[Federal Register Volume 66, Number 244 (Wednesday, December 19, 2001)]
[Notices]
[Pages 65507-65508]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-31261]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval of Missouri 
State Plan Amendment 91-50

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

ACTION: Notice of hearing.

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SUMMARY: This notice announces an administrative hearing to reconsider 
the decision to disapprove Missouri State Plan Amendment 91-50, on 
January 23, 2002, at 10:00 a.m., at the Richard Bolling Federal 
Building; Plaza Room 664; 601 East Twelfth Street; Kansas City, 
Missouri 64106-2808.

CLOSING DATES: Requests to participate in the hearing as a party must 
be received by the presiding officer by January 3, 2002.

FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Office of 
Hearings, CMS, Suite L, 2520 Lord Baltimore Drive, Baltimore, Maryland 
21244-2670, Telephone: (410)-786-2055.

SUPPLEMENTARY INFORMATION: This notice announces an administrative 
hearing to reconsider the decision to disapprove Missouri State Plan 
Amendment (SPA) 91-50.
    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 Centers for Medicare & Medicaid (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.
    The issue is whether this amendment proposed a retroactive 
effective date that is not consistent with law for an additional 
disproportionate share hospital (DSH) payment to the 10 highest 
Medicaid utilization hospitals in the State that had a high volume of 
nursery and neonatal care days. This SPA was submitted on November 18, 
1991, with a proposed effective date of October 21, 1991.
    Under the Medicaid Voluntary Contribution and Provider Specific Tax

[[Page 65508]]

Amendments of 1991 (Pub. L. 102-234), which added section 1923(f)(1)(A) 
of the Act and the Federal regulation at 42 CFR 447.296(b)(6), the 
State cannot increase DSH payments to hospitals based on amendments 
submitted after September 30, 1991, for payments made during the period 
January 1, 1992, through September 30, 1992, except in very limited 
circumstances. The reason for this moratorium on DSH payments was so 
CMS could determine a state's base DSH allotments for an annual period 
beginning in Federal fiscal year 1993.
    This proposed amendment is not within the statutory exception for 
payments under certain SPAs submitted to the Secretary between 
September 30, 1991, and November 26, 1991. This exception applies only 
to an amendment that designates only DSHs with a Medicaid or low-income 
utilization percentage at or above the statewide arithmetic mean. In 
regulations at 42 CFR 447.296(b), the Secretary has interpreted this 
exception to apply only when the amendment is intended to limit the 
state's overall definition of DSH to those specified hospitals.
    While this proposed amendment meets the timing criteria for this 
exception, as it was submitted on November 18, 1991, it does not meet 
the substantive criteria for this exception. The proposed amendment 
does not limit the State's overall definition of DSH to those with a 
Medicaid or low-income utilization percentage at or below the statewide 
arithmetic mean. This proposed amendment did not concern the 
designation of DSHs, but only concerned the payment rate for some 
already designated hospitals. This proposed amendment provided for a 
10-percent additional payment to certain hospitals otherwise designated 
and receiving DSH payments. Therefore, CMS found that this exception 
did not apply and disapproved Missouri SPA 91-50.
    The notice to Missouri announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Ms. Dana Katherine Martin,
Director, Department of Social Services,
Broadway State Office Building,
P.O. Box 1527,
Jefferson City, Missouri 65102.

Dear Ms. Martin:
    I am responding to your request for reconsideration of the 
decision to disapprove Missouri State Plan Amendment (SPA) 91-50, 
which was submitted on November 18, 1991.
    The issue is whether this amendment proposed a retroactive 
effective date that is not consistent with law for an additional 
disproportionate share hospital (DSH) payment to the 10 highest 
Medicaid utilization hospitals in the State that had a high volume 
of nursery and neonatal care days. The proposed effective date of 
the SPA is October 21, 1991.
    Under the Medicaid Voluntary Contribution and Provider Specific 
Tax Amendments of 1991 (Public Law 102-234), which added section 
1923(f)(1)(A) of the Social Security Act (the Act) and the Federal 
regulation at 42 CFR 447.296(b)(6), the State cannot increase DSH 
payments to hospitals based on amendments submitted after September 
30, 1991, for payments made during the period January 1, 1992, 
through September 30, 1992, except in very limited circumstances. 
The reason for this moratorium on DSH payments was so the Centers 
for Medicare & Medicaid Services (CMS), could determine a state's 
base DSH allotments for an annual period beginning in Federal fiscal 
year 1993.
    This proposed amendment is not within the statutory exception 
for payments under certain SPAs submitted to the Secretary between 
September 30, 1991, and November 26, 1991. This exception applies 
only to an amendment that designates only DSHs with a Medicaid or 
low-income utilization percentage at or above the statewide 
arithmetic mean. In regulations at 42 CFR 447.296(b), the Secretary 
has interpreted this exception to apply only when the amendment is 
intended to limit the state's overall definition of DSH to those 
specified hospitals.
    While this proposed amendment meets the timing criteria for this 
exception, as it was submitted on November 18, 1991, it does not 
meet the substantive criteria for this exception. The proposed 
amendment does not limit the State's overall definition of DSH to 
those with a Medicaid or low-income utilization percentage at or 
below the statewide arithmetic mean. This proposed amendment did not 
concern the designation of DSHs, but only concerned the payment rate 
for some already designated hospitals. This proposed amendment 
provided for a 10-percent additional payment to certain hospitals 
otherwise designated and receiving DSH payments. Therefore, CMS 
found that this exception did not apply and disapproved Missouri SPA 
91-50.
    I am scheduling a hearing on your request for reconsideration to 
be held on January 23, 2002, at 10:00 a.m.; Richard Bolling Federal 
Building; Plaza Room 664; 601 East Twelfth 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 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.
(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: December 10, 2001.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 01-31261 Filed 12-18-01; 8:45 am]
BILLING CODE 4120-01-P