Washington State Department of Social and Health Services, DAB No. 1033 (1989)

DEPARTMENTAL APPEALS BOARD

Department of Health and Human Services

SUBJECT: Washington State Department DATE: April 6, 1989 of
Social and Health Services Docket No. 88-128 Decision
No. 1033

DECISION

The Washington Department of Social and Health Services (State) appealed
a determination by the Health Care Financing Administration (HCFA,
Agency) disallowing $149,470 in federal financial participation claimed
by the State under Title XIX of the Social Security Act (Medicaid) for
the period July 1, 1986 through December 31, 1987. The State claimed
federal financial participation (FFP) for salaries of certain State
employees at an enhanced FFP rate of 75% for compensation of skilled
professional medical personnel (SPMP). The Agency disallowed the
portion of the State's claim which exceeded the 50% rate generally
applicable to administrative costs for the Medicaid program. The Agency
determined that none of the individuals claimed by the Mental Health
Division as SPMP had "professional education and training in the field
of medical care or appropriate medical practice" and that one employee
did not qualify as "directly supporting staff."

The disallowance of $149,470 was for 13 positions claimed at the 75%
rate. The State in its brief indicated that it was appealing the
disallowance only as it applied to eight positions (seven SPMP positions
and one direct support staff position). Accordingly, both parties
agreed that the actual amount in dispute is probably approximately
$100,000, but that the exact amount could be determined on remand by the
parties. The parties also agreed to determine on remand the precise
amount of time each individual spent performing SPMP or direct support
functions if the Board reversed part of the Agency's disallowance.

This decision concerns the educational and functional limitations set
forth at 42 C.F.R. 432.50(d)(1)(ii) and (iii) (1986). These limitations
specify that SPMP have "professional education and training in the field
of medical care or appropriate medical practice" and that SPMP have
"duties and responsibilities that require those professional medical
knowledge and skills." This decision also concerns the support staff
limitation set forth at 42 C.F.R. 432.50(d)(1)(v). This limitation
specifies that "directly supporting staff. . . provide clerical services
that are directly necessary for the completion of the professional
medical responsibilities and functions of the skilled professional
medical staff" and "the skilled professional medical staff must directly
supervise the supporting staff and the performance of the supporting
staff's work." The regulations provide that all applicable limitations
must be met for 75% FFP to be available.

For the reasons discussed below, our determinations on the seven SPMP
positions (one position was filled by two different employees) and the
one directly supporting staff position are as follows:

o We sustain the disallowance for two employees who do not qualify
as SPMP because they did not meet the educational limitation;

o We reverse the disallowance for two employees who we
determine qualify as SPMP to the extent of their time spent in
performance of SPMP functions, because these employees met both
the educational and functional limitations;

o We reverse the disallowance for one direct support employee for
the amount of time (to be determined on remand) this employee
directly supports the work of SPMPs; and

o We remand part of the disallowance regarding four employees
for further consideration by the Agency as to whether these
employees meet the educational limitation and if so, the extent
of their time spent in performance of SPMP functions.

I. Applicable Law, Regulations, and Guidelines

Section 1903(a)(2) of the Social Security Act provides for FFP at the
increased rate of 75% for states' Medicaid costs which are properly
attributable to the compensation or training of SPMP. Costs for state
personnel who do not meet the SPMP requirements are reimbursable at the
50% rate generally applicable to FFP claims for costs of administration.
Section 1903(a)(7).

Agency implementing regulations at 42 C.F.R. 432.50(b)(1) (1986) provide
75% FFP for skilled professional medical personnel. Section
432.50(b)(6) implements the 50% matching provision generally applicable
to FFP claims for costs of administration.

The term "skilled professional medical personnel," which is not defined
in the Act, is defined at 42 C.F.R. 432.2 as:

. . . physicians, dentists, nurses, and other specialized medical
personnel who have professional education and training in the field
of medical care or appropriate medical practice and who are in an
employer-employee relationship with the Medicaid agency. It does
not include other nonmedical health professionals such as public
administrators, medical analysts, lobbyists, senior managers or
administrators of public assistance programs or the Medicaid
program.

"Directly supporting staff" is defined also at 42 C.F.R. 432.2 as:

. . . secretarial, stenographic, and copying personnel and file and
records clerks who provide clerical services that directly support
the responsibilities of skilled professional medical personnel, who
are directly supervised by the skilled professional medical
personnel, and who are in an employer-employee relationship with
the Medicaid agency.

