Federal Register / Vol. 72, No. 65 / Thursday, April 5, 2007 / Notices 16793 

Dated: March 29, 2007. 

Joan F. Karr, 

Acting Reports Clearance Officer, Centers for 

Disease Control and Prevention. 

[FR Doc. E7–6344 Filed 4–4–07; 8:45 am] 

BILLING CODE 4163–18–P 

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. 

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 


jlentini on PROD1PC65 with NOTICES
16794 Federal Register / Vol. 72, No. 65 / Thursday, April 5, 2007 / Notices 

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 ScullyHayes 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 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1270–RCN] 

RIN 0938–AN14 

Medicare Program; Competitive 

Acquisition for Certain Durable 

Medical Equipment, Prosthetics, 

Orthotics, and Supplies; Extension of 

Timeline for Publication of Final Rule 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Extension of timeline for 

publication of final rule. 

SUMMARY: This notice announces an 

extension of the timeline for publication 

of a Medicare final rule in accordance 

with section 1871(a)(3)(B) of the Social 

Security Act, which allows us to extend 

the timeline for publication of the final 

rule. 

EFFECTIVE DATE: This notice is effective 

on March 30, 2007. 

FURTHER INFORMATION CONTACT: Ralph 

Goldberg, (410) 786–4870. 

SUPPLEMENTARY INFORMATION: In the May 

1, 2006 Federal Register (71 FR 25654), 

we published a proposed rule that 

would have implemented competitive 

bidding programs for certain covered 

items of durable medical equipment, 

prosthetics, orthotics, and supplies 

(DMEPOS) throughout the United States 

in accordance with sections 1847(a) and 

(b) of the Social Security Act (the Act). 

These programs would change the way 

that Medicare pays for these items 

under Part B of the Medicare program 

by utilizing bids submitted by DMEPOS 

suppliers to establish applicable 

payment amounts. 

Section 1871(a)(3)(A) of the Act 

requires us to establish and publish a 

regular timeline for the publication of 

final regulations based on the previous 

publication of a proposed regulation. In 

accordance with section 1871(a)(3)(B) of 

the Act, the timeline may vary among 

different regulations based on 

differences in the complexity of the 

regulation, the number and scope of 

comments received, and other relevant 

factors, but may not be longer than 3 

years except under exceptional 

circumstances. In addition, in 

accordance with section 1871(a)(3)(B) of 

the Act, the Secretary may extend the 

initial targeted publication date of the 

final regulation, if the Secretary, no later 

than the regulation’s previously 

established proposed publication date, 

causes to have published a notice with 

the new target date, and such notice 

includes a brief explanation of the 

justification for the variation. 

We announced in the December 2006 

Unified Agenda (December 11, 2006, 71 

FR 72734) that we would issue the final 

rule in March 2007. However, we are 

not able to meet the announced 

publication target date due to the 

number of extensive comments received 

on the proposed rule and interagency 

coordination. We received over 2,000 

timely comments on the proposed rule. 

The commenters presented extremely 

complex policy and legal issues, which 

require extensive consultation and 

analysis. 

This final rule also is extremely 

complex because it will establish an 

entirely new program that will affect the 

DMEPOS industry as well as Medicare 

beneficiaries who use DMEPOS. This 

final rule will establish a new concept 

for Medicare payment for DMEPOS, 

which necessitates the development of 

new regulations and a competitive 

bidding process in addition to extensive 

payment system changes. 

This notice extends the timeline for 

publication of the final rule until April 

30, 2007. 

Authority: Section 1871 of the Social 

Security Act (42 U.S.C. 201395hh). 

(Catalog of Federal Domestic Assistance 

Program No. 093.774, Medicare—

Supplementary Medical Insurance Program) 

Dated: March 30, 2007. 

Ann Agnew, 

Executive Secretary to the Department. 

[FR Doc. 07–1658 Filed 3–30–07; 4:01 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Public Education Study on Public 

Knowledge of Abstinence and 

Abstinence Education 

OMB No.: New Collection. 

Description: In support of the goal to 

prevent unwed childbearing, pregnancy, 

and sexually transmitted diseases, 

Congress has recently authorized 

funding increases to support abstinence 

education. 

To learn more about the public’s 

views, the Administration for Children 

and Families (ACF) will conduct a 

public opinion survey of a nationally 

representative sample of adolescents 

(age 12 to 18) and their parents to 

examine current attitudes on abstinence 

and knowledge of abstinence education. 

The survey data will be used to inform 

current and future public education 


jlentini on PROD1PC65 with NOTICES