Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Appellate Division
SUBJECT:
New York State Department of Social Services
Docket No. 90-229
Decision No. 1213
DATE: December 17, 1990
DECISION
The New York State Department of Social Services (State) appealed
a
determination of the Health Care Financing Administration
(HCFA)
disallowing $733,950 in federal financial participation (FFP) claimed
by
the State under Title XIX of the Social Security Act for the
quarter
ended June 30, 1990. The State's claim was for costs associated
with
its Welfare Management System in New York City (WMS/NYC).
HCFA
disallowed the costs claimed at the 75 percent rate for operation
of
WMS/NYC. The amount disallowed represents the difference between FFP
at
the 75 percent enhanced funding rate (available for operational costs
of
an approved mechanized claims processing and information
retrieval
system), and FFP at 50 percent (the rate generally available
for
administrative costs of the Medicaid program).
In its Notice of Appeal, the State indicated that the issues in
this
appeal were similar to the issues decided in New York State Dept.
of
Social Services, DAB No. 1145 (1990), and requested that the Board
issue
a summary decision based on that decision. HCFA had no
objection. See
also New York State Dept. of Social Services, DAB Nos.
1170 and 1194
(1990) (summary decisions based on DAB No. 1145).
In DAB No. 1145, the Board sustained HCFA's disallowance of
operational
costs of the WMS/NYC. The Board found that the State's
claim for 75
percent FFP for the operation of its WMS/NYC was improper
because HCFA
had not yet reviewed the system and approved it as
operational. The
Board determined:
o Only 50 percent funding is
available for Medicaid
administrative costs unless the State shows that
the special
requirements for a higher rate are met.
o The WMS/NYC must be approved by
HCFA in order to receive
enhanced funding for operational costs of the
system. . o
HCFA has the authority
to require a review of WMS/NYC in accordance with
the regulations and policy
for mechanized claims processing and
information retrieval systems.
o HCFA informed the State that
enhanced funding was
subject to its review and approval.
o HCFA's authority is not limited
to initial approval of
the MMIS (Medicaid Management Information
System) or an annual
System Performance Review of the MMIS.
o HCFA's actions in reviewing the
WMS/NYC and Upstate WMS
were consistent with HCFA policy and
reasonable.
Therefore, we sustain the disallowance of $733,950 based on DAB No.
1145,
which we incorporate by reference.
Cecilia Sparks Ford
Norval D. (John) Settle
Judith A. Ballard Presiding Board Member