DEPARTMENTAL GRANT APPEALS BOARD
DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBJECT: New York State Department of Social Services
Docket No. 86-175
Decision No. 815
DATE: December 4, 1986
DECISION
The New York State Department of Social Services (State) appealed
a
decision of the Health Care Financing Administration
(Agency),
disallowing $13,428 in federal financial participation claimed
under
Title XIX (Medicaid) of the Social Security Act (Act).
Some of the expenditures claimed by the State were made prior to
October
1, 1979, and the balance were made in the period from October 1, 1979
to
December 31, 1983.
The Agency relied for the disallowance of the claims for expenditures
made
prior to October 1, 1979 on section 306(b) of Pub. L. 96-272, and
46 Fed.
Reg. 3528 (January 15, 1981), which provided that claims for
such
expenditures had to be filed by May 15, 1981. For the claims
for
expenditures from October 1, 1979 forward, the Agency relied on
section
1132 of the Act and 45 CFR 95.7, which required that these claims
be
filed within two years after the calendar quarter in which the
state
agency made the expenditures. The Agency also stated in
the
disallowance that none of the exceptions in
45 CFR 95.19 were
applicable.
The expenditures were all claimed on a Quarterly Statement of
Expenditures
dated March 7, 1986, which was later than the filing
deadlines referred to
above.
The State first requested that the disallowance be reversed solely on
the
procedural ground that the Agency did not formally defer the amount
claimed,
as required by 45 CFR 201.15, but processed a reduction on the
grant award to
the State. The State argued that the failure of HCFA to
issue a formal
deferral notice "effectively deprived" the State of its
right "to submit
documentation to support the allowability of its
claims." (Notice of
Appeal, p.1)
Since the same procedural issue was raised by the State in Docket
Nos.
86-117 and 86-146, the Board stayed this appeal pending decision
in
either of these cases. On November 17, 1986, the Board issued a
partial
decision in both 86-117 and 86-146. We concluded in Decision
No. 807
that even if the Agency had failed to follow the procedure set out in
45
CFR 201.15 when it deferred the claims, the Board would not reverse
the
disallowances on that basis.
That decision is directly applicable here, and so we decide the
procedural
issue in favor of the Agency. We point out, as we
did in
Decision No. 807 in reference to 86-146, that there was no
reason for
the Agency to defer the claims and ask for any additional
documents or
materials under 45 CFR 201.15, if, as the State admitted, the
claims
were filed too late under the Board's reasoning in New York
State
Department of Social Services, Decision No. 521, March 6, 1984.
It
therefore made no difference that the Agency in effect deferred
the
claim, and in doing so, may not have followed the appropriate
procedure.
The State in any event had the opportunity to submit documentation
to
the Board during the appeal process.
The State in its notice of appeal requested that if the Board accepted
the
disallowance as "procedurally valid," the Board should issue a
summary
decision based upon our holding in Decision No. 521.
The State 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, and which the Board rejected in Decision
No.
521. This appeal does not present any material issues of fact
which
distinguish it from Board Docket Nos. 83-170 and 83-180. The
State
submitted no new argument why Decision No. 521
was wrong.
We conclude that the claims of $13,428 disallowed here are barred
by
statutory and regulatory filing requirements and sustain
the
disallowance of this amount, based on Decision No. 521, which
we
incorporate herein.
Judith A. Ballard
Donald F. Garrett
Alexander G.
Teitz
Presiding
Board