18136 Federal Register / Vol. 60, No. 68 / Monday, April 10, 1995 / Notices

through the Superintendent of

Documents, Government Printing

Office, Washington, DC 20402–9325,

telephone (202) 512–1800.

A copy of ‘‘Preventing Lead Poisoning

in Young Children—a Statement by the

Centers for Disease Control,’’ (October

1991) may be obtained from the Lead

Poisoning Prevention Branch, Division

of Environmental Hazards and Health

Effects, National Center for

Environmental Health, Centers for

Disease Control and Prevention (CDC),

4770 Buford Highway, NE., Mailstop F–

28, Atlanta, GA 30333, telephone (404)

488–7330.

Dated: April 3, 1995.

Joseph R. Carter,

Acting Associate Director for Management

and Operations, Centers for Disease Control

and Prevention (CDC).

[FR Doc. 95–8717 Filed 4–7–95; 8:45 am]

BILLING CODE 4163–18–P

CDC Advisory Committee on the

Prevention of HIV Infection: Meeting

In accordance with section 10(a)(2) of

the Federal Advisory Committee Act

(Pub. L. 92–463), the Centers for Disease

Control and Prevention (CDC)

announced the following committee

meeting.

Name: CDC Advisory Committee on the

Prevention of HIV Infection.

Times and Dates: 9 a.m.–4:30 p.m., May 8,

1995; 9 a.m.–12 noon, May 9, 1995.

Place: Sheraton Colony Square Hotel, 188

14th Street, NE, Atlanta, Georgia 30061.

Status: Open to the public, limited only by

the space available.

Purpose: This committee charged with

advising the Director, CDC, regarding

objectives, strategies, and priorities for HIV

prevention efforts including maintaining

surveillance of HIV infection and AIDS, the

epidemiologic and laboratory study of HIV

and AIDS, information/education and risk

reduction activities designed to prevent the

spread of HIV infection, and other preventive

measures that become available.

Matters to Be Discussed: The Committee

will be updated on the ongoing

reorganization of CDC’s HIV/AIDS

prevention programs. Other discussions will

center around current HIV prevention

activities. Agenda items are subject to change

as priorities dictate.

Contact Person for More Information:

Connie Granoff, Committee Assistant, Office

of the Associate Director for HIV/AIDS, CDC,

1600 Clifton Road, NE, Mailstop E–40,

Atlanta, Georgia 30333, telephone (404) 639–

2918.

Carolyn J. Russell,

Director, Management Analysis and Services

Office, Centers for Disease Control and

Prevention (CDC).

[FR Doc. 95–8715 Filed 4–7–95; 8:45 am]

BILLING CODE 4163–18–M

National Committee on Vital and Health

Statistics (NCVHS) Subcommittee on

Mental Health Statistics: Meeting

Pursuant to Pub. L. 92–463, the

National Center for Health Statistics

(NCHS), Centers for Disease Control and

Prevention (CDC), announces the

following subcommittee meeting.

Name: NCVHS Subcommittee on Mental

Health Statistics.

Time and Date: 9 a.m.-5 p.m., May 17,

1995.

Place: Room 503A–529A, Hubert H.

Humphrey Building, 200 Independence

Avenue, SW., Washington, DC 20201.

Status: Open.

Purpose: The Subcommittee will continue

to work in developing managed care

minimum data sets for enrollment and

encounter data.

Contact Person for More Information:

Substantive program information as well as

summaries of the meeting and a roster of

committee members may be obtained from

Gail F. Fisher, Ph.D., Executive Secretary,

NCVHS, NCHS, CDC, Room 1100,

Presidential Building, 6525 Belcrest Road,

Hyattsville, Maryland 20782, telephone

number 301/436–7050.

Carolyn J. Russell,

Director, Management Analysis and Services

Office, Centers for Disease Control and

Prevention (CDC).

[FR Doc. 95–8714 Filed 4–7–95; 8:45 am]

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Health Care Financing Administration

[MB–84–N]

RIN 0938–AG77

Medicaid Program; Rescission of the

Guidelines for Documenting Medicaid

Recipient Access to Immunizations

Under the Vaccines for Children (VFC)

Program

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Notice.

