GAB Decision 695
October 1, 1985
Pennsylvania Department of Public Welfare;
Ford, Cecilia, S.; Settle, Norval, D. Ballard, Judith, A.
Docket No. 85-175
DECISION
The Pennsylvania Department of Public Welfare appealed a determination
by the Health Care Financing Administration (HCFA) disallowing
$1,552,878 in federal financial participation (FFP) claimed by the State
under Title XIX of the Social Security Act. The State's claim was
related to this Board's decision in Joint Consideration: IMD
Admission/Discharge Issue, Decision No. 436, May 31, 1983, upholding
disallowances against several States (including disallowances of
approximately $17.5 million against Pennsylvania) which had claimed per
diem rates for services provided to individuals aged 22 to 64 during the
partial months of admission to or discharge from institutions for mental
diseases (IMDs). The Board's decision provided that the disallowances
were subject to reduction to the extent any State could show what part
of the rates were for services separately covered under the State plan.
See, also, Decision No. 535, May 9, 1984.
The State subsequently submitted to HCFA documentation which the State
alleged supported $5,159,492 in FFP. HCFA allowed $3,603,616 of that,
but disallowed the remaining amount either because HCFA determined that
costs were for services not separately covered in the State plan or
because no cost report from the provider institution existed to support
the detail of the State's claim. In its notice of appeal, the State
said that it agreed that the disallowance was computed in accordance
with Board Decision Nos. 436 and 535. The State requested the Board to
summarily sustain the disallowance "without prejudice to the State to
resubmit that portion of the claim for which documentation was missing."
Notice of appeal, p. 1. HCFA agreed that it would review further
documentation submitted by the State after cost reports are final and
further agreed to the State's proposed procedure. HCFA letter of
September 26, 1985.
Accordingly, we sustain the disallowance of $1,552,878, without
prejudice to the State to resubmit that part of its claim disallowed for
lack of final cost reports.
JANUARY 14, 1986