[Federal Register: April 5, 2007 (Volume 72, Number 65)]
[Notices]
[Page 16793-16794]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr05ap07-80]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval of Minnesota
State Plan Amendment 05-10
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
May 30, 2007, at 233 N. Michigan Avenue, Suite 600, the Indiana Room,
Chicago, IL 60601, to reconsider CMS' decision to disapprove Minnesota
State plan amendment 05-10.
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: Kathleen Scully-Hayes, Presiding
Officer, CMS, Lord Baltimore Drive, Mail Stop LB-23-20, Baltimore,
Maryland 21244. Telephone: (410) 786-2055.
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider CMS' decision to disapprove Minnesota State plan
amendment (SPA) 05-10 which was submitted on September 21, 2005. This
SPA was disapproved on December 29, 2006.
Under this SPA, the State proposed to revise coverage and
reimbursement methodology for Early and Periodic Screening, Diagnosis,
and Treatment services related to children's mental health
rehabilitative services and rehabilitative services pursuant to an
Individualized Education Plan or Individual Family Service Plan.
The amendment was disapproved because CMS found that the amendment
violated the statute for reasons set forth in the disapproval letter.
The issues to be decided at the hearing are:
Whether the per diem (bundled) payment methodologies for
mental health rehabilitative services described in Minnesota's SPA 05-
10 accurately reflect true costs or reasonable fees for the services
included in the bundles;
Whether the amount or scope of services reimbursed through
the bundled rate is sufficiently constant so that the proposed
methodologies would be an economic and efficient method of payment;
Whether all of the component parts of the service are
delivered as recommended within the scope of practice of the physician
or licensed practitioner of the healing arts;
Whether the actual practitioners who will be furnishing
services can be readily identified; and
Whether the bundled rates provide for direct payment to
the actual practitioners who provide the service.
Section 1116 of the Social Security 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 Minnesota Announcing an Administrative Hearing To
Reconsider the Disapproval of Its SPA Reads as Follows
Ms. Christine Bronson,
Medicaid Director,
Minnesota Department of Human Services,
P.O. Box 64998,
St. Paul, MN 55164-0998
Dear Ms. Bronson: I am responding to your request for
reconsideration of the decision to disapprove the Minnesota State
plan amendment (SPA) 05-10, which was submitted on September 21,
2005, and disapproved on December 29, 2006.
Under this SPA, the State proposed to revise coverage and
reimbursement methodology for Early and Periodic Screening,
Diagnosis, and Treatment services related to children's mental
health rehabilitative services and rehabilitative services pursuant
to an Individualized Education Plan or Individual Family Service
Plan. The Centers for Medicare & Medicaid Services (CMS) disapproved
the SPA because the State did not document that its proposed
reimbursement methodology meets the conditions specified in sections
1902(a)(10), 1902(a)(30), and 1902(a)(32) of the Social Security Act
(the Act).
At issue in this reconsideration is whether Minnesota has
demonstrated that the bundled rate methodology proposed in SPA 05-10
is consistent with the requirements of section 1902(a)(30)(A) of the
Act, which requires that States have methods and procedures to
assure that payments to providers are consistent with efficiency,
economy, and quality of care. A second issue is whether the State
has shown that the payment methodology is for care and services that
are within the scope, and meet the requirements, of section
1902(a)(10)(A) to make available ``medical assistance,'' which is
defined at section 1905(a) and implementing requirements. Also at
issue is whether the proposed payment methodology complies with the
direct payment requirements of section 1902(a)(32) of the Act, which
precludes payment to anyone other than the individual, person, or
institution providing the care and service (with specified
exceptions). We discuss each of these issues in more detail below in
relation to SPA 05-10.
Section 1902(a)(30)(A) of the Act requires that States have
methods and procedures to assure that payments to providers are
consistent with efficiency, economy, and quality of care. The per
diem payment methodologies for mental health rehabilitative services
described in SPA 05-10 represent bundled payment methodologies under
which the State pays a single rate for one or more of a group of
different services furnished to an eligible individual during a
fixed period of time. The State has failed to demonstrate that its
methodologies are in compliance with section 1902(a)(30)(A), in that
it has not shown: that these methodologies accurately reflect true
costs or reasonable fees for the services included in the bundles;
and that the amount or scope of services reimbursed through the
bundled rate is sufficiently constant so that the proposed
methodologies would be an economic and efficient method of payment.
Section 1902(a)(10)(A) requires that State plans make available
medical assistance, which is defined at section 1905(a) and in
implementing regulations. For a number of categories of medical
assistance, there are provider standards applicable to different
types of care and services, and for rehabilitative services there is
a requirement that rehabilitative services must be recommended by a
physician or other licensed practitioner of the healing arts.
Minnesota did not provide evidence of a method to identify that
providers of the component parts of the care and services would meet
all applicable provider requirements. Nor did Minnesota demonstrate
a method to ensure that all of the component parts of the care and
services furnished under the bundled payment methodology proposed in
SPA 05-10, would
[[Page 16794]]
be delivered as recommended within the scope of practice of the
physician or licensed practitioner of the healing arts.
Furthermore, the information provided by the State did not
demonstrate compliance with section 1902(a)(32) of the Act,
requiring direct payment to the provider of care or services. Under
the State's bundled payment methodology, the entities which would
receive the proposed bundled rates for mental health rehabilitation
services are not themselves providers of the service; they are not
billing agents for such providers; nor are they recognized types of
health care providers under Federal law. The underlying services
represent different types of individual services that are furnished
by individual practitioners. The State has failed to show that the
proposed payment methodology is within one of the statutory
exceptions as implemented by Federal regulations at 42 CFR 447.10.
Indeed, the State has not shown that, under its proposed payment
methodology, the actual practitioners furnishing services can even
be readily identified. Thus, the State has not demonstrated that the
use of bundled rates will comply with the requirement for direct
payment to the actual practitioners who provide care or service.
I am scheduling a hearing on your request for reconsideration to
be held on May 30, 2007, at 233 N. Michigan Avenue, Suite 600, the
Indiana Room, 5th Floor, Chicago, IL, 60601, to reconsider the
decision to disapprove SPA 05-10. 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 Ms. Kathleen Scully-Hayes as the presiding
officer. If these arrangements present any problems, please contact
the presiding officer at (410) 786-2055. 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,
Leslie V. Norwalk, Esq.,
Acting 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: March 30, 2007.
Leslie V. Norwalk,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E7-6312 Filed 4-4-07; 8:45 am]
BILLING CODE 4120-01-P