Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Appellate Division
SUBJECT: California Department
DATE: August 14, 1990
of Health Services Docket No. 90-140
Decision No. 1184
DECISION
The California Department of Health Services (State, DHS) appealed a
determination of the Health Care Financing Administration (HCFA)
disallowing $2,473,958 in federal financial participation (FFP) claimed
by the State under Title XIX of the Social Security Act (Medicaid) for
the period July 1, 1983 through June 30, 1985. HCFA's disallowance was
based on a review of administrative costs under four interagency
agreements between DHS and the California Department of Social Services
(DSS). The dispute concerns whether certain expenditures under the
agreements were properly claimed at the enhanced FFP rate of 75 percent
available for compensation and training of skilled professional medical
personnel (SPMP) or supporting staff or at the 50 percent rate available
generally for administrative costs. HCFA disallowed the portion of the
State's claim which exceeded the 50 percent rate.
These same positions were also the subject of a previous appeal to the
Board. In California Dept. of Health Services, DAB No. 1149 (1990), the
Board determined that (1) Disability Evaluation Analysts (DEAs)
functioned as professional adjudicators, not SPMP; (2) DEAs did not
qualify as supporting staff because the positions were clearly
professional, requiring non-routine tasks in the administration of the
Medicaid program; (3) there was no basis in the record to substantiate
enhanced reimbursement at the 75 percent SPMP rate for all the clerical
personnel in the State Programs Bureau because the State did not show
the immediate and direct nexus between SPMP and the clerical personnel
as "supporting staff;" and (4) there is no basis in the applicable
regulation to support enhanced reimbursement in expenditures for
consultative examinations, medical evidence, and claimant transportation
costs. As a result, the Board sustained the disallowance. Also,
although HCFA disallowed the State's DSS enhanced claims in all personal
services, travel, and training costs, as well as indirect costs under a
particular contract, the State's notice of appeal and brief did not
address that aspect of the disallowance. Consequently, the Board upheld
the disallowance of these costs without further discussion. California,
at 7.
Because the issues in the current appeal appeared to have been addressed
by the Board in California, the Board proposed to issue a summary
decision in this appeal based on California unless the State showed good
cause why that decision was not controlling. The State was asked to
specify in what ways this appeal might be different factually and
legally. The State did not respond to the Board's Order to Show Cause.y
1/
Since the State has not shown that this appeal is different factually or
legally from DAB No. 1149, we sustain the Agency's disallowance in the
amount of $2,473,958, based on DAB No. 1149, which we incorporate by
reference.
Judith A. Ballard
Norval D. (John) Settle
Cecilia Sparks Ford Presiding Board Member
1. In a telephone call on August 13, 1990, the State indicated that
the Board could proceed to a Summary Decision based on DAB No.