Section 432.50(d) of 42 C.F.R. states the following limitations on the
availability of 75% FFP:

(1) Medicaid agency personnel and staff. The rate of 75 percent
FFP is available for skilled professional medical personnel and
directly supporting staff of the Medicaid agency if the following
criteria, as applicable, are met:

* * * *

(ii) The skilled professional medical personnel have professional
education and training in the field of medical care or appropriate
medical practice. "Professional education and training" means the
completion of a 2-year or longer program leading to an academic
degree or certificate in a medically related profession. This is
demonstrated by possession of a medical license, certificate, or
other document issued by a recognized National or State medical
licensure or certifying organization or a degree in a medical field
issued by a college or university certified by a professional
medical organization. Experience in the administration, direction,
or implementation of the Medicaid program is not considered the
equivalent of professional training in a field of medical care;

(iii) The skilled professional medical personnel are in positions
that have duties and responsibilities that require those
professional medical knowledge and skills. * * * *

(v) The directly supporting staff are secretarial, stenographic,
and copying personnel and file and records clerks who provide
clerical services that are directly necessary for the completion of
the professional medical responsibilities and functions of the
skilled professional medical staff. The skilled professional
medical staff must directly supervise the supporting staff and the
performance of the supporting staff's work.

The preamble to the final regulation provides further explanation
concerning the Agency's definition of SPMP. The preamble states that:

the law [section 1903(a)(2) of the Act] did not intend to provide
75 percent FFP merely to any staff person who has qualifying
medical education and training and experience, without regard to
his actual responsibilities. Rather, the function performed by the
skilled professional medical personnel must be one that requires
that level of medical expertise in order to be performed
effectively. Consequently, 75 percent FFP is only available for
those positions that require professional medical knowledge and
skills, as evidenced by position descriptions, job announcements,
or job classifications.

50 Fed. Reg. 46652, 46656 (November 12, 1985).

The preamble specifies examples of the functions that would meet the
basic criteria referred to as follows:

o Acting as a liaison on the medical aspects of the program
with providers of services and other agencies that provide
medical care.

o Furnishing expert medical opinions for the adjudication of
administrative appeals.

o Reviewing complex physician billings.

o Providing technical assistance and drug abuse screening on
pharmacy billings.

o Participating in medical review or independent professional
review team activities.

o Assessing the necessity for and the adequacy of medical care
and services provided, as in utilization review.

o Assessing, through case management activities, the necessity
for and adequacy of medical care and services required by
individual recipients.

50 Fed. Reg. at 46656.

II. Background

The disallowance is based upon findings made in a HCFA financial
management review of the State's SPMP expenditures. Appellant's Appeal
File, Exhibit (Ex.) 6. The Agency reviewed 21 positions claimed by the
Mental Health Division as SPMP or direct support staff and found that
none of these positions met the federal requirements. Originally, the
State disagreed with the Agency's findings on 13 positions, but actually
appealed only eight of those positions.

Specifically, the Agency found that of seven SPMP positions appealed by
the State, none of the eight incumbents in those positions had the
required professional education in a field of medical care or
appropriate medical practice. HCFA also determined that the incumbents'
positions did not have duties and responsibilities that required
professional medical knowledge and skills. HCFA further determined that
one clerical position claimed as "directly supporting staff" was not
performing clerical services directly associated with SPMP functions.
Thus, the Agency disallowed the difference between the State's claim at
the 75% rate of reimbursement for these positions and the 50% rate
generally applicable to Medicaid administrative costs.

III. Skilled Professional Medical Personnel

The State argued that the positions the Mental Health Division claimed
as SPMP qualified for enhanced reimbursement under the applicable
federal law because they were medical social workers or other
specialized personnel. The State pointed out that the legislative
history of the statutory provisions for SPMP specifically included
"medical social work personnel, and other specialized personnel" as
examples of the type of staff which would be considered SPMP. See
Report of the Committee on Finance to Accompany H.R. 6675, S.Rep. No.
404, 89th Cong., 1st Sess., Pt. 1, p. 83 (1965). The State argued that
the amended SPMP regulations and the interpretation of those regulations
by HCFA are contrary to congressional intent because they preclude 75%
FFP for "medical social workers" as well as mental health professionals
with advanced degrees who should qualify as SPMP under the legislative
history's rubric "other specialized personnel." The State further
pointed out that since the Medicaid program includes FFP for mental
health care and services, it would follow that some state mental health
professionals should qualify as SPMP in order to assure the performance
of a quality job in the mental health aspect of the Medicaid program.
Below, we examine these arguments in relation to the specific positions
in dispute.

