[Federal Register Volume 79, Number 128 (Thursday, July 3, 2014)]
[Notices]
[Pages 38034-38036]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-15615]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval Texas Medicaid 
State Plan Amendment (SPA) 13-0045-MM2 and Texas Children's Health 
Insurance Program SPA 13-0035

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

ACTION: Notice of hearing: reconsideration of disapproval.

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SUMMARY: This notice announces an administrative hearing to be held on 
August 14, 2014, at the Department of Health and Human Services, 
Centers for Medicare and Medicaid Services, Division of Medicaid & 
Children's Health, Dallas Regional Office, 1301 Young Street, Room 
801, 8th Floor Dallas, Texas 75202 to reconsider CMS' decision 
to disapprove Texas' Medicaid SPA 13-0045-MM2 and the CHIP SPA 13-0035.
    Closing Date: Requests to participate in the hearing as a party 
must be received by the presiding officer by (15 days after 
publication).

FOR FURTHER INFORMATION CONTACT: Benjamin R. 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 the Texas Medicaid 
SPA 13-0045-MM2 and the Children's Health Insurance Program (CHIP) SPA 
13-0035 which were submitted to the Centers for Medicare and Medicaid 
Services (CMS) on December 31, 2013 and disapproved on March 31, 2014. 
In part, these SPAs request CMS approval of the state's proposed 
alternative single, streamlined application, both a paper version and 
online version, for completing an eligibility determination based on 
modified adjusted gross income (MAGI). Specifically, Texas's proposals 
requiring all applicants to submit information on assets and provide 
detailed information on absent parents make the application longer and 
the information is not necessary for completing an eligibility 
determination based on MAGI.
    The issues to be considered at the hearing are:
     Whether Texas Medicaid SPA 13-0045-MM2, complied with the 
statutory requirement in section 1902(a)(19) of the Social Security Act 
(the Act), under which the state plan must assure that eligibility for 
care and services under

[[Page 38035]]

the plan will be determined and provided in a manner consistent with 
the simplicity of administration and the best interests of the 
recipients. Requiring applicants to provide additional detailed 
information, which is not necessary for determining their eligibility 
for coverage, is inconsistent with simplicity of administration of the 
state plan and is not in the best interests of Medicaid recipients or 
applicants.
     Whether Texas CHIP SPA 13-0035, complied with section 
2101(a) of the Act which specifies that the state plan must assure that 
eligibility for care and services must be provided in an effective and 
efficient manner. Requiring applicants to provide additional detailed 
information, which is not necessary for determining their eligibility 
for coverage, is inconsistent with simplicity of administration of the 
state plan and is not in the best interests of CHIP recipients or 
applicants.
     Whether the state failed to comply with section 
1902(e)(14)(C) of the Act, as added by section 2002 of the Affordable 
Care Act, and section 2102(b)(1)(B)(v) of the Act, as added by section 
2101 of the Affordable Care Act, which prohibit the use of asset or 
resource tests as criteria for Medicaid and CHIP eligibility among 
eligibility groups subject to MAGI, including children, pregnant women, 
parents, and, if eligible in a state, other nondisabled, nonelderly 
adults. Consistent with these statutory provisions, questions about 
assets and resources were not included in the Secretary's model single 
streamlined application, which was released on April 30, 2013.
     Whether the state complied with the requirements of 
sections 1902(a)(4) and 2101(a) of the Act, as implemented in 42 CFR 
435.907 and 42 CFR 457.330, for approval of an alternative single, 
streamlined application. While an alternative application may be 
tailored to accommodate state preferences and policies, it must also 
reflect the general principles of the model application and must comply 
with the applicable provisions of law and regulation. The regulations 
at 42 CFR 435.907 and 42 CFR 457.330 note specifically that the 
alternative application may be no more burdensome on the applicant than 
the model application. CMS guidance released June 18, 2013 further 
clarified that the application may only include questions that ``are 
necessary for determining eligibility for coverage in a Qualified 
Health Plan (QHP) and all insurance affordability programs, or the 
administration of these programs.''
    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 Texas announcing an administrative hearing to 
reconsider the disapproval of its SPAs reads as follows:

Ms. Kay Ghahremani, State Medicaid Director, Texas Health and Human 
Services Commission, P.O. Box 13247, Austin, TX 78711.

