 42 CFR 440.20 because it would include as 
hospital services (for purposes of the disproportionate share 
calculations) health services that were not within the regulatory 
definition of hospital services or otherwise characterized as 
hospital services. Therefore, the Centers for Medicare & Medicaid 
Services' Administrator, after consulting with the Secretary as 
required by 42 CFR 430.15, informed Louisiana that Louisiana SPA 01-
03 was disapproved.
    I am scheduling a hearing on your request for reconsideration to 
be held on December 19, 2001, at 10 a.m.; 1301 Young Street; 
Conference Room 1113; Dallas, Texas 75202.
    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.

(Sec. 1116 of the Social Security Act (42 U.S.C. 1316); 42 CFR 
430.18)

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

    Dated: November 5, 2001.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 01-28220 Filed 11-8-01; 8:45 am]
BILLING CODE 4120-03-P