A. Mental Health Program Administrators II

There are six Mental Health Program Administrators II claimed by the
State as SPMP. Four of these have Masters degrees in social work (Sally
H., Dorene B., Bruce W., and Ronald W.); one of these four (Sally H.)
was replaced during the last six and one-half months of the period in
dispute by Mary Ann H., an R.N. with a Masters degree in nursing
science. The sixth one, Jann H., has a Bachelor's degree in psychology
and a Masters degree in public administration. We first examine whether
the four incumbents with Masters degrees in social work meet the
educational limitation.

1. Mental Health Program Administrators with Masters Degrees in Social
Work

The State argued that Sally H., Dorene B., Bruce W. and Ronald W. met
the educational limitation of the revised regulations. The State argued
that the legislative history expressly included "social work personnel"
among the individuals Congress intended would qualify as SPMP. The
State indicated that consistent with this intent, prior to the revisions
in the SPMP regulations, "psychiatric social workers" were expressly
included in the definition of SPMP contained in the previous version of
the regulation. The State contended that despite the elimination of
this specific job title in the revised regulations, consistent with
legislative intent, "psychiatric social workers" still fall within the
classification of "other specialized personnel" who qualify as SPMP in
the revised regulation. The State also described the functions
performed by these individuals. As regional mental health program
administrators, their primary function was to assess the necessity for
and adequacy of mental health care and services provided in their
respective regions. They also assessed the adequacy of clinical
services furnished by Medicaid service providers pursuant to Title XIX
contracts, which involved utilization reviews and determining when
clinical conditions require contract exceptions. They also provided
clinical technical assistance to counties and service providers and
acted as liaisons between service providers and the Mental Health
Division staff.

Additionally, Sally H., and later her successor Mary Ann H., had
responsibility statewide for development and maintenance of rural mental
health programs, which involved evaluating the necessity for and
adequacy of services provided in rural areas of the state. Dorene B.
had the additional statewide responsibility for day treatment programs.
This involved supplying technical assistance to counties and providers
to assure that available services are appropriate for those who need
them, and that such programs are in compliance with the medical aspects
of Medicaid.

The State explained that 95% of Sally H.'s and Dorene B.'s time is spent
performing these SPMP duties, 85% of Bruce W.'s time is spent performing
SPMP functions, and 84% of Ronald W.'s time is spent performing SPMP
functions.

The Agency argued that these employees did not meet the educational
limitation because a Masters in social work was not sufficient to meet
the regulatory requirements as professional education and training in
the field of medical care or practice. Therefore, the Agency contended
that it was not necessary to discuss whether these employees also met
the functional limitation.

In the Montana appeal, the Agency had argued that the revised
regulations were not inconsistent with the legislative history of the
statute because a medical social worker is not precluded from being an
SPMP. The Agency, however, contended in Montana that a degree in social
work could not meet the educational requirement of the revised
regulations because it was not education in a medically related field.

As discussed in Montana, medical social work is considered an integral
part of the health care delivery system in this country so that social
work in the health care context is a medically related profession.
Montana, supra, pp. 3 and 4. Consequently, the Board determined that
the Agency cannot both agree that the functional definition of a
"medical social worker," as that position is defined in the Dictionary
of Occupational Titles, is appropriately considered the functions of an
SPMP and deny, across the board, SPMP status to those individuals whose
education and training is in that field. Therefore, the Board concluded
that an individual with a Masters degree in social work from an
accredited two-year graduate program and whose education (including
training received as part of academic work) has specifically included
health care and/or medical applications of social work meets the
requirements of 42 C.F.R. 432.50(d)(1)(ii) for "professional education
and training" in a medically related field. Montana, supra, pp. 17-18.

