Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Appellate Division
SUBJECT: New York State Department of Social Services
DATE: March 21, 1996
Docket No. A-96-53
Control No. NY-95-011-ADM
Decision No. 1565
DECISION
The New York State Department of Social Services (NYSDSS)
appealed a determination by the Health Care Financing
Administration (HCFA) disallowing $713,625 in federal
financial participation (FFP) claimed for the quarter
ended June 30, 1995. 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 Board 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 relation to a prior summary decision in DAB No. 1425,
the parties agreed that the disallowances relating to WMS
at issue in these cases do not include any costs
pertaining solely to input or transmission of data to the
MMIS. Therefore, no remand is necessary in this case.
In its notice of appeal of the present disallowance,
NYSDSS continued to disagree with the Board's analysis in
DAB No. 1405, but acknowledged that the facts and
circumstances were "substantially similar" and consented
to a summary decision in this case without further
proceedings. HCFA did not object to this course of
action.
We therefore sustain the disallowance of $713,625 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