DEPARTMENTAL GRANT APPEALS BOARD
Department of Health and Human Services
SUBJECT: New York State Department of Social Services
Docket Nos. 86-144, 86-198, 87-104
Decision No. 886
DATE: August 4, 1987
The New York State Department of Social Services (State)separately
appealed three disallowances by the Health CareFinancing
Adminis#ration
(HCFA) #f federal financialparticipation claimed under title
XIX of the
Social Security Act(Act). Docket No. 86�144 involves a
disallowance of
$100,942,328claimed for the period April 1983 through March
1984.
Docket No.86�198 involves a disallowance of $18,757,164 claimed
for
theperiod April through June 1984. Docket No. 87�104
involves
adisallowance of $44,256,184 claimed for the period July
throughDecember
1984. The costs claimed represented amounts
originallypaid under the
State�funded medical assistance program
toindividuals whom the State
later determined were eligible forMedicaid on
the basis of disability.
The costs were disallowedthe ground that, at the
time the claims were
filed, there were nodisability determinations for the
individuals
involved.
Proceedings in Docket Nos. 86�144 and 86�198 were stayed
pendingthe
issuance of a decision by the Board in an earlier appealinvolving
a
similar disallowance. The State contended, however,that these
stayed
cases, as well as Docket No. 87�104, weredistinguishable from
the
earlier appeal in that part of theState's claims in each case could
be
supported by disabilitydeterminations which were made before the
claims
were filed.
In New York State Department of Social Services, Decision No.854,
March
31, 1987, the Board upheld the di#allowance of costsreclassified
as
payments to Medicaid�eligibles, concluding thatthe claims as
originally
filed were not supported by adequatedocumentation and that the
State's
later attempts to document theclaims were untimely under section 1132
of
the Act, which imposesa two�year deadline on filing claims under
the
public assistanceprograms of the Act. Specifically, the Board
found
that not onlyhad the State not made the required
disability
determinations
at the time the claims were filed, but also that there was noassurance
at
that time that the medical report and social historyrequired to
support a
disability determination existed and couldbe easily retrieved.
In a ruling
dated May 18, 1987, the Boarddenied the State's request for
reconsideration
of Decision No.854.
The parties subsequently agreed that it would be appropriate forthe
Board
to issue a summary decision upholding in part thedisallowance in
Docket Nos.
86�144, 86�198, and 87�104 based onDecision No. 854, but
dismissing the
appeals without prejudice to�j
�Conclusion�
(1) Based on the analysis in Decision No. 854, and our
ruling
onreconsideration, both of which we incorporate here, we
uphold
theportion of the disallowance in Docket No. 86�144
(i.e.,$83,361,063)
and the portion of the disallowance in Docket No.86�198
(i.e.,
$17,648,566) for which the State has presented noevidence of
timely
documentation, and the portion of thedisallowance in Docket No.
87�104
for which the State presents nosuch evidence of timely documentation
by
August 5, 1987.
(2) Based on the agreement of the parties, we dismiss withoutprejudice
the
remaining portions of the disallowances in thesethree cases, so that
HCFA may
undertake a review of thedocumentation presented by the State.
Once HCFA has
completedthis review, it should promptly notify the State
in writing ofits
determinations concerning what amounts, if any, of
theremaining portions of
the disallowances stand. If the Statedisputes
part or all of these HCFA
determinations, it may returnto the
Board (for review of the disputed determinations only) withinthirty
(30)
days after receiving HCFA's written notice.
#arret# � �
� .��..��..��..��.#̔ #
##'/ !. �v#### � Norval.D.##John)
#ettle_� �
Presiding BoardMember�#J