GAB Decision 175
April 30, 1981 Missouri Department of Social Services; Board Docket
Nos. 79-16-MO-HC, 79-53-MO-HC, 79-54-MO-HC, 79-99-MO-HC, 80-80-MO-HC,
80-131-MO-HC, 81-9-MO-HC, 81-45-MO-HC Settle, Norval; Garrett, Donald
Ford, Cecilia
Introduction
By a series of disallowance letters the Health Care Financing
Administration (HCFA) disallowed Federal financial participation (FFP)
at several facilities in the State of Missouri on grounds that no valid
provider agreements were in effect between the State and the facilities.
Each docket number above corresponds with a separate disallowance
letter, except 79-16-MO-HC, which represents two disallowance letters.
Listed in the chart on page 14 is relevant information concerning each
case.
In an Order to Show Cause dated October 16, 1980, the Board proposed
to consider the above referenced cases (except 81-9-MO-HC and
81-45-MO-HC which had not at that time been appealed to the Board) and
certain other cases (involving other states) jointly with respect to the
issue of whether Federal financial participation (FFP) is available for
services to Medicaid recipients during the pendency of an appeal by a
provider from the decertification, termination, or other nonrenewal of
its certification. That Order noted that there were independent issues
which would be considered separately, and by a subsequent Order to Show
Cause dated February 11, 1981, the Board addressed those other issues
(including the issue involved in 81-45-MO-HC, in which the State adopted
the arguments made in 79-16-MO-HC and the other cases).
This decision is based on the appeals filed by the State of Missouri
and HCFA's responses to the appeals; the October 16, 1980 Order to Show
Cause, the parties' responses to that Order, a February 11-12, 1981
informal conference on the issues raised in that Order, and the
transcript of that conference; and the February 11, 1981 Order to Show
Cause, and the parties' responses to the Order.
As the chart on page 14 shows, each of the facilities in question
appears in more than one of the referenced Board docket numbers and most
of those docket numbers involve more than one facility. Accordingly,
for convenience this decision is rendered by facility.
(2) Victoria Estates Convalescent Center (Victoria) (also known as
American Convalescent Center)
Issue
The questions presented are (1) whether a provider agreement is valid
for purposes of FFP when it is entered into pursuant to a State court
order directing the State to retroactively reinstate the facility as a
certified provider and continue payments pending a hearing on whether
the State was correct in decertifying the facility, and (2) whether a
provider agreement is valid when certification is based on a plan of
correction (POC) which is disapproved by the State survey agency.
Facts
In February 1976, and on July 7-8, and July 19-22, 1976, the State
conducted surveys of Victoria and noted deficiencies. (See Agency
response dated July 11, 1979, hereafter referred to as "Agency
Response," Exhibit 1.) On or about August 26, 1976, the State notified
Victoria that it was not in compliance with standards for skilled
nursing facility (SNF) and intermediate care facility (ICF) services and
that its provider agreement would not be renewed on October 1, 1976.
(See State's Request for Reconsideration, hereafter "State's Appeal,"
dated April 4, 1979, p. 3, and Exhibit C.)
On November 24, 1976, Victoria filed suit in the Circuit Court of
Cole County, Missouri, and the Court issued an Order to Show Cause and
Temporary Restraining Order requiring the State to retroactively
reinstate Victoria as a certified provider from November 1, 1976, to
enter into a temporary provider agreement with Victoria, to make payment
to Victoria retroactively from November 1, 1976, and to refrain from
enforcing its previous recommendation of decertification. (State's
Appeal, dated April 4, 1979, Exhibit D.) The Court subsequently issued
an amended Order to Show Cause and Temporary Restraining Order on
December 28, 1976, which continued the Order entered on November 24, and
further ordered the State to continue Victoria's status as a certified
provider as it existed on August 20, 1976. (State's Appeal, April 4,
1979, Exhibit E.)