SUMMARY: This notice rescinds the

guidelines that we published in the

Federal Register on October 3, 1994,

that required States to document equal

access to immunizations for Medicaid

children if States elected to use lower

vaccine administration fees than the

maximum charges that were published

and applicable under the Vaccines for

Children program. These guidelines are

rescinded in response to public

comments on the October 3, 1994

notice. States indicated that there were

numerous problems regarding the

collection of useable data.

FOR FURTHER INFORMATION CONTACT:

Marge Sciulli, (410) 966–0691.

SUPPLEMENTARY INFORMATION:

I. Background

On October 3, 1994, we published in

the Federal Register a notice with

comment period (59 FR 50235) that

listed, by State, the interim regional

maximum charges that providers may

impose for the administration of

pediatric vaccines to Federally vaccineeligible children under the Vaccines for

Children (VFC) Program. (The VFC

Program, which became effective on

October 1, 1994, required States to

provide a program for the purchase and

distribution of pediatric vaccines to

registered providers.) State Medicaid

agencies may establish lower Medicaid

fees than the maximum charges.

According to the guidelines, States were

required to provide assurances of equal

access to immunizations for Medicaid

children to the same extent as for the

general population, unless their

Medicaid payment rates equaled the

maximum charges.

The October 3, 1994, notice allowed

States the option of using one or more

of the following guidelines to document

equal access to immunizations for

Medicaid children:

(1) Comparison of Ratios. In order for

a State to have used this guideline as an

equal access assurance, the ratio of

Medicaid children immunized to the

number of Medicaid children would

have to be equal to or greater than the

ratio of children in the general

population immunized to the number of

children in the general population.

(2) Comparison to Private Insurance.

In order for the State to have used this

guideline as an equal access assurance,

the Medicaid rates for the

administration of pediatric vaccines

would have to be set at a rate equal to

or greater than the private insurance

company’s rates up to the established

State maximum fee.

(3) Practitioner Participation. Under

this guideline, the State would have

compared the number of Medicaid

pediatric practitioners who are

Medicaid program-registered providers

to the total number of pediatric

practitioners providing immunizations

to children. The program-registered

providers must have at least one

Medicaid pediatric immunization claim

per month or an average of 12 such

claims during the year. The State would

have needed 50 percent participation to

show equal access through use of this

guideline.

(4) Other. States had the flexibility to

devise alternative measures of equal

access to immunizations. These

measures were to have been evaluated

by HCFA before being found acceptable.
Federal Register / Vol. 60, No. 68 / Monday, April 10, 1995 / Notices 18137

The October 1994 notice required

State Medicaid agencies to specify the

reimbursement for the administration of

the pediatric vaccines, and, if

applicable, submit documentation of

equal access, due by April 1 of each

year, beginning April 1, 1995 (and

which is effective July 1, 1995), as part

of its obstetrical/pediatric payment rate

State Medicaid plan amendment

submittal. The notice also stated that if

the State Medicaid agency elected to

pay the maximum regional amount

statewide, it need only specify this in its

State plan amendment submittal (no

additional documentation would have

been needed). However, if the State

Medicaid agency elected to vary the

vaccine administration fee by

geographic areas within the State, the

State must list the administration fee,

specify the methodology, and provide

data for each geographic area where the

maximum charges are not applied.

Additionally, the notice stated that,

because of the October 1, 1994

implementation date, the State plan

amendment must have been submitted

by December 31, 1994, and have been

effective October 1, 1994. For the

interim period of October 1, 1994,

through March 31, 1995, the notice

provided that States may claim Federal

matching funds for the costs of

administration of vaccines to Medicaideligible children using the maximum

charges or lower fees established on the

basis of the guidance provided in the

notice. For this interim State plan

amendment, the State would have been

required to submit the methodology to

document access to immunizations but

would not have been required to supply

supporting data by which Medicaid

beneficiary access to immunizations

was assured. Beginning April 1, 1995,

documentation of equal access to

immunizations would have been

required to be included as part of the

yearly obstetrical/pediatric State plan

amendment submittal in accordance

with section 1926 of the Social Security

Act.

