New York Department of Social Services v. Shalala

21 F.3d 485, 1994 U.S. App. LEXIS 6642
CourtCourt of Appeals for the Second Circuit
DecidedApril 4, 1994
DocketNo. 734, Docket 93-6158
StatusPublished
Cited by7 cases

This text of 21 F.3d 485 (New York Department of Social Services v. Shalala) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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New York Department of Social Services v. Shalala, 21 F.3d 485, 1994 U.S. App. LEXIS 6642 (2d Cir. 1994).

Opinion

JACOBS, Circuit Judge:

Beginning in January 1985, the State of New York Department of Social Services (“New York”) developed a computer system for use in New York City that would improve New York’s ability to perform eligibility determinations for Medicaid and other social services programs, and installed the system serially at 92 locations in New York City. The Health Care Financing Administration (“HCFA”) has paid a portion of the development and operating costs of the system, but New York and the federal government disagree as to the extent of HCFA’s obligation to pay operating costs incurred at individual sites as they became operational prior to the date in 1989 as of which the entire system was certified complete. New York contends that the Medicaid Act and principles of administrative procedure require a 75% contribution from HCFA, and HCFA contends that the Medicaid Act and administrative regulations adopted pursuant thereto require no more than the 50% contribution that HCFA has already paid. New York brought an administrative appeal before the Departmental Appeals Board (“DAB”), challenging HCFA’s disallowance. After DAB upheld [487]*487HCFA’s decision, New York challenged that ruling in the United States District Court for the Southern District of New York (Conboy, /.), which granted summary judgment in favor of Defendants-Appellees Donna E. Sha-lala, Secretary of the U.S. Department of Health and Human Services (the “Secretary”, “HHS”); HHS; Gail R. Wilensky, Administrator of HCFA; and HCFA.

We affirm.

BACKGROUND

A. Statutory and Regulatory Framework

Under the Medicaid Act, 42 U.S.C. § 1396 et seq. (1988 & Supp. Ill 1991) (the “Act”), the federal government reimburses a portion of state expenditures for medical assistance to low income or disabled people. The level of federal funding available to a state, called the Federal Financial Participation (“FFP”), varies according to the service provided. See id. § 1396b(a). Unless otherwise specified in § 1396b, states are reimbursed for 50% of expenditures that are “found necessary by the Secretary for the proper and efficient administration of the State plan.” Id. § 1396b(a)(7). Enhanced funding is available in specific instances. See id. § 1396b(a). Among the expenses that may be reimbursed at an enhanced level of FFP are those associated with the development and operation of computerized claims processing programs. In 1972, Congress determined that computerized systems for claims processing and information retrieval would reduce Medicaid costs. See H.R.Rep. No. 231, 92d Cong., 2d Sess. 8 (1972), reprinted in 1972 U.S.C.C.A.N. 4989, 5089. In order to encourage states to develop these systems, Congress amended the Act to provide 90% FFP for costs “attributable to the design, development, or installation of such mechanized claims processing and information retrieval systems,” id. § 1396b(a)(3)(A)(i), and 75% FFP for costs “attributable to the operation of [such] systems,” id. § 1396b(a)(3)(B).

The statutory language relevant to this appeal is as follows:

§ 1396b. Payment to States
(a) Computation of amount
From the sums appropriated therefor, the Secretary ... shall pay to each State [quarterly] ...
sfc 5{c Hí H* ‡ ‡
(3) an amount equal to—
(A)(i) 90 per centum of so much of the sums expended during such quarter as are attributable to the design, development, or installation of such mechanized claims processing and information retrieval systems as the Secretary determines are likely to provide more efficient, economical, and effective administration of the plan ... and
* * 4s * * *
(B) 75 per centum of so much of the sums expended during such quarter as are attributable to the operation of systems ... of the type described in sub-paragraph (A)(i) (whether or not designed, developed, or installed with assistance under such subparagraph) which are approved by the Secretary
‡ ^ ‡ sfc
plus
^ * 4? :{; #
(7) ... an amount equal to 50 per centum of the remainder of the amounts expended during such quarter as found necessary by the Secretary for the proper and efficient administration of the State plan.

42 U.S.C. § 1396b(a) (emphasis added).

In 1974, the Secretary promulgated regulations to implement § 1396b(a)(3). Before a state may become eligible to receive federal reimbursement for developing or operating a computerized claims system, these regulations require a state to submit to the Secretary an Advance Planning Document describing the proposed system. See 42 C.F.R. § 433.112(a). If the proposal meets the conditions outlined in the regulations, the Secretary will approve the system, see id. § 433.-112(b), and federal funds will become available at the 90% FFP rate for the system’s “design, development, installation or improvement,” id. § 433.112(a). After the system is installed, “FFP is available at 75 percent of expenditures for operation of a [488]*488mechanized claims processing and information retrieval system approved by HCFA, from the first day of the calendar quarter after the date the system met the conditions of initial approval, as established by HCFA (including a retroactive adjustment of FFP if necessary to provide the 75 percent rate beginning on the first day of that calendar quarter).” Id. § 433.116(a). The regulations provide that HCFA will approve the system operation if, inter alia, “[t]he system [has] been operating continuously during the period for which FFP is claimed.” Id. § 433.-116(d).

The regulations indicate that “[ajdditional HHS regulations and HCFA procedures for implementing these regulations” are set forth in Part 11 of the State Medicaid Manual (“SMM”). 42 C.F.R. § 433.110(a)(1). Section 11255 of the SMM, known as the “transition funding policy,” provides that:

Projects for designing, developing, installing, or improving an automated claims processing and information retrieval system will be funded during the transition between 90% FFP and 75% FFP as follows:
• FFP at the 90% level is available for design, development, installation, or im- ■ provement of each subsystem in an approved complete system meeting the requirements of § 11205.
• FFP at the 90% level for any subsystem terminates on the date the subsystem or improvement to a subsystem is fully tested and subsequently accepted by the State.
• FFP at the 50% level is available for operation of any subsystem from that point that 90% FFP ceases until the complete system is fully operational

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21 F.3d 485, 1994 U.S. App. LEXIS 6642, Counsel Stack Legal Research, https://law.counselstack.com/opinion/new-york-department-of-social-services-v-shalala-ca2-1994.