[Federal Register Volume 75, Number 244 (Tuesday, December 21, 2010)]
[Notices]
[Pages 80058-80059]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-32007]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval of California 
State Plan Amendments (SPAs) 08-009A; 08-009B1; 08-009B2; 08-009D; and 
08-019

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 
February 10, 2011, at the CMS San Francisco Regional Office, 90 7th 
Street, 5-300 (5W), San Francisco, California 94103 to 
reconsider CMS' decision to disapprove California SPAs 08-009A; 08-
009B1; 08-009B2; 08-009D; and 08-019.

CLOSING DATE: Requests to participate in the hearing as a party must be 
received by the presiding officer by January 5, 2011.

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 the decision of the Centers for Medicare & 
Medicaid Services (CMS) to disapprove California State plan amendments 
(SPAs) 08-009A; 08-009B1; 08-009B2; 08-009D; and 08-019 which were 
submitted on December 31, 2008, and disapproved on November 18, 2010. 
The SPAs proposed to reduce the reimbursement rates for certain 
services furnished under the approved State plan.
    In the initial determination, CMS determined, after consulting with 
the Secretary, that it is unable to approve these SPAs because 
California has not demonstrated that it would meet the conditions set 
out in section 1902(a)(30)(A) of the Social Security Act (Act).
    Section 1902(a)(30)(A) of the Act requires that State plans assure 
that ``payments [to providers] * * * are sufficient to enlist enough 
providers so that care and services are available under the [State's 
Medicaid] plan [to recipients] at least to the extent that such care 
and services are available to the general population in the geographic 
area.''
    When the SPAs were initially submitted, the State did not provide 
information concerning the impact of the proposed reimbursement 
reductions on beneficiary access to services, even though available 
national data indicate that this may be an issue for California. In the 
Requests for Additional Information (RAI) for SPAs TN 08-009A, TN 08-
009B-1, TN 08-009D, (sent to the State in December 2008), and 08-019 
(sent to the State in March, 2009), CMS requested information about 
beneficiary access to services, but California did not respond. As 
indicated in a January 2, 2001, letter to State Medicaid Directors, to 
the extent that responses to such RAIs are not received within 90 days, 
CMS may initiate disapproval action. In this instance, in addition, CMS 
had concerns that, given the time that has elapsed since these SPAs 
were submitted but not implemented, the cumulative effect of a 
retroactively effective approval of these reimbursement reductions 
would only serve to exacerbate beneficiary access concerns.
    For these reasons, and after consulting with the Secretary as 
required by Federal regulations at 42 CFR 430.15(c)(2), these SPAs were 
disapproved.

[[Page 80059]]

    The issues to be considered at the hearing are:
     Whether California has demonstrated that the proposed 
payments to providers were sufficient to enlist enough providers so 
that care and services were available under the State's Medicaid plan 
at least to the extent that such care and services are available to the 
general population in the geographic area as required by section 
1902(a)(30)(A) of the Social Security Act.
     Whether the application of the payment rates under the 
SPAs retroactively, based on the proposed effective date, would be 
consistent with that requirement under section 1902(a)(30)(A) 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 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 California announcing an administrative hearing to 
reconsider the disapproval of its SPAs reads as follows:

Mr. Toby Douglas, Chief Deputy Director
Health Care Programs
Department of Health Care Services
1501 Capitol Avenue, 6th Floor
MS 0002
Sacramento, CA 95814
Dear Mr. Douglas:
    I am responding to your request for reconsideration of the decision 
to disapprove the California State Plan Amendments (SPAs) 08-009A; 08-
009B1; 08-009B2; 08-009D which were submitted on September 30, 2008, 
and 08-019 which was submitted on December 31, 2009, and disapproved on 
November 18, 2010. The SPAs proposed to reduce the reimbursement rates 
for certain services furnished under the approved State plan.
    The issues to be considered at the hearing are:
     Whether California has demonstrated that the SPAs assured 
that the proposed payments to providers would be sufficient to enlist 
enough providers so that care and services were available under the 
State's Medicaid plan at least to the extent that such care and 
services are available to the general population in the geographic area 
as required by section 1902(a)(30)(A) of the Social Security Act.
     Whether the application of the payment rates under the 
SPAs retroactively, based on the proposed effective date, would be 
consistent with that requirement under section 1902(a)(30)(A) of the 
Act.
    In reviewing this issue, we note that, when the SPAs were initially 
submitted, the State did not provide any information concerning the 
impact of the proposed reimbursement reductions on beneficiary access 
to services, even though available national data indicated that this 
may be an issue for California.
    In Requests for Additional Information (RAI) for SPAs TN 08-009A, 
TN 08-009B1, TN 08-009D (sent to the State in December 2008) and 08-019 
(sent to the State in March 2009), CMS requested information about 
beneficiary access to services, but California never responded. As 
indicated in a January 2, 2001, letter to State Medicaid Directors, to 
the extent that responses to such RAIs are not received within 90 days, 
CMS may initiate disapproval action. In this instance, in addition, CMS 
was concerned that, given the time that had elapsed since these SPAs 
had been submitted but were not implemented, the cumulative effect of a 
retroactively effective approval of these reimbursement reductions 
exacerbate beneficiary access concerns.
    I am scheduling a hearing on your request for reconsideration to be 
held on February 10, 2011, at the CMS San Francisco Regional Office, 90 
7th Street, 5-300 (5W), San Francisco, California 94103-6706, 
in order to reconsider the decision to disapprove SPAs 08-009A; 08-
009B1; 08-009B2; 08-009D; and 08-019. 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 are not acceptable, please contact the presiding 
officer at (410) 786-3169. 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 to provide names of the individuals who will 
represent the State at the hearing.

Sincerely,

Donald M. Berwick, M.D.
Section 1116 of the Social Security Act (42 U.S.C. section 1316; 42 CFR 
section 430.18)

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

    Dated: December 15, 2010.
Donald M. Berwick,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2010-32007 Filed 12-20-10; 8:45 am]
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