New York State Dept. of Social Services, DAB No. 967 (1988)

DEPARTMENTAL GRANT APPEALS BOARD

Department of Health and Human Services

SUBJECT:  New York State Dept. of Social Services

Docket No. 88-98
Decision No. 967

DATE:  July 14, 1988

DECISION

The New York State Department of Social Services (State) appealed the
decision of the Health Care Financing Administration (HCFA) disallowing
$7,344,903 claimed under title XIX of the Social Security Act (Act) for
the period April 1, 1987 through December 31, 1987.  The disallowed
costs, which were included in the per diem rates for hospitals, were
incurred for supplemental malpractice insurance purchased by the
hospitals for their affiliated physicians and dentists. The disallowance
was taken on the ground that the costs were claimed under proposed State
plan amendments which were disapproved by HCFA.  Section 1903(a)(1) of
the Act requires that costs be claimed under an approved state plan in
order to be eligible for reimbursement under title XIX.

The Board previously issued a decision upholding a similar disallowance
for prior quarters.  New York State Dept. of Social Services, DGAB No.
947 (1988).  The Board observed that both parties had agreed that the
costs were not allowable absent approval of the plan amendments.
Although the State had requested pursuant to 45 C.F.R. Part 213 that
HCFA reconsider its decision disapproving the proposed plan amendments,
that proceeding was still pending.  Accordingly, the Board concluded
that the disallowance was properly taken on the ground that the costs
were not claimed pursuant to an approved State plan, and sustained the
disallowance.  The Board noted, however, that HCFA had stated that were
it to later approve the plan amendments, it would pay the costs in
question.

In its current appeal, the State indicated that the Part 213 proceeding
was still before HCFA, and requested that the Board issue a summary
decision upholding the disallowance consistent with its holding in DGAB
No. 947.  HCFA did not object to the requested action.

Conclusion

Accordingly, based on the analysis in DGAB No. 947, we sustain the
disallowance in full.  If the proposed plan amendments under which the
costs were claimed are subsequently approved by HCFA, this decision
would not preclude HCFA from carrying out its agreement to pay the
costs.

 


                            ________________________________ Donald F.
                            Garrett

 

                            ________________________________ Alexander
                            G. Teitz

 

                            ________________________________ Norval D.
                            (John) Settle