Advantage Home Health Care, Inc. v. Indiana State Department of Health

792 N.E.2d 914, 2003 Ind. App. LEXIS 1412, 2003 WL 21802276
CourtIndiana Court of Appeals
DecidedAugust 6, 2003
Docket18A02-0211-CV-928
StatusPublished
Cited by3 cases

This text of 792 N.E.2d 914 (Advantage Home Health Care, Inc. v. Indiana State Department of Health) is published on Counsel Stack Legal Research, covering Indiana Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Advantage Home Health Care, Inc. v. Indiana State Department of Health, 792 N.E.2d 914, 2003 Ind. App. LEXIS 1412, 2003 WL 21802276 (Ind. Ct. App. 2003).

Opinions

OPINION

BAKER, Judge.

We are called upon today to determine whether certain directives issued by our State Department of Health to a health care agency constituted an “order” within the meaning of the Administrative Orders and Procedures Act (AOPA), thereby affording that institution a right to review under the AOPA. Appellant-defendant Advantage Home Health Care, Inc. (Advantage), a home health care agency located in Muncie, appeals the trial court’s grant of summary judgment in favor of the Indiana State Department of Health and the Indiana State Health Commissioner (collectively, the ISDH), claiming entitlement to a hearing under the AOPA after a number of violations were found by the ISDH. Specifically, Advantage asserts that the administrative review process was triggered in these circumstances because the statutory definition of an “order” under the AOPA was satisfied. Concluding that a “Statement of Deficiencies” issued by the ISDH against Advantage along with a “Letter of Correction” effectively established Advantage’s rights and obligations as to its continued operation in the State and were orders under the AOPA, we reverse the trial court’s judgment and remand with instructions that the ISDH permit a review of its decision in accordance with the AOPA.

FACTS

Advantage is a home health agency licensed by the State under the ISDH and is certified to participate as a health provider under the federal Medicare program. More specifically, Advantage provides both skilled and unskilled health care services to individuals in their homes, including nursing and daily living assistance. The ISDH regulates the state-licensed home health care agencies and periodically conducts investigations or “surveys” of the various agencies. ISDH employees perform such annual surveys to determine whether an agency is in compliance with the applicable rules and regulations. However, if a complaint is filed against an agency, an additional survey is performed.

The ISDH also conducts federal surveys on behalf of the Centers of Medicaid and Medicare Services to check the provider’s compliance with federal law. Because Advantage is a certified provider, it receives funds through both of these federal programs, as long as it complies with the standards known as the “conditions of participation.” Appellant’s App. p. 747. Such conditions govern the standard of care to patients as well as many facets of the day-to-day operation of the health agency.

Once a survey is completed, the investigator generates a written report setting forth various findings that include a determination of the facts and the particular violations that were committed. Those reports are then documented on a “Statement of Deficiencies and Plan of Correction” form that is sent to ISDH’s main office, where it is forwarded to the home health care agency. Thereafter, the ISDH issues a Letter of Correction with each Statement of Deficiency, regardless of whether those deficiencies involve state or federal violations. The Letter of Correction outlines the violations found and requires the submission of a plan of correction by the violating agency within ten days. The Statement of Deficiencies is [916]*916published by the ISDH on an internet website under a “report card” section intended for use by health care consumers. Appellant’s App. p. 586.

On April 25, 2001, the ISDH completed state and federal surveys of Advantage in response to complaints that had been lodged against the agency. This particular investigation was triggered .by a complaint that the ISDH received regarding one of Advantage’s nurses, who allegedly struck a special needs child in the mouth. In the end, the State survey identified three violations of the Indiana home health rules and nearly twenty-six federal violations. As a result, the ISDH determined that Advantage was prohibited from providing a home health training program for two years beginning April 25, 2001, through April 25, 2003. The ISDH then requested that Advantage submit a plan of correction to address the particular violations. The ISDH also determined that Advantage could contest the deficiencies by way of its informal dispute resolution process.

In response, Advantage requested a formal administrative review of the surveys and a stay of the ISDH determination. The ISDH sent Advantage a letter dated June 8, 2001, indicating that its surveys did not constitute orders that were subject to judicial review under the AOPA. ISDH indicated, however, that if Advantage sought reconsideration of its decision by an Administrative Law Judge (ALJ), it should file a petition requesting such a review. The ISDH’s letter went on to note that Advantage was obligated to file its petition for reconsideration with the Department of Health by June 26, 2001. Finally, the letter explained that the ALJ assigned to the case would conduct a preliminary hearing as to whether the survey could be reviewed under the AOPA.

On August 23, 2001, Advantage requested that the ISDH conduct an internal “paper review” of both the federal and state surveys. That review was conducted, and the ISDH issued revised surveys on October 22, 2001. Thereafter, Advantage sought a face-to-face review of the federal survey and that procedure was scheduled for January 17, 2002. At the same time, the ISDH and Advantage representatives discussed how Advantage might continue to provide home health aide training and competency evaluations during the two-year period of suspension that had been imposed upon it without violating either federal or state law. The face-to-face review took place as scheduled, and the ISDH issued yet another revised federal survey. However, it was still determined that Advantage could not provide any training, thus compelling it to retain individuals not associated with Advantage to perform these functions.

On September 25, 2001, Advantage filed a complaint for a Declaratory Judgment, requesting the trial court to determine as a matter of law that the Statement of Deficiencies issued to it by the ISDH were subject to review under the AOPA. In essence, Advantage urged that the Statement of Deficiencies qualified as orders under the AOPA. Advantage also sought an order from the trial court declaring that the issuance of the Statements of Deficiency triggered due process concerns, given the various legal ramifications, automatic penalties, and Internet publication of the ISDH surveys.

In response, the ISDH filed a motion for summary judgment, asserting that it was entitled to a judgment as a matter of law because its actions were exempt from the procedures set forth under the AOPA. The ISDH contended that the surveys it conducted constituted only non-adversary investigative actions. Moreover, the ISDH asserted that the surveys only documented findings of its investigations and did not [917]*917determine any of Advantage’s legal rights or obligations. Advantage then filed a cross motion for summary judgment on July 22, 2002, asserting that the ISDH’s determinations with respect to the violations constituted orders under the AOPA and that the surveys determined compliance status under state and federal law. Advantage also contended that it was entitled to relief under the AOPA, given the imposition of penalties and the Internet publication of the ISDH’s surveys. Following a hearing on the motions, the trial court granted the ISDH’s motion for summary judgment on October 4, 2002, and Advantage now appeals.

DISCUSSION AND DECISION

I. Standard Of Review

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Advantage Home Health Care, Inc. v. Indiana State Department of Health
792 N.E.2d 914 (Indiana Court of Appeals, 2003)

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Bluebook (online)
792 N.E.2d 914, 2003 Ind. App. LEXIS 1412, 2003 WL 21802276, Counsel Stack Legal Research, https://law.counselstack.com/opinion/advantage-home-health-care-inc-v-indiana-state-department-of-health-indctapp-2003.