Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Appellate Division
SUBJECT: New York
State
DATE: December 28, 1993
Department of Social
Services
Docket
No. A-94-30 Decision No. 1455
DECISION
The New York State Department of Social Services (NYSDSS) appealed
a
determination by the Health Care Financing Administration
(HCFA)
disallowing $899,104 in federal financial participation (FFP)
claimed
for the quarter ended June 30, 1993. 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
Board
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 relation to a prior summary decision in DAB No. 1425, the
parties
agreed that the disallowances relating to WMS at issue in these cases
do
not include any costs pertaining solely to input or transmission of
data
to the MMIS. Therefore, no remand is necessary in this case.
In its notice of appeal of the present disallowance, NYSDSS continued
to
disagree with the Board's analysis in DAB No. 1405, but
acknowledged
that the facts and circumstances were "substantially similar"
and
consented to a summary decision in this case without
further
proceedings. HCFA did not object to this course of action.
We therefore sustain the disallowance of $899,104 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