DEPARTMENTAL GRANT APPEALS BOARD
Department of Health and Human Services
SUBJECT: Alabama Medicaid Agency
Docket No. 87-153
Decision No. 917
DATE: October 27, 1987
DECISION
The Alabama Medicaid Agency (Alabama) appealed a determination by
the
Health Care Financing Administration (HCFA) disallowing $105,651
in
federal financial participation (FFP) claimed by Alabama under
the
Medicaid program for the fiscal quarter ending March 31, 1987.
The
disallowance represented a reduction of enhanced funding (from 75%
to
70% FFP) provided for the operational costs of Alabama's
Medicaid
Management Information System (MMIS). HCFA based the
disallowance on
its disapproval of Alabama's MMIS. HCFA disapproved the
MMIS because
Alabama failed to meet a standard for orderly and timely
claims
processing in the Systems Performance Review.
This same issue was the subject of an earlier Board Decision,
Alabama
Medicaid Agency, Decision No. 880, July 6, 1987. There,
Alabama
challenged a similar disallowance on the ground that it had been
denied
administrative review for what it contended was a state plan
compliance
issue. Additionally, Alabama alleged that HCFA acted
improperly by
changing the original MMIS performance standards without
publishing
those changes in the Federal Register. Alabama also asserted
that the
timeliness of claims payment was an invalid standard by which to
assess
its MMIS, since the MMIS was not responsible for actually paying
claims.
In Decision No. 880, we rejected Alabama's arguments on these points
and
upheld the disallowance.
In the current appeal, Alabama reiterated its prior arguments and
added
that HCFA's reliance on Decision No. 880 is misplaced since
that
decision is under judicial review. 1/ We issued an Order (September
16,
1987) directing Alabama to show cause why we should not issue a
summary
decision in this appeal consistent with our holding in Decision No.
880.
2/ Responding to the Order (October 15, 1987), Alabama indicated
that
it did not object to our proposal to issue a summary decision. In
a
letter dated October 22, 1987, HCFA indicated that it agreed with
our
proposal to issue a summary decision.
Therefore, based on our analysis in Decision No. 880 (which we
incorporate
by reference here), we sustain this disallowance in the
amount of
$105,651.
________________________________
Cecilia
Sparks Ford
________________________________ Norval
D.
(John) Settle
________________________________
Alexander
G. Teitz Presiding Board Member
1. Although Alabama did not provide specific
citations, we are aware
of two pending appeals involving Decision No. 880:
Alabama Medicaid
Agency v. Bowen, No. C.A. 87-H-823-N (M.D. Ala., filed Aug.
20, 1987);
and Alabama Medicaid Agency v. Bowen, No. 87-7531 (11th
Cir., filed
Sept. 2, 1987).
2. In a cover letter accompanying the Order, we
explained to Alabama
that where we receive an appeal involving issues
previously contested by
a state, which we have addressed in a decision, and
no new substantive
arguments have been made, it is our practice to issue a
summary decision
thereby enabling a state to take whatever steps it sees as
necessary to
preserve its