Based on that conclusion, we find that these four employees with
Masters degrees in social work (Sally H., Dorene B., Bruce W. and Ronald
W.) may have met the educational requirement for SPMP status. We agree
with the State that consistent with the legislative history of the
statutory provisions for SPMP, the functions of a "psychiatric social
worker" are appropriately considered functions of an SPMP. Moreover,
all of the functions attributed to these employees by the State as SPMP
functions are functions which the preamble to the revised regulations
indicated were appropriately considered SPMP functions. Both acting as
a liaison on the medical aspects of the program with providers of
services as well as assessing the necessity for and the adequacy of
medical care and services provided (as in utilization review) are
expressly recognized as SPMP functions. These are the functions which
these employees performed and which required professional education and
training in the field of psychiatric social work to perform. See
Appellant's Appeal File, Exs. 11-14. Therefore, we conclude that the
record here demonstrates that these position duties met the functional
limitation of the regulations necessary to qualify for SPMP status.

Thus, since the State has not had the opportunity to demonstrate, as
required by our holding in Montana, whether these employees met the
educational limitation, we remand the disallowance for these four
employees to the parties for the Agency's consideration as to whether
these individuals qualify as SPMP because their education and training
for their Masters degrees included health care (including mental health
care) and/or medical applications of social work.

Therefore, if the Agency on remand determines that these four employees
met the educational limitation, these employees qualify as SPMP and the
State is entitled to claim them at the 75% rate of reimbursement for the
actual amount of time these employees spent in the performance of their
SPMP functions.

2. Mental Health Program Administrator with a Masters Degree in
Nursing Science

The Agency indicated that it would accept the State's claim for Mary Ann
H. as SPMP for the six and one-half months she occupied this position if
the State could prove she met the functional limitation of the
regulations. The Agency, however, argued that Mary Ann H. does not meet
the functional requirement for the following reasons:

Professional education and training is the condition precedent to
arrive at the subsequent consideration of functional requirement.
Since Sally H., the Social Worker, could not pass the threshold
requirement of educational qualification, she could not have
fulfilled the functional requirement. Therefore, if the state
asserts, as it does, that both of them performed the same job
function, although Ms. [Mary Ann] H. is educationally qualified,
she could not be considered an SPMP since the deficient functional
requirement of Sally H. is ascribed to Ms. [Mary Ann] H.

Respondent's Reply Brief, p. 3.

The Agency later argued in the reply brief that "[o]nly when a social
worker has education and training in a medically related field" and
meets the regulatory criteria for the functional limitation, can he or
she be considered an SPMP. Respondent's Reply Brief, p. 5.

There is no question here that Mary Ann H. qualifies under the
educational limitation. The Agency's argument that Mary Ann H. is
somehow precluded from satisfying the functional limitation does not
follow. First, as we indicated above, Sally H. may have met the
educational limitation and we found her position duties certainly
satisfied the functional limitation. The mere fact that the State
previously may have filled a position with someone who does not qualify
as an SPMP cannot be determinative of whether the position now
qualifies. In Montana, we did not accept the Agency's contentions that
just because a position incumbent did not qualify as SPMP under the
limitation as stated in the revised regulations for education or
training in a medically related field, it could be inferred that medical
expertise was not necessary to perform the functions of a position. It
is uncontroverted that the revised regulations substantially narrow the
scope of the positions that may properly carry the label "SPMP." This
does not mean that administrative functions that are medical in nature
suddenly lose that status, even if performed by those who cannot qualify
personally as SPMP under the new regulation. In addition, while the
Agency could treat any one of the limitations on SPMP status as a
threshold requirement, since they all must be met, the failure to meet
one limitation is not dispositive of the status of a position under
other limitations. Thus, we conclude that this employee qualified as an
SPMP. Therefore, we reverse the Agency's disallowance to the extent of
time actually spent by this employee on SPMP functions (alleged to be
approximately 95%).

3. Mental Health Program Administrator with a Masters Degree in Public
Administration

The State argued that this employee's (Jann H.) combination of a
Bachelors degree in psychology and a Masters degree in public
administration comprised the equivalent of an advanced degree program in
health care. We agree with the Agency here that this combination does
not satisfy the clear requirements of the regulation of "completion of a
2-year or longer program leading to an academic degree or certificate in
a medically related profession." 42 C.F.R. 432.50(d)(1)(ii). Public
administration is clearly not a medically related profession. This
conclusion is also consistent with the definition of SPMP in the revised
regulations which specifically excludes "public administrators" from the
SPMP definition. Thus, we uphold the Agency's disallowance for this
position.

