New Jersey, Department of Human Services v. Secretary of the United States Department of Health & Human Services

748 F. Supp. 1120, 1990 U.S. Dist. LEXIS 13952
CourtDistrict Court, D. New Jersey
DecidedOctober 19, 1990
DocketCiv. No. 89-4923 (CSF)
StatusPublished
Cited by1 cases

This text of 748 F. Supp. 1120 (New Jersey, Department of Human Services v. Secretary of the United States Department of Health & Human Services) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
New Jersey, Department of Human Services v. Secretary of the United States Department of Health & Human Services, 748 F. Supp. 1120, 1990 U.S. Dist. LEXIS 13952 (D.N.J. 1990).

Opinion

OPINION

CLARKSON S. FISHER, District Judge.

Plaintiff-appellant, State of New Jersey, Department of Human Services (hereinafter “State”), appeals from two final decisions of the Departmental Appeals Board (Board), acting on behalf of the defendant-respondent, Secretary of Health and Human Services (hereinafter “Secretary”), which sustained a disallowance of federal funds for costs claimed by the State under Title XIX of the Social Security Act.1 The costs were incurred by the State in the administration of its computerized Medicaid Management Information System (MMIS) and were partially disallowed following a Health Care Financing Administration (the HCFA) review of the State’s claims for federal financial participation (FFP).

The State seeks a declaration of its right to the federal funds pursuant to federal statute, 42 U.S.C. § 1396b, and seeks an injunction precluding the Secretary from enforcing a policy which reduces the matching federal funds for particular State MMIS expenditures. The Secretary cross-moves for summary judgment dismissing the State’s complaint. For the reasons set forth below, the State’s motion will be de[1122]*1122nied, and the Secretary’s motion will be granted.

Introduction

The Medicaid program, enacted in 1965 as Title XIX of the Social Security Act, is a nationwide, state-administered medical assistance program. States wishing to participate in the program must submit a comprehensive plan conforming to certain statutory requirements. See 42 U.S.C. §§ 1396 et seq. (1990). The state plan must be approved by the Secretary. Upon implementation of the plan, the Medicaid program enables the participating state to assist individuals who cannot meet the costs of necessary medical care. The federal government, in turn, partially reimburses the state for providing the Medicaid services and for administering the program.

In 1972, Congress amended Title XIX to provide federal reimbursement of up to 90% of the state’s expenditures which were attributable to the design, development, and installation of mechanized (computerized) Medicaid claims processing and information retrieval systems. Federal reimbursement of at least 50% was provided for costs associated with the efficient operation of such systems; enhanced reimbursement (75% or 90%) was provided when prescribed by statute. See 42 U.S.C. § 1396b(a)(2) through (7). The regulations implementing the above provisions are codified in Section 433(c) of 42 C.F.R.

The regulations set forth at 42 C.F.R. Sections 433.112(a) and 433.116(a) mirror the aforesaid statutory language, providing 90% FFP for design, development, and installation of MMIS systems, and up to 75% for operation of the MMIS. Other regulations more specifically outline the expenditures for which enhanced reimbursement is awarded. For example, with respect to staffing, the FFP rate for personnel “engaged directly in the operation” of an MMIS is 75%. 42 C.F.R. § 432.50(b)(2) (1989) (emphasis added). When an individual works in an area for which enhanced reimbursement has not been authorized, however, the state is reimbursed at only 50% FFP. All miscellaneous activities necessary for the proper and efficient administration of the state program receive 50% FFP. 42 C.F.R. § 433.15(7) (1989).

A review of the evolution of the HCFA’s rules with respect to the above provisions, though lengthy, is required. The HCFA first identified the types of costs “directly attributable” to the operation of an MMIS, and hence qualified for enhanced FFP, in June 1974, in Part 7 of the Medical Assistance Manual. (Tr. 87). In April 1978, the HCFA issued Action Transmittal HCFA-AT-78-33 to clarify the applicability of 90% and 75% FFP to MMIS costs other than salary, travel, training and other compensation. (Tr. 89). In that transmittal, the HCFA stated that “all costs — direct and indirect — benefiting the operation of an approved MMIS are reimbursable at the 75% Federal matching rate.” (Tr. 89).

In July 1981, the HCFA superseded, in toto, the Medical Assistance Manual and, among other things, transmittal HCFA-AT-78-33. In its place, the HCFA issued Part 11 of the State Medicaid Manual (SSM), entitled “Medicaid Management Information System (MMIS).” (Tr. 91). Section 11275.21 of the manual provides that “FFP at either 90% or 75% may be paid only for those functions that are attributable to an MMIS.” (Tr. 95).

In February 1982, the SSM was revised in an effort to “clarify” previous policy. (Tr. 98). In so doing, the HCFA added section 11275.26, entitled List of Reimbursable Costs for State Systems. This section stated that “the higher FFP will be granted for costs that are directly incurred by the approved MMIS.” (Tr. 99) (emphasis added). Further, section 11275.26 stated that the only indirect costs eligible for the higher FFP are those “directly attributable to the MMIS.” Id. Indeed, “[ijndirect costs [which are] not directly attributable to the MMIS cost center, such as personnel, finance, etc., will be funded at 50 percent.” Id. Finally, the section stated that “[anything that is not on this list as being eligible for the higher match will only be funded at the normal [50% FFP] match.” Id.

In July 1986, the HCFA again revised Part 11 in an attempt to “clarify funding policy” with respect to MMIS-related activi[1123]*1123ties. (Tr. 102). The 1986 revisions, whose cover page bore the heading “New Policy— Effective Date: July 31, 1986,” added several new sections in an attempt to further refine the HCFA’s position as to which costs received normal federal matching funds, and which costs received enhanced FFP. (Tr. 101-23). In that regard, the HCFA Section 11275.26 was renumbered section 11275.32 and provided a table which itemized the various costs associated with the design, implementation, operation and administration of an MMIS and listed the corresponding FFP for each cost. (Tr. 110-22).

Section 11275.32 states that the only indirect costs which will be funded at the higher FFP are those “directly attributable to the MMIS.” Further, section 11275.30 provides that “[ojverhead costs not directly resulting from the MMIS cost center are reimbursed at the 50-percent FFP rate.” (Tr. 108). These modifications serve as the backdrop for the present appeal.

Prior History

On September 26, 1988, the HCFA informed the State that it was disallowing $71,014 FFP for indirect administrative costs for the period July 1, 1986, through September 30, 1987. (Tr. 19). The HCFA found that the disallowed indirect costs had been claimed at the enhanced 75% FFP rate reserved for direct costs incurred in operating an MMIS. Id. The HCFA concluded that the indirect costs should have been claimed at the normal (50%) FFP reserved for indirect overhead costs. Id. This decision was affirmed in part by the Departmental Appeals Board (Board) on July 19, 1989. (Tr. 2). The Board, in Decision No.

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748 F. Supp. 1120, 1990 U.S. Dist. LEXIS 13952, Counsel Stack Legal Research, https://law.counselstack.com/opinion/new-jersey-department-of-human-services-v-secretary-of-the-united-states-njd-1990.