83 FR 32300 - Notice of Hearing: Reconsideration of Disapproval Washington Medicaid State Plan Amendment (SPA) 17-0027

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services

Federal Register Volume 83, Issue 134 (July 12, 2018)

This notice announces an administrative hearing to be held on August 9, 2018, at the Department of Health and Human Services, Centers for Medicare & Medicaid Services, Division of Medicaid & Children's Health, Seattle Regional Office, 701 Fifth Avenue, Suite 1600, Seattle, WA 98104 to reconsider CMS' decision to disapprove Washington's Medicaid SPA 17-0027.

[Federal Register Volume 83, Number 134 (Thursday, July 12, 2018)]
[Notices]
[Pages 32300-32301]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-14876]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Notice of Hearing: Reconsideration of Disapproval Washington 
Medicaid State Plan Amendment (SPA) 17-0027

AGENCY: Centers for Medicare & 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 9, 2018, at the Department of Health and Human Services, Centers 
for Medicare & Medicaid Services, Division of Medicaid & Children's 
Health, Seattle Regional Office, 701 Fifth Avenue, Suite 1600, Seattle, 
WA 98104 to reconsider CMS' decision to disapprove Washington's 
Medicaid SPA 17-0027.

DATES: Closing Date: Requests to participate in the hearing as a party 
must be received by the presiding officer by July 27, 2018.

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 Washington's Medicaid 
state plan amendment (SPA) 17-0027, which was submitted to the Centers 
for Medicare & Medicaid Services (CMS) on August 22, 2017 and 
disapproved on May 14, 2018. This SPA requested CMS approval to add 
coverage and reimbursement of services provided by Dental Health Aide 
Therapists (DHATs) under the Other Licensed Practitioner (OLP) benefit. 
Specifically, SPA 17-0027 proposed the coverage and reimbursement of 
services provided by DHATs only when furnished in a practice setting 
within the boundaries of a tribal reservation and only when operated by 
an Indian health program, and proposed to make coverage of DHAT 
services available only to members of a federally recognized tribe or 
those otherwise eligible for services under Indian Health Service 
criteria. Washington would, therefore, not permit Medicaid 
beneficiaries to receive Medicaid coverage for DHAT services if they 
are not members of a federally recognized tribe or otherwise eligible 
for services under Indian Health Service criteria.
    The issues to be considered at the hearing are whether Washington 
SPA 17-0027 is inconsistent with the requirements of:
     Section 1902(a)(23) of the Social Security Act (the Act) 
because it would restrict access to services provided by a DHAT to a 
limited group of beneficiaries, and it would also prevent beneficiaries 
from receiving DHAT services from similarly qualified dental services 
providers that provide services outside the boundaries of a tribal 
reservation or that are not Indian health programs.
     Section 1902(a)(10)(A) of the Act because it was unclear 
whether DHATs must be supervised by a licensed professional consistent 
with the requirements of the OLP benefit, and because CMS was therefore 
unable to determine whether DHAT services are ``medical assistance'' 
consistent with 1902(a)(10)(A) and 1905 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 in the Federal Register 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 state Medicaid agency of additional issues that 
will be considered at the hearing, we will also publish that notice in 
the Federal Register.
    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 Washington announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Ms. MaryAnne Lindeblad
Director
State of Washington, Health Care Authority
626 8th Avenue PO Box 45502
Olympia, WA 98504-5050

Dear Ms. Lindeblad:

    I am responding to your June 8, 2018 request for reconsideration 
of the decision to disapprove Washington's State Plan amendment 
(SPA) 17-0027. Washington SPA 17-0027 was submitted to the Centers 
for Medicare & Medicaid Services (CMS) on August 22, 2017, and 
disapproved on May 14, 2018. I am scheduling a hearing on your 
request for reconsideration to be held on August 9, 2018, at the 
Department of Health and Human Services, Centers for Medicare & 
Medicaid Services, Division of Medicaid & Children's Health, Seattle 
Regional Office, 701 Fifth Avenue, Suite 1600, Seattle, WA 98104.
    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

[[Page 32301]]

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.
    This SPA requested CMS approval to add coverage and 
reimbursement of services provided by Dental Health Aide Therapists 
(DHATs) under the Other Licensed Practitioner (OLP) benefit. 
Specifically, SPA 17-0027 proposed the coverage and reimbursement of 
services provided by DHATs only when furnished in a practice setting 
within the boundaries of a tribal reservation and only when operated 
by an Indian health program, and proposed to make coverage of DHAT 
services available only to members of a federally recognized tribe 
or those otherwise eligible for services under Indian Health Service 
criteria. Washington would, therefore, not permit Medicaid 
beneficiaries to receive Medicaid coverage for DHAT services if they 
are not members of a federally recognized tribe or otherwise 
eligible for services under Indian Health Service criteria.
    The issues to be considered at the hearing are whether 
Washington SPA 17-0027 is inconsistent with the requirements of:
     Section 1902(a)(23) of the Social Security Act (the 
Act) because it would restrict access to services provided by a DHAT 
to a limited group of beneficiaries, and it would also prevent 
beneficiaries from receiving DHAT services from similarly qualified 
dental services providers that provide services outside the 
boundaries of a tribal reservation or that are not Indian health 
programs.
     Section 1902(a)(10)(A) of the Act because it was 
unclear whether DHATs must be supervised by a licensed professional 
consistent with the requirements of the OLP benefit, and because CMS 
was therefore unable to determine whether DHAT services are 
``medical assistance'' consistent with 1902(a)(10)(A) and 1905 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.

Sincerely,

Seema Verma

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: July 6, 2018.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2018-14876 Filed 7-6-18; 4:15 pm]
 BILLING CODE 4120-01-P