Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Appellate Division
SUBJECT: New York State Department
DATE: September 10, 1990
of Social Services Docket No. 90-178
Decision No. 1194
DECISION
The New York Department of Social Services (State) appealed a
determination of the Health Care Financing Administration (HCFA)
disallowing $647,575 in federal financial participation (FFP) claimed by
the State under Title XIX of the Social Security Act for the quarter
ended March 31, 1990. The State's claim was for costs associated with
its Welfare Management System in New York City (WMS/NYC). HCFA
disallowed the costs claimed at the 75 percent rate for operation of
WMS/NYC. The amount disallowed represents the difference between FFP at
the 75 percent enhanced funding rate (available for operational costs of
an approved mechanized claims processing and information retrieval
system), and FFP at 50 percent (the rate generally available for
administrative costs of the Medicaid program).
In its Notice of Appeal, the State indicated that the issues in this
appeal were similar to the issues decided in New York Dept. of Social
Services, DAB No. 1145 (1990), and requested that the Board issue a
summary decision based on that decision. HCFA had no objection. See,
also, New York Dept. of Social Services, DAB No. 1170 (1990) (a summary
decision based on DAB No. 1145).
In DAB No. 1145, the Board sustained HCFA's disallowance of operational
costs of the WMS/NYC. The Board found that the State's claim for 75
percent FFP for the operation of its WMS/NYC was improper because HCFA
had not yet reviewed the system and approved it as operational. The
Board determined:
o Only 50 percent funding is available for Medicaid
administrative costs unless the State shows that the special
requirements for a higher rate are met.
o The WMS/NYC must be approved by HCFA in order to receive
enhanced funding for operational costs of the system. o
HCFA has the authority to require a review of WMS/NYC in accordance
with the regulations and policy for mechanized claims
processing and information retrieval systems.
o HCFA informed the State that enhanced funding was subject to
its review and approval.
o HCFA's authority is not limited to initial approval of the MMIS
(Medicaid Management Information System) or an annual System
Performance Review of the MMIS.
o HCFA's actions in reviewing the WMS/NYC and Upstate WMS were
consistent with HCFA policy and reasonable.
Therefore, we sustain the disallowance of $647,575 based on DAB No.
1145, which we incorporate by reference.
Cecilia Sparks Ford
Norval D. (John) Settle
Judith A. Ballard Presiding Board