[Federal Register Volume 66, Number 250 (Monday, December 31, 2001)]
[Notices]
[Pages 67534-67535]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-32110]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services (CMS)


Notice of Hearing: Reconsideration of Disapproval of Ohio State 
Plan Amendment 98-020

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice of hearing.

-----------------------------------------------------------------------

SUMMARY: This notice announces an administrative hearing to reconsider 
the decision to disapprove Ohio State Plan Amendment (SPA) 98-020, on 
February 21, 2002, at 10:00 a.m., Chicago Regional Office Federal 
Building; Fifth Floor; Minnesota Room; 233 North Michigan Avenue; 
Chicago, Illinois 60601.

CLOSING DATE: Requests to participate in the hearing as a party must be 
received by the presiding officer by January 15, 2002.

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

SUPPLEMENTARY INFORMATION: This notice announces an administrative 
hearing to reconsider CMS's decision to disapprove Ohio SPA 98-020.
    Section 1116 of the Social Security Act (the Act) and 42 CFR, part 
430 establish Department 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 
day 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 curia 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 claiming methodology Ohio proposed for 
determining allowable administrative costs is consistent with the 
requirements of the Social Security Act (the Act) and implementing 
regulations, including the issue of whether the methodology would 
adequately document such claims. As discussed below in more detail, the 
disapproval was based on findings that the proposed claiming 
methodology would permit the development of unallowable claims for 
Federal financial participation (FFP) primarily because it was based on 
time study that did not reflect Medicaid requirements.
    Ohio submitted SPA 98-020 on December 24, 1998. This amendment 
contains an interagency agreement between the Ohio Department of Job 
and Family Services and the Ohio Department of Education through which 
the State would claim FFP under the Medicaid program for the costs of 
administrative activities performed by local education agencies in the 
State of Ohio. The CMS was unable to approve Ohio Medicaid SPA 98-020 
because the methodology that would serve as the basis for the 
development of Medicaid administrative claims is flawed.
    After review of the information and materials in the December 24, 
1998, SPA submission and the June 25, 2001, response to our request for 
additional information, CMS determined that the requirements for 
administrative claiming in schools were not met. The primary basis for 
this conclusion is that the administrative claiming methodology was 
based on a time study that would permit development of unallowable 
Medicaid claims. The time study developed as part of this methodology 
includes: (1) Education-related activities that are not allowed under 
Medicaid; (2) activities at the enhanced FFP rate, which do not meet 
the requirements for Skilled

[[Page 67535]]

Professional Medical Personnel claiming; and (3) an activity code 
structure that does not meet the requirement to account for all the 
activities performed by time study participants. As a result, CMS found 
that SPA 98-020 did not comply with applicable Medicaid requirements, 
including those related to methods of administration under section 
1902(a)(4) of the Act and implementing CMS regulations.
    The CMS found that the flawed methodology means that the claim 
which would be authorized by SPA 98-020 are not reasonable and 
necessary for the proper and efficient administration of the State 
plan. This conclusion is based on the CMS review of the proposed 
activity code definitions, sampling methodology, documentation 
requirements, interagency agreement, and indirect cost rate. Therefore, 
after consulting with the Secretary as required by Federal regulation, 
CMS informed Ohio of its decision to disapprove this amendment.
    The notice to Ohio announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

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: December 11, 2001.
Thomas A. Scully,
Administrator, Center for Medicare & Medicaid Services.
[FR Doc. 01-32110 Filed 12-28-01; 8:45 am]
BILLING CODE 4163-18-M