Medicaid Program; Medicaid Fiscal Accountability Regulation
| Published date | 19 January 2021 |
| Record Number | 2021-01078 |
| Section | Proposed rules |
| Court | Centers For Medicare & Medicaid Services |
Federal Register, Volume 86 Issue 11 (Tuesday, January 19, 2021)
[Federal Register Volume 86, Number 11 (Tuesday, January 19, 2021)]
[Proposed Rules]
[Pages 5105-5106]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-01078]
[[Page 5105]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 430, 433, 447, 455, and 457
[CMS-2393-WN]
RIN 0938-AT50
Medicaid Program; Medicaid Fiscal Accountability Regulation
ACTION: Withdrawal of proposed rule.
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SUMMARY: This document withdraws a proposed rule that was published in
the Federal Register on November 18, 2019. The proposed rule would have
established new reporting requirements and codified other Medicaid
financing requirements, including related to permissible sources for
non-federal share financing.
DATES: The proposed rule on Medicaid Fiscal Accountability Regulation,
published on November 18, 2019 at 84 FR 63722 is withdrawn January 21,
2021.
ADDRESSES: In commenting, please refer to file code CMS-2393-WN.
Comments, including mass comment submissions, must be submitted in
one of the following three ways (please choose only one of the ways
listed):
1. Electronically. You may submit electronic comments on this
regulation to http://www.regulations.gov. Follow the ``Submit a
comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-2393-WN, P.O. Box 8016,
Baltimore, MD 21244-8016.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-2393-WN, Mail
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
FOR FURTHER INFORMATION CONTACT:
Andrew Badaracco, (410) 786-4589, Richard Kimball, (410) 786-2278,
and Daniil Yablochnikov, (410) 786-8912, for Medicaid Provider
Payments, Supplemental Payments, Upper Payment Limits, Provider
Categories, Intergovernmental Transfers, and Certified Public
Expenditures.
Timothy Davidson, (410) 786-1167, Jonathan Endelman, (410) 786-
4738, and Stuart Goldstein, (410) 786-0694, for Health Care-Related
Taxes, Provider-Related Donations, and Disallowances.
Lia Adams, (410) 786-8258, Charlie Arnold, (404) 562-7425, Richard
Cuno, (410) 786-1111, and Charles Hines, (410) 786-0252, for Medicaid
Disproportionate Share Hospital Payments and Overpayments.
Jennifer Clark, (410) 786-2013, and Deborah McClure, (410) 786-
3128, for Children's Health Insurance Program (CHIP).
SUPPLEMENTARY INFORMATION: On November 18, 2019, we published a
proposed rule that proposed to amend our regulations dealing with
grants to states for medical assistance programs, state fiscal
administration, payments for services, Medicaid program integrity, and
allotments to states and grants. (84 FR 63722). After an internal
review of the proposed rule, CMS has decided to withdraw the proposed
rule.
The proposed rule sought to promote accountability and transparency
for Medicaid payments by establishing new reporting requirements for
states to provide CMS with certain information on supplemental payments
to Medicaid providers, including supplemental payments approved under
either Medicaid state plan or demonstration authority, codification of
parameters for Medicaid upper payment limit calculations, provider
definitions associated with data reporting and Medicaid financing,
Medicaid disproportionate share hospital audit requirements and changes
to some existing operational processes to better align with technology
improvements. This proposed rule also sought to establish additional
requirements to ensure that state plan amendments proposing new
supplemental payments are consistent with the proper and efficient
operation of the state plan and with efficiency, economy, and quality
of care. Finally, this proposed rule sought to address the non-federal
share financing of supplemental and base Medicaid payments, including
states' uses of health care-related taxes and provider-related
donations, and other requirements for sources of the non-federal share.
We received approximately 10,188 individual comments (4,225
unduplicated comment submissions) through the extended comment
period.\1\ We received significant comments on the proposed rule
regarding its potential impact on states and their budgets, Medicaid
providers and Medicaid beneficiary access to needed services. Many
commenters stated their belief that the proposed rule did not include
adequate analysis of these matters. Numerous commenters indicated that
CMS, in some instances, lacked statutory authority for its proposals
and was creating regulatory provisions that were ambiguous or unclear
and subject to excessive Agency discretion.
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\1\ On December 30, 2019, CMS extended the comment period for
the November 18, 2019, proposed rule by 15 days, from January 17,
2020, to February 1, 2020, in response to feedback from stakeholders
indicating additional time was needed to review the proposed rule in
light of several holidays and the complexity of the rule.
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While we continue to support the intent and purpose of the rule to
increase fiscal accountability and improve transparency in the Medicaid
program, based on the considerable feedback we received through the
public comment process, we have determined it appropriate to withdraw
the proposed provisions at this time. Moving forward, we want to ensure
agency flexibility in re-examining these important issues and exploring
options and possible alternative approaches that best implement the
requirements of the Medicaid statute. We also believe it is important
to re-examine and fully analyze the proposed Medicaid reporting
requirements in consideration of the recent Congressional action
through the Consolidated Appropriations Act of 2021 (H.R. 116-133, Pub.
L. 116-260) which establishes new statutory requirements for Medicaid
supplemental payment reporting. This withdrawal action does not limit
our prerogative to make new regulatory proposals in the areas addressed
by the withdrawn proposed rule, including new proposals that may be
substantially identical or similar to those described therein.
Finally, the withdrawal of this proposed rule does not affect
existing federal legal requirements or policy that were merely proposed
to be codified in regulation, including certain provisions related to
Medicaid financing and Medicaid Upper Payment Limit (UPL) requirements.
For example, without limitation, this includes guidance in State
Medicaid Director Letter (SMDL) #13-003, which discussed a submission
process to comply with the UPL requirements; SMDL #14-004, which
discussed Medicaid financing and provider-related donations; as well as
State Health Officials (SHO) Letter #14-001, which addressed health
care-related taxes. This withdrawal action does not affect CMS' ongoing
application of existing statutory and regulatory requirements or its
[[Page 5106]]
responsibility to faithfully administer the Medicaid program.
Dated: January 12, 2021.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
Dated: January 12, 2021.
Alex M. Azar II,
Secretary, Department of Health and Human Services.
[FR Doc. 2021-01078 Filed 1-14-21; 4:15 pm]
BILLING CODE 4120-01-P
