16506 Federal Register / Vol. 78, No. 51 / Friday, March 15, 2013 / Notices 

Specialist, Technology Transfer Office, 

Centers for Disease Control and 

Prevention (CDC), 4770 Buford 

Highway, Mailstop K–79, Atlanta, GA 

30341, Telephone: (770) 488–8612; 

Facsimile: (770) 488–8615; Email: 

dmprather@cdc.gov. 

SUPPLEMENTARY INFORMATION: 

Applications for a license filed in 

response to this notice will be treated as 

objections to the giving of the planned 

license. Comments and objections 

submitted in response to this notice will 

not be made available for public 

inspection, and, to the extent permitted 

by law, will not be released under the 

Freedom of Information Act, 5 U.S.C. 

552. 

Dated: March 8, 2013. 

Tanja Popovic, 

Deputy Associate Director for Science, 

Centers for Disease Control and Prevention. 

[FR Doc. 2013–05990 Filed 3–14–13; 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 Florida State Plan 

Amendments (SPA) 12–015 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice of hearing. 

SUMMARY: This notice announces an 

administrative hearing to be held on 

April 30, 2013, at the CMS Atlanta 

Regional Office, Atlanta Federal Center, 

3rd Floor, 61 Forsyth Street SW., Suite 

3B52, Atlanta, Georgia 30303–8909, to 

reconsider CMS’ decision to disapprove 

Florida SPA 12–015. 

DATES: 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: 

Benjamin Cohen, Presiding Officer, 

CMS, 2520 Lord Baltimore Drive, Suite 

L, Baltimore, Maryland 21244, 

Telephone: (410) 786–3169. 

SUPPLEMENTARY INFORMATION: This 

notice announces an administrative 

hearing to reconsider CMS’ decision to 

disapprove Florida SPA 12–015 which 

was submitted on September 14, 2012, 

and disapproved on December 13, 2012. 

The SPA reflects a Florida state law that 

would limit outpatient hospital 

emergency room visits to six per fiscal 

year for non-pregnant adults, 21 years of 

age and older, effective August 1, 2012. 

CMS disapproved this SPA after 

consulting with the Secretary as 

required at 42 CFR 430.15(c)(2), because 

it appeared to impose a limitation on 

outpatient hospital services that was 

based on the individual’s diagnosis, 

illness, or condition and because the 

state failed to demonstrate that the 

limitation is consistent with the 

provision of a sufficient amount, 

duration, and scope to reasonably 

achieve the purpose of the benefit. As a 

result, CMS concluded that the 

proposed coverage under the SPA 

would not be sufficient to meet statutory 

requirements set forth in section 

1902(a)(10)(A) of the Social Security Act 

(the Act), which incorporates by 

reference the provisions of 1905(a)(2)(A) 

of the Act, and 42 CFR 440.20(a)(3)(ii), 

and the requirements of section 

1902(a)(10)(B) of the Act. We explain in 

more detail below. 

Under section 1902(a)(10)(A) of the 

Act, a state plan must provide for 

making medical assistance available to 

eligible individuals, including for most 

eligible individuals the medical 

assistance specified in section 

1905(a)(2) of the Act. This provision 

includes in the definition of medical 

assistance ‘‘outpatient hospital 

services.’’ Section 1902(a)(17) of the Act 

requires the state plan to include 

reasonable standards for determining 

the extent of medical assistance, and 

under section 1902(a)(19) of the Act, the 

state plan must assure that eligibility for 

care and services are provided in the 

best interest of the recipients. As the 

implementing regulations at 42 CFR 

440.230(b) require, a state plan must 

‘‘specify the amount, duration, and 

scope of each service that it provides,’’ 

and ‘‘each service must be sufficient in 

amount, duration, and scope to 

reasonably achieve its purpose.’’ While 

states may place ‘‘appropriate limits on 

a service based such criteria as medical 

necessity or utilization control 

procedures’’ under CFR 440.230(d), 42 

CFR 440.230(c) specifies that a state 

may not arbitrarily deny or reduce the 

amount, duration, or scope of required 

services, including physicians’ services, 

solely because of the diagnosis, type of 

illness, or condition. 

