New York State Department of Social Services, DAB No. 886 (1987)

DEPARTMENTAL GRANT APPEALS BOARD

Department of Health and Human Services

SUBJECT:  New York State Department  of Social Services

Docket Nos. 86-144, 86-198, 87-104
Decision No. 886

DATE:  August 4, 1987

The New York State Department of Social Services (State)separately
appealed three disallowances by the Health CareFinancing Adminis#ration
(HCFA) #f federal financialparticipation claimed under title XIX of the
Social Security Act(Act).  Docket No. 86©144 involves a disallowance of
$100,942,328claimed for the period April 1983 through March 1984.
Docket No.86©198 involves a disallowance of $18,757,164 claimed for
theperiod April through June 1984.  Docket No. 87©104 involves
adisallowance of $44,256,184 claimed for the period July throughDecember
1984.  The costs claimed represented amounts originallypaid under the
State©funded medical assistance program toindividuals whom the State
later determined were eligible forMedicaid on the basis of disability.
The costs were disallowedthe ground that, at the time the claims were
filed, there were nodisability determinations for the individuals
involved.

Proceedings in Docket Nos. 86©144 and 86©198 were stayed pendingthe
issuance of a decision by the Board in an earlier appealinvolving a
similar disallowance.  The State contended, however,that these stayed
cases, as well as Docket No. 87©104, weredistinguishable from the
earlier appeal in that part of theState's claims in each case could be
supported by disabilitydeterminations which were made before the claims
were filed.

In New York State Department of Social Services, Decision No.854, March
31, 1987, the Board upheld the di#allowance of costsreclassified as
payments to Medicaid©eligibles, concluding thatthe claims as originally
filed were not supported by adequatedocumentation and that the State's
later attempts to document theclaims were untimely under section 1132 of
the Act, which imposesa two©year deadline on filing claims under the
public assistanceprograms of the Act.  Specifically, the Board found
that not onlyhad the State not made the required disability
determinations

at the time the claims were filed, but also that there was noassurance
at that time that the medical report and social historyrequired to
support a disability determination existed and couldbe easily retrieved.
In a ruling dated May 18, 1987, the Boarddenied the State's request for
reconsideration of Decision No.854.

The parties subsequently agreed that it would be appropriate forthe
Board to issue a summary decision upholding in part thedisallowance in
Docket Nos. 86©144, 86©198, and 87©104 based onDecision No. 854, but
dismissing the appeals without prejudice toÜj

”Conclusion•

(1) Based on the analysis in Decision No. 854, and our ruling
onreconsideration, both of which we incorporate here, we uphold
theportion of the disallowance in Docket No. 86©144 (i.e.,$83,361,063)
and the portion of the disallowance in Docket No.86©198 (i.e.,
$17,648,566) for which the State has presented noevidence of timely
documentation, and the portion of thedisallowance in Docket No. 87©104
for which the State presents nosuch evidence of timely documentation by
August 5, 1987.

(2) Based on the agreement of the parties, we dismiss withoutprejudice
the remaining portions of the disallowances in thesethree cases, so that
HCFA may undertake a review of thedocumentation presented by the State.
Once HCFA has completedthis review, it should promptly notify the State
in writing ofits determinations concerning what amounts, if any, of
theremaining portions of the disallowances stand.  If the Statedisputes
part or all of these HCFA determinations, it may returnto the

Board (for review of the disputed determinations only) withinthirty (30)
days after receiving HCFA's written notice.

 


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