[Federal Register Volume 71, Number 218 (Monday, November 13, 2006)]
[Notices]
[Pages 66174-66175]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-19069]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval of Colorado 
State Plan Amendment 05-006

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 
December 29, 2006, at the Colorado State Bank Building, 1600 Broadway, 
Suite 700, Keystone Conference Room, Denver, CO 80202-4967, to 
reconsider CMS' decision to disapprove Colorado State plan amendment 
05-006.
    Closing Date: Requests to participate in the hearing as a party 
must be received by the presiding officer by November 28, 2006.

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 CMS' decision to disapprove Colorado State plan 
amendment (SPA) 05-006 which was submitted on July 26, 2005. This SPA 
was disapproved on July 13, 2006.
    In SPA 05-006, Colorado proposed to modify the reimbursement 
methodology in the State plan for covered Medicaid Early and Periodic 
Screening, Diagnostic and Treatment (EPSDT) services provided in 
schools. Specifically, this amendment specified cost elements used to 
determine reimbursement rates for school-based services and targeted 
case management.
    The amendment was disapproved because it did not comport with the 
requirements of sections 1902(a)(2), 1902(a)(4), 1902(a)(23), 
1902(a)(30)(A), 1902(a)(10)(B), and 1903(a)(1) of the Social Security 
Act (the Act).
    The issues to be decided in the hearing are:
     Whether Colorado has established that the indirect cost 
elements specified in Colorado SPA 05-006 would not duplicate direct 
cost elements also specified, to ensure that the payment rate is 
consistent with efficiency and economy as required by section 
1902(a)(30)(A) of the Act.
     Whether Colorado has shown that certified public 
expenditures that will be used as the basis for claims under SPA 05-006 
will be documented through auditable methods for determining or 
documenting actual and non-duplicative Medicaid expenditures incurred 
for school-based health services by a governmental entity, so that the 
claims will be consistent with sections 1902(a)(2), 1902(a)(4) and 
1903(a)(1) of the Act.
     Whether the State has assured that the payment methodology 
specified under SPA 05-006, when read together with the State plan 
provisions authorizing the covered services that are the subject of SPA 
05-006, would allow beneficiaries the ability to receive services from 
any willing and qualified provider within the State, consistent with 
the requirements of section 1902(a)(23) of the Act.
     Whether the State has established that the covered EPSDT 
services that are the subject of SPA 05-006 would be available in 
comparable amount, duration, and scope to the EPSDT services available 
to all eligible Medicaid beneficiaries, including those who do not 
attend schools paid under SPA 05-006, consistent with the

[[Page 66175]]

requirements of section 1902(a)(10)(B) of the Act.
    Section 1116 of the Act and Federal regulations at 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 in Federal regulations 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 in Federal regulations at 42 CFR 
430.76(c). If the hearing is later rescheduled, the presiding officer 
will notify all participants.
    The notice to Colorado announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Ms. Lisa M. Esgar, Senior Director,
Operations and Finance Office,
Department of Health Care Policy and Financing,
1570 Grant Street,
Denver, CO 80203-1818.

    Dear Ms. Esgar: I am responding to your request for 
reconsideration of the decision to disapprove the Colorado State 
plan amendment (SPA) 05-006, which was submitted on July 26, 2005, 
and disapproved on July 13, 2006.
    In SPA 05-006, Colorado was proposed to modify the reimbursement 
methodology in the State plan for covered Medicaid Early and 
Periodic Screening, Diagnostic and Treatment (EPSDT) services 
provided in schools. Specifically, this amendment specified cost 
elements used to determine reimbursement rates for school-based 
services and targeted case management.
    The amendment was disapproved because it did not comport with 
the requirements of sections 1902(a)(2), 1902(a)(4), 1902(a)(23), 
1902(a)(30)(A), 1902(a)(10)(B), and 1903(a)(1) of the Social 
Security Act (the Act).
    The issues to be decided in the hearing are:
     Whether Colorado has established that the indirect cost 
elements specified in Colorado SPA 05-006 would not duplicate direct 
cost elements also specified, to ensure that the payment rate is 
consistent with efficiency and economy as required by section 
1902(a)(30)(A) of the Act.
     Whether Colorado has shown that certified public 
expenditures that will be used as the basis for claims under SPA 05-
006 will be documented through auditable methods for determining or 
documenting actual and non-duplicative Medicaid expenditures 
incurred for school-based health services by a governmental entity, 
so that the claims will be consistent with section 1902(a)(2), 
1902(a)(4) and 1903(a)(1) of the Act.
     Whether the State has assured that the payment 
methodology specified under SPA 05-006, when read together with the 
State plan provisions authorizing the covered services that are the 
subject of SPA 05-006, would allow beneficiaries the ability to 
receive services from any willing and qualified provider within the 
State, consistent with the requirements of section 1902(a)(23) of 
the Act.
     Whether the State has established that the covered 
EPSDT services that are the subject of SPA 05-006 would be available 
in a comparable amount, duration and scope to the EPSDT services 
available to all eligible Medicaid beneficiaries, including those 
who do not attend schools paid under SPA 05-006, consistent with the 
requirements of section 1902(a)(10)(B) of the Act.
    I am scheduling a hearing on your request for reconsideration to 
be held on December 29, 2006, at the Colorado State Bank Building, 
1600 Broadway, Suite 700, Keystone Conference Room, Denver, CO, 
80202-4967, to reconsider the decision to disapprove SPA 05-006. 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 by Federal regulations 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 at (410) 786-2055. 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.

 Sincerely, Leslie V. Norwalk, Esq.,
Acting Administrator.


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)

    Dated: November 6, 2006.
Leslie V. Norwalk,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E6-19069 Filed 11-9-06; 8:45 am]
BILLING CODE 4120-01-P