On December 29, 1976, the Division of Health (DH or State survey
agency) issued a Certification and Transmittal form (C&T) certifying
Victoria for ICF and SNF services. There is no indication in the record
that the certification was based on a new survey, and the C&T form
itself states that the certification was being made pursuant to the
court order. (Agency Response, Exhibit 5.) The Division of Family
Services (DFS or single State agency) and Victoria entered into a
provider agreement on December 30, 1976. The agreement shows an
effective date of November 1, 1976 and states on its face that it should
terminate one year from the effective date of the agreement, or upon
determination of the court case (3) in the State's favor, or upon
determination of the State's motion to dismiss in the appellate court in
the State's favor. /1/ (State's Appeal, April 4, 1979, Exhibit F.)
A C&T dated June 3, 1977 notes that the facility was voluntarily
withdrawing from the SNF program; no effective date for withdrawal is
shown. (Agency Response, Exhibit 6.) By letter dated October 26, 1977,
the Bureau of Nursing Home Licensing and Certification (apparently a
branch of the State survey agency) informed the Administrator of
Victoria that surveys conducted on October 18, 19, and 20, 1977 revealed
deficiencies which prevented certification as a provider of ICF
services. (Agency Response, Exhibits 7 and 8.)
On July 12, 13, and 14, 1978, the State again conducted a survey of
Victoria and noted deficiencies. (Agency Response, Exhibit 12.) On July
19, 1978, DFS signed an ICF provider agreement with Victoria for the
period July 1 through January 31, 1979. (Agency Response, Exhibit 10.)
On July 28, 1978, DH certified Victoria as an ICF for the period July 25
through December 31, 1978 based on a plan of correction. (Agency
Response, Exhibit 9.) On August 4, 1978, the administrator of Victoria
signed the POC, and on August 11, 1978 DH disapproved the POC. (Agency
Response, Exhibit 12.)
On September 6 and 7, 1978, Federal officials surveyed Victoria.
(Agency Response, Exhibits 11 and 12.) By letter dated October 5, 1978,
the Agency notified the State that there were differences between the
findings of the State and Federal surveys and that the State findings
alone should have precluded certification. (Agency Response, Exhibits
11 and 13.)
Discussion
The first question presented here is whether the court order is a
basis on which the Agency is authorized to provide FFP, and, if so, for
how long.
The Board dealt with similar questions in Ohio Department of Public
Welfare, Decision No. 173, April 30, 1981. The Board concluded in that
case that under MSA-PRG-11 (a Program Regulation Guide issued on
December 20, 1971 by the Commissioner, Medical Services Administration,
Social and Rehabilitation Service, the predecessor to HCFA) and 45 CFR
205.10(b)(3), FFP is available in the cost of covered services to
Medicaid recipients in nursing homes with provider agreements that have
been terminated (including cancelled) or have expired and not (4) been
renewed, where a facility appeals the adverse determination and a State
or Federal court orders the State to continue payments because of that
appeal, thereby effectively continuing the provider agreement. The
Board decided in Ohio that the Agency is authorized to reimburse the
State the Federal matching share if the facility is not upheld on
appeal, but the period of reimburseable services may not exceed 12
months from the termination or nonrenewal determination; except that if
within the 12 months a State conducts an inspection of the facility and
makes a new determination on certification, FFP may not be available
beyond the date of that determination. See Ohio, p. 14.
The record in this case reveals that the facility's provider
agreement expired on September 30, 1976; that the court order was
entered on November 24, 1976 (amended on December 28) and required the
State to make payments as of November 1, 1976; and that a determination
on the next survey was made by letter dated October 26, 1977.
Accordingly, following the Ohio decision the Agency should provide FFP
for services at Victoria for the period of 11 months from November 1,
1976 through September 30, 1977. /2/
The next question is whether the provider agreement entered into on
July 19, 1978 for the period July 1 through January 31, 1979 is valid
for purposes of FFP.
