GAB Decision 555
Docket No. 84-29
July 23, 1984
Delaware Department of Health and Social Services;
Ballard, Judith; Garrett, Donald Settle, Norval
The Delaware Department of Health and Social Services appealed a
determination by the Health Care Financing Administration concerning the
allowability of the costs of certain psychiatric care and services
provided to Medicaid recipients aged 22 to 64 during partial months in
institutions for mental diseases.
Delaware's appeal was stayed pending resolution of appeals by the
States of New York and New Jersey raising the same issue. Those appeals
were decided by the Board in Decision No. 535, May 9, 1984. In that
decision, the Board concluded that HCFA could not disallow partial month
claims for costs of services covered in a state plan solely because the
services were psychiatric in nature. The Board then issued an order to
HCFA, directing it to show cause why the Board should not proceed to
decision in the Delaware appeal, holding for the State based on the
analysis set out in Decision No. 535. HCFA responded that, while it
believed Decision No. 535 was incorrect, it saw no basis for
distinguishing the issue in Delaware's case from the issue in Decision
No. 535. Response of HCFA to Order to Show Cause, July 18, 1984. HCFA
incorporated by reference the arguments it made in the cases leading to
Decision No. 535, but raised no new arguments.
Accordingly, for the reasons stated in Decision No. 535 (which we
incorporate here by reference), we reverse HCFA's determination.
NOVEMBER 14, 1984