The proposed limitation on certain 

outpatient hospital services appeared to 

be based on the diagnosis, illness, or 

condition because it is limited to 

outpatient services furnished at a 

hospital emergency room, which are 

designed to address acute and 

immediate conditions. Thus, the 

limitation appeared to violate the 

requirements of 42 CFR 440.230(c). 

Even if that were not the case, the state 

has not demonstrated that the limitation 

is consistent with provision of a 

sufficient amount, duration, and scope 

to reasonably achieve the purpose of the 

benefit, which in this case would be 

providing reasonable coverage that 

meets the needs of most beneficiaries 

who need the outpatient hospital 

services, consistent with 42 CFR 

440.230(b). 

In disapproving SPA 12–015, CMS 

staff suggested to the state some 

alternate methods to address 

inappropriate utilization of hospital 

emergency rooms, including the 

development of payment rates for 

hospital emergency rooms that are lower 

if the individual does not require care 

for an acute and immediate condition, 

or the use of the alternative cost sharing 

authority available to states under 

section 1916(d) of the Act, permitting 

higher beneficiary cost sharing for 

elective non-emergency use of the 

emergency room. CMS offered to work 

with the state on these options and 

technical assistance. 

At issue in this appeal are the 

following issues, which are more 

detailed than set out in the disapproval 

letter: 

• Whether the exceptions to the 

proposed general service limitations on 

outpatient hospital services violate 

comparability requirements under 

section 1902(a)(10)(B) of the Act and 

implementing regulations at 42 CFR 

440.230(c) because they provide that 

some individuals described in section 

1902(a)(10)(A) of the Act, who have 

particular diagnoses or conditions, will 

receive benefits that individuals with 

other diagnoses and conditions will not 

receive. 

• Whether the imposition of a limit 

specifically on emergency outpatient 

hospital visits would violate those 

comparability requirements because the 

limitation would be imposed only on 

outpatient hospital visits that are 

warranted to address acute and 

immediate conditions, which means 

that the limitation is based on the 

diagnosis or condition. 

• Whether the exception to the 

limitation on emergency room visits for 

‘‘aliens’’ would violate section 

1902(a)(10)(B) of the Act because it 

would provide that aliens would receive 

a greater amount, duration and scope of 

emergency outpatient hospital benefits 

than other individuals described in 

section 1902(a)(10)(A) of the Act. 

• Whether the state has demonstrated 

that the resulting outpatient hospital 

benefits are of a sufficient amount, 

duration and scope to reasonably 

achieve the purpose of the benefit, 

consistent with the requirements of 

sections 1902(a)(10)(A) and 1905(a)(2) of 


srobinson on DSK4SPTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 51 / Friday, March 15, 2013 / Notices 16507 

the Act, and implementing regulations 

at 42 CFR 440.230(b), which CMS has 

interpreted to mean that the state 

provides reasonable coverage of the 

benefit that meets the needs of most 

beneficiaries who need the outpatient 

hospital services. While the state 

provided information on emergency 

room services, it did not provide 

information on outpatient hospital 

services. 

Section 1116 of the 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 Florida announcing an 

administrative hearing to reconsider the 

disapproval of its SPA reads as follows: 

Stuart F. Williams, Esq., General 

Counsel, Agency for Health Care 

Administration, Office of the General 

Counsel, 2727 Mahan Drive, Building 

3, MS #3, Tallahassee, FL 323008 

Dear Mr. Williams: 

I am responding to your request for 

reconsideration of the decision to 

disapprove the Florida State Plan 

Amendment (SPA) 12–015 which was 

submitted on September 14, 2012, and 

disapproved on December 13, 2012. The 

SPAs reflects a Florida state law that 

would limit outpatient hospital 

emergency room visits to six per fiscal 

year for non-pregnant adults, 21 years of 

age and older, effective August 1, 2012. 

