80 FR 37268 - Notice of Hearing: Reconsideration of Disapproval Texas Medicaid State Plan Amendment (SPA) 14-25

DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Centers for Medicare and Medicaid Services

Federal Register Volume 80, Issue 125 (June 30, 2015)

This notice announces an administrative hearing to be held on August 6, 2015, at the Department of Health and Human Services, Centers for Medicare and Medicaid Services, Division of Medicaid & Children's Health, Dallas Regional Office, 1301 Young Street, Room 714, Dallas, TX 75202, to reconsider CMS' decision to disapprove Texas' Medicaid SPA 14-25. Closing Date: Requests to participate in the hearing as a party must be received by the presiding officer by July 15, 2015.

[Federal Register Volume 80, Number 125 (Tuesday, June 30, 2015)]
[Notices]
[Pages 37268-37269]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-16098]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)

Centers for Medicare and Medicaid Services


Notice of Hearing: Reconsideration of Disapproval Texas Medicaid 
State Plan Amendment (SPA) 14-25

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

ACTION: Notice of Hearing: Reconsideration of Disapproval.

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SUMMARY: This notice announces an administrative hearing to be held on 
August 6, 2015, at the Department of Health and Human Services, Centers 
for Medicare and Medicaid Services, Division of Medicaid & Children's 
Health, Dallas Regional Office, 1301 Young Street, Room 714, Dallas, TX 
75202, to reconsider CMS' decision to disapprove Texas' Medicaid SPA 
14-25.
    Closing Date: Requests to participate in the hearing as a party 
must be received by the presiding officer by July 15, 2015.

FOR FURTHER INFORMATION CONTACT: Benjamin R. 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 Texas' Medicaid SPA 
14-25, which was submitted to the Centers for Medicare and Medicaid 
Services (CMS) on August 26, 2014 and disapproved on April 7, 2015. In 
part, this SPA requested CMS approval to revise the methodology for 
calculating the hospital-specific limit for the Disproportionate Share 
Hospital (DSH) program. Specifically, SPA 14-25 proposed to exclude 
from the calculation, the portion of a Medicare payment for an 
individual who is dually-eligible for Medicare and Medicaid that 
exceeds the Medicaid allowable cost for the service provided to the 
recipient. This exclusion would permit the state to make Medicaid DSH 
payments that are above and beyond hospitals' reported uncompensated 
costs of providing services to Medicaid and uninsured individuals.
    The issue to be considered at the hearing is:

     Whether Texas SPA 14-25 is inconsistent with Medicaid 
DSH requirements of sections 1902(a)(13)(A)(iv) and 1923 of the 
Social Security Act (Act) because it would provide for payment to 
disproportionate share hospitals of amounts that exceed the 
hospital's uncompensated costs which cannot be considered consistent 
with DSH requirements pursuant to the hospital-specific limit under 
section 1923(g)(1) of the Act.

    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

[[Page 37269]]

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 Texas announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Ms. Kay Ghahremani
State Medicaid/CHIP Director
Health and Human Services Commission
Post Office Box 13247
Mail Code H100
Austin, TX 78711

Dear Ms. Ghahremani:

    I am responding to your request for reconsideration of the 
decision to disapprove Texas' State Plan amendment (SPA) 14-25, 
which was submitted to the Centers for Medicare & Medicaid Services 
(CMS) on August 26, 2014, and disapproved on April 7, 2015. I am 
scheduling a hearing on your request for reconsideration to be held 
on August 6, 2015, at the Department of Health and Human Services, 
Centers for Medicare & Medicaid Services, Division of Medicaid & 
Children's Health, Dallas Regional Office, 1301 Young Street, Room 
714, Dallas, TX 75202.
    I am designating Mr. Benjamin R. Cohen as the presiding officer. 
If these arrangements present any problems, please contact 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 hearing date 
that has been scheduled and provide names of the individuals who 
will represent the State at the hearing. If the hearing date is not 
acceptable, Mr. Cohen can set another date mutually agreeable to the 
parties. The hearing will be governed by the procedures prescribed 
by federal regulations at 42 CFR part 430.
    In part, this SPA requested CMS approval to revise the 
methodology for calculating the hospital-specific limit for the 
Disproportionate Share Hospital (DSH) program. Specifically, SPA 14-
25 proposed to exclude from the calculation, the portion of a 
Medicare payment for an individual who is dually-eligible for 
Medicare and Medicaid that exceeds the Medicaid allowable cost for 
the service provided to the recipient. This exclusion would permit 
the state to make Medicaid DSH payments that are above and beyond 
hospitals' reported uncompensated costs of providing services to 
Medicaid and uninsured individuals.
    The issue to be considered at the hearing is:
     Whether Texas SPA 14-25 is inconsistent with Medicaid 
DSH requirements at sections 1902(a)(13)(A)(iv) and 1923 of the 
Social Security Act (Act) because it would provide for payment to 
disproportionate share hospitals of amounts that exceed the 
hospital's uncompensated costs which cannot be considered consistent 
with DSH requirements pursuant to the hospital-specific limit under 
section 1923(g)(1) of the Act.
    In the event that CMS and the State come to agreement on 
resolution of the issues which formed the basis for disapproval, 
this SPA may be moved to approval prior to the scheduled hearing. I 
am responding to your request for reconsideration of the decision to 
disapprove Texas' Medicaid state plan amendment (SPA) 14-025, which 
was submitted to the Centers for Medicare and Medicaid Services 
(CMS) on August 26, 2014, and disapproved on April 7, 2015. I am 
scheduling a hearing on your request for reconsideration to be held 
on August 6, 2015, at the Department of Health and Human Services, 
Centers for Medicare and Medicaid Services, Division of Medicaid & 
Children's Health, Dallas Regional Office, 1301 Young Street, Room 
714, Dallas, TX 75202.

Sincerely,

Andrew M. Slavitt

cc: Benjamin R. Cohen

Section 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: June 24, 2015.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2015-16098 Filed 6-29-15; 8:45 am]
 BILLING CODE 4120-01-P