GAB Decision 761
June 25, 1986
New York State Department of Social Services;
Docket No. 86-75
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 (Agency) of
$2,122,548 in federal financial participation claimed by the State under
the Medicaid program. The amount disallowed was claimed on Quarterly
Statements of Expenditures for the periods October 1, 1981 to September
30, 1984.
The disallowance letter stated that the expenditure reports (QER,
HCFA-64)
included Medical Assistance claims for public providers which
related to
expenditures made during calendar quarters which ended more
than two years
prior to the filing date of the respective HCFA-64s. 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 claims
were untimely. The State argued that the statement that "all
of the
claims in question relate to expenditures made after September
30, 1979"
(emphasis by State) was confusing and unclear. The State
claimed that
this statement "does not clearly indicate why claims filed
between October 1,
1981 and September 30, 1984 were untimely."
The Board in its acknowledgment of the notice of appeal denied the
State's
motion to dismiss the disallowance, and gave the Agency the
opportunity to
furnish the Board "with sufficient information to
identify the expenditure
dates and filing dates for the various claims
referred to in the disallowance
notice." This was similar to the
procedure followed by the Board in Docket
No. 86-44, which led to
Decision No. 753, New York State Department of Social
Services, May 19,
1986.
The Agency furnished the itemized breakdown requested by the Board.
The
Agency in doing so, however, disputed the statement by the State
that
the notice of disallowance did not specify why(2) the questioned
claims
were untimely. The Agency pointed out that the disallowance
notice did
state that the claims were for expenditures made in calendar
quarters
which had ended more than two years before the claims were
filed. The
Agency also noted that all the information about dates of
filing and
claiming was available to the State in its own files, since the
QERs
were identified in the disallowance.
The State in reply still contended that the disallowance did not meet
the
requirements of 45 CFR 74.304, giving requirements for final
decisions in
disputes, since the Agency had to provide additional
factual information to
the State.
The disallowance letter indicated the legal basis for the position
that
the claims were untimely; the claims (QERs) were identified;
and the
State could identify the dates the expenditures were made and the
claims
filed. On the other hand, it is not unreasonable to expect the
Agency
to spell out detailed dates of filing and claiming, even if the
State
could look up the information in its own records.
We have already denied the State's motion to dismiss, and so far as
the
State's June 9, 1986 letter is a repetition of that motion, we
again
deny it. There was certainly no prejudice here to the
State. The
Agency furnished the itemized breakdown when requested by
the Board.
The State was given ample opportunity to question the accuracy of
this
information, and did not do so.
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,
and, if the Board refused to dismiss the disallowance, requested
the
Board to issue a summary decision based upon our holding in Decision
No.
521. 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 in addition to
the
repetition of its arguments in Docket Nos. 83-170 and 83-180.
We
conclude that the claims here are barred by statutory and
regulatory
filing requirements and sustain the disallowance(3) of $2,122,548,
based
on Decision No. 521, which we incorporate herein, and our analysis
above
of the State's additional arguments.
MARCH 28, 1987