[Federal Register Volume 66, Number 244 (Wednesday, December 19, 2001)]
[Notices]
[Pages 65506-65507]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-31260]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval of Missouri 
State Plan Amendment (SPA) 92-33

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice of hearing.

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SUMMARY: This notice announces an administrative hearing to reconsider 
the decision to disapprove Missouri SPA 92-33 on January 23, 2002, at 
10 a.m., Richard Bolling Federal Building; Plaza Room 664; 601 East 
Twelfth Street; Kansas City, Missouri 64106-2808.

CLOSING DATES: Requests to participate in the hearing as a party must 
be received by the presiding officer by January 3, 2002.

FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Office of 
Hearings, Centers for Medicare & Medicaid Services, Suite L 2520 Lord 
Baltimore Drive, Baltimore, Maryland 21244-2670, Telephone: (410) 786-
2055.

SUPPLEMENTARY INFORMATION: This notice announces an administrative 
hearing to reconsider our decision to disapprove Missouri SPA 92-33.
    Section 1116 of the Social Security Act (the Act) and 42 CFR part 
430 establish HHS procedures that provide an administrative hearing for 
reconsideration of a disapproval of a State plan or plan amendment. The 
Centers for Medicare & Medicaid Services (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 issue is whether the provisions of section 1923(f)(1)(A) of the 
Act and regulations at 42 CFR 447.296(b)(6) would permit the State to 
increase disproportionate share hospital (DSH) payments under this 
State plan amendment submitted after September 30, 1991. Missouri 
submitted SPA 92-33 on November 18, 1991, as part of SPA 91-50. This 
amendment would provide for an additional payment to 10 DSH hospitals 
that have the highest Medicaid utilization in the State and had a high 
volume of nursery and neonatal care days.
    Under the Medicaid Voluntary Contribution and Provider Specific Tax 
Amendments of 1991 (Pub. L. 102-234), which added section 1923(f)(l)(A) 
of the Act and the Federal regulation at 42 CFR 447.296(b)(6), the 
State cannot increase DSH payments to hospitals based on amendments 
submitted after September 30, 1991, for payments made during the period 
January 1, 1992, through September 30, 1992, except in very limited 
circumstances. The reason for this moratorium on DSH payments was so 
CMS could determine a state's base DSH allotments for an annual period 
beginning in Federal fiscal year 1993.
    The additional DSH payment included in this amendment is not within 
the statutory exception for payments under certain SPAs submitted to 
the Secretary between September 30, 1991, and November 26, 1991. This 
exception applies only to an amendment that designates only DSHs with a 
Medicaid or low-income utilization percentage at or above the statewide 
arithmetic mean. In

[[Page 65507]]

regulations at 42 CFR 447.296(b), the Secretary has interpreted this 
exception to apply only when the amendment is intended to limit the 
state's overall definition of DSH to those specified hospitals.
    While the additional DSH payment meets the timing criteria for this 
exception (it was submitted on November 18, 1991, as part of SPA 91-
50), it was not intended to limit the State's overall definition of 
DSHs to those with a Medicaid or low-income utilization percentage at 
or below the statewide arithmetic mean. This provision did not concern 
the designation of DSHs at all, but only concerned the payment rate for 
some already designated hospitals. It provided for a 10-percent 
additional payment to certain hospitals otherwise designated and 
receiving DSH payments. Therefore, CMS found this exception not to 
apply, and disapproved Missouri SPA 92-33.
    The notice to Missouri announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Ms. Dana Katherine Martin, Director, Department of Social Services, 
Broadway State Office Building, P.O. Box 1527, Jefferson City, 
Missouri 65102

Dear Ms. Martin:
    I am responding to your request for reconsideration of the 
decision to disapprove Missouri State Plan Amendment (SPA) 92-33.
    The issue is whether the provisions of section 1923(f)(1)(A) of 
the Social Security Act (the Act) and regulations at 42 CFR 
447.296(b)(6) would permit the State to increase disproportionate 
share hospital (DSH) payments under this State plan amendment 
submitted after September 30, 1991. Missouri submitted SPA 92-33 on 
November 18, 1991, as part of SPA 91-50. This amendment would 
provide for an additional payment to 10 DSH hospitals that have the 
highest Medicaid utilization in the State and had a high volume of 
nursery and neonatal care days.
    Under the Medicaid Voluntary Contribution and Provider Specific 
Tax Amendments of 1991 (Pub. L. 102-234), which added section 1923 
(f)(l)(A) of the Act and the Federal regulation at 42 CFR 
447.296(b)(6), the State cannot increase DSH payments to hospitals 
based on amendments submitted after September 30, 1991, for payments 
made during the period January 1, 1992, through September 30, 1992, 
except in very limited circumstances. The reason for this moratorium 
on DSH payments was so CMS could determine a state's base DSH 
allotments for an annual period beginning in Federal fiscal year 
1993.
    The additional DSH payment included in this amendment is not 
within the statutory exception for payments under certain SPAs 
submitted to the Secretary between September 30, 1991, and November 
26, 1991. This exception applies only to an amendment that 
designates only DSHs with a Medicaid or low-income utilization 
percentage at or above the statewide arithmetic mean. In regulations 
at 42 CFR 447.296(b), the Secretary has interpreted this exception 
to apply only when the amendment is intended to limit the state's 
overall definition of DSH to those specified hospitals.
    While the proposed amendment meets the timing criteria for this 
exception (it was submitted on November 18, 1991, as part of SPA 91-
50), it does not meet the substantive criteria for this exception. 
The proposed amendment does not limit the State's overall definition 
of DSHs to those with a Medicaid or low-income utilization 
percentage at or below the statewide arithmetic mean. This provision 
did not concern the designation of DSHs at all, but only concerned 
the payment rate for some already designated hospitals. It provided 
for a 10-percent additional payment to certain hospitals otherwise 
designated and receiving DSH payments. Therefore, CMS found this 
exception not to apply, and disapproved Missouri SPA 92-33.
    I am scheduling a hearing on your request for reconsideration to 
be held on January 23, 2002, at 10:00 a.m.; Richard Bolling Federal 
Building; Plaza Room 664; 601 East Twelfth Street; Kansas City, 
Missouri 64106-2808.
    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 
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. The 
presiding officer may be reached at (410) 786-2055.

      Sincerely,
Thomas A. Scully.

(Sec. 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: December 10, 2001.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 01-31260 Filed 12-18-01; 8:45 am]
BILLING CODE 4120-01-P