[Federal Register Volume 73, Number 249 (Monday, December 29, 2008)]
[Notices]
[Pages 79491-79492]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-30820]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval of Montana 
State Plan Amendment (SPA) 08-003

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 27, 2009, at the CMS Denver Regional Office, 1600 Broadway, 
Suite 700, Denver, Colorado 80202 to reconsider CMS' decision to 
disapprove Montana SPA 08-003.
    Closing Date: Requests to participate in the hearing as a party 
must be received by the presiding officer by January 13, 2009.

FOR FURTHER INFORMATION CONTACT: Benjamin Cohen, Presiding Officer, 
CMS, 2520 Lord Baltimore Drive, Suite L, Baltimore, Maryland 21244, 
Telephone: (410) 786-3169.

SUPPLEMENTARY INFORMATION: This notice announces an administrative 
hearing to reconsider CMS' decision to disapprove Montana SPA 08-003 
which was submitted on December 27, 2007, and disapproved on September 
23, 2008. The SPA proposed to modify the reimbursement methodology for 
licensed denturist services and dental services effective October 1, 
2007.
    Section 1902(a)(30)(A) of the Social Security Act (the Act) 
requires that States have methods and procedures to ensure payments are 
consistent with economy, efficiency, and quality of care. The overall 
requirement in section 1902(a) of the Act for a State plan, and the 
specific requirement at section 1902(a)(30)(A) of the Act for methods 
and procedures related to payment, are implemented by Federal 
regulations at 42 CFR 430.10 and 42 CFR 447.252(b), which require that 
the State plan include a comprehensive description of the methods and 
standards used to set payment rates, and provide a basis for Federal 
financial participation (FFP). To be comprehensive, payment 
methodologies should be understandable, clear, and unambiguous. In 
addition, since the plan is the basis for FFP, it is important that the 
plan language provide an auditable basis for determining if payment was 
appropriate.
    Montana SPA 08-003 proposed to reimburse denturist and dental 
services on a fee-for-service basis by multiplying a nationally 
recognized relative value unit for each service by a State specific 
conversion factor. CMS requested the State to include the exact 
conversion factor in the reimbursement methodology in order to meet the 
requirements of a comprehensive reimbursement methodology in accordance 
with Federal regulations at 42 CFR 430.10 and 447.252(b). Including the 
conversion rate would ensure that payment calculations were verifiable 
and auditable. Absent that detail, CMS requested that the State include 
sufficient information so that providers and CMS would know the initial 
rate for each service (either directly or through reference to a fee 
schedule) and have notice of any subsequent changes to each rate. The 
State declined to include such information in the SPA. Therefore, CMS 
was unable to approve the SPA because it does not comply with section 
1902(a)(30)(A) of the Act as implemented by Federal regulations at 42 
CFR 430.10 and 447.252(b).
    Based on the above, and after consultation with the Secretary of 
the Department of Health and Human Services as required under Federal 
regulations at 42 CFR 430.15(c)(2), CMS disapproved Montana Medicaid 
SPA 08-003.
    The hearing will involve the following issues:
     Whether Montana's proposed methodologies for payment of 
dental and denturist services, meet the requirements of section 
1902(a)(30)(A) of the Social Security Act and Federal regulations at 42 
CFR 430.10 and 42 CFR 447.252(b), which require that the State plan 
include a comprehensive description of the methods and

[[Page 79492]]

standards used to set payment rates, and provide a basis for FFP, when 
the proposed plan did not specify the amount or methodology to 
determine a key variable that would determine the rate (a ``conversion 
factor''); and
     Whether CMS incorrectly disapproved SPA 08-003 on 
September 23, 2008, by means of a hardcopy, date-stamped, signed letter 
from the CMS Acting Administrator, with a courtesy electronic copy of 
the signed letter e-mailed to Montana on September 24, 2008.
    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 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 Montana announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Ms. Mary E. Dalton,
Acting Medicaid Director,
Montana DPHHS,
Helena, MT 59604-4210.

Dear Ms. Dalton:

    I am responding to your request for reconsideration of the 
decision to disapprove the Montana State plan amendment (SPA) 08-
003, which was submitted on December 27, 2007, and disapproved on 
September 23, 2008. The SPA proposed to modify the reimbursement 
methodology for licensed denturist services and dental services 
effective October 1, 2007.
    The issues to be considered at the hearing are:
     Whether Montana's proposed methodologies for payment of 
dental and denturist services, meet the requirements of section 
1902(a)(30)(A) of the Social Security Act and Federal regulations at 
42 CFR 430.10 and 42 CFR 447.252(b), which require that the State 
plan include a comprehensive description of the methods and 
standards used to set payment rates, and provide a basis for Federal 
financial participation, when the proposed plan did not specify the 
amount or methodology to determine a key variable that would 
determine the rate (a ``conversion factor''); and
     Whether CMS incorrectly disapproved SPA 08-003 on 
September 23, 2008, by means of a hardcopy, date-stamped, signed 
letter from the CMS Acting Administrator, with a courtesy electronic 
copy of the signed letter e-mailed to Montana on September 24, 2008.
    I am scheduling a hearing on your request for reconsideration to 
be held on January 27, 2009, at the CMS Denver Regional Office, 1600 
Broadway, Suite 700, Denver, Colorado 80202, in order to reconsider 
the decision to disapprove SPA 08-003. 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 Mr. Benjamin Cohen as the presiding officer. If 
these arrangements present any problems, please contact the 
presiding officer at (410) 786-3169. 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 
430.18).

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

    Dated: December 22, 2008.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.

 [FR Doc. E8-30820 Filed 12-24-08; 8:45 am]
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