B. Mental Health Program Administrator III

The State argued that the incumbent in this position (Paul P.) has
professional education and training in a medically related profession as
required in 42 C.F.R. 432.50(d)(1)(ii). The incumbent has a Ph.D. in
psychology and possesses a "medical license to practice psychology."
Appellant's Brief, p. 10; Appellant's Appeal File, Ex. 8. The State
indicated that, in order to be a licensed "psychologist," State statute
requires that, among other things, the applicant must hold a doctoral
degree in psychology from a regionally accredited institution, must have
no fewer than two years of supervised experience, at least one of which
shall have been obtained subsequent to the granting of the doctoral
degree, and must pass the written and oral examinations prescribed by
the Examining Board of Psychology. The State contended that since the
administration of the Medicaid program involves overseeing mental health
services, a licensed psychologist is ideally suited to provide the
professional expertise necessary to administer the mental health aspects
of the Medicaid program.

The State also explained that the primary function of this position is
to supervise the medical aspects of the mental health program managed by
the incumbent's staff. The incumbent also acts as a liaison on the
medical aspects of the program with providers of services and other
agencies that provide medical care. The incumbent in addition assesses
the necessity for and adequacy of medical care and services provided
statewide in the process of developing plans for the inclusion of
medical services within the mental health program. The State indicated
that approximately 45% of the incumbent's time is spent in performing
these described functions in the administration of the Medicaid program.
Thus, the State argued that this position is partially a SPMP position.

The Agency never addressed the State's arguments that part of the
functions performed by this employee qualified as SPMP functions. The
Agency instead argued only that this employee did not have the required
"professional education and training;" therefore, it was not necessary
to discuss whether the employee met the functional limitation. The
Agency claimed that this employee did not meet the educational
limitation because "a degree in social work, psychology, counseling, or
public administration does not constitute 'professional education and
training' because those disciplines are not in a field of 'medical care
or practice'." HCFA's Brief, p. 9.

In an analogous situation, the Board found it significant that social
work in the health care context is considered a medically related
profession. Relying in part on the history of the development of
medical social work as an integral part of this country's health care
delivery system, we determined in Montana Dept. of Social and
Rehabilitation Services, DAB No. 1024 (1989), that an individual with a
two-year graduate degree in social work from an accredited college or
university whose education (including training received as part of
academic work) has specifically included health care and or medical
applications would meet the educational limitation.

Just as medical social workers are considered an important part of this
country's health care delivery system, so are psychologists. Certainly,
there is recognition in the medical arena that psychologists have an
important and expanding role in the provision of mental health services.
HCFA in fact recognizes this too in using psychologists both for the
team which certifies the need for inpatient psychiatric services for
individuals under the age of 21 and for the team which develops the
individual plans of care for those patients. 42 C.F.R. 441.152,
441.153, 441.155 and 441.156. Moreover, HCFA also reimburses as medical
assistance under the Act the services of psychologists as providers of
necessary psychological services provided to residents of intermediate
care facilities for the mentally retarded. 42 C.F.R. 442.489 and
442.490. The Agency's argument that this employee could not qualify
because the field of psychology is not a discipline in a field of
medical care or practice appears to conflict with HCFA's own recognition
of psychologists as providing medical care in the area of mental health
and was not supported by any authoritative information or analysis. As,
in essence, a conclusory characterization, we do not find the Agency's
view persuasive. Therefore, we conclude that a Ph.D. in psychology
together with a State license to practice as a psychologist meets the
educational limitation for SPMP status.

The State here argued that 45% of this employee's time is spent in
performing functions which require that he use his professional
education and training in administering the mental health aspect of the
State's Medicaid program. In light of its conclusion on the educational
limitation, the Agency had not specifically addressed whether this
employee's duties met the functional limitation. Nevertheless, the
record here is sufficient to demonstrate that this employee's duties,
discussed above, relate to the medical aspects of program administration
and are the types of management and liaison duties that are properly
regarded as SPMP. This position was regarded as SPMP under the prior
regulations and there is no basis to conclude that the proportion of the
employee's time spent on medical administration has changed. Also, this
position's role in the evaluation of the mental health services to be
provided under the State's Medicaid program is certainly a non-routine
function that is unique to medical programs. Moreover, the preamble to
the revised regulations specifically reference liaison activities as an
example of qualifying functions. Accordingly, we reverse the Agency's
disallowance for this position to the extent of time this employee
actually spent on SPMP functions.

