Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Appellate Division
SUBJECT: New York
State
DATE: July 20, 1993
Department of Social
Services
Docket
No. A-93-170 Decision No. 1425
DECISION
The New York State Department of Social Services (NYSDSS) appealed
a
determination by the Health Care Financing Administration
(HCFA)
disallowing $1,013,726 in federal financial participation (FFP)
claimed
for the quarter ended December 31, 1992. The disallowance
amount
represented the difference between the 75 percent enhanced funding
rate
available for administrative costs attributable to the operation of
New
York's Medicaid Management Information System (MMIS) under Title XIX
of
the Social Security Act (Act) and the 50 percent rate
generally
available for Medicaid administrative expenses. The costs at
issue were
expenditures for New York's Welfare Management System (WMS).
HCFA
determined that eligibility determination systems, including WMS,
were
excluded by regulation from enhanced funding as part of the MMIS.
See
42 C.F.R. . 433.112(c).
NYSDSS argued that the regulations were intended to apply only to
certain
eligibility determination systems, known as Family Assistance
Management
Information Systems (FAMIS), which receive funding under
Title IV-A of the
Act. NYSDSS contended that WMS continued to qualify
for enhanced
funding as an enhancement to the MMIS despite the
regulations, because WMS is
not a FAMIS and because WMS performs some
function beyond eligibility
determination (relating among other things
to determining third party
liability).
The issues presented by this case were previously addressed in New
York
State Department of Social Services, DAB No. 1405 (1993). In
that
decision, the Board found that the regulations applied to WMS.
Further,
the Board concluded that expenditures for WMS did not qualify
for
enhanced funding as an enhancement to the MMIS. The Board
rejected
NYSDSS's arguments that costs relating to
post-eligibility
determination and third party liability functions performed
by WMS
independently qualified for enhanced funding, except that the
Bard
remanded to HCFA to determine if any portion of the costs were
allowable
because they pertained solely to the input or transmission of data
to
the MMIS.
In its notice of appeal of the present disallowance, NYSDSS continued
to
disagree with the Board's analysis in DAB No. 14 5, but ac@
We therefore sustain the disallowance of $1,013,726, based on the
reasons
and analysis set forth in DAB No. 1405, which we incorporate
here in
full.
___________________________
Judith
A.
Ballard
___________________________
Norval
D. (John)
Settle
___________________________
M.
Terry Johnson
Presiding
Board
Member