[Federal Register Volume 69, Number 97 (Wednesday, May 19, 2004)]
[Notices]
[Pages 28895-28896]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-11268]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval of 
Connecticut's Medicaid State Plan Amendment 03-002A

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

ACTION: Notice of hearing.

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SUMMARY: This notice announces an administrative hearing to be held on 
June 8, 2004, at 10 a.m., JFK Federal Building, Room 2325, Boston, 
Massachusetts 02203-0003, to reconsider CMS' decision to disapprove 
Connecticut's Medicaid State Plan Amendment (SPA) 03-002A.

DATES: Closing Date: Requests to participate in the hearing as a party 
must be received by the presiding officer by June 3, 2004.

FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Presiding 
Officer CMS, Lord Baltimore Drive, Mail Stop LB-23-20, Baltimore, 
Maryland 21244, Telephone: (410) 786-2055.

SUPPLEMENTARY INFORMATION: This notice announces an administrative 
hearing to reconsider the CMS' decision to disapprove Connecticut's 
Medicaid State Plan Amendment (SPA) 03-002A.
    Connecticut submitted SPA 03-002A on February 13, 2003, which 
proposes to establish new pharmacy reimbursement rates for the period 
January 1, 2003, through February 4, 2003. The CMS reviewed this 
proposal and for the reasons set forth below, the Agency was unable to 
approve SPA 03-002A as submitted.
    The sole issue is whether the requested effective date is 
consistent with statutory and regulatory requirements. In a separate 
action, CMS approved SPA 03-002B, which made the requested changes to 
pharmacy reimbursement rates for a subsequent period. Under section 
1902(a)(30)(A) of the Social Security Act (the Act), states are 
required to have methods and procedures to ensure that rates are 
consistent with efficiency, economy, and quality of care. Under that 
authority, the Secretary has issued regulations prescribing state rate-
setting procedures. One of those requirements, set forth at 42 CFR 
447.205(d), is issuance of public notice prior to the effective date of 
a significant change in any methods and standards for setting payment 
rates for services. While the State indicated that a legislative 
hearing was held in February 2002, and that other activities occurred 
in the Connecticut General Assembly, the required public notice was not 
published in the Connecticut Law Journal until February 4, 2003. The 
regulations at 42 CFR 447.205(d) are quite specific that in order to 
meet the public notice requirements, a notice must be published in one 
of the following publications: (1) A state register similar to the 
Federal Register; (2) the newspaper of widest circulation in each city 
with a population of 50,000 or more; or (3) the newspaper of widest 
circulation in the state, if there is not a city with a population of 
50,00 or more. Hearings and activities before a state legislature are 
not included in the regulation as meeting the requirements of public 
notice. Therefore, the change in pharmacy reimbursement rates contained 
in SPA 03-002A could not be effective until February 5, 2003.
    Therefore, based on the reasoning set forth above, and after 
consultation with the Secretary as required under 42 CFR 430.15(c)(2), 
CMS disapproved Connecticut SPA 03-002A.
    Section 1116 of 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. 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 notice to Connecticut announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows: Mr. Michael 
Starkowski, Deputy Commissioner, State of Connecticut, Department of 
Social Services, 25 Sigourney Street, Hartford, CT 06106-5033.

Dear Mr. Starkowski:

    I am responding to your request for reconsideration of the 
decision to disapprove State Plan Amendment (SPA) 03-002A.
    Connecticut submitted SPA 03-002A on February 13, 2003, which 
proposes to establish new pharmacy reimbursement rates for the 
period January 1, 2003, through February 4, 2003. The Centers for 
Medicare & Medicaid Services (CMS) reviewed this proposal and for 
the reasons set forth below, the Agency was unable to approve SPA 
03-002A as submitted.
    The sole issue is whether the requested effective date is 
consistent with statutory and regulatory requirements. In a separate 
action, CMS approved SPA 03-002B, which made the requested changes 
to pharmacy reimbursement rates for a subsequent period. Under 
section 1902(a)(30)(A) of the Social Security Act, states are 
required to have methods and procedures to ensure that rates are 
consistent with efficiency, economy, and quality of care. Under that 
authority, the Secretary has issued regulations prescribing state 
rate-setting procedures. One of those requirements, set forth at 42 
CFR 447.205(d), is issuance of public notice prior to the effective 
date of a significant change in any methods and standards for 
setting payment rates for services. While the State indicated that a 
legislative hearing was held in February 2002, and that other 
activities occurred in the Connecticut General Assembly, the 
required public notice was not published in the Connecticut Law 
Journal until February 4, 2003. The regulations at 42 CFR 447.205(d) 
are quite specific that in order to meet the public notice 
requirements, a notice must be published in one of the following 
publications: (1) A state register similar to the Federal Register; 
(2) the newspaper of widest circulation in each city with a 
population of 50,000 or more; or (3) the newspaper of widest 
circulation in the state, if there is not a city with a population 
of 50,000 or more. Hearings and activities before a state 
legislature are not included in the regulation as meeting the 
requirements of public notice. Therefore, the change in pharmacy 
reimbursement rates contained in SPA 03-002A could not be effective 
until February 5, 2003.

[[Page 28896]]

    Therefore, based on the reasoning set forth above, and after 
consultation with the Secretary as required under 42 CFR 
430.15(c)(2), CMS disapproved Connecticut SPA 02-003A.
    I am scheduling a hearing on your request for reconsideration to 
be held on June 8, 2004, at 10 a.m., JFK Federal Building, Room 
2325, 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. Ms. 
Kathleen Scully-Hayes may be reached at (410) 786-2055.
     Sincerely,
     Mark B. McClellan, M.D., Ph.D.

    Authority: Section 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)

Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 04-11268 Filed 5-18-04; 8:45 am]
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