Under 42 CFR 449.10(b)(15)(vi) (1977), the Federal government is
authorized to make a determination as to whether a provider agreement
should be considered valid evidence that a facility meets all pertinent
Federal requirements for certification (substantially the same provision
is found at 42 CFR 442.30 (1978), but 1977 regulation hereafter cited
for convenience). If any one of the four failures on the part of a
State survey agency listed in 42 CFR 449.10(b)(15)(vi) is established
with respect to a particular Title XIX facility, the provider agreement
is not accepted as evidence that the facility meets the standards.
One basis for finding that the provider agreement is not evidence of
certification is the failure of the survey agency to "follow the rules
and procedures for the certification of an intermediate care facility
set forth under Section 449.33(a)(4)(ii)(B)." (42 CFR 449.10(b)(15)(
vi)(B) (1977).) Section 449.33(a)(4)(ii)(B) allows certification of a
facility which does not fully meet the required standards if "the
facility provides in writing a plan of correction acceptable to the
survey agency." The record shows that the facility was never in
compliance with ICF standards and further that the C&T was based on a
POC which was not acceptable to the State survey agency. Accordingly, we
find that the survey agency should not have certified the facility
without an acceptable POC and that the July 19, 1978 provider agreement
is not evidence of proper certification.
(5) Conclusion
Based on the foregoing, the Board concludes that HCFA should provide
FFP to Victoria from November 1, 1976 to September 30, 1977. The Board
upholds the disallowances for the remainder of the periods in question
with respect to Victoria.
Hillhaven Convalescent Center (Hillhaven)
Issue
The questions presented are (1) whether the Agency must provide FFP
under regulations allowing 30 days of additional FFP under certain
conditions, but where the State presents no evidence that it complied
with the conditions; and, (2) whether the Federal government must
provide FFP where the State has denied the facility's request for a
two-month extension of its provider agreement but a State court orders
the State to continue Medicaid payments pending a hearing on whether the
State should have granted a two-month extension of the provider
agreement.
Facts
From August 10 to 13, 1976, the State conducted a survey of Hillhaven
which revealed certain deficiencies. (Agency Response, Exhibit 17.) On
September 24, 1976, the State signed a C&T indicating
"non-certification" of Hillhaven as a provider of SNF and ICF services,
effective October 31, 1976. (Agency Response, Exhibit 16.)
On November 3, 1976, DFS notified Hillhaven that due to continuing
deficiencies, Hillhaven's Medicaid agreement with DFS would not be
renewed on October 31, 1976. (Agency Response, Exhibit 25.) On or about
November 26, 1976, Hillhaven requested that DFS grant a two-month
extension of the Medicaid agreement, and on December 7, 1976 the State
denied the request. (State's Appeal, April 4, 1979, p. 9, and Exhibits
K. L, and M; and Agency Response, p. 20.)
Hillhaven appealed to the Circuit Court of Cole County, Missouri, the
State's decertification as a provider of SNF and ICF services under
Title XIX. On December 7, 1976, Hillhaven filed a Petition for Relief,
and the Circuit Court of Cole County entered a Preliminary Writ of
Prohibition commanding the State:
... to refrain from stopping the Medicaid payments to Hillhaven until
further action by this court; and further, that on the 23rd day of
December, 1976, you show cause before this Court why you should not be
absolutely restrained from stopping said payments until you have
provided an opportunity, by hearing and/or forum, for the presentation
of evidence as stated above, have granted or denied the requested
extension based upon the evidence presented,... (State's Appeal, April
4, 1979, Exhibit K.)
(6) On December 23, 1976, the Circuit Court entered an Amended
Preliminary Writ of Prohibition which directed the State --
... to continue Hillhaven, Inc.'s status as a certified provider as
such status existed on August 1, 1976, and... to do all acts necessary
for the continuance of said status. (State's Appeal, April 4, 1979,
Exhibit L.)
Pursuant to the court orders, the State survey agency prepared a C&
Twhich stated that the facility was certified effective December 1,
1976. The C&T did not show an ending date for the period of
certification. (Agency Response, Exhibit 26.) On March 14, 1978, DFS,
DH, and Hillhaven entered into a stipulation and agreement for dismissal
of the court orders, which included as one of its provisions that the
State, if necessary, grant Hillhaven --
... a two month extension, through December 1976, of the term of the
Medicaid agreement.... (State's Appeal, April 4, 1979, Exhibit M.)
