Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Appellate Division
SUBJECT: New York State
DATE: June 5, 1990
Department of Social Services Docket No. 90-61
Decision No. 1163
DECISION
The New York State Department of Social Services (State) appealed the
decision by the Health Care Financing Administration (HCFA) to disallow
$877,335 in federal financial participation (FFP) claimed under Title
XIX (Medicaid) of the Social Security Act (Act). The disallowance had
two components. First, HCFA disallowed $20,561 which represented the
difference between the State's application of the 75% FFP rate for the
training of skilled professional medical personnel (SPMP) and the 50%
FFP rate applied by HCFA on the basis that the training costs in
question were for general administrative training unrelated to SPMP
functions. Second, HCFA disallowed $856,774 claimed by the State as a
Medicaid administrative cost for three contracts for training employees
who deliver care at facilities. HCFA asserted that the costs of
training facility employees are not administrative costs, but rather
must be claimed through the facility's per diem rate claimed to HCFA as
a medical assistance cost. Both these issues have been previously
considered by the Board.
In New York State Dept. of Social Services, DAB No. 1008 (1989), at
pages 5-7, the Board held that the SPMP enhanced rate of FFP is narrowly
limited under the applicable regulations to training, whether medical or
administrative, of SPMP related to their functions as SPMP. The Board
found that the training at issue was in general administrative subjects
and that there was no evidence in the record either that the SPMP
actually attended the training or that the training related to their
SPMP duties. Therefore, New York failed to establish that the training
costs were appropriately charged at the SPMP rate.
In a May 17, 1990 telephone conference, the State declared that the
factual situation surrounding the $20,561 was similar to that in DAB No.
1008. The State requested that that issue be resolved in a summary
decision based on DAB No. 1008.
In New York State Dept. of Social Services, DAB No. 1146 (1990), HCFA
contended that costs claimed by the State for the training provided to
personnel in county or city nursing homes, hospitals, and homeless
shelters were related to service delivery rather than program
administration, so that the costs could be claimed for FFP only by means
of the rate-setting mechanism established for reimbursement of the costs
of facility services. The Board considered HCFA's determination
reasonable, finding that the fact that the State Medicaid agency
contracted and paid for the training did not change the character of the
expenditure from a services cost to an administrative cost. The Board
stated that the training courses focused on direct service
responsibilities of the facilities, not on elements related to plan
administration. The Board concluded that the costs were properly
allocable to facility services, rather than State plan administration,
so that the proper mechanism for claiming the costs was through the
individual facility's per diem rate.
In a May 10, 1990 letter, the State informed the Board that the three
contracts for training costs remaining at issue in this appeal were
identical to those decided in DAB No. 1146. The State therefore
requested a summary decision based on DAB No. 1146.
HCFA did not object to the issuance of a summary decision based on the
two cited prior Board decisions.
Conclusion
Accordingly, based on the analysis in DAB Nos. 1008 and 1146, which we
incorporate by reference, we sustain the disallowance here in the amount
of $877,335.
__________________________ Judith A.
Ballard
__________________________ Alexander G.
Teitz
__________________________ Cecilia Sparks
Ford Presiding Board