New York State Department of Social Services, DAB No. 1425 (1993)


  Department of Health and Human Services

        DEPARTMENTAL APPEALS BOARD

     Appellate Division


SUBJECT:        New York State                  DATE: July 20, 1993
   Department of Social Services            Docket
   No. A-93-170 Decision No. 1425

   DECISION

The New York State Department of Social Services (NYSDSS) appealed a
determination by the Health Care Financing Administration (HCFA)
disallowing $1,013,726 in federal financial participation (FFP) claimed
for the quarter ended December 31, 1992.  The disallowance amount
represented the difference between the 75 percent enhanced funding rate
available for administrative costs attributable to the operation of New
York's Medicaid Management Information System (MMIS) under Title XIX of
the Social Security Act (Act) and the 50 percent rate generally
available for Medicaid administrative expenses.  The costs at issue were
expenditures for New York's Welfare Management System (WMS).  HCFA
determined that eligibility determination systems, including WMS, were
excluded by regulation from enhanced funding as part of the MMIS.  See
42 C.F.R. . 433.112(c).

NYSDSS argued that the regulations were intended to apply only to
certain eligibility determination systems, known as Family Assistance
Management Information Systems (FAMIS), which receive funding under
Title IV-A of the Act.  NYSDSS contended that WMS continued to qualify
for enhanced funding as an enhancement to the MMIS despite the
regulations, because WMS is not a FAMIS and because WMS performs some
function beyond eligibility determination (relating among other things
to determining third party liability).

The issues presented by this case were previously addressed in New York
State Department of Social Services, DAB No. 1405 (1993).  In that
decision, the Board found that the regulations applied to WMS.  Further,
the Board concluded that expenditures for WMS did not qualify for
enhanced funding as an enhancement to the MMIS.  The Board rejected
NYSDSS's arguments that  costs relating to post-eligibility
determination and third party liability functions performed by WMS
independently qualified for enhanced funding, except that the Bard
remanded to HCFA to determine if any portion of the costs were allowable
because they pertained solely to the input or transmission of data to
the MMIS.

In its notice of appeal of the present disallowance, NYSDSS continued to
disagree with the Board's analysis in DAB No. 14 5, but ac@

We therefore sustain the disallowance of $1,013,726, based on the
reasons and analysis set forth in DAB No. 1405, which we incorporate
here in full.

 


      ___________________________
       Judith A.
       Ballard

 


      ___________________________
       Norval D. (John)
       Settle

 


      ___________________________
       M. Terry Johnson
       Presiding Board
       Member