Cliff House Nursing Home, Inc. v. Rate Setting Commission

390 N.E.2d 723, 378 Mass. 189
CourtMassachusetts Supreme Judicial Court
DecidedJune 4, 1979
StatusPublished
Cited by26 cases

This text of 390 N.E.2d 723 (Cliff House Nursing Home, Inc. v. Rate Setting Commission) is published on Counsel Stack Legal Research, covering Massachusetts Supreme Judicial Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cliff House Nursing Home, Inc. v. Rate Setting Commission, 390 N.E.2d 723, 378 Mass. 189 (Mass. 1979).

Opinion

*190 Wilkins, J.

The central issue in this appeal by the Rate Setting Commission (commission) is whether it or the Division of Hearings Officers (division), established pursuant to G. L. c. 7, § 4H, has the final authority at the agency level to determine questions of law relating to the rate of payment to a provider of health care services when a decision of the commission has been appealed to the division. G. L. c. 6A, § 36. A judge of the Superior Court ruled that the division had the final word. We agree with that conclusion and affirm the judgment.

The plaintiff, Cliff House Nursing Home, Inc., is a provider of health care services for which rates of reimbursement must be established by the commission. G. L. c. 6A, § 32. Cliff House’s role in this appeal is now incidental. 2 It disagrees with the rate established by the commission and with the somewhat higher rate which, on appeal, the division determined for it. Cliff House has not appealed from the lower court judgment remanding the proceedings to the commission for further action, and in its brief has not joined in the dispute between the commission and the division.

The commission, however, has appealed. It has not argued the question whether the judge was correct in his decision concerning the rates set for Cliff House by it and by the division. It expressly disclaims any interest in presenting to this court questions concerning the appropriate rate of reimbursement for Cliff House, although it disagrees with the division’s and the lower court’s determination of this point. What the commission does present for our consideration is the correctness of the judge’s determination that under G. L. c. 6A, § 36, the division, and not the commission, is the controlling administrative agency when the two disagree concerning a rate of reim *191 bursement determined by the division on appeal from a decision of the commission.

We turn first to the division’s argument that, because the judgment remanded the proceeding for further agency action, the commission has no right to appellate review at this time. The division relies on opinions holding that an order of remand to an administrative agency is interlocutory. See Metropolitan Dist. Comm’n v. Department of Pub. Utils., 352 Mass. 18, 30 (1967); Marlborough Hosp. v. Commissioner of Pub. Welfare, 346 Mass. 737, 738 (1964). In those cases, every issue in dispute could have been raised injudicial proceedings brought subsequent to the further agency action. The situation is different here, if the judge was correct in ruling that the commission must follow the division’s conclusions on questions of law. If the division’s word is final at the agency level, the commission will be assured of appellate review of the Superior Court judgment only by an appeal taken at this time. The commission cannot logically appeal from its own decision on remand. Thus, if the commission cannot now appeal from the judgment remanding the case to it for further proceedings, the commission may never have another opportunity to obtain judicial review of the basic question of the relationship between the commission and the division. From the commission’s viewpoint, the Superior Court judgment was final on the question of that relationship. The issue being appealed will not be involved in any way in the further agency proceedings ordered by the court.

There is no doubt that this court has jurisdiction to entertain the commission’s appeal (G. L. c. 30A, § 15), and we see no reason to abstain from passing on the merits simply because the judge remanded the matter for further, unrelated administrative action. See Massachusetts Gen. Hosp. v. Commissioner of Pub. Welfare, 347 Mass. 24, 29 n.4 (1964). The appeal is properly here, at least assuming the judge’s ruling on the principal point in issue was correct. 3

*192 The commission was created pursuant to G. L. c. 6A, § 32, inserted by St. 1973, c. 1229, § 2, to establish fair, reasonable, and adequate rates to be paid providers of health care services by governmental units. The commission consists of three members, a chairman "who shall have administrative experience and an advanced degree in the field of business administration, public administration or law, and two other members of whom one shall be a certified public accountant and one shall be a person experienced in the field of medical economics.” Id. The procedures by which the commission establishes interim and final rates of reimbursement need not be recounted in detail here. The rates are calculated pursuant to regulations issued by the commission. Id. A person aggrieved by a rate established by the commission may "file an appeal with the division of hearings officers established by [G. L. c. 7, § 4H].” G. L. c. 6A, § 36, inserted by St. 1973, c. 1229, § 2. It is at this point that the issue in contention here becomes significant.

The commission argues that it has the last word on all issues of law, including the interpretation of its regulations. The Attorney General, arguing in support of the commission, reiterates conclusions expressed in an opinion he gave to the Secretary of Human Services on January 12,1978. 4 The position of the division is presented by *193 a special assistant attorney general, whom the Attorney General appropriately appointed for that purpose. The division’s argument is that the Legislature intended that the division make determinations on questions of law which would be binding on the commission, subject only to judicial review.

Section 36 of G. L. c. 6A does not explicitly define the relative roles of the commission and the division. We shall describe the procedures set forth in that section, pausing where appropriate to note whatever implications of legislative intent may be found in particular statutory language.

The division does not become involved unless a person aggrieved by a commission rate determination claims a right to review of commission action. "On appeal, the rate determined for any provider of services shall be adequate, fair and reasonable for such provider . ...” G. L. c. 6A, § 36. The division thus is to determine a rate of reimbursement. The division is instructed to conduct an adjudicatory proceeding in accordance with G. L. c. 30A. G. L. c. 6A, § 36. This is the first administrative hearing at which a trial-type proceeding is required in the determination of a rate. The division’s decision must be filed with the commission and the State Secretary and must contain "a statement of the reasons therefore [sic], including a determination of each issue of fact or law on which the decision was based.” Id. The commission, of course, may be a party, and normally would be a party, to the proceedings, as it was here. We think it significant that the division is given explicit authority to decide questions of law, and not merely to make recommendations on questions of law or to make findings of fact on the basis of which the commission would reach its own conclusions.

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Bluebook (online)
390 N.E.2d 723, 378 Mass. 189, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cliff-house-nursing-home-inc-v-rate-setting-commission-mass-1979.