By two letters dated January 23, 1979 and one dated March 17, 1981,
the Agency disallowed FFP for services at Hillhaven for the period
November 1, 1976 through December 31, 1976.
The State has alleged that both DFS and HEW provided Hillhaven with
an additional 30 days (through November 30, 1976) of Medicaid funding to
facilitiate the relocation of patients. (State's Appeal, April 4, 1979,
p. 9.) The State presents no evidence to support this contention, and
the Agency states that it has no evidence whether this additional
funding was actually requested or allowed. (Agency Response, p. 19.)
The State also argues that the court orders overcome the usual limits
on a two-month extesion and establish the existence of a valid provider
agreement for the period November 1, 1976 to December 31, 1976. The
Agency argues that the court-ordered provider agreement, not based upon
certification that the facility is in compliance with Medicaid
standards, is not a valid provider agreement, and that without a valid
provider agreement FFP is not available.
Discussion
In order for the State to obtain FFP for SNF or ICF services for
eligible individuals for an additional 30 days in a facility whose
provider agreement has expired or has been terminated, the State had to
meet the requirements of the "30-day rule" allowing FFP --
(7)... only if such individuals were admitted to the facility before
the date of expiration or other termination of its provider agreement,
and if the State agency makes a showing satisfactory to the Secretary
that it has made reasonable efforts to facilitate the orderly transfer
of such individuals from such facility to another facility. (45 CFR
249.10(b)(4)(i)(E) and 45 CFR 249.10(b)(15)(v) (1976).)
The State has presented no evidence that it made any efforts to
facilitate the orderly transfer of any patients in Hillhaven to other
certified facilities, despite the fact that the lack of evidence was
cited in the Board's February 11, 1981 Order as a potential basis for
upholding the Agency. Therefore, FFP is not available under the 30-day
rule for services provided by Hillhaven.
With respect to the two-month extension of Hillhaven's Medicaid
agreement, the regulations in effect during the period in question
provide:
... the single State agency may extend (the term of a provider
agreement) for a period not exceeding two months where the survey agency
has notified the single State agency in writing prior to the expiration
of the provider agreement that the health and safety of the patients
will not be jeopardized thereby, and that such extension is necessary to
prevent irreparable harm to such facility or hardship to the individuals
being furnished items or services or that it is impracticable within
such provider agreement period to determine whether such facility is
complying with the provisions and requirements under the program. (45
CFR 249.33(a)(6)(1976).)
The State has presented no evidence that the survey agency provided
the single State agency with the notice required under the regulation,
although the Board noted in its February 11 Order that without such a
showing the Board could not find that the denial was inappropriate.
Furthermore, the State has not shown that the required findings were
made. Irrespective of such factors, however, the question remains
whether the State court order overcomes the Federal regulatory
requirements.
45 CFR 205.10(b)(3) makes FFP available for:
Payments of assistance within the scope of Federally aided public
assistance programs made in accordance with a court order.
(8) The Board concludes that but for the lack of a two-month
extension, the payments here are "within the scope" of the Medicaid
program. Accordingly under 45 CFR 205.10(b)(3), FFP is available for
the period in question. (See also the discussion of Sec. 205.10(b)(3)
in Ohio, supra, pp. 10-13.)
Conclusion
For the reasons stated above, the Board reverses the Agency's
disallowances of FFP for services at Hillhaven during the period
November 1 through December 31, 1976.
Department of Community Health and Medical Care (DCHMC)
Issue
The questions presented are (1) whether a certification and provider
agreement based on standards for SNF services are sufficient for the
State to claim and receive FFP for ICF services and (2) whether a
surveyor's statement, made after the period in question, regarding a
facility's compliance with conditions for participation is a sufficient
basis for claiming FFP.
