Source: https://law.justia.com/cases/federal/appellate-courts/F2/939/153/31761/
Timestamp: 2019-12-16 03:14:04
Document Index: 289476019

Matched Legal Cases: ['§ 671', '§ 1320', '§ 1320', '§ 1291', '§ 1320', '§ 671', '§ 674']

Carolyn W. Colvin, Secretary; Maryland Department of Humanresources, Plaintiffs-appellees, v. Louis W. Sullivan, Secretary of Health and Human Services;department of Health and Human Services,defendants-appellants, 939 F.2d 153 (4th Cir. 1991) :: Justia
Justia › US Law › Case Law › Federal Courts › Courts of Appeals › Fourth Circuit › 1991 › Carolyn W. Colvin, Secretary; Maryland Department of Humanresources, Plaintiffs-appellees, v. Louis...
Carolyn W. Colvin, Secretary; Maryland Department of Humanresources, Plaintiffs-appellees, v. Louis W. Sullivan, Secretary of Health and Human Services;department of Health and Human Services,defendants-appellants, 939 F.2d 153 (4th Cir. 1991)
U.S. Court of Appeals for the Fourth Circuit - 939 F.2d 153 (4th Cir. 1991) Argued Feb. 7, 1991. Decided July 3, 1991. As Amended Aug. 5, 1991
Congress passed Title IV-E in 1980, establishing a program through which states could receive reimbursement for expenses associated with foster care programs. Title IV-E requires states to submit a "Cost Allocation Plan" (CAP) explaining how administrative costs would be allocated among various programs run by the state. 42 U.S.C. § 671(a).
Maryland argued that the regulatory presumption against retroactive adoption of CAP amendments was inconsistent with the statute of limitations provision of the Social Security Act, 42 U.S.C. § 1320b-2. Maryland argued in the alternative that retroactive adoption of its plan amendment was necessary to avoid a "significant inequity." HHS determined that its regulation was valid, and that the exception was inapplicable. Maryland appealed the denial of retroactive reimbursements to HHS' Departmental Appeals Board, and then to the District Court of Maryland.
The district court reversed the Departmental Appeals Board and granted summary judgment in favor of Maryland. It found that 45 C.F.R. Sec. 95.515 was invalid, at least as applied to the facts of this case, because it conflicted with 42 U.S.C. § 1320b-2, which states:
(Emphasis added.) The district court found that the statute allows states to request retroactive adjustments of their reimbursements in the two year period, and that HHS' regulation impermissibly restricted that right. The district court remanded the matter to HHS with instructions to determine the proper reimbursement for expenses between October 1, 1983 and October 1, 1985. HHS has appealed the remand order. The district court granted summary judgment based on its review of the agency's administrative record, which has also been presented before us. " [O]nce appealed, the district court decision is accorded no particular deference." Brown v. Department of Interior, 679 F.2d 747, 749 (8th Cir. 1982).
The district court's remand order was a final judgment, allowing appeal under 28 U.S.C. § 1291. The procedural posture is functionally equivalent to that in Sullivan v. Finkelstein, --- U.S. ----, 110 S. Ct. 2658, 110 L. Ed. 2d 563 (1990). In that case, a district court had ruled that an HHS regulation was invalid, and directed the Secretary to reconsider its earlier decision denying benefits without regard to the regulation. Although the order directed a remand and did not enter judgment for a particular sum of money for the petitioner, the Supreme Court held that it was an appealable judgment:
Finkelstein, 110 S. Ct. at 2664. In this case as well, the Secretary might have no opportunity to defend 45 C.F.R. Sec. 95.515 before an appellate court if he were to comply with the remand order and recalculate Maryland's reimbursement for the past 1983-1985 period. We shall therefore consider the merits of this appeal.III.
The principal issue in this case is whether HHS' regulation is inconsistent with the statute of limitations, 42 U.S.C. § 1320b-2(a). We perceive no inconsistency. The regulation defines HHS' criteria for approving claims for reimbursement, and does not address when claims must be filed. Section 1320b-2 requires HHS to consider any claim filed within two years of the period requested, but does not list any substantive criteria for judging the merits of such claims. HHS did consider Maryland's claim for reimbursement for the period from October 1, 1983, so it complied with Sec. 1320b-2.
Maryland has asserted that denying retroactive approval of its CAP will result in its receiving less than full reimbursement for the expenses it incurred that could have been eligible for Title IV-E reimbursement. Approval of a plan and compliance with the plan approved are two different things. HHS approved the SSTS plan, but Maryland could not comply because it could not furnish satisfactory evidence of costs incurred for the eight quarters preceding the final quarter of 1985. However, even if Maryland could prove that some of its actual expenses were not reimbursed, HHS would not be compelled to provide reimbursement. Title IV-E mandates that the United States pay only for expenses incurred under a "plan approved by the Secretary," 42 U.S.C. § 671(a), not for all expenses incurred in foster care programs. Thus, a state that administered a program substantively complying with Title IV-E but did not submit a plan would be entitled to no funds at all. This provision provides legislative recognition of the United States' interest in determining compliance by states with reasonable accounting standards before disbursing large sums of money. 42 U.S.C. § 674(a) (3) requires HHS to reimburse states for half of all administrative expenses, but that provision also applies only to costs "found necessary by the Secretary for the proper and efficient administration of the State plan." Until 1985, the higher administrative expenses calculated by SSTS were not part of the CAP; nor has Maryland made a case under 45 C.F.R. Sec. 95.515 that they should be recaptured retroactively.