[Federal Register Volume 72, Number 234 (Thursday, December 6, 2007)]
[Notices]
[Pages 68888-68889]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-23734]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval of New York 
State Children's Health Insurance Program (SCHIP) State Child Health 
Plan Amendment (SPA) 10

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 
January 16, 2008, at the CMS New York Regional Office, 38-110A, 26 
Federal Plaza, New York, New York 10278, to reconsider CMS' decision to 
disapprove New York SCHIP SPA 10.
    Closing Date: Requests to participate in the hearing as a party 
must be received by the presiding officer by December 21, 2007.

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 New York SCHIP SPA 
10 which was submitted on April 12, 2007, with additional 
information submitted on May 9, 2007, and August 27, 2007, and 
disapproved on September 7, 2007.
    This SPA would have increased the financial eligibility standard 
for the State's separate SCHIP from the current effective family income 
eligibility level at or below 250 percent of the Federal poverty level 
(FPL) to an effective family income eligibility level at or below 400 
percent of the FPL. The SPA also would have imposed a 6-month waiting 
period from the date of last insurance coverage for children with 
family incomes above 250 percent of the FPL, with certain listed 
exceptions.
    The CMS disapproved the SPA because it would result in a child 
health plan that did not comport with the requirements of sections 
2101(a), 2102(a), and 2102(b)(3)(C) of the Social Security Act (the 
Act). These requirements provide that funding must be used to provide 
coverage to uninsured, low-income children in an effective and 
efficient manner that is coordinated with other sources of health 
benefits coverage, that the State plan includes effective outreach 
procedures to enroll all eligible uninsured children, and that the 
coverage made available does not merely substitute for private 
coverage. This disapproval is also consistent with the August 17, 2007, 
letter to State Health Officials clarifying how CMS believes these 
existing statutory requirements should be applied by all States 
expanding SCHIP effective eligibility levels above 250 percent of the 
FPL.
    The following will be at issue at the hearing:
     Whether the State has demonstrated that SPA 10 is 
consistent with the requirement in section 2101(a) of the Act for 
effective and efficient program operation. SPA 10 would 
require that the State devote limited SCHIP funding to children with 
higher effective family incomes when the program has not enrolled 
substantially all of the core

[[Page 68889]]

population of targeted low-income children with family incomes below 
200 percent of the FPL;
     Whether New York has demonstrated that SPA 10 is 
consistent with the requirements in section 2102(a) to identify and 
enroll all uncovered children who are eligible to participate in public 
health insurance programs, to ensure that the SCHIP program is 
coordinated with those efforts, and to have effective outreach 
procedures;
     Whether the State has met the requirements to have 
reasonable procedures in place to ensure that health benefits coverage 
provided under the State plan does not substitute for coverage provided 
under group health plans, consistent with section 2102(b)(3)(C) of the 
Act, as implemented by 42 CFR 457.805. For family income eligibility 
levels higher than 250 percent of the FPL, the preamble to that 
regulatory provision indicated that States would need to have specific 
procedures in place, and later the August 17, 2007, State Health 
Officials' Letter further articulated the procedures that CMS would 
consider reasonable. SPA 10 did not include those specific 
procedures (including a period of uninsurance of at least 1 year, and 
cost sharing comparable to competing private plans subject to the 
overall 5 percent family cap).
    Section 1116 of the Act and Federal regulations at 42 CFR 457.204 
and 42 CFR part 430, subpart D, 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 New York announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Ms. Deborah Bachrach, Deputy Commissioner, Office of Health 
Insurance Programs, State of New York, Department of Health, Corning 
Tower, Empire State Plaza, Albany, NY 12237.

Dear Ms. Bachrach:

    I am responding to your request for reconsideration of the 
decision to disapprove the New York State Children's Health 
Insurance Program (SCHIP) State Child Health Plan Amendment (SPA) 
10, which was submitted on April 12, 2007, with additional 
information submitted on May 9, 2007, and August 27, 2007, and 
disapproved on September 7, 2007.
    This SPA would have increased the financial eligibility standard 
for the State's separate SCHIP from the current effective family 
income eligibility level at or below 250 percent of the Federal 
poverty level (FPL) to an effective family income eligibility level 
at or below 400 percent of the FPL. The SPA also would have imposed 
a 6-month waiting period from the date of last insurance coverage 
for children with family incomes above 250 percent of the FPL, with 
certain listed exceptions.
    The Centers for Medicare & Medicaid Services (CMS) disapproved 
the SPA because it would result in a child health plan that did not 
comport with the requirements of sections 2101(a), 2102(a), and 
2102(b)(3)(C) of the Social Security Act (the Act). These 
requirements provide that funding must be used to provide coverage 
to uninsured, low-income children in an effective and efficient 
manner that is coordinated with other sources of health benefits 
coverage, that the State plan includes effective outreach procedures 
to enroll all eligible uninsured children, and that the coverage 
made available does not merely substitute for private coverage. This 
disapproval is also consistent with the August 17, 2007, letter to 
State Health Officials clarifying how CMS believes these existing 
statutory requirements should be applied by all States expanding 
SCHIP effective eligibility levels above 250 percent of the FPL.
    The following will be at issue at the hearing:
     Whether the State has demonstrated that SPA 10 
is consistent with the requirement in section 2101(a) of the Act for 
effective and efficient program operation. SPA 10 would 
require that the State devote limited SCHIP funding to children with 
higher effective family incomes when the program has not enrolled 
substantially all of the core population of targeted low-income 
children with family incomes below 200 percent of the FPL;
     Whether New York has demonstrated that SPA 10 
is consistent with the requirements in section 2102(a) to identify 
and enroll all uncovered children who are eligible to participate in 
public health insurance programs, to ensure that the SCHIP program 
is coordinated with those efforts, and to have effective outreach 
procedures;
     Whether the State has met the requirements to have 
reasonable procedures in place to ensure that health benefits 
coverage provided under the State plan do not substitute for 
coverage provided under group health plans, consistent with section 
2102(b)(3)(C) of the Act, as implemented by Federal regulations at 
42 CFR 457.805. For family income eligibility levels higher than 250 
percent of the FPL, the preamble to that regulatory provision 
indicated that States would need to have specific procedures in 
place, and later the August 17, 2007, State Health Officials' Letter 
further articulated the procedures that CMS would consider 
reasonable. SPA 10 did not include those specific 
procedures (including a period of uninsurance of at least 1 year, 
and cost sharing comparable to competing private plans subject to 
the overall 5 percent family cap).
    I am scheduling a hearing on your request for reconsideration to 
be held on January 16, 2008, at the CMS New York Regional Office, 
38-110A, 26 Federal Plaza, New York, New York 10278, to reconsider 
the decision to disapprove SCHIP SPA 10. 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, 
Subpart D.
    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,

Kerry Weems,
Acting Administrator.

Section 1116 of the Social Security Act (42 U.S.C. 1316); 42 CFR 
457.203)

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

    Dated: November 30, 2007.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
 [FR Doc. E7-23734 Filed 12-5-07; 8:45 am]
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