Beverly Health & Rehabilitation Services, Inc. v. Metcalf

484 S.E.2d 156, 24 Va. App. 584, 1997 Va. App. LEXIS 241
CourtCourt of Appeals of Virginia
DecidedApril 22, 1997
Docket1757962
StatusPublished
Cited by18 cases

This text of 484 S.E.2d 156 (Beverly Health & Rehabilitation Services, Inc. v. Metcalf) is published on Counsel Stack Legal Research, covering Court of Appeals of Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Beverly Health & Rehabilitation Services, Inc. v. Metcalf, 484 S.E.2d 156, 24 Va. App. 584, 1997 Va. App. LEXIS 241 (Va. Ct. App. 1997).

Opinion

ELDER, Judge.

Beverly Health and Rehabilitation Services, Inc. (appellant) appeals the decision of the Circuit Court of the City of Richmond (circuit court) affirming the decision of the Director *588 of the Virginia Department of Medical Assistance Services (DMAS) denying appellant’s request for reimbursement from the Medicaid program of certain depreciation and interest expenses. Appellant contends that DMAS erroneously reversed a hearing officer’s recommendation and that DMAS’ interpretation of applicable regulations was arbitrary and capricious. For the reasons that follow, we affirm in part, reverse in part, and remand.

I.

BACKGROUND

Appellant is a Delaware corporation that operates nursing facilities, retirement living centers, home health agencies and pharmacies throughout the United States. Appellant is also a provider under the Medicaid program who operates several nursing facilities in Virginia. DMAS is the state agency authorized to administer Virginia’s Medicaid program.

In the years relevant to this appeal, appellant claimed reimbursement from DMAS for two types of expenses. The first claim was for interest expense and depreciation related to four facilities (REIT facilities) leased to appellant by Nationwide Health Properties, Inc. (Nationwide). The other claim was for interest expense arising from a revolving line of credit (revolving debt) that was initially obtained by appellant at its corporate level. A portion of the interest expense from the revolving debt was allocated to each of appellant’s facilities in Virginia, and appellant sought reimbursement from DMAS for these interest expenses.

Following an audit of appellant’s cost reports for the years relevant to this appeal, DMAS adjusted appellant’s reports to exclude these interest expenses and depreciation as allowable costs under the Medicaid program. The Director of DMAS’ Division of Cost Settlement and Audit held an informal fact' finding conference and upheld these adjustments. Appellant appealed, and a hearing officer appointed by DMAS recommended reversing the adjustments and allowing the reimbursement of the depreciation and interest expense sought by *589 appellant. Appellant filed exceptions, and the Director of DMAS (DMAS director) rejected the hearing officer’s recommendation. He held that DMAS was correct when it adjusted appellant’s cost reports to deny reimbursement to appellant for the depreciation and interest expenses associated with the REIT facilities and the interest expense arising from the revolving debt. Appellant appealed, and the Circuit Court of the City of Richmond affirmed the decision of the DMAS director.

II.

THE DMAS DIRECTOR’S REVIEW OF THE HEARING OFFICER’S WRITTEN RECOMMENDATION

Appellant initially contends that the DMAS director’s decision should be reversed on procedural grounds. It argues that the DMAS director lacked the power to reject the hearing officer’s recommendation because DMAS did not file timely exceptions. In the alternative, appellant argues that the DMAS director did not accord sufficient deference to the hearing officer’s factual findings.

The record establishes that the hearing officer recommended allowing the costs associated with both the REIT facilities and the revolving debt and based his recommendation upon the exhibits and testimony of the parties. The hearing officer did not make any credibility determinations based on recorded observations of the witnesses’ demeanor. The DMAS director rejected the hearing officer’s recommendation based on several legal grounds, including the hearing officer’s refusal to qualify a DMAS witness as an expert, the hearing officer’s admission that he did not review the entire record, his reliance upon informal case decisions as precedent, and his erroneous application of the Medicare principles of reimbursement. The DMAS director also stated that appellant had excepted to the hearing officer’s recommendation while DMAS had failed to file timely exceptions.

*590 Administrative proceedings before DMAS are governed by the Administrative Process Act (APA), DMAS regulations known as the “state plan for medical assistance” 1 and applicable federal law. See Code § 32.1-325.1. Federal regulations require DMAS to:

provide an appeals or exception procedure that allows individual providers an opportunity to submit additional evidence and receive prompt administrative review, with respect to such issues as the agency determines appropriate, of payment rates.

42 C.F.R. § 447.253(e). The NHPS satisfies this federal requirement by providing for two levels of administrative review: an informal proceeding and a formal hearing. See 12 V.A.C. § 30-90-130(111). After DMAS makes an informal decision, the provider may request a formal hearing. Upon such a request, the DMAS director appoints a hearing officer who is authorized to conduct the formal hearing and to “make a written recommendation.” Id. § 30-90-130(III)(C).

Under the APA, the hearing officer’s decision is subject to agency' review in two instances: first, if a party files “exceptions thereto,” Code § 9-6.14:12(D), or second, if:

the agency shall by its procedural regulations provide for the making of findings and an initial decision by [a hearing officer] subject to review and reconsideration by the agency ... on its own motion.

Id. § 9-6.14:12(C). The NHPS authorizes the DMAS director to broadly review a hearing officer’s recommendation. In fact, the NHPS characterizes the DMAS director’s final decision as distinct from the recommendation of the hearing officer. 12 V.A.C. § 30-90-130(III)(E) states that “[t]he director shall notify the provider of his final decision within 30 business days of the date of the appointed hearing officer’s written recommendation ....” (Emphasis added). Thus, under the *591 NHPS, the recommendation of a hearing officer is just that — a recommendation, and the DMAS director may reexamine all of the hearing officer’s conclusions. Regarding a hearing officer’s factual findings, the DMAS director is required by the APA to defer to findings in the hearing officer’s recommendation that are “explicitly based on the demeanor of witnesses.” Code § 9-6.14:12(0).

We hold that the DMAS director did not exceed his authority when he reviewed and rejected the hearing officer’s recommendation. Even though DMAS failed to file timely exceptions, the DMAS director was empowered to review all of the hearing officer’s conclusions based on both the exceptions filed by appellant and on his own motion. In addition, contrary to appellant’s assertion, the DMAS director is authorized to reject the factual findings of the hearing officer that are not based on the hearing officer’s express observations of the demeanor of the witnesses.

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Bluebook (online)
484 S.E.2d 156, 24 Va. App. 584, 1997 Va. App. LEXIS 241, Counsel Stack Legal Research, https://law.counselstack.com/opinion/beverly-health-rehabilitation-services-inc-v-metcalf-vactapp-1997.