[Federal Register: November 21, 2003 (Volume 68, Number 225)]
[Notices]               
[Page 65715-65716]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr21no03-75]                         

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

 
Notice of Hearing: Reconsideration of Disapproval of Rhode Island 
State Plan Amendment 02-009

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

ACTION: Notice of hearing.

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SUMMARY: This notice announces an administrative hearing to be held on 
January 7, 2004, at 10 a.m., Government Center, JFK Federal Building, 
Viewstation 2350, Boston, Massachusetts 02203-0003.
    Closing Date: Requests to participate in the hearing as a party 
must be received by the presiding officer by December 8, 2003.

FOR FURTHER INFORMATION CONTACT: Kathleen Scully-Hayes, Presiding 
Officer, CMS, Lord Baltimore Drive, Mail Stop LB-23-20, Baltimore, 
Maryland 21244, Telephone: (410) 786-2055.

SUPPLEMENTARY INFORMATION: This notice announces an administrative 
hearing to reconsider CMS' decision to disapprove Rhode Island State 
Plan Amendment (SPA) 02-009, submitted on September 28, 2002. The 
amendment would provide coverage for targeted case management services 
to children age 21 and under who are receiving such services from the 
Rhode Island Department of Children, Youth, and Families.
    The issues are whether CMS properly found that SPA 02-009 is not 
consistent with Medicaid requirements because the proposed amendment: 
(1) Duplicates coverage of services that are integral components of the 
Federal-state child welfare programs; and (2) fails to include a 
payment methodology for the proposed services and thereby does not 
comprehensively describe the plan and provide sufficient information to 
determine compliance with applicable statutory and regulatory 
requirements.
    Under section 1902(a) of the Social Security Act (the Act), states 
must submit plans ``for medical assistance.'' Medical assistance is 
defined in sections 1905(a) and 1905(a)(19) of the Act, and includes 
targeted case management authorized by section 1915(g)(2) of the Act. 
In authorizing coverage of case management services, Congress 
specifically indicated that coverage for case management services must 
not duplicate payments made to public agencies or private entities 
under other program authorities for the same purpose. Congress provided 
an exception, in section 8435 of the Technical and Miscellaneous 
Revenue Act of 1988, Public Law 100-647, when the state is required to 
provide such services under state law, or is or was otherwise paying 
for the services using non-Federal funds. The case management services 
proposed in this SPA, however, do not come within this exception 
because they are provided through a Federal-state program rather than a 
non-Federal program operated under state law. Specifically, case 
management comprises an integral part of the Federal child welfare 
program.
    At issue is whether the activities proposed under this SPA as case 
management services were integral and inseparable to fulfillment of a 
state's responsibilities under title IV of the Act.
    Under title IV-B of the Act, section 422(b)(2) expressly requires 
that states must ``provide for coordination between the services 
provided for children under the [state welfare] plan and the services 
and assistance provided under title XX, under the state program funded 
under part A (Title IV-A)-under the state plan approved under part E 
(Title IV-E) and under other state programs having a relationship to 
the program under this subpart.'' The implementing regulations specify 
that services be organized and ``linked to a wide variety of supports 
and services which can be crucial to meeting families' and children's 
needs, for example, housing, substance abuse treatment, mental health, 
education, job training, child care, and informal support networks.'' 
(45 CFR section 1355.25(f))
    In addition, 45 CFR section 1357.10(c)(6) requires the Child and 
Family Services Plan, defined at 45 CFR section 1357.10(c) as ``the 
document, developed through joint planning, which describes the 
publicly-funded state child and family continuum,'' to include a broad 
spectrum of services, including foster care and child welfare services. 
Even though the activities in question may not always have been 
explicitly labeled as case management when performed under the State's 
title IV responsibilities, the State has provided no evidence that the 
activities are not the same.
    Also at issue is whether SPA 02-009 comprehensively described the 
State program and contained sufficient information to determine whether 
it complied with Federal law. In the review process, CMS asked the 
State to submit an associated amendment to Attachment 4.19B of the 
State plan to describe the payment methodology that Rhode Island would 
use to make payments for the proposed services in accordance with the 
requirements of section 1902(a)(30)(A) of the Act and 42 CFR 430.10. 
The State did not submit the payment methodology for the proposed 
services. CMS concluded that without any payment methodology for the 
proposed services, SPA 02-009 did not comprehensively describe the 
State's proposed Medicaid program and did not contain sufficient 
information for CMS to determine that the proposed coverage was in 
compliance with applicable statutory and regulatory requirements.
    Based on the reasoning set forth above, and after consultation with 
the Secretary as required under 42 CFR section 430.15(c)(2), CMS 
disapproved Rhode Island SPA 02-009 on August 14, 2003.
    Section 1116 of the Act and 42 CFR, part 430 establishes 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 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 section 430.76(c). If the hearing is later 
rescheduled, the presiding officer will notify all participants.
    The notice to Rhode Island announcing an administrative hearing to 
reconsider the disapproval of its SPA reads as follows:

