59930 Federal Register / Vol. 69, No. 193 / Wednesday, October 6, 2004 / Notices 

beneficiaries who meet the criteria to 

participate in existing demonstrations or 

CCIP. 

Organizations may be paid a monthly 

fee per participant or participate under 

a gain-sharing arrangement based on 

Medicare savings; however, fee and 

gain-sharing payments will be 

contingent on improvements in clinical 

quality of care, beneficiary and provider 

satisfaction, and savings to Medicare in 

the intervention groups compared to 

control groups.

II. Provisions of This Notice 

This demonstration is intended to test 

models of care management for highcost beneficiaries under the Medicare 

FFS program, incorporating relevant 

features from traditional disease 

management programs, but allowing 

sufficient flexibility for us and the 

awardees to adapt the design of CMHCB 

programs to meet the unique needs of 

the high-cost Medicare population. For 

some beneficiaries with high-cost 

conditions, the restructuring of the care 

management plan to integrate provider 

services in the program and to deliver 

those services in non-acute care 

locations such as the beneficiary’s home 

could significantly improve the 

beneficiary’s quality of life while 

simultaneously reducing costs. Under 

the CMHCB demonstration, we hope to 

test a variety of models such as 

intensive case management, increased 

provider availability, structured chronic 

care programs, restructured physician 

practices, and expanded flexibility in 

care settings to deliver care to high-cost 

beneficiaries with multiple conditions. 

The organization(s) that are awarded 

the demonstration project will be 

required to agree to assume financial 

risk in the event of failure to meet 

agreed upon performance guarantees for 

clinical quality, beneficiary and 

provider satisfaction and savings targets. 

That financial risk will include all fees 

and gain-sharing payments. 

Organizations eligible to apply to 

implement and operate care 

management programs under CMHCB 

include—

• Physician groups; 

• Hospitals; or 

• Integrated delivery systems.

Other organizations may apply, but 

only as part of a consortium that 

includes physician groups, hospitals, or 

integrated delivery systems that would 

play a major role in the operation of the 

proposed CMHCB demonstration. 

Eligible organizations must be capable 

of providing ambulatory health care 

services. 

We plan to make approximately four 

to six awards. Interested parties can 

obtain complete solicitation and 

supporting information on the CMS 

Web site at http://www.cms.hhs.gov/

researchers/demos/cmhcb.asp. Paper 

copies can be obtained by writing to 

Cynthia Mason at the address listed in 

the ADDRESSES section of this notice. 

III. Collection of Information 

Requirements 

This information collection 

requirement is subject to the Paperwork 

Reduction Act of 1995 (PRA); however, 

the collection is currently approved 

under OMB control number 0938–0880 

entitled ‘‘Medicare Demonstration 

Waiver Application’’ with a current 

expiration date of 7/31/2006.

Authority: Section 402(a)(1)(B) and (a)(2) 

of the Social Security Amendments of 1967, 

Pub. L. 90–248, as amended, 42 U.S.C. 

1395b–1(a)(1)(B) and (a)(2).

(Catalog of Federal Domestic Assistance 

No. 93.773 Medicare-Hospital Insurance 

Program; and No. 93.774, Medicare—

Supplementary Medical Insurance 

Program)

Dated: September 15, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services.

[FR Doc. 04–22459 Filed 10–1–04; 4:00 pm] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

Notice of Hearing: Reconsideration of 

Disapproval of New Hampshire State 

Plan Amendment (04–001A)

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Notice of hearing.

SUMMARY: This notice announces an 

administrative hearing on November 19, 

2004, at 10 a.m., JFK Federal Building, 

Room E275A, Boston, Massachusetts 

02203–0003, to reconsider the decision 

to disapprove New Hampshire State 

Plan Amendment (SPA) 04–001A.

DATES: Requests to participate in the 

hearing as a party must be received by 

the presiding officer by October 21, 

2004.

FOR FURTHER INFORMATION CONTACT:

Kathleen Scully-Hayes, Presiding 

Officer, CMS, LB–23–20, Lord Baltimore 

Drive, Baltimore, Maryland 21244, 

telephone: (410) 786–2055.

