DEPARTMENTAL GRANT APPEALS BOARD
Department of Health and Human Services
SUBJECT: New York StateDepartment of Social Services
Docket No. 87-146
Decision No. 904
DATE: October 6, 1987
DECISION
The New York State Department of Social Services (State) appealed
the
disallowance by the Health Care Financing Administration (Agency)
of
federal financial participation in the amount of $12,153,066
claimed
under title XIX of the Social Security Act (Act) for the period
January
through March 1985. The costs claimed represented amounts
originally
paid under the State-funded medical assistance program to
individuals
whom the State later determined were eligible for Medicaid on the
basis
of disability. The costs were disallowed on the ground that, at
the
time the claims were filed, there were no disability determinations
for
the individuals involved.
The Board sustained a similar disallowance in New York State Department
of
Social Services, Decision No. 854, March 31, 1987. The Board
concluded
that the claims as originally filed were not supported by
adequate
documentation and that the State's later attempts to document
the claims were
untimely under section 1132 of the Act, which imposes a
two-year deadline on
filing claims under the public assistance programs
of the Act. In a
ruling dated May 18, 1987, the Board denied the
State's request for
reconsideration of Decision No. 854.
The State contended, however, that this appeal was distinguishable
from
Decision No. 854 in that part of the State's claim here could
be
supported by disability determinations which were made before the
claims
were filed. The Board subsequently proposed to issue a summary
decision
upholding the disallowance in part based on Decision No. 854,
but
dismissing the appeal without prejudice to the extent the State
has
documentation which it alleges is timely. The parties agreed to
this
proposal, and set a date, October 13, 1987, for the State's
submission
of such documentation to the Agency. (See letter from Agency
to Board
dated September 29, 1987)
Conclusion
(1) Based on the analysis in Decision No. 854, and our ruling
on
reconsideration, both of which we incorporate here, we uphold
the
portion of the disallowance for which the State presents
no
documentation by October 13, 1987.
(2) Based on the agreement of the parties, we dismiss without
prejudice
the remaining portion of the disallowance so that the Agency
may
undertake a review of the documentation presented by the State.
Once
the Agency has completed this review, it should promptly notify
the
State in writing of its determination concerning what amount, if any,
of
the remaining portion of the disallowance stands. If the State
disputes
part or all of this Agency determination, it may return to the
Board,
for review of the disputed determination only, within 30 days
after
receiving the determination.
________________________________ Donald F. Garrett
________________________________ Alexander G. Teitz
________________________________ Norval D. (John)
Settle
Presiding Board