Alvarado Parkway Institute, Inc. v. Mendez

789 F. Supp. 1190, 1992 U.S. Dist. LEXIS 5625, 1992 WL 82811
CourtDistrict Court, District of Columbia
DecidedApril 9, 1992
DocketCiv. A. No. 90-0490 (GHR)
StatusPublished
Cited by7 cases

This text of 789 F. Supp. 1190 (Alvarado Parkway Institute, Inc. v. Mendez) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Alvarado Parkway Institute, Inc. v. Mendez, 789 F. Supp. 1190, 1992 U.S. Dist. LEXIS 5625, 1992 WL 82811 (D.D.C. 1992).

Opinion

MEMORANDUM AND OPINION

REVERCOMB, District Judge.

This dispute, which is before the Court on dispositive cross-motions, arises out of the prospectively-determined per diem rate system by which the Civilian Health and Military Program of the Uniformed Services (“CHAMPUS”), 10 U.S.C. §§ 1071-1104, reimburses hospitals providing inpatient mental health services to CHAMPUS beneficiaries. In essence, the dispute presents two questions: First, when a federal agency discovers it has made a mistake in calculating rates according to a method adopted in a properly promulgated rule, does the retroactive application of its later corrective recalculations to regulated parties constitute impermissible retroactive rulemak-ing? Second, even if there were no retroactive rulemaking, were the corrective measures of the agency nevertheless unreasonable, or unreasonably executed? On the facts presented here, and for the following reasons, the Court’s answer to both questions is “no.”

Plaintiffs are state-licensed hospitals providing inpatient psychiatric services, and are certified by CHAMPUS to provide such services to CHAMPUS patients. Defendant is the Assistant Secretary of Defense for Health Affairs, who is the government official responsible for administering the CHAMPUS program. The responsibility for day-to-day administration of the CHAMPUS program is delegated from defendant to the Director of the Office of CHAMPUS (“OCHAMPUS”).

Plaintiffs argue that OCHAMPUS’s decision, announced in the Federal Register on November 28, 1989, to apply a corrected reimbursement rate for inpatient psychiatric services back to October 1, 1989, constituted retroactive rulemaking in violation of CHAMPUS regulations,1 sections 551(4) and 553 of the Administrative Procedure [1192]*1192Act (“APA”),2 and common law doctrines disfavoring retroactive rulemaking absent specific Congressional authorization. For his part, defendant denies that the announcement and implementation of a revised reimbursement rate constituted retroactive rulemaking because it did not alter the methodology previously adopted in final regulations. And, although defendant concedes that OCHAMPUS did in one instance violate its own regulations in revising the reimbursement rates, it argues that the violation did plaintiffs no harm, and that as a consequence plaintiffs lack standing to challenge its agency action.

BACKGROUND

The facts of this case are largely undisputed. The CHAMPUS program provides medical and dental care for dependents of members of the uniformed services and for certain retired military personnel and their dependents. 10 U.S.C. § 1071. These health care benefits include the treatment of mental illness. 10 U.S.C. § 1077(a)(5). Inpatient mental health services are provided at hospitals like plaintiffs, which are certified by CHAMPUS as eligible to provide such care to CHAMPUS beneficiaries. CHAMPUS pays a portion of the cost of such services to CHAMPUS patients; the patients share in the cost.

Prior to January 1, 1989, CHAMPUS reimbursed providers of inpatient psychiatric services on the basis of usual and customary charges billed by the hospitals. In 1988, the Department of Defense (“DOD”) decided to adopt a more cost-effective method of payment for these services “based on prospectively set fixed rates for each day of hospital services provided.” 53 Fed.Reg. 20,585 (June 3, 1988). Accordingly, the DOD commissioned a study by the RAND Corporation to examine the feasibility of a per diem payment system, and published for comment a proposed rule based on the RAND analysis. See 53 Fed. Reg. 34,285 (Sept. 6, 1988). On September 6, 1988, OCHAMPUS responded to public comments and promulgated its final regulations establishing a prospectively determined per diem rate method of payment for inpatient mental health care. See 53 Fed. Reg. 34,285 (codified at 32 C.F.R. § 199.-14(a)(2) (1991)).

Under this new reimbursement system, certain hospitals — known as “high volume” hospitals — which have historically provided a sufficient volume of services to CHAM-PUS patients to permit a valid rate calculation, were to receive hospital-specific per diem rates. These per diem rates were calculated on the basis of each hospital’s actual average daily charges during a period from July 1, 1987 to May 31, 1988, trended forward through an inflationary adjustment to September 30, 1988. See 32 C.F.R. § 199.14(a)(2)(v)(A).3 This period then became the base period in determining per diem rates, except that rates were subject to a “cap” set at the 80th percentile of the average daily charges of all high-volume hospitals.4 Thus, no high-volume hospital, regardless of its actual per diem charges, could receive a rate beyond the rate cap. The capped rate for high-volume hospitals was calculated to be $629 per day, and this figure was published in the Federal Register in a section titled “General Description of the CHAMPUS Per Diem Payment System for Psychiatric Hospitals and Units.” 53 Fed.Reg. 34,286. Thus conceived, this prospective per diem reimbursement system was to go into effect on January 1, 1989. In most instances, high-volume providers were notified of their respective hospital-specific dates prior to January 1, 1989.

The regulations promulgated on September 6, 1988, also stated that subsequent increases in per diem rates would be limit[1193]*1193ed to annual increases prescribed by Congress for Medicare providers, and that there would be no update of rates for fiscal year 1989. 32 C.F.R. § 199.14(a)(2)(iv)(C).5 The regulations only discuss retrospective payments in a subsection addressing payments to new hospitals that qualify as high-volume hospitals. See 32 C.F.R. § 199.14(a)(2)(v)(C).

After the regulation and the originally calculated per diem rates had gone into effect, OCHAMPUS officials discovered that the provider rates as calculated were “substantially erroneous.” This error appears to stem from deficiencies in the data base used to calculate the per diem rates.6 As a consequence of these errors, OCHAM-PUS officials discovered that in many cases high-volume hospitals were being reimbursed • at “substantially inflated” rates. Accordingly, OCHAMPUS officials decided to recalculate the per diem rates, including the “hospital-specific rate cap,” to correct error attributable to the faulty data base.7 This recalculation did not apply to all rates, because some hospital-specific per diem rates had already been recalculated prior to October 1, 1989 by CHAMPUS Fiscal Intermediaries 8 pursuant to a regulatory administrative review procedure. OCHAM-PUS officials decided to honor these recalculated “FI rates.”

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789 F. Supp. 1190, 1992 U.S. Dist. LEXIS 5625, 1992 WL 82811, Counsel Stack Legal Research, https://law.counselstack.com/opinion/alvarado-parkway-institute-inc-v-mendez-dcd-1992.