[Federal Register: December 27, 2002 (Volume 67, Number 249)]
[Notices]
[Page 79121-79122]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27de02-109]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of New Jersey
State Plan Amendment 02-10
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of hearing.
-----------------------------------------------------------------------
SUMMARY: This notice announces an administrative hearing to be held on
February 4, 2003, 10 a.m., Centers for Medicare & Medicaid Services'
New York Regional Office, 26 Federal Plaza, Room 38-110A; New York, New
York 10278-0063, to reconsider our decision to disapprove New Jersey
State Plan Amendment 02-10.
CLOSING DATE: Requests to participate in the hearing as a party must be
received by the presiding officer by January 13, 2003.
FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Presiding
Officer, CMS, 2520 Lord Baltimore Drive, Suite L, Baltimore, Maryland
21244-2670, Telephone: (410) 786-2055.
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider the decision to disapprove New Jersey State Plan
Amendment (SPA) 02-10. This SPA was disapproved on September 19, 2002.
In this amendment, New Jersey proposes to establish a new target group
for case management services for youth and young adults under the age
of 21 who are in the care of the Juvenile Justice Commission as a
result of a commitment order. The SPA further specifies that the target
group is limited to youth and young adults who reside in their own
homes, the homes of relatives, community-based residences or
residential group centers, or other community-based living arrangements
as a result of their original placement or conditional release from a
public institution.
At issue is whether CMS properly concluded as a basis for
disapproving the amendment that: (1) The State had not demonstrated
that the proposed services were within the statutory definition of case
management services found in section 1915(g)(2) of the Social Security
Act (the Act); (2) the proposed services are available without charge
to the user and thus payment under the amendment is not reasonable and
necessary and would duplicate payment under other program authorities;
and (3) the amendment would restrict beneficiary freedom of choice by
limiting providers to employees of New Jersey's Juvenile Justice
Commission.
Medicaid coverage of targeted case management is authorized by
section 1915(g) of the Act, which defines case management as services
that assist beneficiaries in gaining access to needed services and does
not include the direct provision of those services. Because the
services proposed as Medicaid targeted case management are segments of
the State's juvenile justice program, CMS believes that they are
integral components of the direct services and administrative functions
of that juvenile justice program. In this instance, Medicaid payment
for portions of the juvenile justice program would duplicate payment
under other programs that are the responsibility of the State
Government.
During CMS conversation with the State, section 8435 of the
Technical and Miscellaneous Revenue Act of 1988, Public Law Number 100-
647 was discussed. In this section, Congress clarified that the
Secretary may not deny approval of either an SPA or a claim on the
basis that the state is required to provide such services under state
law, or is or was otherwise, paying for the services using non-Federal
funds. However, section 8435 also expressly states that this was not to
be construed to require the Secretary to make payment for case
management services that are provided without charge to the users of
such services. Approval of this amendment, therefore, would be contrary
to this express statutory provision, since this SPA seeks payment from
the Medicaid program for services that are available without charge to
the users.
In addition, while states are free to set qualifications for
providers, a state must comply with Medicaid law and regulations
concerning freedom of choice at section 1902(a)(23) of the Act and the
implementing regulation at 42 CFR 431.51. These provisions require that
a state plan permit beneficiaries to obtain services from any qualified
provider that undertakes to provide the services. Section 1915(g)(1) of
the Act states, ``The provision of case management services under this
subsection shall not restrict the choice of the individual to receive
medical assistance in violation of section 1902(a)(23).'' The proposed
SPA restricts beneficiary choice of case managers by imposing standards
that are not reasonably related to the qualifications of providers, but
instead limits available providers to employees of the Juvenile Justice
Commission.
Section 1116 of the Act and 42 CFR Part 430 establish Department
procedures that provide an administrative hearing for reconsideration
of a disapproval of a state plan or plan amendment. The 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
[[Page 79122]]
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. Therefore, based on the reasoning
set forth above, and after consultation with the Secretary as required
under 42 CFR 430.15(c)(2), CMS is disapproving New Jersey SPA 02-10.
The notice to New Jersey announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows:
Ms. Kathryn A. Plant
Director, Division of Medical Assistance and Health Services,
Department of Human Services, P.O. Box 712. Trenton, NJ 08625-0712.
Dear Ms. Plant: I am responding to your request for
reconsideration of the decision to disapprove New Jersey State Plan
Amendment (SPA) 02-10.
In the SPA, New Jersey proposes to establish a new target group
for case management services for youth and young adults under the
age of 21 who are in the care of the Juvenile Justice Commission as
a result of a commitment order. The SPA further specifies that the
target group is limited to youth and young adults who reside in
their own homes, the homes of relatives, community-based residences
or residential group centers, or other community-based living
arrangements as a result of their original placement or conditional
release from a public institution.
At issue is whether the Centers for Medicare & Medicaid Services
(CMS) properly concluded as a basis for disapproving the amendment
that: (1) The State had not demonstrated that the proposed services
were within the statutory definition of case management services
found in section 1915(g)(2) of the Social Security Act (the Act);
(2) the proposed services are available without charge to the user
and thus payment under the amendment is not reasonable and necessary
and would duplicate payment under other program authorities; and (3)
the amendment would restrict beneficiary freedom of choice by
limiting providers to employees of New Jersey's Juvenile Justice
Commission.
Medicaid coverage of targeted case management is authorized by
section 1915(g) of the Act, which defines case management services
as services that assist beneficiaries in gaining access to needed
services and does not include the direct provision of those
services. Because the services proposed as Medicaid targeted case
management are segments of the State's juvenile justice program, CMS
believes they are integral components of the direct services and
administrative functions of that juvenile justice program. In this
instance, Medicaid payment for portions of the juvenile justice
program would duplicate payment under other programs that are the
responsibility of the State Government.
During CMS' conversation with the State, section 8435 of the
Technical and Miscellaneous Revenue Act of 1988, Public Law Number
100-647 was discussed. In this section, Congress clarified that the
Secretary may not deny approval of either an SPA or a claim on the
basis that the state is required to provide such services under
state law, or is or was otherwise, paying for the services using
non-Federal funds. However, section 8435 also expressly states that
this was not to be construed to require the Secretary to make
payment for case management services that are provided without
charge to the users of such services. Approval of this amendment,
therefore, would be contrary to this express statutory provision,
since this SPA seeks payment from the Medicaid program for services
that are available without charge to the users.
In addition, while states are free to set qualifications for
providers, a state must comply with Medicaid law and regulations
concerning freedom of choice at section 1902(a)(23) of the Act and
the implementing regulation at 42 CFR 431.51. These provisions
require that a state plan permit beneficiaries to obtain services
from any qualified provider that undertakes to provide the services.
Section 1915(g)(1) of the Act states, ``The provision of case
management services under this subsection shall not restrict the
choice of the individual to receive medical assistance in violation
of section 1902(a)(23).'' The proposed SPA restricts beneficiary
choice of case managers by imposing standards that are not
reasonably related to the qualifications of providers, but instead
limits available providers to employees of the Juvenile Justice
Commission.
This notice announces an administrative hearing to be held on
February 4, 2003, at 10 a.m., Centers for Medicare & Medicaid
Services, New York Regional Office, 26 Federal Plaza, Room 38-110A;
New York, New York 10278-0063.
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 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. 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. The presiding officer may
be reached at (410) 786-2055.
Sincerely,
Thomas A. Scully
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 19, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 02-32654 Filed 12-26-02; 8:45 am]
BILLING CODE 4120-01-P