GAB Drecision 247
January 19, 1982 Missouri Department of Social Services -- Carlson
Towers Geriatric Center; Docket No. 81-102-MO-HC Garrett, Donald;
Settle, Norval Ford, Cecilia
The Missouri Department of Social Services (Missouri, State) appealed
a Health Care Financing Administration (HCFA, Agency) disallowance of
$93,958 Federal financial participation (FFP) claimed under Title XIX of
the Social Security Act. The amount disallowed related to services to
Medicard recipients by Carlson Towers Geriatric Center (Center) during
periods when the provider agreement between the Center and the State had
expired and not been renewed, or had been terminated.
Effect of Decision No. 233
The disallowance appealed in Docket No. 81-102 involves services
during two periods: May 10, 1979 to March 21, 1980 and October 5, 1980
to November 3, 1980. In its prior decision in a series of related
cases, the Board decided that the State was entitled to FFP in the cost
of services rendered by the Center during the period May 10, 1979 to
March 1, 1980. Missouri Department of Social Service, Decision No.
233, November 30, 1981. That decision is incorporated into this one
with respect to any part of this disallowance which may have been for
services during the period May 10, 1979 to March 1, 1980. The Agency
withdrew its disallowance for the period March 1-21, 1980.
This case
That leaves only the period October 5, 1980 to November 3, 1980.
Missouri admitted that the provider agreement between the Center and the
State had been terminated by the State effective October 4, 1980, but
contended that during the 30-day period following termination the State
made reasoable efforts to transfer the patients to other facilities and
thus was entitled to FFP under 42 C.F.R. Sec. 444.11. Finding that the
State had not made reasonable efforts, we uphold the disallowance. This
decision is based on the written record.
Discussion
The Social Security Act and implementing regulations require a state
to have an agreement (provider agreement) in effect with a facility
serving Medicaid recipients in order for the state to claim FFP in (2)
the cost of those services. Section 1902(a)(27) of the Act, 42 U.S.C.
Sec. 1396a(27); 42 C.F.R. Sec. 431.107 (1980). If a state Medicaid
agency terminates a provider agreement, FFP may be continued for 30 days
only:
1) For payment for individuals admitted to the facility before the
provider agreement terminated . . .
2) If the agency makes reasonable efforts to transfer the individuals
(Medicaid recipients) to another facility or to alternate care.
42 C.F.R. Sec. 441.11(a) (1980).
Missouri had executed a provider agreement with the Center for the
period March 1980 to February 28, 1981. On September 16, 1980, the
State determined that the provider agreement would be terminated as of
October 4, 1980. A new certificatin and provider agreement were not
effective until November 3, 1980.
The reasonableness of the State's effort
The State contended that it was entitled to FFP for its unsuccessful
but reasonable effort to locate an alternate facility or facilities for
the 213 patients housed in the Center. To back its assertion it offered
the affidavits and supporting contemporary memoranda of two State
employees who made the search for certified nursing home beds. They
attested that they were able to find no more than six beds in the St.
Louis area, where the Center is located.
In response, the Agency submitted an affidavit of HCFA's Associate
Regional Administrator alleging that the State's report to HCFA for
October 1980 showed that there were 1,229 potentially available beds for
Medicaid patients in the St. Louis area. * If, as the State claimed,
there were so few beds, the State should have offered evidence to show
why the beds were unavailable.
After the State had been given an opportunity to reply, a Board staff
attorney telephoned the attorney for the State on December 29, 1981.
Counsel for Missouri stated that he had no additinal factual information
to submit in reply to HCFA's response. Confirmation of Telephone
Conversation, dated December 30, 1981.
(3) The State here did offer proof of what it argued was a reasonable
effort within the meaning of 42 C.F.R. Sec. 441.11, but HCFA rebutted
with the State's monthly report indicating that there were potentially
1,229 beds available. The State's subsequent failure to offer any other
information or explanation for the apparent contradiction under mines
its initial offer of proof. As a result, we find that the State has not
made a sufficient showing that it made the reasonable effort required to
entitle it to an additional 30 days of FFP following termination of the
provider agreement.
Conclusion
For the reasons stated above, we uphold the disallowance of FFP for
services during the period October 5 to November 4, 1980. The balance
of the disallowance either has been withdrawn or is covered by Decision
No. 233. * The Agency alleged that the State reported 1649 Medicaid
beds in St. Louis City and 2682 Medicaid beds in St. Louis County, but
only 3102 Medicaid patients to occupy those beds. Response, p. 6. The
State's report is Exhibit D to HCFA's Response.
OCTOBER 22, 1983