Notice2021-26136
Notice of Hearing: Reconsideration of Disapproval South Carolina Medicaid State Plan Amendment (SPA) 19-0004-A
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
December 1, 2021
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This notice announces an administrative hearing to be held on January 12, 2022, at the Department of Health and Human Services, Division of Medicaid Field Operations, South, Centers for Medicare & Medicaid Services, Division of Medicaid and Children's Health Operations, 61 Forsyth St., Suite 4T20, Atlanta, Georgia 30303-8909 to reconsider CMS' decision to disapprove South Carolina's Medicaid SPA 19-0004-A.
Full Text
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<title>Federal Register, Volume 86 Issue 228 (Wednesday, December 1, 2021)</title>
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[Federal Register Volume 86, Number 228 (Wednesday, December 1, 2021)]
[Notices]
[Pages 68260-68261]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-26136]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Notice of Hearing: Reconsideration of Disapproval South Carolina
Medicaid State Plan Amendment (SPA) 19-0004-A
AGENCY: Centers for Medicare & Medicaid Services, HHS.
ACTION: Notice of hearing: reconsideration of disapproval.
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SUMMARY: This notice announces an administrative hearing to be held on
January 12, 2022, at the Department of Health and Human Services,
Division of Medicaid Field Operations, South, Centers for Medicare &
Medicaid Services, Division of Medicaid and Children's Health
Operations, 61 Forsyth St., Suite 4T20, Atlanta, Georgia 30303-8909 to
reconsider CMS' decision to disapprove South Carolina's Medicaid SPA
19-0004-A.
DATES:
Closing Date: Requests to participate in the hearing as a party
must be received by the presiding officer by December 16, 2021.
FOR FURTHER INFORMATION CONTACT: Benjamin R. Cohen, Presiding Officer,
CMS, 7500 Security Blvd., MS B1-01-31, Baltimore MD 21244-1850,
Telephone: (410) 786-3169.
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider CMS's decision to disapprove South Carolina's
Medicaid state plan amendment (SPA) 19-0004-A, which was submitted to
the Centers for Medicare & Medicaid Services (CMS) on June 28, 2019 and
disapproved on May 21, 2021. This SPA requested CMS approval to update
annual supplemental teaching physician (STP) payment program using the
Average Commercial Rate (ACR) methodology effective April 1, 2019. This
SPA included Greenville Memorial Hospital, and Palmetto Health,
Richland/USC.
The issues to be considered at the hearing are whether South
Carolina SPA 19-0004-A is inconsistent with the requirements of:
<bullet> Section 1902(a)(2) of the Social Security Act (the Act),
providing that the state plan must assure adequate funding for the non-
federal share of expenditures from state or local sources, such that
the lack of adequate funds from local sources will not result in
lowering the amount, duration, scope, or quality of care and services
available under the plan.
<bullet> Sections 1903(a) and 1905(b) of the Act, providing that
states receive a statutorily determined Federal Medicaid Assistance
Percentage (FMAP) for allowable state expenditures on medical
assistance.
<bullet> Section 1903(w)(1)(A)(i)(I) of the Act, providing that,
notwithstanding the previous provisions of section 1903, for purposes
of determining the amount to be paid to a State (as defined in
paragraph (7)(D)) under subsection (a)(1) for quarters in any fiscal
year, the total amount expended during such fiscal year as medical
assistance under the State plan (as determined without regard to
section 1903(w)) shall be reduced, inter alia, by the sum of any
revenues received by the State (or by a unit of local government in the
State) during the fiscal year from provider-related donations other
than bona fide provider-related donations, as defined in section
1903(w)(2)(B).