SUPPLEMENTARY INFORMATION: This 

notice announces an administrative 

hearing to reconsider the decision to 

disapprove New Hampshire State Plan 

Amendment (SPA) 04–001A, which 

New Hampshire submitted on March 31, 

2004. SPA 04–001A sought to reduce 

the Estimated Acquisition Cost (EAC) 

for prescription drugs from Average 

Wholesale Price (AWP) minus 12 

percent to AWP minus 16 percent and 

the dispensing fee from $2.50 to $1.75 

per prescription, effective for the period 

from January 12, 2004, to March 11, 

2004. The CMS reviewed this proposal 

and for the reasons set forth below, was 

unable to approve SPA 04–001A as 

submitted. 

At issue is whether the requested 

effective date of January 12, 2004, is 

consistent with statutory and regulatory 

requirements. In a separate action, CMS 

approved SPA 04–001B, which made 

the same changes in the EAC and 

dispensing fee calculations, effective 

March 12, 2004. Section 1902(a)(30) of 

the Social Security Act (the Act) 

requires a state’s Medicaid state plan to 

provide such methods and procedures 

as may be necessary to ensure that 

payments are consistent with efficiency, 

economy, and quality of care. Under 

that authority, the Secretary has issued 

regulations prescribing state rate-setting 

procedures. Federal regulations at 42 

CFR 447.205(d) require public notice to 

be issued prior to the effective date of 

a significant change in any methods and 

standards for setting payment rates for 

services. The state did not issue a public 

notice for the proposed changes in 

payment methodology until March 11, 

2004. Therefore, the earliest that such 

changes could be effective is March 12, 

2004. 

Based on the above, and after 

consultation with the Secretary as 

required under 42 CFR 430.15(c)(2), 

CMS disapproved New Hampshire SPA 

04–001A. 

Section 1116 of the Act and 42 CFR 

part 430 establish Departmental 

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 also 

will publish that notice. 

Any interested 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 person or organization 

that wants to participate as amicus

Federal Register / Vol. 69, No. 193 / Wednesday, October 6, 2004 / Notices 59931

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 New Hampshire 

announcing an administrative hearing to 

reconsider the disapproval of its SPA 

reads as follows: Mr. John A. Stephen, 

Commissioner, Department of Health 

and Human Services, 129 Pleasant 

Street, Concord, NH 03301–3857 

Dear Mr. Stephen: I am responding to 

your request for reconsideration of the 

decision to disapprove New Hampshire 

State Plan Amendment (SPA) 04–001A, 

which the State submitted on March 31, 

2004. The SPA 04–001A sought to 

reduce the Estimated Acquisition Cost 

(EAC) for prescription drugs from 

Average Wholesale Price (AWP) minus 

12 percent to AWP minus 16 percent 

and the dispensing fee from $2.50 to 

$1.75 per prescription, effective for the 

period from January 12, 2004, to March 

11, 2004. The Centers for Medicare & 

Medicaid Services (CMS) reviewed this 

proposal, and for the reasons set forth 

below, was unable to approve SPA 04–

001A as submitted.

At issue is whether the requested 

effective date of January 12, 2004, is 

consistent with statutory and regulatory 

requirements. In a separate action, CMS 

approved SPA 04–001B, which made 

the same changes in the EAC and 

dispensing fee calculations, effective 

March 12, 2004. Section 1902(a)(30) of 

the Social Security Act (the Act) 

requires a state’s Medicaid state plan to 

provide such methods and procedures 

as may be necessary to ensure that 

payments are consistent with efficiency, 

economy, and quality of care. Under 

that authority, the Secretary has issued 

regulations prescribing state rate-setting 

procedures. Federal regulations at 42 

CFR 447.205(d) require public notice to 

be issued prior to the effective date of 

a significant change in any methods and 

standards for setting payment rates for 

services. The State did not issue a 

public notice for the proposed changes 

in payment methodology until March 

11, 2004. Therefore, the earliest that 

such changes could be effective is 

March 12, 2004. Based on the above, 

and after consultation with the 

Secretary as required under 42 CFR 

430.15(c)(2), CMS disapproved New 

Hampshire SPA 04–001A. 

