DEPARTMENTAL GRANT APPEALS BOARD
Department of Health and Human Services
SUBJECT: New York State Dept. of Social Services
Docket No. 88-98
Decision No. 967
DATE: July 14, 1988
DECISION
The New York State Department of Social Services (State) appealed
the
decision of the Health Care Financing Administration (HCFA)
disallowing
$7,344,903 claimed under title XIX of the Social Security Act
(Act) for
the period April 1, 1987 through December 31, 1987. The
disallowed
costs, which were included in the per diem rates for hospitals,
were
incurred for supplemental malpractice insurance purchased by
the
hospitals for their affiliated physicians and dentists. The
disallowance
was taken on the ground that the costs were claimed under
proposed State
plan amendments which were disapproved by HCFA. Section
1903(a)(1) of
the Act requires that costs be claimed under an approved state
plan in
order to be eligible for reimbursement under title XIX.
The Board previously issued a decision upholding a similar
disallowance
for prior quarters. New York State Dept. of Social
Services, DGAB No.
947 (1988). The Board observed that both parties had
agreed that the
costs were not allowable absent approval of the plan
amendments.
Although the State had requested pursuant to 45 C.F.R. Part 213
that
HCFA reconsider its decision disapproving the proposed plan
amendments,
that proceeding was still pending. Accordingly, the Board
concluded
that the disallowance was properly taken on the ground that the
costs
were not claimed pursuant to an approved State plan, and sustained
the
disallowance. The Board noted, however, that HCFA had stated that
were
it to later approve the plan amendments, it would pay the costs
in
question.
In its current appeal, the State indicated that the Part 213
proceeding
was still before HCFA, and requested that the Board issue a
summary
decision upholding the disallowance consistent with its holding in
DGAB
No. 947. HCFA did not object to the requested action.
Conclusion
Accordingly, based on the analysis in DGAB No. 947, we sustain
the
disallowance in full. If the proposed plan amendments under which
the
costs were claimed are subsequently approved by HCFA, this
decision
would not preclude HCFA from carrying out its agreement to pay
the
costs.
________________________________ Donald
F.
Garrett
________________________________
Alexander
G. Teitz
________________________________ Norval
D.
(John) Settle