Broen Memorial Home v. Minnesota Department of Human Services

364 N.W.2d 436, 1985 Minn. App. LEXIS 3974
CourtCourt of Appeals of Minnesota
DecidedMarch 12, 1985
DocketC1-84-1618
StatusPublished
Cited by9 cases

This text of 364 N.W.2d 436 (Broen Memorial Home v. Minnesota Department of Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals of Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Broen Memorial Home v. Minnesota Department of Human Services, 364 N.W.2d 436, 1985 Minn. App. LEXIS 3974 (Mich. Ct. App. 1985).

Opinion

OPINION

POPOVICH, Chief Judge.

Broen Memorial Home appeals from an order in which the Commissioner of Human Services held (1) Minn.R. 9510.0030, subp. *438 3.J. (1983) requires the use of the gross dollar method when calculating paybacks, (2) Minn.R. 9510.0470, subp. 4.B. (1983) permits only nursing homes with 65 percent welfare patient days to obtain a waiver of the 93 percent occupancy limitation, and (3) the Commissioner has no jurisdiction to determine whether a rule is arbitrary.

Broen contends (1) the gross dollar method should not be applied in setting its paybacks because its occupancy has decreased, and (2) the Commissioner erred by failing to grant a waiver of the 93 percent occupancy limitation.

We affirm.

FACTS

Broen Memorial Nursing Home is a nonprofit, long-term care facility. It is certified to participate in the Title XIX Medicaid Program. At the times in question the welfare resident per diem rates for nursing homes were set pursuant to Minn.R. 9510. Prospective per diem rates are based on historical cost plus projected known cost increases divided by “adjusted patient days.” If unimplemented known cost changes exceed under-projected known cost changes, the Department of Human Services (DHS) claims a payback and the nursing home must refund the money.

Based on Broen’s cost reports for the fiscal year ending April 30, 1981, DHS approved welfare rates of $28.99 and $20.69 per day effective for the period May 1, 1981 through April 30, 1982. Known cost change allowances accounted for $1.31 of the first rate and $1.25 for the second rate. During a desk audit of Broen’s cost report for the fiscal year ending April 30, 1982, DHS determined Broen made a net over-projection of known cost changes of $18,-275. It adjusted Broen’s welfare rates for the fiscal year ending April 30, 1982 to $28.91 and $20.25 per day. These adjusted rates included a payback of $.08 per day and $.44 per day respectively.

For the fiscal year ending April 30, 1982, welfare patient days accounted for 54.47 percent of the actual patient days. Broen’s occupancy rate was 85.46 percent.

Based on Broen’s cost change report for the fiscal year ending April 30, 1982, DHS approved welfare rates of $31.39 and $21.68 effective May 1, 1982 through April 30, 1983. Known cost change allowances accounted for $1.48 of the first rate and $.97 on the second rate. During a desk audit of Broen’s cost report for fiscal year ending April 30, 1983, DHS determined Broen over-projected known cost changes by $73,324 and adjusted Broen’s welfare rates for fiscal year ending April 30, 1983 to $30.25 and $20.89 per day. These adjusted rates included a payback of $1.14 per day and $.79 per day respectively.

For the fiscal year ending April 30, 1983, welfare patient days accounted for 55.05 percent of the actual patient days. Broen’s occupancy rate was 76.74 percent.

In determining the paybacks DHS used the gross dollar method. Under the gross dollar method, a nursing home’s prior year projection of expenditures in known cost change categories is compared with the actual current year’s expenditures in those categories. If the home underspent its projection, DHS calculates the payback rate based on the gross dollar that the home underspent.

Broen appealed the retroactive adjustment of its rates and requested a waiver of the 93 percent occupancy limitation rule. The request was denied, and Broen appealed the denial.

The matters were submitted to an administrative law judge on stipulated facts and cross motions for summary disposition. The administrative law judge determined (1) Minn.R. 9510.0030, subp. 3.J. (1983) requires the use of the gross dollar method for calculating paybacks rather than the per diem method as advocated by Broen, (2) Minn.R. 9510.0470, subp. 4.B. (1983) permits only nursing homes with 65 percent welfare patient days to request a waiver of the 93 percent occupancy limitation, and (3) the validity of a rule cannot be challenged in a contested case on the grounds it is arbitrary. He granted DHS’s motion for summary disposition and denied Broen’s *439 cross motion. The Commissioner of Human Services adopted the administrative law judge’s findings and conclusions.

ISSUES

1. Does Minn.R.‘9510.0030, subp. 3.J. (1983) require the use of the gross dollar method for calculating paybacks?

2. Did DHS err when it denied Broen’s request for a waiver of the 93 percent occupancy limitation?

ANALYSIS

I.

1. Broen contends, because it experienced a material decrease in occupancy, a per diem method rather than the gross dollar method used by DHS should be employed in calculating paybacks. DHS has used both methods in the past. DHS employed the gross dollar method generally but employed a per diem method when there were material changes in patient day occupancy between reporting periods. Where the occupancy of a nursing home decreases between the prior year and the next year, the per diem method works to the nursing home’s advantage but works to DHS’s advantage in cases of increased occupancy.

In 1982, the Supreme Court considered “whether the Department of Public Welfare’s practice of computing cost change implementation on a per diem basis constitutes a permissible interpretation of [Minn.R. 9510.0030] or an improper promulgation of the new rule.” White Bear Lake Care Center, Inc. v. Minnesota Department of Public Welfare, 319 N.W.2d 7, 7 (1982). The court held:

[Calculations made using the per diem method cannot be enforced because the per diem method is a rule which has not been promulgated in accordance with the Administrative Procedure Act.

Id. The court found Minn.R. 9510 unambiguous stating, “There is no suggestion in the language that present occupancy rates are in any way involved in the calculation * * Id. at 9.

The rule permits “allowance for known cost changes” in computing the per diem welfare rate. Future cost increases or decreases “must be added to or deducted from the historical rate”. These changes are projected in gross dollar amounts. If the changes do not in fact occur the welfare rate is readjusted and repayment required.

Id. Ever since the court’s decision in White Bear Lake, DHS has used only the gross dollar method for calculating paybacks.

The administrative law judge and the Commissioner found White Bear Lake controlling and concluded that Minn.R. 9510.0030, subp. 3.J. (1983) requires the use of the gross dollar method for calculating paybacks in this case. We agree.

We understand Broen’s frustration upon discovering the DHS no longer employed a per diem method in calculating paybacks when there were material changes in patient day occupancy between reporting periods. White Bear Lake, however, precludes the DHS from using the per diem method for calculating paybacks. It is irrelevant that in White Bear Lake

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Bluebook (online)
364 N.W.2d 436, 1985 Minn. App. LEXIS 3974, Counsel Stack Legal Research, https://law.counselstack.com/opinion/broen-memorial-home-v-minnesota-department-of-human-services-minnctapp-1985.