I am scheduling a hearing for 

November 19, 2004, at 10 a.m., JFK 

Federal Building, Room E275A, Boston, 

Massachusetts 02203–0003, to 

reconsider the decision to disapprove 

SPA 04–001A. 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 that 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, 

Mark B. McClellan, M.D., PhD.

Authority: Section 1116 of the Social 

Security Act (42 U.S.C. 1316); 42 CFR 430.18.

(Catalog of Federal Domestic Assistance 

Program No. 13.714, Medicaid Assistance 

Program)

Dated: September 27, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services.

[FR Doc. 04–22419 Filed 10–5–04; 8:45 am] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

SES Performance Review Board

ACTION: Notice.

SUMMARY: Notice is hereby given of the 

appointment of members of the CMS 

Senior Executive Service (SES) 

Performance Review Board.

DATES: Effective September 30, 2004.

FOR FURTHER INFORMATION CONTACT:

Donna Mueller, Executive Resources 

Management Team, Baltimore Human 

Resources Center, Department of Health 

and Human Services, C2–12–16, 7500 

Security Boulevard, Baltimore, MD 

21244–1850, (410) 786–5554.

SUPPLEMENTARY INFORMATION: Section 

4314(c)(1) through (5) of Title 5, U.S.C., 

requires each agency to establish, in 

accordance with regulations prescribed 

by the Office of Personnel Management, 

one or more SES performance review 

boards. The purpose of the board is to 

provide fair and impartial review of the 

initial appraisal prepared by the senior 

executive’s immediate supervisor; to 

make recommendations to the 

appointing authority regarding the 

performance of the senior executive; 

and to make recommendations for 

monetary performance awards. 

Composition of the specific PRB will be 

determined on an ad hoc basis from 

among the individuals listed below:

Gale Arden, Director, Disabled and Elderly 

Health Program Group. 

Gary Bailey, Deputy Director for Health 

Plans, Center for Beneficiary Choices. 

Dara Bendavid, Director, Program Integrity 

Group. 

Judith Berek, Senior Advisor on National 

Policy Implementation. 

Charlene Brown, Deputy Director, Center for 

Medicaid and State Operations. 

Glenn Chaney, Director, Accounting 

Management Group. 

Rose Crum-Johnson, Atlanta Regional 

Administrator. 

Robert Donnelly, Director, Health Plan Policy 

Group. 

John Dyer, Chief Operating Officer. 

James Farris, Dallas Regional Administrator. 

Jeffrey Flick, San Francisco Regional 

Administrator. 

Robert Foreman, Director, Office of 

Legislation. 

Richard Foster, Chief Actuary/Director Office 

of the Actuary. 

Wallace Fung, Deputy Director (Technology). 

Jacqueline Garner, Chicago Regional 

Administrator. 

Edward Gendron, Director, Financial 

Systems Budget Group. 

Thomas Gustafson, Deputy Director, Center 

for Medicare Management. 

Stuart Guterman, Director, Office of 

Research, Development and Information. 

Thomas Hamilton, Director, Office of Survey 

and Certification. 

Kathleen Harrington, Director, Office of 

External Affairs. 

Timothy B. Hill, Director, Office of Financial 

Management. 

Gary Kavanagh, Director, Business Systems 

Operations Group. 

Carmen Keller, Director, Office of Medicare 

Adjudication. 

James Kerr, New York Regional 

Administrator. 

Thomas Kickham, Director, Partnership and 

Promotion Group. 

Herb Kuhn, Director, Center for Medicare 

Management. 

Mary Laureno, Director, Beneficiary 

Information Services Group. 

Timothy Love, Director, Office of Information 

Services. 

Gail McGrath, Director, Center for 

Beneficiary Choices. 

Michael McMullan, Deputy Director, Center 

for Beneficiary Choices. 

Regina McPhillips, Director, Beneficiary 

Education and Analysis Group. 

Solomon Mussey, Director, Office of 

Medicare and Medicaid Cost Estimates 

Group. 

Leslie V. Norwalk, Deputy Administrator, 

Chair. 

Kevin Piper, Director, Medicare Reform 

Implementation. 

Elizabeth Richter, Director, Hospital and 

Ambulatory Policy Group. 

Roy Ruff, Seattle Regional Administrator. 

Jean Sheil, Director, Family and Children’s 

Health Program Group.