II. Rescission of Access Guidelines

As a result of our preliminary review

of public comments on the October 1994

notice regarding the documentation of

access requirements, we are rescinding

the requirement that States use the

access guidelines to provide assurances

of equal access, pending further

evaluation.

Following are some of the problems

the commenters identified with the

access requirements:

• Difficulties in obtaining current

data on the number of children in the

general population who have received

immunizations, despite the fact that

States have data on the number of

Medicaid children who have been

immunized.

• Difficulties in obtaining private

insurance information only on

administration fee reimbursement. It is

unlikely that private insurance

companies will have a reimbursement

rate that only covers the provider’s costs

for administration of the immunization.

• Difficulties in obtaining useable

data currently. These problems stem

from the fact that some States have not

yet implemented the VFC Program for

private providers.

• Difficulties in obtaining VFC

Program reimbursement data. Due to the

October 1, 1994, implementation date,

most of the claims data that would be

used to document access in April 1995

would reflect provider participation

based on the current reimbursement

system rather than reimbursement

through the VFC program.

• Difficulties in obtaining reliable and

meaningful measures of access.

Commenters urged HCFA to develop

meaningful measures of access for

vaccines and for all other obstetrical and

pediatric services.

As a result of the rescission of the

access guidelines, States will not be

required to provide a methodology or

data to document that payment levels

are sufficient to enlist enough providers

so that immunizations under the State

plan are available to Medicaid

recipients at least to the extent that

those services are available to the

general population.

HCFA is forming a workgroup that

will examine alternative measures of

access to vaccines. After this

examination is completed, we will

evaluate the various suggestions of the

group and formulate specific guidelines

for States. These guidelines, along with

responses to all other timely public

comments on the October 3, 1994,

notice, will be published in a final

Federal Register document.

In accordance with the provisions of

Executive Order 12866, this notice has

been reviewed by the Office of

Management and Budget.

(Catalog of Federal Domestic Assistance

Program No. 93.778, Medical Assistance

Program)

Dated: February 5, 1995.

Bruce C. Vladeck,

Administrator, Health Care Financing

Administration.

Dated: March 2, 1995.

Donna E. Shalala,

Secretary.

[FR Doc. 95–8646 Filed 4–4–95; 4:13 am]

BILLING CODE 4120–01–P

Substance Abuse and Mental Health

Services Administration

Hearing Procedures for Certain Issues

Related to the Substance Abuse

Prevention and Treatment and the

Community Mental Health Services

Block Grant Programs

AGENCY: Substance Abuse and Mental

Health Services Administration

(SAMHSA), HHS.

ACTION: Notice.

SUMMARY: SAMHSA administers two

block grant programs: the Substance

Abuse Prevention and Treatment

(SAPT) Block Grant Program and the

Community Mental Health Services

(CMHS) Block Grant Program, both of

which are authorized by Title XIX of the

Public Health Service (PHS) Act.

Section 1945(e) of the PHS Act provides

a State the opportunity for a hearing on

certain noncompliance issues relating to

the block grants prior to the Secretary

taking final action against the State. To

the extent that the hearing procedures

contained in 45 CFR part 96, subpart E,

42 CFR part 50, subpart D, or 45 CFR

part 16 do not apply to the

noncompliance issue raised, the

guidelines established below for

hearings will apply to assist in

providing a prompt and orderly hearing.

When these procedures are applicable,

the State will be provided a copy of the

procedures with the notice of

noncompliance.

These procedures are currently

effective. However, we are inviting

comments from the public on the

procedures and such comments are to

be sent to the information contact

person identified immediately below

within 60 days from the date of this

publication. Comments received will be

carefully considered and may cause the

procedures to be revised.

FOR FURTHER INFORMATION CONTACT:

Richard Kopanda, Acting Executive

Officer, SAMHSA, 5600 Fishers Lane,

Room 12–105, Rockville, MD 20857,

Telephone No. (301) 443–3875.

Hearing Procedures

Sec. 1. Limitations on Issues Subject to

Review During the Hearing

The scope of review shall be limited

to (a) the facts relevant to the

noncompliance at issue, and (b) the

necessary interpretations of those facts,

any applicable regulations, and other

relevant law. The legal validity of any

regulations or statutes shall not be

subject to review under these

procedures.