Opinion ID: 375761
Heading Depth: 2
Heading Rank: 2

Heading: HEW's obligation

Text: 14 Section 1396a(a)(13)(E) obligates HEW to approve and verify the cost-finding methods utilized in a state's reimbursement plan. However, Congress clearly intended that HEW's obligations to approve and verify extend beyond the cost-finding methods so as to encompass the state's proposed rate-setting methodology. 15 The States would use acceptable cost-finding techniques . . . to determine reasonable reimbursement and apply to the results appropriate methodologies for determining payment. The methods would have to be approved and validated by the Secretary (of HEW). 16 Senate Report at 287 (emphasis added). HEW previously has recognized and accepted this enlarged obligation. 17 The language of the Committee Report makes clear that the State's methodologies for rate-setting, as well as the State's methods for cost-finding, are subject to the Secretary's approval. 18 . . . In light of the concern expressed in the legislative history of section (1396a(a)(13)(E)) about the dangers to the objectives of the Medicaid statute of either underpayment or overpayment of long-term care facilities, the Secretary (of HEW) in carrying out his statutory functions of reviewing, approving, and verifying the States' methodologies, has the responsibility to seek to assure that the methodologies will in fact result in reasonable cost-related reimbursement, . . . . 19 41 Fed.Reg. at 27,300 (emphasis added).