Cheshire Hospital v. New Hampshire-Vermont Hospitalization Service, Inc.

689 F.2d 1112
Court of Appeals for the First Circuit·Decided September 16, 1982·No. No. 82-1097·Published·Cited by 25 cases

Opinion

PETTINE, Senior District Judge.

Cheshire Hospital, a 170 bed health care facility located in Keene, New Hampshire, is a provider of services to patients covered by Medicare1, the national health insurance program for the aged. Under Part A2 of the Medicare program, Cheshire is entitled [1116]*1116to reimbursement for the reasonable costs of providing these services. 42 U.S.C. § 1395f(b). This appeal concerns the proper determination of reasonable costs under the program. In large part we agree with the district court that the administrative determination in this matter was not arbitrary, capricious, or an abuse of discretion. However, because administrative clarification on one point seems necessary, a limited remand is required.

I. Facts

The controversy in this case involves the proper treatment of interest expense incurred by Cheshire Hospital in 1977. The facts pertaining to this expense are not in dispute. In April, 1971, Cheshire incurred $9,450,000 in debt through the sale of revenue bonds issued under the auspices of the New Hampshire Higher Educational and Health Facilities Authority (NHHEHFA). The proceeds of this financing were used to construct a new hospital facility in Keene, New Hampshire, a facility which all parties agree was necessary to meet the medical needs of the community. Pursuant to the bond agreement, $880,000 of the proceeds of the bond sale were deposited in a Debt Service Reserve Fund (DSRF) which was created to provide security for the bondholders.3 The funds in the DSRF are held by an independent trustee, the Shawmut Bank of Boston, N. A., which invests them in government and government-guaranteed securities.

The bond agreement provides that the amount of funds in the DSRF must be maintained at a level equal to the maximum amount of interest and principal which remains payable in any one year period under the agreement. In case of a default by Cheshire, the trustee is authorized to make immediate payment to the bondholders from the funds maintained in the DSRF. If no default occurs, the interest income earned on the DSRF (and any other amounts which exceed the required level of funds in the DSRF) flow into the Project Reserve Fund, a fund created to provide for any extraordinary repairs and maintenance which the hospital facility may require. When the funding requirement of the Project Reserve Fund is met, any surplus from the DSRF or the Project Reserve Fund, flows into the Redemption Fund. The bond agreement specifies that when the amount of money in the DSRF, the Project Reserve Fund, and the Redemption Fund equals the amount of outstanding principal and contingent and accrued interest owed on the bonds, the money in the three funds will be used to redeem the bonds.

Cheshire filed a Medicare cost report for the year ending June 25, 1977 in which it claimed as an allowable cost the amount of annual interest it had paid on the 1971 revenue bonds. Blue Cross-Blue Shield of New Hampshire-Vermont, a fiscal intermediary appointed by the Secretary to assist in the administration of the Medicare program,4 disallowed as a reimbursable cost $51,995 of this interest expense. The intermediary made this adjustment because the Medicare regulation known as the offset rule requires that interest expense “[b]e reduced by investment income except where such income is from gifts and grants, whether restricted or unrestricted, and which are held separate and not commingled with other funds. Income from funded depreciation or a provider’s qualified pension fund is not used to reduce interest expense.” 42 C.F.R. § 405.419(b)(2)(iii). The intermediary determined that $51,995 in interest income earned on funds in the DSRF was investment income which was not within either the gifts and grants exception or the funded depreciation exception of the regulation, and that an offset of allowable interest expense was therefore required.

Following the intermediary’s issuance of its final notice of program reimbursement, [1117]*1117Cheshire sought review of the intermediary’s determination before the Provider Reimbursement Review Board (PRRB) pursuant to 42 U.S.C. § 1395oo(a). After hearing testimony and receiving documentary evidence, the PRRB affirmed the determination of the intermediary on March 3, 1981. On March 25, 1981 the Secretary declined to reverse, affirm or modify the decision of the Board, and the decision became a final one for purposes of judicial review. Cheshire then sought such review in the district court pursuant to 42 U.S.C. § 1395oo(f). Under the limited scope of review provided by 42 U.S.C. § 1395oo(f), the district court entered summary judgment in favor of the intermediary and the Secretary. Cheshire Hospital v. New Hampshire-Vermont Hospitalization Service, Inc., 528 P.Supp. 1104 (D.N.H.1981). This appeal followed.

II. Interpretation of the Offset Rule

Cheshire’s principal contention in this ease is that the Secretary erred when he determined that interest income earned on the DSRF was investment income within the meaning of the offset rule of 42 C.F.R. § 405.419(b) (2) (iii), and required that such interest income be used to offset reimbursable interest expense. We approach this question mindful of the limited scope of judicial review provided for by statute.5 Specifically, we are authorized to set aside agency actions, findings, and conclusions only if we find them to be:

(A) arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law;

(B) contrary to constitutional right, power, privilege, or immunity;

(C) in excess of statutory jurisdiction, authority, or limitations, or short of statutory right;

(D) without observance of procedure required by law; or

(E) unsupported by substantial evidence. 5 U.S.C. § 706.

Moreover, in this case appellant is challenging an agency’s interpretation of its own regulation. It is well settled that in such cases courts should afford considerable respect to the agency’s interpretation.6 Ford Motor Credit Co. v. Milhollin, 444 U.S. 555, 566, 100 S.Ct. 790, 797, 63 L.Ed.2d 22 (1980). Generally, such an interpretation is of controlling weight, unless the reviewing court determines that it is plainly erroneous or inconsistent with the regulation. Udall v. Tallman, 380 U.S. 1, 16-17, 85 S.Ct. 792, 801, 13 L.Ed.2d 616 (1965);

Free access — add to your briefcase to read the full text and ask questions with AI

Cheshire Hospital v. New Hampshire-Vermont Hospitalization Service, Inc., 689 F.2d 1112 (1st Cir. 1982).

689 F.2d 1112 (Cheshire Hospital v. New Hampshire-Vermont Hospitalization Service, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Universirty of Kentucky v. Shalala
858 F. Supp. 639 (E.D. Kentucky, 1994)
Monongahela Valley Hospital, Inc. v. Sullivan
945 F.2d 576 (Third Circuit, 1991)
John L. Kelly v. United States
924 F.2d 355 (First Circuit, 1991)
Atlas Development Ass'n v. Commonwealth
587 A.2d 817 (Commonwealth Court of Pennsylvania, 1991)
United States v. John Sherman
912 F.2d 907 (Seventh Circuit, 1990)
Northwood Nursing & Convalescent Home, Inc. v. Commonwealth
531 A.2d 873 (Commonwealth Court of Pennsylvania, 1987)
Sikeston Prod. Credit Ass'n v. Farm Credit Admin.
647 F. Supp. 1155 (E.D. Missouri, 1986)
Memorial Hospital of Carbondale v. Heckler
760 F.2d 771 (Seventh Circuit, 1985)
Citizens Savings Bank v. Bell
605 F. Supp. 1033 (D. Rhode Island, 1985)
Sacred Heart Hospital v. Heckler
601 F. Supp. 299 (E.D. Pennsylvania, 1984)
New York Eye and Ear Infirmary v. Heckler
594 F. Supp. 396 (S.D. New York, 1984)
Bouchard v. Secretary of Health & Human Services
583 F. Supp. 944 (D. Massachusetts, 1984)
Trull Nursing Home, Inc. v. State Department of Human Services
461 A.2d 490 (Supreme Judicial Court of Maine, 1983)