GAB Decision 578
Docket No. 84-174
October 11, 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 $1,802,524 by the Regional Administrator, Health Care
Financing Administration (Agency), of State claims for federal financial
participation (FFP) under Title XIX (Medicaid) of the Social Security
Act for local district supplemental claims. 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 $72,245 FFP 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 expenditure, as
required by Pub. L. 97-92, Pub. L. 97-276, and 45 CFR 95.11.
The Agency disallowed $70,471 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 remaining amount disallowed of $1,659,808 FFP related to
expenditures for FY 1980 and forward. 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,
which involved the question of the one-year filing restrictions. That
portion of the appeal relating to the pre-FY 1979 claims, amounting to
$72,245, is therefore proceeding as a separate case, docketed as 84-175.
(See Acknowledgment of Notice of Appeal, September 18, 1984)
The State argued that the claims for expenditures in FY 1979 and
later, totalling $1,730,279, were exempt from the statutory filing
limitations because they involved "audit exceptions or adjustments to
prior year costs." (Section 1132(a), Social Security Act) In addition,
the State contended that the claims were filed timely (2) 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 $1,730,279 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 $1,730,279 FFP for claims for expenditures in FY
1979 and later periods. * In Decision No. 521 we pointed out that the
limitation provision on filing claims in Pub. L. 96-272 was not truly a
retroactive statute, since there was a transition period where time was
allowed after passage of the statute for filing claims for expenditures
made before the law was enacted (p. 12).
MARCH 19, 1985