[Federal Register: August 29, 2003 (Volume 68, Number 168)]
[Notices]
[Page 52043-52044]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr29au03-70]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of Oklahoma
Medicaid State Plan Amendment (SPA) 02-14
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of hearing.
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SUMMARY: This notice announces an administrative hearing on October 7,
2003, 10 a.m.; Room 714, 1301 Young Street; CMS Dallas Regional Office;
Dallas, Texas 75202 to reconsider our decision to disapprove Oklahoma
State Plan Amendment 02-14.
Closing Date: Requests to participate in the hearing as a party
must be received by the presiding officer by September 15, 2003.
FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Presiding
Officer, CMS, 2520 Lord Baltimore Drive, Suite L, Baltimore, Maryland
21244, Telephone: (410) 786-2055.
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider the decision dated May 28, 2003, to disapprove
Oklahoma Medicaid State Plan Amendment (SPA) 02-14.
Oklahoma submitted SPA 02-14 on October 22, 2002, and revised it on
May 14, 2003. On May 28, 2003, CMS disapproved SPA 02-14, after
consultation with the Secretary as required under 42 CFR 430.15(c)(2).
The State requested reconsideration by letter dated July 25, 2003.
At issue is whether the proposed supplemental payment methodology
contained in the SPA complies with the requirement at section
1902(a)(30)(A) of the Social Security Act (the Act) that payment
methodologies must assure that ``payments are consistent with
efficiency, economy and quality of care.'' The proposed payment
methodology would provide supplemental payment for services rendered by
doctors of medicine, osteopathy, and dentists who are State employees.
The State asserted that increased payment was warranted because of the
specialized services provided by these State employees. The State
failed to demonstrate, however, that delivering Medicaid services
through State employees generated significantly higher costs sufficient
to justify the requested supplemental payment. Moreover, the
supplemental payment methodology proposed by the State is not a
customary method for paying physicians and other health professionals.
The methodology would make it difficult to track payments for specific
services and would complicate auditing processes. In sum, at issue is
whether it is consistent with efficiency, economy, and quality of care
to use a methodology that: (1) Is not justified by any increased costs
to the State to ensure access to services for Medicaid beneficiaries;
(2) is not a usual and customary payment methodology; and (3) would
unduly complicate tracking and audit processes.
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 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 Oklahoma announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows:
Mr. Jim Hancock, Director
Health Policy Division
Oklahoma Health Authority
4545 North Lincoln Boulevard, Suite 124
Oklahoma City, OK 73105
Dear Mr. Hancock: I am responding to your request for
reconsideration of the decision to disapprove Oklahoma State Plan
Amendment (SPA) 02-14.
Oklahoma submitted SPA 02-14 on October 22, 2002, and revised it
on May 14, 2003. On May 28, 2003, I disapproved SPA 02-14, after
consultation with the Secretary as required under 42 CFR
430.15(c)(2). You requested reconsideration by letter dated July 25,
2003.
At issue is whether the proposed supplemental payment
methodology contained in the SPA complies with the requirement at
section 1902(a)(30)(A) of the Social Security Act that payment
methodologies must assure that ``payments are consistent with
efficiency, economy and quality of care.'' The proposed payment
methodology would provide supplemental payment for services rendered
by doctors of medicine, osteopathy, and dentists who are State
employees. The State asserted that increased payment was warranted
because of the specialized services provided by these State
employees. The State failed to demonstrate, however, that delivering
Medicaid services through State employees generated significantly
higher costs sufficient to justify the requested supplemental
payment. Moreover, the supplemental payment methodology proposed by
the State is not a customary method for paying physicians and other
health professionals. The methodology would make it difficult to
track payments for specific services and would complicate auditing
processes. In sum, at issue is whether it is consistent with
efficiency, economy, and quality of care to use a methodology that:
(1) Is not justified by any increased costs to the State to ensure
access to services for Medicaid beneficiaries; (2) is not a usual
and customary payment methodology; and (3) would unduly complicate
tracking and audit processes. For the above stated reasons, and
after consulting with the Secretary as required by 42 CFR
430.15(c)(2), the Centers for Medicare & Medicaid Services (CMS)
disapproved Oklahoma SPA 02-14.
I am scheduling a hearing on your request for reconsideration to
be held on October 7, 2003, at 10 a.m., 1301 Young Street, Room 714,
CMS Dallas Regional Office, Dallas, Texas 75202. 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
[[Page 52044]]
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: August 25, 2003.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 03-22245 Filed 8-28-03; 8:45 am]
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