Seittelman v. Sabol

158 Misc. 2d 498, 601 N.Y.S.2d 391, 1993 N.Y. Misc. LEXIS 275
CourtNew York Supreme Court
DecidedJune 1, 1993
StatusPublished
Cited by3 cases

This text of 158 Misc. 2d 498 (Seittelman v. Sabol) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Seittelman v. Sabol, 158 Misc. 2d 498, 601 N.Y.S.2d 391, 1993 N.Y. Misc. LEXIS 275 (N.Y. Super. Ct. 1993).

Opinion

OPINION OF THE COURT

Bruce McM. Wright, J.

This action, which is a combined declaratory judgment action and article 78 proceeding, challenges certain aspects of the Medicaid program administered by the New York State Department of Social Services (DSS) and the New York City Department of Social Services/Human Resources Administra[500]*500tian (HRA). The action is brought by plaintiff-petitioner (hereinafter referred to as plaintiff) Estelle Seittelman in her capacity as the administrator of the estate of Ida Zichlinsky, on behalf of herself and all others similarly situated. Plaintiff Marguerite Holohan intervened in this action in August 1992.

Proposed plaintiff-intervenors Leah Silverman and Nancy Levanoni, as attorney-in-fact for Sadye Bass, seek to intervene into this action on behalf of themselves and all others similarly situated.

Plaintiffs seek, inter alla, a declaration that 18 NYCRR 360-7.5 (a) (5), which regulates reimbursement to Medicaid recipients of medical expenses incurred prior to the time of application for Medicaid (three-month preapplication period) is irrational, and violative of Federal and State law, as well as the Court of Appeals decision Matter of Krieger v Krauskopf (70 NY2d 637, affg 121 AD2d 448).

Plaintiffs have moved for an order permitting Silverman and Levanoni to intervene in this action, individually and as representative class plaintiffs, and allowing plaintiffs to serve a proposed intervenor class action complaint and petition dated August 26, 1992, in lieu of the previously served amended class action complaint. Plaintiffs also seek an order pursuant to CPLR article 9, converting this action to a class action and certifying the plaintiff class to be defined as follows: "All New York City recipients of Medical Assistance or their representatives who, on or after December 16, 1988, incurred out of pocket expenses for medical and other health care services of a type generally covered by Medicaid yet received from providers who are non-Medicaid enrollees during the three month period prior to the month of applying for Medical Assistance and whose application for reimbursement of such expenses was, will be or would have been denied on the basis that such care was provided by non-Medicaid enrollees.”

Plaintiffs have also moved for partial summary judgment. They seek a declaratory judgment that 18 NYCRR 360-7.5 (a) (5) is void to the extent that it limits reimbursement for expenses incurred during the three-month preapplication period, to those services which were provided by Medicaid enrollees. In connection with their request for a judgment declaring that 18 NYCRR 360-7.5 (a) (5) is void, plaintiffs seek related relief which would implement such a declaration.

Defendant New York State Department of Social Services [501]*501has opposed plaintiffs’ motion for class certification and partial summary judgment and has cross-moved for an order granting it summary judgment dismissing the complaint. Defendant New York City Human Resources Administration has joined in the State defendant’s opposition to class certification, and cross motion for summary judgment. However, HRA has stated that it takes no position on the rationality or legality of 18 NYCRR 360-7.5 (a) (5).

PROCEDURAL ISSUES

Initially, the court notes that by order dated July 29, 1992, plaintiff Holohan was permitted to intervene in this action; the proposed complaint dated June 5, 1992 was deemed to have been served on all parties; and defendants were directed to answer the complaint within 20 days after service of a copy of the order with notice of entry.

Yet, DSS has not based its cross motion for summary judgment on the most recent June 5, 1992 complaint. Instead, DSS’s motion is based on the May 5, 1992 amended complaint (served prior to the time that Holohan intervened) and DSS’s answer to the May 5th complaint dated July 15,1992.

Further, neither defendant DSS’s answer nor defendant HRA’s answer to the June 5, 1992 complaint have been included in the bulk of papers submitted to the court in support of these motions. If there is any mention of defendant DSS’s answer to the June 5, 1992 complaint it has escaped the court, and the only reference to the HRA’s answer to that complaint is in plaintiffs’ counsel’s affirmation in support of the motion for summary judgment, where it is stated that HRA served its answer to the complaint on or around August 3, 1992.

Thus, plaintiffs move for partial summary judgment based upon the June 5, 1992 complaint and/or the proposed class action intervenor complaint dated August 26, 1992. Defendant DSS cross-moves for summary judgment based upon the complaint dated May 5, 1992, and its answer to that complaint. Despite this procedural morass, the motions shall be entertained to the extent that the issues raised in the various pleadings are the same. Each of plaintiff’s pleadings have alleged that 18 NYCRR 360-7.5 (a) (5) is void, and that defendants fail to apprise applicants and recipients of their right to apply for reimbursement. Those allegations are addressed by DSS in its July 15, 1992 answer to the May 5, 1992 [502]*502complaint. Thus, these issues shall be addressed at this juncture.

THE MEDICAID PROGRAM

The Medicaid program is a joint Federal-State program which furnishes medical assistance to individuals “whose income and resources are insufficient to meet the costs of necessary medical expenses” (42 USC § 1396). Federal law requires that a State plan for medical assistance provide for “the establishment or designation of a single State agency to administer or to supervise the administration of the plan” (42 USC § 1396a [a] [5]). In New York, the Department of Social Services has been designated to act as the single State agency to supervise the administration of the Medicaid plan. (Social Services Law § 363-a [1].) In New York City, HRA administers the Medicaid program subject to supervision by DSS. (Social Services Law §§ 56, 77, 365 [1].)

Social Services Law § 363-a (2) provides that DSS "shall make such regulations, not inconsistent with law, as may be necessary to implement [the Medicaid plan]”. One such regulation promulgated by DSS, specifically, 18 NYCRR 360-7.5 (a) (5), is the subject of a challenge by plaintiffs here. That regulation pertains to reimbursement for medical expenses incurred during the three-month period prior to application for Medicaid and ending with receipt of a Medicaid card.

REIMBURSEMENT FOR MEDICAL EXPENSES INCURRED DURING THE THREE-MONTH PREAPPLICATION PERIOD

18 NYCRR 360-7.5, which is entitled "[M]ethod of payment for medical care” provides, in pertinent part, as follows:

"(a) Payment for medical care provided under the MA [Medical Assistance or Medicaid] program will be made to the person or institution supplying the care. However, payment for services or care may be made, at the MA rate or fee in effect at the time such services or care were provided, to the following * * *
"(5) a recipient or his/her representative for paid medical bills for medical expenses incurred during the period beginning three months prior to the month of application for MA and ending with the recipient’s receipt of his/her MA identification card, provided that the recipient was eligible in the [503]*503month in which the medical care and services were received

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Related

Jamie B. v. Hernandez
182 Misc. 2d 954 (New York Supreme Court, 1999)
Seittelman v. Sabol
697 N.E.2d 154 (New York Court of Appeals, 1998)
Seittelman v. Sabol
217 A.D.2d 523 (Appellate Division of the Supreme Court of New York, 1995)

Cite This Page — Counsel Stack

Bluebook (online)
158 Misc. 2d 498, 601 N.Y.S.2d 391, 1993 N.Y. Misc. LEXIS 275, Counsel Stack Legal Research, https://law.counselstack.com/opinion/seittelman-v-sabol-nysupct-1993.