<bullet> Section 1903(w)(2)(A) of the Act, providing that, in
section 1903(w), except as provided in section 1903(w)(6), the term
``provider-related donation'' means any donation or other voluntary
payment (whether in cash or in kind) made (directly or indirectly) to a
State or unit of local government by--(i) a health care provider (as
defined in section 1903(w)(7)(B)), (ii) an entity related to a health
care provider (as defined in section 1903(w)(7)(C)), or (iii) an entity
providing goods or services under the State plan for which payment is
made to the State under paragraph (2), (3), (4), (6), or (7) of section
1903(a).
<bullet> Section 1903(w)(2)(B) of the Act, providing that, for
purposes of section 1903(w)(1)(A)(i)(I), the term ``bona fide provider-
related donation'' means a provider-related donation that has no direct
or indirect relationship (as determined by the Secretary) to payments
made under title XIX to that provider, to providers furnishing the same
class of items and services as that provider, or to any related entity,
as established by the State to the satisfaction of the Secretary. The
Secretary may by regulation specify types of provider-related donations
described in the previous sentence that will be considered to be bona
fide provider-related donations.
<bullet> Section 1903(w)(6)(A) of the Act, providing that,
notwithstanding the provisions of section 1903(w), the Secretary may
not restrict States'' use of funds where such funds are derived from
State or local taxes (or funds appropriated to State university
teaching hospitals) transferred from or certified by units of
government within a State as the non-Federal share of expenditures
under title XIX, regardless of whether the unit of government is also a
health care provider, except as provided in section 1902(a)(2), unless
the transferred funds are derived by the unit of government from
donations or taxes that would not otherwise be recognized as the non-
Federal share under section 1903.
<bullet> 42 CFR 433.54(b), (c)(2), and (c)(3), providing that
provider-related donations will be determined to have no direct or
indirect relationship to Medicaid payments if those donations are not
returned to the individual provider, the provider class, or related
entity under a hold harmless provision or practice, as described in 42
CFR 433.54(c). A hold harmless practice exists if, inter alia, all or
any portion of the Medicaid payment to the donor, provider class, or
related entity, varies based only on the amount of the donation,
including where Medicaid payment is conditional on receipt of the
donation; or if the State (or other unit of government) receiving the
donation provides for any direct or indirect payment, offset, or waiver
such that the provision of that payment, offset, or waiver directly or
indirectly guarantees to return any portion of the donation to the
provider (or other parties responsible for the donation).
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
[[Page 68261]]
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 South Carolina announcing an administrative hearing
to reconsider the disapproval of its SPAs reads as follows:
Robert M. Kerr
Director, South Carolina Department of Health and Human Services,
Post Office Box 8206, Columbia, SC 29202-8206
Dear Mr. Kerr:
I am responding to the July 19, 2021 request for reconsideration
of the decision to disapprove South Carolina's State Plan amendment
(SPA) 19-0004-A. South Carolina SPA 19-0004-A was submitted to the
Centers for Medicare & Medicaid Services (CMS) on June 28, 2019 and
disapproved on May 21, 2021. I am scheduling a hearing on the
request for reconsideration to be held on January 12, 2022, at the
Department of Health and Human Services, Division of Medicaid Field
Operations, South, Centers for Medicare & Medicaid Services,
Division of Medicaid and Children's Health Operations, 61 Forsyth
St., Suite 4T20, Atlanta, Georgia 30303-8909.
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.
This SPA requested CMS approval to update annual supplemental
teaching physician (STP) payment program using the Average
Commercial Rate (ACR) methodology effective April 1, 2019. This SPA
included Greenville Memorial Hospital, and Palmetto Health Richland/
USC.
The issues to be considered at the hearing are whether South
Carolina SPA 19-0004-A is inconsistent with the requirements of:
<bullet> Section 1902(a)(2) of the Social Security Act (the
Act), providing that the state plan must assure adequate funding for
the non-federal share of expenditures from state or local sources,
such that the lack of adequate funds from local sources will not
result in lowering the amount, duration, scope, or quality of care
and services available under the plan.
<bullet> Sections 1903(a) and 1905(b) of the Act, providing that
states receive a statutorily determined Federal Medicaid Assistance
Percentage (FMAP) for allowable state expenditures on medical
assistance.