Facts
The parties agree that during the period in question, March 18, 1975
to March 31, 1977, the facility was not certified as an ICF. (See
State's Appeal, April 4, 1979, p. 14; and Agency Response, p. 22.) The
C&T for the following period, April 1, 1977 to March 31, 1978, notes
certification for ICF services. (Agency Response, Exhibit 29.) Attached
to this C&T was a statement dated April 12, 1977 by a hospital nursing
consultant, regarding her survey of DCHMC during the earlier period.
(Agency Response, Exhibit 30.) She stated that she surveyed DCHMC on
January 4-5, 1977 and September 30 and October 1, 1975, that the
"SNF/ICF" was in compliance with all Medicare-Medicaid conditions,
and
that the facility had certain specialists and written agreements with
physicians. The "Statement of Deficiencies and Plans of Correction"
forms prepared after the completion of the surveys or revisits in
January 1977, April 1976, and September and October 1975, make no
reference to the facility's compliance with ICF standards, however.
(Agency Response, Exhibit 31.)
By letter dated January 23, 1979 the Agency disallowed FFP for ICF
services provided at DCHMC during the period March 18, 1975 through
March 31, 1977.
(9) Discussion
The State has argued without further explanation that SNF
certification requirements encompass those for ICFs and, in fact, are
more stringent. The State also has argued that it was merely an
oversight that the facility was not properly certified, and the
surveyor's April 12, 1977 statement "relates back" to cure the defect
for the earlier period.
It is possible that prior to the period in question here SNF
certification requirements may have overlapped with ICF requirements.
On January 17, 1974, however, the Agency published regulations at 39 FR
2220, implementing section 4 of Public Law 92-223 which transferred ICF
services to Title XIX. The regulations set forth distinct standards and
conditions which had to be met for a facility to qualify as an ICF and
the methods and procedures to be followed by States in certifying ICFs.
To be qualified as an ICF, a facility had to meet the newly promulgated
standards for ICF participation by March 18, 1975. (45 CFR
249.10(b)(15)(i)(E) and (ii)(A), and see 30 FR 2235 for effective date.)
Also on January 17, 1974, the Agency published 39 FR 2254, requiring
separate ICF certifications and provider agreements.That regulation,
effective February 19, 1974, requires that the single State agency,
"prior to execution" of the provider agreement for ICF services, obtain
certification from the State survey agency that the facility meets ICF
standards.(45 CFR 249.33(a)(2).)
Under 1974 and subsequent regulations, certain criteria for SNF and
ICF certification are different. (See generally 45 CFR 249.33(a)(1) and
(2), 249.10(b)(4)(i), 249.10(b)(15) and 249.12 (1974) and 42 CFR
405.1101 (1977).) Although the State may be correct that SNF standards
are generally more stringent than ICF standards, the State incorrectly
asserts that SNF standards encompass ICF standards such that
qualification as a SNF necessarily means qualification as an ICF.
The State argues, in effect, that the surveyor's statement fulfilled
the certification requirements. That statement is deficient for several
reasons. Under regulations in effect during the period in question, a
certification was not complete until a determination was made on the
results of the survey. (See Maryland Department of Health and Mental
Hygiene, Decision No. 107, July 2, 1980.) There is no evidence here that
the survey agency (as opposed to the consultant who conducted the
survey) ever made a determination on the results of the survey, much
less at the appropriate time. Moreover, even if the surveyor's
statement could be viewed as the survey agency's determination, the
statement does not contain the necessary information for proper (10)
certification, e.g., period of certification is not specified. (See New
Jersey Department of Human Services, Decision No. 137, December 1,
1980.) Furthermore, it is clear from the regulations and New Jersey,
supra, that a certification entails the survey agency communicating
information about the facility to the single State agency prior to
execution of the provider agreement. That was absent here.
Conclusion
For the foregoing reasons, the Board upholds the disallowance of FFP
for ICF services provided by DCHMC during the period March 18, 1975 to
March 31, 1977.
