[Federal Register Volume 60, Number 67 (Friday, April 7, 1995)]
[Notices]
[Pages 17791-17792]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-8524]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
Notice of Hearing: Reconsideration of Disapproval of Utah State
Plan Amendment (SPA)
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Notice of hearing.
-----------------------------------------------------------------------
SUMMARY: This notice announces an administrative hearing on May 17,
1995 in Room 578, 1961 Stout Street, Denver, Colorado to reconsider our
decision to disapprove Utah SPA 93-033.
CLOSING DATE: Requests to participate in the hearing as a party must be
received by the presiding officer by April 24, 1995.
FOR FURTHER INFORMATION CONTACT: Stan Katz, Presiding Officer,
Groundfloor, Meadowwood East Building, 1849 Gwynn Oak Avenue,
Baltimore, Maryland 21207, telephone: (410) 597-3013.
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider our decision to disapprove Utah State plan
amendment (SPA) number 93-033.
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 Health Care Financing Administration (HCFA) 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 430.76(c). If the hearing is later rescheduled, the
presiding officer will notify all participants.
The State of Utah submitted SPA 93-033 which proposed changes in an
asset test for poverty level pregnant women. Specifically, Utah's
amendment required certain poverty level pregnant women who did not
meet the resource test to make a one-time payment equal to 4 percent of
the individual's total non-exempt resources. In addition, Utah's
amendment would waive this requirement for high risk pregnant women.
The issues in this matter are whether Utah SPA 93-033 adheres to
the Federal law at section 1902(a)(14) of the Act (referencing section
1916 of the Act) section 1902(l) and section 1902(a)(17).
Section 1902(a)(14) of the Act specifies that enrollment fees,
premiums, deductions, cost sharing, or similar charges may be imposed
only as provided in section 1916. Section 1916(a)(1) prohibits the
application of any enrollment fee with respect to the categorically
needy. It restricts States from charging a premium for Medicaid for the
categorically needy. An exception is made regarding poverty level
pregnant women with income at or above 150 percent of the Federal
Poverty Level. For these women, the amount of that premium is
restricted to 10 percent of the amount by which the family income (less
expense for care of a dependent child) exceeds 150 percent of the
poverty level. In addition, section 1916(a)(2)(B) prohibits States from
imposing any deduction, cost sharing or similar charge with respect to
services furnished to pregnant women, provided the services relate to
the pregnancy or a complicating condition. HCFA disapproved Utah's
amendment finding contrary to the statute's prohibition on imposing
premiums (other than those authorized in section 1916(c) of the Act)
enrollment fees, or similar charges on categorically needy individuals.
Utah believes its proposed policy to waive the resource spenddown
for pregnant women determined to be in the high risk category is
supported by section 1902(1)(3) of the Act. Utah believes this is the
only statutory authority over resource standards and methodologies for
poverty level pregnant women. Utah also claims that section 1902(a)(17)
explicitly exempts pregnant women from all requirements in that
section. HCFA did not agree with Utah's interpretation of the statute
that section 1902(l) exempts this group from the comparability
requirements in section 1902(a)(17).
While HCFA acknowledges that subsection (l)(3) exempts the States
from using a resource test for high-risk pregnant women, this exemption
does not override the remainder of section 1902 (a)(17) which requires
comparability of services to all such women. Utah cites the phrase,
``except as provided in subsections (l)(3), (m)(3), and (m)(4) include
reasonable standards (which shall be comparable for all groups * * *)''
as a rationale for this assertion. However, section 1902(1)(3) applies
only in cases in which its application would be inconsistent with the
requirements of subsection (a)(17). HCFA believed that subsection
(l)(3) authorizes States to establish a more liberal resource standard
or to drop the resource test for all section 1902(l)(A) pregnant women,
but not to adopt either of these approaches for a specific segment of
that group. While the goal of removing barriers to ensure positive
birth outcomes is a shared one, HCFA did not approve foregoing a
resource test exclusively for high-risk pregnant women because they are
not a separate group described in section 1902(l).
Utah points out that subsection (l)(3) prescribes that a resource
standard or methodology may not be more restrictive than applied under
Title XVI. Utah also believes that exclusion of all resources based
upon the level of medical risk factors is less restrictive than Title
XVI, and is also reasonable. However, HCFA believed that section
1902(a)(17) is explicitly meant to be inclusive of whole eligibility
groups and not portions of groups. HCFA contended it cannot authorize a
State to single out any part of an eligibility group for preferential
treatment. HCFA's position was, in order to drop the resource test for
high risk pregnant women, the State must do so for the entire poverty
level group of pregnant women.
The notice to Utah announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows:
Mr. Rod L. Betit,
Executive Director, Utah Department of Health, 288 North 1460 West,
P.O. Box 16700, Salt Lake City, Utah 84116-0700.
Dear Mr. Betit: I am responding to your request for
reconsideration of the decision to disapprove Utah State Plan
Amendment (SPA) 93-033.
The State of Utah submitted SPA 93-33 which proposed changes in
an asset test for poverty level pregnant women. Specifically, Utah
proposed policy regarding a one-time payment equal to 4 percent of
the individual's total non-exempt resources if [[Page 17792]] they
are equal to or exceed $5,000. In addition, Utah proposed to waive
this payment requirement for high risk pregnant women.
The issues in this matter are whether Utah SPA 93-033 adheres to
the Federal law at section 1902(a)(14) of the Act (referencing
section 1916 of the Act), section 1902(l) and section 1902(a)(17).
I am scheduling a hearing on your request for reconsideration to
be held on May 17, 1995, in Room 578, 1961 Stout Street, Denver,
Colorado. 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 residing
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) 597-3013.
Sincerely,
Bruce C. Vladeck,
Administrator.
(Section 1116 of the Social Security Act (42 U.S.C. 1316); 42 CFR
section 430.18)
(Catalog of Federal Domestic Assistance Program No. 13.714, Medicaid
Assistance Program)
Dated: March 30, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 95-8524 Filed 4-6-95; 8:45 am]
BILLING CODE 4120-01-P