Ms. Jane A. Hayward, Director
Department of Human Services
600 New London Avenue
Cranston, RI 02920


[[Page 65716]]


Dear Ms. Hayward:
    I am responding to your request for reconsideration of Rhode 
Island State Plan Amendment (SPA) 02-009. Rhode Island submitted SPA 
02-009 on September 28, 2002. In this amendment, Rhode Island 
proposed to provide coverage for targeted case management services 
to children age 21 and under who are receiving such services from 
the Rhode Island Department of Children, Youth, and Families.
    The issues are whether the Centers for Medicare & Medicaid 
Services (CMS) properly found that SPA 02-009 is not consistent with 
Medicaid requirements because the proposed amendment: (1) duplicates 
coverage of services that are integral components of the Federal-
state child welfare programs; and (2) fails to include a payment 
methodology for the proposed services and thereby does not 
comprehensively describe the plan and provide sufficient information 
to determine compliance with applicable statutory and regulatory 
requirements.
    Under section 1902(a) of the Social Security Act (the Act), 
states must submit plans ``for medical assistance.'' Medical 
assistance is defined in section 1905(a) and 1905(a)(19) of the Act, 
and includes targeted case management authorized by section 
1915(g)(2) of the Act. In authorizing coverage of case management 
services, Congress specifically indicated that coverage for case 
management services must not duplicate payments made to public 
agencies or private entities under other program authorities for the 
same purpose. Congress provided an exception, in section 8435 of the 
Technical and Miscellaneous Revenue Act of 1988, Public Law 100-647, 
when the state is required to provide such services under state law, 
or is or was otherwise paying for the services using non-Federal 
funds. The case management services proposed in this SPA, however, 
do not come within this exception because they are provided through 
a Federal-state program rather than a non-Federal program operated 
under state law. Specifically, case management comprises an integral 
part of the Federal child welfare program.
    At issue is whether the activities proposed under this SPA as 
case management services were integral and inseparable to 
fulfillment of a state's responsibilities under title IV of the Act.
    Under title IV-B of the Act, section 422(b)(2) expressly 
requires that states must ``provide for coordination between the 
services provided for children under the [state welfare] plan and 
the services and assistance provided under title XX, under the state 
program funded under part A (Title IV-A), under the state plan 
approved under part E (Title IV-E), and under other state programs 
having a relationship to the program under this subpart.'' The 
implementing regulations specify that services be organized and 
``linked to a wide variety of supports and services which can be 
crucial to meeting families' and children's needs, for example, 
housing, substance abuse treatment, mental health, education, job 
training, child care, and informal support networks.'' (45 CFR 
section 1355.25(f))
    In addition, 45 CFR 1357.10(c)(6) requires the Child and Family 
Services Plan, defined at 45 CFR section 1357.10(c) as ``the 
document, developed through joint planning, which describes the 
publicly-funded state child and family continuum,'' to include a 
broad spectrum of services, including foster care and child welfare 
services. Even though the activities in question may not always have 
been explicitly labeled as case management when performed under the 
State's title IV responsibilities, the State has provided no 
evidence that the activities are not the same.
    Also at issue is whether SPA 02-009 comprehensively described 
the State program and contained sufficient information to determine 
whether it complied with Federal law. In the review process, CMS 
asked the State to submit an associated amendment to Attachment 
4.19B of the State plan to describe the payment methodology that 
Rhode Island would use to make payments for the proposed services, 
in accordance with requirements set forth in section 1902(a)(30)(A) 
of the Act and 42 CFR 430.10. The State did not submit any payment 
methodology for the proposed services. CMS concluded that without 
any payment methodology for the proposed services, SPA 02-009 did 
not comprehensively describe the State's proposed Medicaid program, 
and did not contain sufficient information for CMS to determine that 
the proposed coverage was in compliance with applicable statutory 
and regulatory requirements.
    I am scheduling a hearing on your request for reconsideration to 
be held on January 7, 2004, at 10 a.m., Government Center, JFK 
Federal Building, Viewstation 2320, Boston, Massachusetts 02203-
0003. 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. Ms. Scully-
Hayes may be reached at (410) 786-2055.

Sincerely,
Thomas A. Scully

    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)

Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 03-29143 Filed 11-20-03; 8:45 am]

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