Compton Hill Convalescent Center (Compton) (also referred to as Mercy
Convalescent Center)
Issue
The primary question presented is whether the operation of a facility
by a State agency as agent for a State court overrides Medicaid
regulations such that the State is eligible for FFP without having
certified, or entered into a provider agreement with the facility.
Facts
State surveys of Compton conducted in February, April, and May, 1978
revealed certain deficiencies. (See Agency Response, Exhibit 33.) A
"Statement of Dificiencies and Plan of Correction" was formulated,
but
disapproved by the State on June 26, 1978. (Agency Response, Exhibit
33.)
The State notified the facility that its SNF and ICF certification
and provider agreement, which expired on June 30, 1978, would not be
renewed. (Agency Response, Exhibits 34 and 35.) The Circuit Court of
the City of St. Louis assumed control over Compton on July 27, 1978 and
appointed the Director of the Department of Social Services as its agent
to manage Compton. On October 16, 1978, the Circuit Court terminated
its jurisdiction over Compton and released the Director as its agent
effective October 31, 1978.
The parties agree that no certification or provider agreement was in
effect for the period July 1, 1978 through November 31, 1978. The
facility was subsequently certified as an ICF for the period December
28, 1978 through June 30, 1979. (Agency Response, June 19, 1979, p.
3-5, and Exhibit 1.) The record contains a provider agreement for ICF
services showing an effective date of December 1, 1978. (State's
Appeal, April 12, 1979, pp. 8-9, State's Appeal, May 17, 1979, Exhibit
C.)
(11) By letters dated February 8, 1979, April 26, 1979, and April 14,
1980, the Agency disallowed FFP for the period July 1, 1978 through
April 30, 1980, on grounds that the State did not have in effect the
appropriate certifications and provider agreements to support its claims
for FFP for services provided at the facility during that period. /3/
Discussion
The State has admitted that there was no certification or provider
agreement with the facility for the period July 1, 1978 through November
31, 1978. (State's Appeal, May 17, 1979, p.6.) The State has argued,
however, that because the State, through the Circuit Court and Director
of the Department of Social Services, assumed control of the facility it
was not sensible for the State to do what amounted to certifying itself
and entering into a provider agreement with itself. The State has
argued further that while technically there was no certification or
provider agreement, the facility did meet all of the requirements for
participation during the entire period it was operated by the State
(July 27 through October 31, 1978) and was, therefore, certified and had
a valid provider agreement for that period. The Agency has argued that
the regulations do not provide for exceptions to certification and
execution of a provider agreement when the State operates a nursing
home.
Under the regulations, FFP in payments to a facility providing SNF
and ICF services is available only if the facility has met all
requirements for participation in the Medicaid program as evidenced by
provider agreements. (See 42 CFR 442.30(a) (1978) and 42 CFR 449.10(
b)(4)(i)(C) and (b)(15)(i)(E) (1977).) The execution of a provider
agreement is contingent upon certification of the facility by the State
survey agency. (See 42 CFR 442.12 (1978), and 45 CFR 449.33(a) (1977).)
The survey agency is required to certify that the facility is in
compliance with each condition of participation. (See 42 CFR 442.100
(1978) and 42 CFR 449.33(a)(4)(i) (1977).) In order for a State to
obtain FFP, the execution of the provider agreement must be in
accordance with Federal regulations. (See 42 CFR 442.12 (1978), and 45
CFR 449.33(a)(6) (1977).)
(12) The State argues that compliance with Federal standards is
necessarily implied by State operation of the facility. Such an
implication alone falls short of meeting the regulatory requirements,
and there is no exception in the regulation to the above stated
requirements for a facility operated by the head of a State agency as
agent for a State court. The facility was decertified initially due to
deficiencies and there is no evidence that, during the period the
facility was operated by the State (July 27 - October 31), a proper plan
of correction was implemented or that the deficiencies were corrected.
/4/ Accordingly, the Board upholds the disallowance for the period July
27 through October 31, 1978.
