Boot Heel Nursing Center, Inc. v. Missouri Department of Social Services

826 S.W.2d 14, 1992 Mo. App. LEXIS 30, 1992 WL 780
CourtMissouri Court of Appeals
DecidedJanuary 7, 1992
DocketWD 44636
StatusPublished
Cited by14 cases

This text of 826 S.W.2d 14 (Boot Heel Nursing Center, Inc. v. Missouri Department of Social Services) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Boot Heel Nursing Center, Inc. v. Missouri Department of Social Services, 826 S.W.2d 14, 1992 Mo. App. LEXIS 30, 1992 WL 780 (Mo. Ct. App. 1992).

Opinion

FENNER, Judge.

Appellants are three nursing homes located in southeast Missouri. They are Boot Heel Nursing Centers, Inc., d/b/a East Prairie Nursing and Rehabilitation Care Center (hereinafter East Prairie); Semo Nursing Centers, Inc., d/b/a Miner Nursing and Residential Care Center (hereinafter Miner); and Semo Nursing Centers, Inc., d/b/a Advance Nursing and Residential Care Center (hereinafter Advance). 1 Respondent is the Missouri Department of Social Services’ integral Division of Medical Services (DMS). DMS has responsibility for administering the Missouri Medicaid Program.

Appellants appeal the dismissal by the trial court of their Petitions for Declaratory Judgment and Injunctive Relief. The trial court dismissed the petitions on the basis that the appellants failed to exhaust their administrative remedies.

Appellants alleged in their petitions that they are each certified to participate in the state’s Medicaid Program. They alleged that under the regulation in effect at the time the facilities were licensed, 13 CSR 70-10.010(7)(B)1. (effective October 1, 1981) (hereinafter the Old Plan), newly constructed facilities were assigned a tentative prospective Medicaid reimbursement rate for their first twelve months of operation. At the end of the first twelve months, each facility was required, under the Old Plan to submit a cost report within a specified time to DMS itemizing the facility’s total cost of operation for the first twelve months. 13 CSR 70-10.010(7)(B)2. Appellants alleged that they timely submitted cost reports for their first twelve months of operation as required under the Old Plan and that there was no reduction in their Medicaid reimbursement rates while the Old Plan remained in effect.

Appellants alleged that effective July 1, 1990, a new Long Term Care Reimbursement Plan was adopted at 13 CSR 70-10.010 (hereinafter the New Plan) and at the same time all provisions of the Old Plan were rescinded. The New Plan provides that appellants, and other nursing facilities similarly situated, would have a Medicaid reimbursement rate under the New Plan equal to the greater of their rate determined from their fiscal year end 1988 or their per diem rate in effect for services rendered on June 30, 1990, for services dated on and after July 1, 1990.

The Petitions state that in July of 1990, the appellants were advised of their Medicaid reimbursement rates under the New Plan. Appellants then register what is the essence of their complaint herein, which is that in August of 1990, they were notified by DMS that their future Medicaid reimbursement rates would be reduced in order to recoup overpayments made under the Old Plan. This reduction was pursuant to audits completed February 22, 1989.

In addition to their Petitions for Declaratory and Injunctive Relief, appellants have also filed complaints with the Administrative Hearing Commission (AHC) in which they seek hearings before the AHC to review the DMS decision. In their complaints with the AHC, appellants challenge the validity and reasonableness of their *16 reimbursement rates and further allege that the rates are not adequate to meet costs incurred, that their reimbursement rates do not take into account relevant economic trends and conditions and that the state is prohibited from setting reimbursement rates solely on budgetary considerations.

DMS filed a Motion to Dismiss appellants’ Petitions for Declaratory and Injunc-tive relief for failure to exhaust administrative remedies. The Motion to Dismiss was granted and this appeal followed.

Appellants argue on appeal that their Petitions for Declaratory and Injunctive relief challenged the validity of the application by DMS of the rescinded regulations for reimbursement under the Old Plan. Appellants argue that application of the Old Plan regulations after the Old Plan had been rescinded was illegal. Appellants argue that they are not required to exhaust administrative remedies under the circumstances herein for three reasons: 1) because the application by DMS of their regulations reducing appellants’ reimbursement rate violates the Equal Protection clauses of The United States and Missouri Constitutions by treating them different than other nursing homes and further is a denial of due process because they were not afforded a hearing; 2) because an unfavorable administrative determination would result in irreparable harm, and 3) because application of the doctrine of exhaustion of administrative remedies should not be strictly applied without consideration of the policies underlying the doctrine.

Missouri follows the exhaustion of administrative remedy doctrine where an administrative remedy must be exhausted before a court may give injunctive or declaratory relief. Westside Enterprises, Inc. v. City of Dexter, 559 S.W.2d 638, 640 (Mo.App.1977). Furthermore, such a remedy is generally exclusive, and failure to exhaust it deprives a court of jurisdiction to give equitable or declaratory relief. Id. Exhaustion is generally required as a matter of preventing premature interference with agency processes, so that the agency may function efficiently and so that it may have an opportunity to correct its own errors, to afford the parties and the courts the benefit of its experience and expertise, and to compile a record which is adequate for judicial review. State ex rel. Missouri State Board of Registration for the Healing Arts v. Hartenbach, 768 S.W.2d 657, 659 (Mo.App.1989); citing State ex rel. J.S. Alberici v. City of Fenton, 576 S.W.2d 574 (Mo.App.1979).

An exception to the exhaustion requirement is recognized under some circumstances where a constitutional challenge to a statute, which statute formed the only basis for denial of relief, is the only issue presented. State ex rel. Missouri State Board of Registration for the Healing Arts v. Hartenbach, 768 S.W.2d at 659. Like statutes, rules or regulations of a state administrative agency which have been duly promulgated pursuant to properly delegated authority have the force and effect of law. Woodall v. Director of Revenue, 795 S.W.2d 419 (Mo.App.1990). Therefore, a direct constitutional challenge to a regulation of a state administrative agency, with no other issue presented, would not require exhaustion of administrative remedy.

In the case at bar, appellants do not challenge the constitutionality of a regulation directly. Appellants challenge the application of state regulations to them, claiming that the state’s application of the regulations in question violated their constitutional rights. Appellants’ challenge in reality involves the construction and application of state regulations as applied to them and in comparison to others in like circumstances.

A challenge to the construction and application of a law does not involve a constitutional challenge in an appellate jurisdictional sense. State v. Zilafro, 206 S.W.2d 496 (Mo.1947).

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Bluebook (online)
826 S.W.2d 14, 1992 Mo. App. LEXIS 30, 1992 WL 780, Counsel Stack Legal Research, https://law.counselstack.com/opinion/boot-heel-nursing-center-inc-v-missouri-department-of-social-services-moctapp-1992.