I disapproved Florida SPA 12–015 

because it appeared to impose a 

limitation on outpatient hospital 

services that was based on the 

individual’s diagnosis, illness, or 

condition and because the state failed to 

demonstrate that the limitation is 

consistent with the provision of a 

sufficient amount, duration and scope to 

reasonably achieve the purpose of the 

benefit. At issue in this appeal are the 

following issues, which are more 

detailed than set out in the disapproval 

letter: 

• Whether the exceptions to the 

proposed general service limitations on 

outpatient hospital services violate 

comparability requirements under 

section 1902(a)(10)(B) of the Act and 

implementing regulations at 42 CFR 

440.230(c) because they provide that 

some individuals described in section 

1902(a)(10)(A) of the Act, who have 

particular diagnoses or conditions, will 

receive benefits that individuals with 

other diagnoses and conditions will not 

receive. 

• Whether the imposition of a limit 

specifically on emergency outpatient 

hospital visits would violate those 

comparability requirements because the 

limitation would be imposed only on 

outpatient hospital visits that are 

warranted to address acute and 

immediate conditions, which means 

that the limitation is based on the 

diagnosis or condition. 

• Whether the exception to the 

limitation on emergency room visits for 

‘‘aliens’’ would violate section 

1902(a)(10)(B) of the Act because it 

would provide that aliens would receive 

a greater amount, duration and scope of 

emergency outpatient hospital benefits 

than other individuals described in 

section 1902(a)(10)(A) of the Act. 

• Whether the state has demonstrated 

that the resulting outpatient hospital 

benefits are of a sufficient amount, 

duration and scope to reasonably 

achieve the purpose of the benefit, 

consistent with the requirements of 

sections 1902(a)(10)(A) and 1905(a)(2) of 

the Act, and implementing regulations 

at 42 CFR 440.230(b), which CMS has 

interpreted to mean that the state 

provides reasonable coverage of the 

benefit that meets the needs of most 

beneficiaries who need the outpatient 

hospital services. While the state 

provided information on emergency 

room services, it did not provide 

information on outpatient hospital 

services. 

I am scheduling a hearing on your 

request for reconsideration to be held on 

April 30, 2013, at the CMS Atlanta 

Regional Office, Atlanta Federal Center, 

3rdh Floor, 61 Forsyth Street, SW., Suite 

3B52, Atlanta, Georgia 30303–8909, to 

reconsider CMS’ decision to disapprove 

Florida SPA 12–015. 

If this date is not acceptable, I 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 Mr. Benjamin Cohen 

as the presiding officer. If these 

arrangements present any problems, 

please contact the Mr. Cohen at (410) 

786–3169. In order to facilitate any 

communication that may be necessary 

between the parties prior to the hearing, 

please notify the presiding officer to 

indicate acceptability of the scheduled 

hearing date and provide names of the 

individuals who will represent the state 

at the hearing. 

Sincerely, 

Marilyn Tavenner 

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 8, 2013. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2013–05978 Filed 3–14–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–64, CMS– 

10295, CMS–10302 and CMS–10185] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

In compliance with the requirement 

of section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995, the 

Centers for Medicare & Medicaid 

Services (CMS) is publishing the 

following summary of proposed 

collections for public comment. 

Interested persons are invited to send 

comments regarding this burden 

estimate or any other aspect of this 

collection of information, including any 

of the following subjects: (1) The 

necessity and utility of the proposed 

information collection for the proper 

performance of the agency’s functions; 

(2) the accuracy of the estimated 

burden; (3) ways to enhance the quality, 

utility, and clarity of the information to 

be collected; and (4) the use of 

automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 


srobinson on DSK4SPTVN1PROD with NOTICES