New York State Department of Social Services, DAB No. 904 (1987)

DEPARTMENTAL GRANT APPEALS BOARD

Department of Health and Human Services

SUBJECT:  New York StateDepartment of Social Services

Docket No. 87-146
Decision No. 904

DATE:  October 6, 1987

DECISION

The New York State Department of Social Services (State) appealed the
disallowance by the Health Care Financing Administration (Agency) of
federal financial participation in the amount of $12,153,066 claimed
under title XIX of the Social Security Act (Act) for the period January
through March 1985.  The costs claimed represented amounts originally
paid under the State-funded medical assistance program to individuals
whom the State later determined were eligible for Medicaid on the basis
of disability.  The costs were disallowed on the ground that, at the
time the claims were filed, there were no disability determinations for
the individuals involved.

The Board sustained a similar disallowance in New York State Department
of Social Services, Decision No. 854, March 31, 1987.  The Board
concluded that the claims as originally filed were not supported by
adequate documentation and that the State's later attempts to document
the claims were untimely under section 1132 of the Act, which imposes a
two-year deadline on filing claims under the public assistance programs
of the Act.  In a ruling dated May 18, 1987, the Board denied the
State's request for reconsideration of Decision No. 854.

The State contended, however, that this appeal was distinguishable from
Decision No. 854 in that part of the State's claim here could be
supported by disability determinations which were made before the claims
were filed.  The Board subsequently proposed to issue a summary decision
upholding the disallowance in part based on Decision No. 854, but
dismissing the appeal without prejudice to the extent the State has
documentation which it alleges is timely.  The parties agreed to this
proposal, and set a date, October 13, 1987, for the State's submission
of such documentation to the Agency.  (See letter from Agency to Board
dated September 29, 1987)

Conclusion

(1)  Based on the analysis in Decision No. 854, and our ruling on
reconsideration, both of which we incorporate here, we uphold the
portion of the disallowance for which the State presents no
documentation by October 13, 1987.

(2)  Based on the agreement of the parties, we dismiss without prejudice
the remaining portion of the disallowance so that the Agency may
undertake a review of the documentation presented by the State.  Once
the Agency has completed this review, it should promptly notify the
State in writing of its determination concerning what amount, if any, of
the remaining portion of the disallowance stands.  If the State disputes
part or all of this Agency determination, it may return to the Board,
for review of the disputed determination only, within 30 days after
receiving the determination.

 

 ________________________________ Donald F. Garrett

 

 ________________________________ Alexander G. Teitz

 

 ________________________________ Norval D. (John) Settle
 Presiding Board