GAB Decision 764
July 9, 1986
New York State Department of Social Services;
Docket No.86-92
Ballard Judith A.; Garrett, Donald F. Teitz, Alexander G.
The New York State Department of Social Services (State) appealed the
disallowance by the Health Care Financing Administration of $358,222 in
federal financial participation claimed by the State under the Medicaid
program. The amount disallowed was claimed on a Quarterly Statement of
Expenditures submitted for the quarter ending September 30, 1985 and
dated November 1, 1985.
The disallowance letter stated that the expenditure report
included
Medical Assistance claims for public providers which or related
to
expenditures made during calendar quarters that ended on or
before
September 30, 1983. The disallowance went on to say that all
these
claims related to expenditures made after September 30, 1979.
The
letter gave as the reason for the disallowance that such claims had
to
be filed within two years after the calendar quarter in which the
State
made the expenditures, as provided in section 1132 of the
Social
Security Act and implementing regulations at 45 CFR 95.7.
The State in its notice of appeal first challenged the sufficiency of
the
notice of disallowance on its face because it did not specify why
the claim
was untimely. The State argued that the statement that "all
of the
claims in question relate to expenditures made after September
30, 1979" did
not "clearly indicate" why a claim filed on November 1,
1985 was
untimely.
The Board in its acknowledgement of the notice of appeal denied
the
State's motion to dismiss the disallowance. The Board pointed out
that
the only significance to the statement that all the claims in
question
related to expenditures made after September 30, 1979, is that
the
two-year filing period requirement established by section 1132 of
the
Social Security Act is applicable to expenditures made on or
after
October 1, 1979.
The Board stated that on the face of the disallowance the claim
was
clearly untimely. The disallowance stated that the expenditures
were
made no later than September 30, 1983, and the claim was not filed
until
November 1, 1985. Such a claim could not meet the two-year
timely
filing requirement of section 1132 and 45 CFR 95.7.
After denying the motion to dismiss, the Board offered the State
the
opportunity to request further particulars regarding the
disallowed
claim. The State said it did not seek any additional
particulars, and
never disputed the Agency's statements concerning the dates
of the
expenditures.
The State in its notice of appeal also repeated the arguments
pertaining
to the applicability of the relevant filing requirements which it
had
put forward in Board Docket Nos. 83-170 and 83-180, decided in New
York
State Department of Social Services, Decision No. 521, March 6,
1984.
The State admitted that this appeal does not present any material
issues
of fact which distinguish it from Board Docket Nos. 83-170 and
83-180.
The State requested the Board to issue a summary decision based upon
our
holding in Decision No. 521 if the Board refused to dismiss
the
disallowance. In its notice of appeal the State submitted no
new
argument why Decision No. 521 was wrong.
CONCLUSION
We find no merit in the arguments made by the State. We conclude
that
the claims here are barred by statutory and regulatory
filing
requirements and sustain the disallowance of $358,222, based on
Decision
No. 521, which we incorporate herin, and our analysis in the denial
of
the motion to dismiss the disallowance of the State's
additional
arguments. . MARCH 28, 1987