Dear Ms. Ghahremani:

    I am responding to your request for reconsideration of the 
decision to disapprove Texas's Medicaid state plan amendment (SPA) 
13-0045-MM2 and the Children's Health Insurance Program (CHIP) SPA 
13-0035, which were submitted to the Centers for Medicare and 
Medicaid Services (CMS) on December 31, 2013 and disapproved on 
March 31, 2014. I am scheduling a hearing on your request for 
reconsideration to be held on August 14, 2014, at the Department of 
Health and Human Services, Centers for Medicare and Medicaid 
Services, Division of Medicaid & Children's Health, Dallas Regional 
Office, 1301 Young Street, Room 801, Dallas, Texas 75202.
    In part, these SPAs request CMS approval of the state's proposed 
alternative single, streamlined application, both a paper version 
and online version, for completing an eligibility determination 
based on modified adjusted gross income (MAGI). Specifically, 
Texas's proposals requiring all applicants to submit information on 
assets and provide detailed information on absent parents make the 
application longer and the information is not necessary for 
completing an eligibility determination based on MAGI.
    In your request for reconsideration, you described changes that 
the state is considering with respect to these SPAs, and we will 
continue to talk with you about these changes. In the event that CMS 
and the state come to agreement on resolution of the issues, which 
formed the basis for disapproval, these SPAs may be moved to 
approval prior to the scheduled hearing.
    The issues to be considered at the hearing are:
     Whether Texas Medicaid SPA 13-0045-MM2, complied with 
the statutory requirement in section 1902(a)(19) of the Social 
Security Act (the Act), under which the state plan must assure that 
eligibility for care and services under the plan will be determined 
and provided in a manner consistent with simplicity of 
administration and the best interests of the recipients. Requiring 
applicants to provide additional detailed information, which is not 
necessary for determining their eligibility for coverage, is 
inconsistent with the simplicity of administration of the state plan 
and is not in the best interests of Medicaid recipients or 
applicants.
     Whether Texas CHIP SPA 13-0035, complied with section 
2101(a) of the Act which specifies that the state plan must assure 
that eligibility for care and services must be provided in an 
effective and efficient manner. Requiring applicants to provide 
additional detailed information, which is not necessary for 
determining their eligibility for coverage, is inconsistent with 
simplicity of administration of the state plan and is not in the 
best interests of CHIP recipients or applicants.
     Whether the state failed to comply with section 
1902(e)(14)(C) of the Act, as added by section 2002 of the 
Affordable Care Act, and section 2102(b)(1)(B)(v) of the Act, as 
added by section 2101 of the Affordable Care Act which prohibit the 
use of asset or resource tests as criteria for Medicaid and CHIP 
eligibility among eligibility groups subject to MAGI, including 
children, pregnant women, parents, and, if eligible in a state, 
other nondisabled, nonelderly adults. Consistent with these 
statutory provisions, questions about assets and resources were not 
included in the Secretary's model single streamlined application, 
which was released on April 30, 2013.
     Whether the state complied with the requirements of 
sections 1902(a)(4) and 2101(a) of the Act, as implemented in 42 CFR 
435.907 and 42 CFR 457.330, for approval of an alternative single, 
streamlined application. While an alternative application may be 
tailored to accommodate state preferences and policies, it must also 
reflect the general principles of the model application and must 
comply with the applicable provisions of law and regulation. The 
regulations at 42 CFR 435.907 and 42 CFR 457.330 note specifically 
that the alternative application may be no more burdensome on the 
applicant than the model application. CMS guidance released June 18, 
2013 further clarified that the application may only include 
questions ``that are necessary for determining eligibility for 
coverage in a Qualified Health Plan (QHP) and all insurance 
affordability programs, or for the administration of these 
programs.''
    If the hearing date is not acceptable, I 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 R. Cohen as the presiding officer. 
If these arrangements present any problems, please contact the Mr. 
Cohen at (410) 786-3169. In order to

[[Page 38036]]

facilitate any communication that may be necessary between the 
parties prior 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,

Marilyn Tavenner,
Administrator.

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: June 27, 2014.
Marilyn Tavenner,
Administrator, Center for Medicare & Medicaid Services.
[FR Doc. 2014-15615 Filed 7-2-14; 8:45 am]
BILLING CODE 4120-01-P