<bullet> Section 1903(w)(1)(A)(i)(I) of the Act, providing that,
notwithstanding the previous provisions of section 1903, for
purposes of determining the amount to be paid to a State (as defined
in paragraph (7)(D)) under subsection (a)(1) for quarters in any
fiscal year, the total amount expended during such fiscal year as
medical assistance under the State plan (as determined without
regard to section 1903(w)) shall be reduced, inter alia, by the sum
of any revenues received by the State (or by a unit of local
government in the State) during the fiscal year from provider-
related donations other than bona fide provider-related donations,
as defined in section 1903(w)(2)(B).
<bullet> Section 1903(w)(2)(A) of the Act, providing that, in
section 1903(w), except as provided in section 1903(w)(6), the term
``provider-related donation'' means any donation or other voluntary
payment (whether in cash or in kind) made (directly or indirectly)
to a State or unit of local government by--(i) a health care
provider (as defined in section 1903(w)(7)(B)), (ii) an entity
related to a health care provider (as defined in section
1903(w)(7)(C)), or (iii) an entity providing goods or services under
the State plan for which payment is made to the State under
paragraph (2), (3), (4), (6), or (7) of section 1903(a).
<bullet> Section 1903(w)(2)(B) of the Act, providing that, for
purposes of section 1903(w)(1)(A)(i)(I), the term ``bona fide
provider-related donation'' means a provider-related donation that
has no direct or indirect relationship (as determined by the
Secretary) to payments made under title XIX to that provider, to
providers furnishing the same class of items and services as that
provider, or to any related entity, as established by the State to
the satisfaction of the Secretary. The Secretary may by regulation
specify types of provider-related donations described in the
previous sentence that will be considered to be bona fide provider-
related donations.
<bullet> Section 1903(w)(6)(A) of the Act, providing that,
notwithstanding the provisions of section 1903(w), the Secretary may
not restrict States'' use of funds where such funds are derived from
State or local taxes (or funds appropriated to State university
teaching hospitals) transferred from or certified by units of
government within a State as the non-Federal share of expenditures
under title XIX, regardless of whether the unit of government is
also a health care provider, except as provided in section
1902(a)(2), unless the transferred funds are derived by the unit of
government from donations or taxes that would not otherwise be
recognized as the non-Federal share under section 1903.
<bullet> 42 CFR 433.54(b), (c)(2), and (c)(3), providing that
provider-related donations will be determined to have no direct or
indirect relationship to Medicaid payments if those donations are
not returned to the individual provider, the provider class, or
related entity under a hold harmless provision or practice, as
described in 42 CFR 433.54(c). A hold harmless practice exists if,
inter alia, all or any portion of the Medicaid payment to the donor,
provider class, or related entity, varies based only on the amount
of the donation, including where Medicaid payment is conditional on
receipt of the donation; or if the State (or other unit of
government) receiving the donation provides for any direct or
indirect payment, offset, or waiver such that the provision of that
payment, offset, or waiver directly or indirectly guarantees to
return any portion of the donation to the provider (or other parties
responsible for the donation).
In the event that CMS and the State come to agreement on
resolution of the issues which formed the basis for disapproval,
these SPAs may be moved to approval prior to the scheduled hearing.
Sincerely,
Chiquita Brooks-LaSure,
Administrator
cc: Benjamin R. Cohen
The Administrator of the Centers for Medicare & Medicaid Services
(CMS), Chiquita Brooks-LaSure, having reviewed and approved this
document, authorizes Evell J. Barco Holland, who is the Federal
Register Liaison, to electronically sign this document for purposes of
publication in the Federal Register.
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: November 26, 2021.
Evell J. Barco Holland,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2021-26136 Filed 11-30-21; 8:45 am]
BILLING CODE 4120-01-P
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</html>Indexed from Federal Register on December 1, 2021.
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