Champaign Cty. Nur. Home v. Ohio D.H.S., Unpublished Decision (4-3-2003)

CourtOhio Court of Appeals
DecidedApril 3, 2003
DocketNo. 98AP-255, No. 00AP-91, No. 97CV-3949) (REGULAR CALENDAR)
StatusUnpublished

This text of Champaign Cty. Nur. Home v. Ohio D.H.S., Unpublished Decision (4-3-2003) (Champaign Cty. Nur. Home v. Ohio D.H.S., Unpublished Decision (4-3-2003)) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Champaign Cty. Nur. Home v. Ohio D.H.S., Unpublished Decision (4-3-2003), (Ohio Ct. App. 2003).

Opinion

OPINION
{¶ 1} These appeals were brought by relator/plaintiff-appellant, Champaign County Nursing Home ("appellant"), from judgments of the Franklin County Court of Common Pleas. In 1997, appellant filed an action in the Franklin County Court of Common Pleas seeking a writ of mandamus, declaratory judgment, injunctive relief, and other relief based on alleged violations of federal and state Medicaid law, violations of federal and state constitutional provisions, and breach of contract. In February 1998, the trial court granted summary judgment in favor of respondent/defendant-appellee, Arnold R. Tompkins, Director of the Ohio Department of Human Services ("ODHS"). Appellant appealed, and we remanded the matter to the trial court to resolve an inconsistency in the decision. In January 2000, the trial court issued a supplemental decision correcting a clerical error and again awarded judgment in favor of ODHS.

{¶ 2} Appellant again appealed. The two appeals were consolidated and additional briefs filed. However, in March 2000, appellant filed another motion in the trial court seeking relief from judgment under Civ.R. 60(B). Appellant asked this court to remand the matter again in order to permit the trial court to rule on the motion. We granted the request, and the trial court denied the motion in June 2000. We then granted leave to amend the notice of appeal and file supplemental assignments of error and briefs. The amended, consolidated appeals are now before this court.

{¶ 3} Appellant is operated by Champaign County and is certified under Medicaid law as a nursing facility and as an intermediate care facility for the mentally retarded ("IC facility"). Under the Medicaid program, facilities across the country are not paid a standard rate for all residents, but each facility is reimbursed on the basis of its costs in providing services, and other factors. See Drake Ctr., Inc. v. Ohio Dept. of Human Serv. (1998), 125 Ohio App.3d 678. Based on federal and state law, and pursuant to provider agreements, ODHS reimburses appellant based on a per diem rate per resident. Section 1396, Title 42, U.S. Code; R.C. 5111.20, et seq.

{¶ 4} During the period of time at issue, the Medicaid payment process in Ohio was a multi-stage process for each year of services provided. After the facility submitted its cost report for the year, the process involved a desk review, rate-setting, interim settlement (at which time ODHS paid the facility), and final settlement (at which time ODHS reached a final decision on disputed matters, determined whether the facility had been overpaid or underpaid, and made a final payment or a recoupment demand). See Am.S.B. No. 206; Am.Sub.H.B. No. 298; Sub.S.B. No. 359; affidavits of D. Wilkins and B. Cummins; deposition transcript of D. Wilkins; R.C. 5111.205111.31; Ohio Adm. Code 5101:3-3. If the facility chose to challenge ODHS's proposed final settlement, it could request an administrative hearing under R.C. Chapter 119.06. Following the administrative remedies within the agency, facilities could then appeal to the common pleas court under R.C. 119.12.

{¶ 5} The present dispute focuses on ODHS's setting of the per diem rate for services provided by appellant from July 1, 1991 through June 30, 1992 ("fiscal year 1992"). In addition, appellant raises issues regarding ODHS's rates for services rendered from July 1, 1992 through June 30, 1993 ("fiscal year 1993").

{¶ 6} The pertinent events occurred against a backdrop of legislation in which the General Assembly modified the Medicaid payment system, changing from a retrospective-rate system to a prospective-rate system for nursing and IC facilities. Under the retrospective-rate system, the facility filed a cost report after each calendar year, and ODHS would make payment based on that year's costs and other factors. The new legislation created a prospective-rate system under which costs incurred during a given period were combined with factors such as inflation to determine a subsequent period's per diem rate. See Am.S.B. No. 206 (effective June 29, 1991); Am.Sub.H.B. No. 298 (effective July 26, 1991) and Sub.S.B. No. 359 (effective Dec. 22, 1992).

{¶ 7} As part of these amendments to state Medicaid law, the General Assembly established a transitional or interim system for the period from July 1, 1991, through June 30, 1993 — fiscal years 1992 and 1993. For example, the legislature provided that ODHS would determine the prospective per diem rates for services provided during fiscal year 1992 based on the cost report for calendar year 1990. Am.S.B. No. 206, Section 36(A)(1). For services provided during fiscal year 1993, prospective rates would be determined from the cost report from July 1 through December 31, 1991. Id. at 36(A)(2).

{¶ 8} Further, in Am.Sub.H.B. No. 298, the General Assembly added a subsection providing that, for services rendered in fiscal year 1992, ODHS could adjust the prospective rate based on renovation costs reported by the facility, if the renovation met three criteria. See Section 23(A)(1)(g) (amending Section 36 of Am.S.B. No. 206). These criteria were placed in former Ohio Adm. Code 5101:3-3-17, which recited the formula and criteria announced in the statute. In addition, the legislature established the source of funds from which ODHS would pay the adjustments under Section 23(A)(1)(g), and it also limited the spending for these adjustments. Sub.S.B. No. 359, Section 8 (amending Section 36 of Am.S.B. No. 206).

{¶ 9} In 1991, appellant completed and filed its cost report for calendar year 1990. Under the former retrospective system, the 1990 cost report would be used for reimbursements for calendar year 1990. In addition, under the new transitional system, the 1990 cost report would be used to determine the per diem rate for fiscal year 1992. Accordingly, after appellant filed a 1990 cost report for the nursing and IC facilities, the administrative process began during which ODHS would set rates for fiscal year 1992, pay an interim settlement for that year, and eventually determine a final settlement for that year.

{¶ 10} By November 1993, ODHS had completed its calculation of the rates for fiscal year 1992, including the adjustments under Section 23(A)(1)(g) for renovation costs. ODHS published a list in November 1993 showing the adjustments and rates for Ohio facilities for fiscal year 1992. Then, in February 1994, in connection with making the interim settlements, ODHS completed distribution of the limited funds available under Section 23(A)(1)(g), according to the testimony of Daniel Wilkins, an agency administrator.

{¶ 11} At some point in 1994, appellant became aware that it had made significant errors in its cost report for calendar year 1990. It had failed to include renovation-related bond interest and depreciation. Appellant sought to amend its 1990 cost report to add these costs. Appellant not only wanted ODHS to use the new figures for the final settlement for calendar year 1990 under the former system, but also sought to have ODHS use the new 1990 figures for the purpose of qualifying for an adjustment under Section 23(A)(1)(g) pursuant to the new legislation. Appellant eventually filed an amended 1990 cost report.

{¶ 12}

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Champaign Cty. Nur. Home v. Ohio D.H.S., Unpublished Decision (4-3-2003), Counsel Stack Legal Research, https://law.counselstack.com/opinion/champaign-cty-nur-home-v-ohio-dhs-unpublished-decision-4-3-2003-ohioctapp-2003.