C. Mental Health Community Program Chief

The State also contended that the position incumbent for this position
(John S.) met the educational limitation of the regulation. The State
argued that this employee had a Masters degree in counseling from an
accredited school. The State reasoned that although this degree is
somewhat unusual, it is similar to a Masters degree in social work.

The State, however, did not provide any information as to how this
degree is similar to a Masters in social work; the State did not provide
any information concerning this degree program at all. While we
determined in Montana that an individual with a Masters degree in social
work might meet the educational limitation if it could be shown that the
education and training received as part of the two-year program included
health care and/or medical applications, we concluded this only after we
determined that medical social work is an integral part of this
country's health delivery system. Therefore, we determined that a
Masters degree in social work which included academic work in health
care and medical applications would meet the educational limitation in
the regulation. Unlike for the fields of medical social work and
psychology, we do not have sufficient information to show that
counseling is a medically related profession. Therefore, we find that
this employee does not meet the educational limitation of 42 C.F.R.
432.50(d)(1)(ii), and thus, does not qualify for SPMP status. Thus, we
sustain the Agency's disallowance for this position.

D. Summary of our Conclusions for the SPMP Positions in Dispute

We sustain the Agency's disallowance for John S. and Jann H.; we reverse
the disallowance for Paul P. and Mary Ann H. to the extent of their
actual time spent in performance of SPMP functions (to be determined on
remand); and we remand four positions, Sally H., Dorene B., Bruce W. and
Ronald W., for further consideration by the Agency as to whether these
employees qualified under the educational limitation and if so, the
extent of their actual time spent in performance of SPMP functions.

Since it is unclear on this record whether the Agency would disagree in
any event with the State's time allocation for SPMP duties, the Agency
should first promptly inform the State whether it will be necessary for
the State to provide further information on remand about the percentage
of time the State asserts here these employees spent on SPMP functions.
The State will then have 30 days or such longer time as the Agency may
allow from receipt of guidance from the Agency on this point to submit
information concerning the remanded positions. If the State disagrees
with any of the Agency's determinations on remand, it may return to the
Board within 30 days of the receipt of such determination.

IV. Direct Support Staff

The State indicated that Linda D. is the only "directly supporting
staff" claimed by the Mental Health Division as qualified for the 75%
rate of FFP. Appellant's Brief, p. 21; Appellant's Appeal File, Ex. 15.
As a Secretary 2, she functioned as the primary clerical support to
professional superiors who are charged with the administration of
specific mental health programs; specifically she spent approximately
45% of her time providing direct secretarial support for Mary Ann H. and
her predecessor Sally H., Dorene B., Bruce W., and Ronald W. The State
acknowledged that her eligibility for the enhanced rate is dependent on
the eligibility of these individuals for SPMP status. Appellant's Reply
Brief, p. 12.

The Agency initially argued that the State's claim that Linda D.
qualified as directly supporting staff was unfounded because the
professionals for whom she provided support did not qualify as SPMP
under the educational limitation. In its response to the State's reply
brief, the Agency argued that only when the functional qualifications of
Mary Ann H. are proven by the State could the Agency consider allowing
Linda D.'s position as qualified support staff.

In light of our foregoing analysis on the Mental Health Program
Administrators II for whom Linda D. provides secretarial support, we
conclude that certainly the time she spent providing secretarial support
for Mary Ann H., an SPMP, in performance of her SPMP functions is
claimable at the 75% rate for directly supporting staff. If the Agency
on remand determines that the four Mental Health Program Administrators
II meet the educational limitation, then the time spent in performing
secretarial support for them in their capacity as SPMPs is claimable
also at the 75% rate. Thus, we conclude that this employee qualified as
directly supporting staff to the extent of her time spent performing
such functions for SPMP. The actual determination of how much time this
employee spent in performing direct support functions of SPMP will be
decided on remand during the process set forth in section III.D. above.

V. Conclusion

For the foregoing reasons, we sustain the disallowance for John S. and
Jann H., reverse the disallowance for Paul P. and Mary Ann H. to the
extent of their time spent in performing SPMP functions, reverse the
disallowance for Linda D. to the extent of her time spent as direct
support staff; and remand for further Agency consideration the
disallowance regarding four employees, Sally H., Dorene B., Bruce W.,
and Ronald W., who may qualify as SPMP.

________________________________ Judith A. Ballard

________________________________ Donald F. Garrett

________________________________ Cecilia Sparks Ford Presiding
Board