The State did not operate the facility during the period July 1
through July 27, 1978 or the period November 1, 1978 through November
31, 1978. The State admits that there were no certifications or
provider agreements for those periods. Since certifications and
provider agreements are prerequisits to FFP, the disallowances for
services provided during these periods was appropriate.
The State has argued that it should receive FFP for services provided
during December 1978, and presumably thereafter, on grounds that the
facility was certified and had an ICF provider agreement effective
December 1, 1978. The record shows, however, that the facility was
certified effective December 28. Under the regulations a provider
agreement is not effective prior to certification of the facility. (42
CFR 442.12(a) (1978) and 45 CFR 449.33(a)(2) (1977), and see Maryland,
Decision No. 107, supra.) Accordingly, the ICF provider agreement here
could not be effective prior to December 28, 1978, and the disallowance
of FFP for SNF and ICF services provided up to that date was
appropriate.
The record indicates that the disallowance of FFP for December 28,
1978 through April 30, 1979, was for SNF services only. (See
disallowance letter dated April 14, 1980.) /5/ The record contains no
evidence of a (13) provider agreement or certification for SNF services
in effect during this period, and the State has made no arguments or
showing to the contrary. Accordingly, the Board upholds the
disallowance for SNF services provided between December 28, 1978 and
April 30, 1979.
Conclusion
Based on the foregoing, the Board upholds the disallowance of FFP for
services provided by Compton during the period July 1, 1978 through
April 30, 1979.
Summary
The Board upholds in part and reverses in part the disallowances in
these cases as set forth in the conclusion section for each facility
discussed above.
(14)
Board HCFA Date of Appeal Docket Docket
Disallowance Date Facility Amount Q.E 79-16 MO/78/01/112
1/23/79 4/4/79 Victoria $64,0533/3 Hillhaven DCHMC
MO/78/01/114 1/23/79 4/4/79 Victoria $377,3803/3
Hillhaven 6/3
9/3
79-53 MO/78/01/139 2/2/79 4/12/79 Victoria $134,5906/3
79-54 MO/78/01/214 2/8/79 4/12/79 Victoria $197,8509/3
Compton 79-99
MO/79/01/008 4/26/79 5/17/79 Victoria $205,71712/ Compton
80-80 MO/79/01/151 4/14/80 6/4/80 Victoria $140,5176/3
Compton 9/3
80-131 MO/79/01/198 7/18/80 9/4/80 Victoria $95,3479/3
12/
81-9 MO/80/01/058 11/17/80 1/26/81 Victoria $25,5673/3
81-45 MO/80/01/066 3/17/81 3/24/81 Hillhaven $16,17512/
3/3
/1/ The State apparently received FFP for the period October 1
through October 31 for some reason not specified in the record. /2/
Continued FFP is based on the court order which required payments to the
facility beginning November 1. Under Ohio, the maximum period for which
FFP would be available begins with the period covered by the court order
and ends 12 months after the expiration of the provider agreement.
/3/ In its February 11, 1981 Order the Board implied that the period for
which services were disallowed was July 1, 1978 through November 31,
1978, whereas the period was actually July 1, 1978 through April 30,
1979. The disallowance letters gave notice to the State of the correct
period involved. /4/ See generally, New Jersey Department of
Human Services, Decision No. 164, April 30, 1981. /5/ The disallowance
letters do not specifically state whether during this period the
disallowance was for SNF or ICF services, although the April 14, 1980
letter indicates that it was for SNF services. The Agency attorney
implies that ICF disallowances after December 28 would be improper.
(See Agency Response, dated June 19, 1979, p. 5.) If the State and
Agency later determine that any amounts disallowed between December 28,
1978 and April 30, 1979 were for ICF services, the Agency should adjust
the disallowance accordingly. /1/ Q.E. = Claim submitted on expenditure
report for quarter ending as shown. /2/ Not a
duplication of amounts disallowed in 80-80-MO-HC for same quarter.
SEPTEMBER 22, 1983