New York State Department of Social Services, DAB No. 569 (1984)

GAB Decision 569
Docket No. 84-133

August 31, 1984

New York State Department of Social Services;
Ballard, Judith; Garrett, Donald Teitz, Alexander


The New York State Department of Social Services (State) appealed the
disallowance of $14,161,599 by the Regional Administrator, Health Care
Financing Administration (Agency) of State claims for federal financial
participation (FFP) under Title XIX of the Social Security Act
(Medicaid). The ground for disallowance was that the claims were
unallowable because they were not filed within the limitations for
timely filing of claims in certain statutes and regulations.

The claim for $637,660 related to expenditures for periods prior to
October 1, 1978. The Agency stated that this amount was disallowed
because claims were not filed within one year of the expenditures, as
required by Pub. L. 97-92, Pub. L. 97-276, and 45 CFR 95.11.

The Agency disallowed $3,596,506 FFP related to expenditures in
fiscal year (FY) 1979 because the claim was not filed by May 15, 1981,
as required by section 306(b) of Pub. L. 96-272 and 45 CFR 95.10.

The other amounts disallowed of $9,925,884 and $1,549 related to
expenditures after FY 1979. The Agency disallowed these claims because
they were not filed within two years after the calendar quarter in which
the State made the expenditures, as required by section 1132 of the
Social Security Act and 45 CFR 95.7.

The State asked the Board to treat separately the pre-FY 1979 claims
and the later claims. The portion of the appeal relating to the pre-FY
1979 claims for $637,660 (docketed as 84-136) is proceeding as a
separate case.

The State argued that the claims for expenditures in FY 1979 and
later, totalling $13,523,939, were exempt from the statutory filing
limitations because they involved "audit exceptions or adjustments to
prior year costs."(Section 1132(a), Social (2) Security Act) In
addition, the State contended that the claims were filed timely because
the underlying expenditures were not incurred until they were
reclassified as eligible for FFP.Finally, the State's position was that
the cited statutory and regulatory provisions for timely filing of
claims for expenditures in FY 1979 and later, namely, section 306(b) of
Pub. L. 96-272, section 1132 of the Social Security Act, and sections
95.10 and 95.7 of 45 CFR could not be applied retroactively.

The State in its notice of appeal pointed out that it had put forward
these same arguments in Board Docket Nos. 83-170 and 180, and the Board
rejected them when it issued Decision No. 521. Since this appeal "does
not present any material issues of fact which distinguish it from Board
Docket Nos. 83-170 and 83-180," the State requested that the Board
"issue a summary decision as to the $13,523,939 disallowance based upon
its holding in Decision No. 521." (Notice of Appeal, p. 2)

The Agency was given the opportunity to object to this course of
action and did not do so.

Therefore, based on New York State Department of Social Services,
Decision No. 521, March 6, 1984 (which we incorporate here), we sustain
the disallowance of $13,523,939 FFP for claims for expenditures in FY
1979 and later periods.

JANUARY 08, 1985