[Federal Register Volume 63, Number 130 (Wednesday, July 8, 1998)]
[Notices]
[Pages 36924-36925]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-18019]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration


Notice of Hearing: Reconsideration of Disapproval of New York 
Title XXI State Plan Amendment (SPA)

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice of hearing.

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SUMMARY: This notice announces an administrative hearing on July 29, 
1998; 10:00 a.m., Thirty-Eighth floor, 26 Federal Plaza, New York, New 
York 10278 to reconsider our decision to disapprove New York Title XXI 
SPA.

CLOSING DATE: Requests to participate in the hearing as a party must be 
received by the presiding officer by July 23, 1998.

FOR FURTHER INFORMATION CONTACT: Stan Katz, Presiding Officer, HCFA, 
C1-09-13, 7500 Security Boulevard, Baltimore, Maryland 21244, 
Telephone: (410)-786-2661.

SUPPLEMENTARY INFORMATION: This notice announces an administrative 
hearing to reconsider our decision to disapprove the New York Title XXI 
State Plan Amendment (SPA) submitted March 26, 1998.
    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. These requirements are made applicable under

[[Page 36925]]

Title XXI by section 2107(e)(2)(B). The Health Care Financing 
Administration (HCFA) is required to publish a copy of the notice to 
the State that informs the State of the time and place of the hearing 
and the issues to be considered. If we subsequently notify the State 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.
    New York submitted this SPA on March 26, 1998 to revise its 
approved Title XXI plan to change the effective date to October 1, 
1997, from the previously approved date of April 15, 1998. This change 
in effective date would permit the State to claim enhanced matching 
payments for the operation of its Child Health Plus (CHP) program for 
the period from October 1, 1997 to April 14, 1998. The SPA was 
disapproved on April 1, 1998.
    At issue in this reconsideration is whether the State is entitled 
to an effective date for its Title XXI plan which included a period 
during which the State was not operating a program which met the 
requirements of Title XXI (or the approved State plan). HCFA 
disapproved this SPA because of two elements of the State's CHP 
program, as in effect between October 1, 1997 and April 14, 1998, which 
were inconsistent with the requirements of Title XXI. First, premiums 
and cost sharing in effect during this period were inconsistent with 
the requirements of section 2103(e)(3)(A) of the Social Security Act. 
For example, the State CHP program provided for a $35 copayment for 
emergency services even if a child's family income was less than 150 
percent of the poverty level. Also the CHP program permitted premiums 
for children with family incomes between 120 percent and 150 percent of 
the federal poverty level. Both of these charges were in amounts higher 
than those authorized under section 2103(e)(3)(A), which makes 
applicable the Medicaid premium and cost sharing limitations. Moreover, 
the State was not applying procedures to ensure ``that children found 
through * * * screening to be eligible for medical assistance under the 
State Medicaid plan under title XIX are enrolled for such assistance 
under such plan'' as required under section 2102(b)(3)(B) of the Social 
Security Act and guidance outlined in a letter to States on January 23, 
1998.
    Section 2106(c)(1) of the Act directs the Secretary to approve 
plans which ``substantially comply with the requirements'' of Title 
XXI. Under section 2106(a)(2)(B), a Title XXI plan ``shall be effective 
beginning with a calendar quarter that is specified in the plan, but in 
no case earlier than October 1, 1997.'' However, this flexibility is 
limited by the requirement in section 2106(d)(1) that ``[T]he State 
shall conduct the program in accordance with the plan (and any 
amendments) approved under subsection (c) and with the requirements of 
this title.'' Approval of the October 1, 1997 effective date was not 
warranted because the State was not operating its program in 
substantial compliance with the requirements of Title XXI or with the 
approved State plan during the period October 1, 1997 through April 14, 
1998.
    Under Section 2106(c) of the Social Security Act, the Secretary may 
approve, disapprove, or request additional information on a proposed 
Title XXI State Plan amendment within ninety days.
    The Secretary has concluded that the State's amendment to its Title 
XXI Plan, submitted on March 26, 1998, to change the effective date of 
the plan, could not be approved because the State program during the 
period in question did not substantially comply with the requirements 
of Title XXI. Therefore, HCFA, in consultation with the Secretary, 
disapproved the amendment.
    The notice to New York announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

    Ms. Barbara A. DeBuono, M.D.; M.P.H., Commissioner, State of New 
York, Department of Health, Corning Tower, Empire State Plaza, Albany, 
New York 12237.

    Dear Ms. DeBuono: I am responding to your request for 
reconsideration of the decision to disapprove New York Title XXI 
State Plan Amendment (SPA) submitted March 26, 1998.
    At issue in this reconsideration is whether the State is 
entitled to an effective date for its Title XXI plan which included 
a period during which the State was not operating a program which 
met the requirements of Title XXI (or the approved State plan). 
Specifically, the premiums and cost sharing provisions for the 
State's Child Health Plus program, in effect during the period in 
which the State seeks retroactive approval through this amendment, 
were inconsistent with the requirements of section 2103 (a)(3)(A) of 
the Social Security Act. In addition, the State was not applying 
procedures to ensure ``that children found through * * * screening 
to be eligible for medical assistance under the State Medicaid plan 
under title XIX are enrolled for such assistance under such plan'' 
as required under section 2102(b)(3)(B) of the Social Security Act 
and guidance outlined in a letter to States on January 23, 1998.
    I am scheduling a hearing on your request for reconsideration to 
be held on July 29, 1998 on the Thirty-Eighth Floor, 26 Federal 
Plaza, New York, New York 10278.
    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 Mr. Stanley Katz 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) 786-2661.

      Sincerely,
Nancy-Ann Min DeParle,
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: June 29, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
[FR Doc. 98-18019 Filed 7-2-98; 10:31 am]
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