Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Appellate Division
SUBJECT: New York State Department of Social Services
DATE: May 18, 1994
Docket No. A-94-116
Decision No. 1476
DECISION
The New York State Department of Social Services (NYSDSS) appealed a
determination by the Health Care Financing Administration (HCFA)
disallowing $938,261 in federal financial participation (FFP) claimed
for the quarter ended September 30, 1993. The disallowance amount
represented the difference between the 75 percent enhanced funding rate
available for administrative costs attributable to the operation of New
York's Medicaid Management Information System (MMIS) under Title XIX of
the Social Security Act (Act) and the 50 percent rate generally
available for Medicaid administrative expenses. The costs at issue were
expenditures for New York's Welfare Management System (WMS). HCFA
determined that eligibility determination systems, including WMS, were
excluded by regulation from enhanced funding as part of the MMIS. See
42 C.F.R. 433.112(c).
NYSDSS argued that the regulations were intended to apply only to
certain eligibility determination systems, known as Family Assistance
Management Information Systems (FAMIS), which receive funding under
Title IV-A of the Act. NYSDSS contended that WMS continued to qualify
for enhanced funding as an enhancement to the MMIS despite the
regulations, because WMS is not a FAMIS and because WMS performs some
function beyond eligibility determination (relating among other things
to determining third party liability).
The issues presented by this case were previously addressed in New York
State Department of Social Services, DAB No. 1405 (1993). In that
decision, the Board found that the regulations applied to WMS. Further,
the Board concluded that expenditures for WMS did not qualify for
enhanced funding as an enhancement to the MMIS. The Board rejected
NYSDSS's arguments that costs relating to post-eligibility determination
and third party liability functions performed by WMS independently
qualified for enhanced funding, except that the Board remanded to HCFA
to determine if any portion of the costs were allowable because they
pertained solely to the input or transmission of data to the MMIS.
In relation to a prior summary decision in DAB No. 1425, the parties
agreed that the disallowances relating to WMS at issue in these cases do
not include any costs pertaining solely to input or transmission of data
to the MMIS. Therefore, no remand is necessary in this case.
In its notice of appeal of the present disallowance, NYSDSS continued to
disagree with the Board's analysis in DAB No. 1405, but acknowledged
that the facts and circumstances were "substantially similar" and
consented to a summary decision in this case without further
proceedings. HCFA agreed to this course of action.
We therefore sustain the disallowance of $938,261 based on the reasons
and analysis set forth in DAB No. 1405, which we incorporate here in
full.
___________________________ Judith A.
Ballard
___________________________ Norval D. (John)
Settle
___________________________ M. Terry Johnson
Presiding Board Member