Connecticut Ass'n of Not-for-Profit Providers for Aging v. Department of Social Services

709 A.2d 1116, 244 Conn. 378, 1998 Conn. LEXIS 92
CourtSupreme Court of Connecticut
DecidedMarch 31, 1998
DocketSC 15735
StatusPublished
Cited by82 cases

This text of 709 A.2d 1116 (Connecticut Ass'n of Not-for-Profit Providers for Aging v. Department of Social Services) is published on Counsel Stack Legal Research, covering Supreme Court of Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Connecticut Ass'n of Not-for-Profit Providers for Aging v. Department of Social Services, 709 A.2d 1116, 244 Conn. 378, 1998 Conn. LEXIS 92 (Colo. 1998).

Opinion

Opinion

CALLAHAN, C. J.

This administrative appeal arises from a petition brought by the plaintiff, the Connecticut Association of Not-For-Profit Providers for the Aging, seeking a declaratory ruling with respect to the legality of a practice employed by the named defendant, the department of social services (department),1 in its rate setting capacity for medicaid reimbursement. The principal issue is whether the department may use the lesser of the statutorily mandated fair rent value or the actual property costs in setting the rate payable to not-for-profit nursing facilities for expenditures eligible for medicaid reimbursement. The plaintiff contends that [380]*380neither the plain text of General Statutes § 17b-340 (f),2 the governing statute, nor its legislative history permits the practice of using the lesser value in setting medicaid reimbursement rates for not-for-profit facilities.3 The plaintiff also seeks compensation for reasonable attorney’s fees and costs incurred in pursuing this litigation [381]*381because, it alleges, the department has acted without substantial justification. The department maintains that its practice of using the lesser value for not-for-profit facilities is mandated by the language of the statute as informed by the legislative purpose in enacting the legislation. It further argues that even if the practice is determined to be impermissible, its interpretation of the law was reasonable and, therefore, the plaintiff is not entitled to attorney’s fees and costs. Additionally, the department contends that if this court concludes that the practice is impermissible, the appropriate remedy is a remand for reconsideration by the department, not a directed judgment. We agree with the plaintiff that the department is not permitted to use the lesser value methodology. We decline to conclude, however, that the plaintiff is entitled to attorney’s fees or that the defendant is entitled to a remand rather than a directed judgment.

The following relevant facts are undisputed. The plaintiff is a trade association whose members are not-for-profit nursing facilities providing care for the elderly and compensated by federal medicaid funds. Federal medicaid funds are distributed to the states, and the department is the state agency vested with authority to regulate and manage the state’s medicaid program, which is established by statute and approved by the federal government.4 See 42 U.S.C. § 1396 et seq.; General Statutes § 17b-260.5 Specifically, the department [382]*382has authority to set, pursuant to a statutory methodology, the annual rates paid to nursing facilities, including members of the plaintiff association.

In 1991, the General Assembly enacted Public Acts, Spec. Sess., June, 1991, No. 91-8, § 22, now codified as § 17b-340 (f), which established a mandatory methodology for setting the rates payable to nursing facilities providing services to patients eligible for medicaid. The statute essentially retained the existing rate setting structure, but introduced several significant modifications that comprehensively and exclusively govern the reimbursement methodology for nursing facilities.6 The relevant portion of that methodology is as follows. The statute creates five categories of allowable costs as the basis for setting the annual rate payable to each facility. General Statutes § 17b-340 (f) (1). Those categories are: direct costs, indirect costs, “fair rent,” capital costs, and administrative and general costs. The statute establishes a preset maximum dollar amount for the direct, indirect, and administrative and general cost categories.7 General Statutes § 17b-340 (f) (3). There is no cap for capital costs, and the only limitation applicable to fair rent is the determination of the original valuation [383]*383of the facility in its certificate of need as approved by the appropriate state agency.8 General Statutes § 17b-340 (f) (3); Regs., Conn. State Agencies § 17-311-52 (f).9 From these five categories, the total allowable costs are determined and serve as the basis of the yearly reimbursement rate payable to a covered nursing facility.

The dispute in this case involves the determination of the proper figure to be used in the fair rent cost category. The statute requires that fair rent “shall be defined in accordance with subsection (f) of section 17-311-52 of the regulations of Connecticut state agencies . . . .”10 General Statutes § 17b-340 (f) (1). That regulation requires the department to calculate a figure, [384]*384known as fair rent,11 and to use that figure in this cost category rather than using the actual property costs12 in determining the total allowable costs. The purpose is to equalize the amount of payments each year and thus compensate the facility over the term of its useful life without fluctuations in the yearly amount. Regs., Conn. State Agencies § 17-311-52 (f) (2). The use of the fair rent figure introduces a degree of certainty as to that cost, which otherwise might vary significantly from year to year.

The gravamen of the plaintiffs complaint is that the department, pursuant to an informal practice, has modified this statutorily mandated reimbursement methodology with respect to not-for-profit nursing facilities. [385]*385Pursuant to this practice, the department uses the lesser of the predetermined fair rent figure or the actual property costs for not-for-profit nursing facilities (the lesser value methodology).13 Thus, in years where the calculated fair rent figure is greater than actual property costs, the department uses the actual property costs. In years when the actual property costs exceed the fair rent figure, the department uses the fair rent figure. The department applies this methodology only to not-for-profit nursing facilities.

The plaintiff petitioned the department for a declaratory ruling with respect to the legality of this practice. The hearing officer appointed by the department concluded that the department’s use of the lesser value methodology was an acceptable interpretation of the statute and denied the plaintiffs petition. The plaintiff appealed from the department’s decision to the trial court pursuant to General Statutes §§ 4-183 and 4-176.14 The trial court, concluding that it owed deference to [386]*386the hearing officer’s decision and that the department’s interpretation was not contrary to law, dismissed the plaintiffs appeal. The plaintiff appealed from the judgment of the trial court to the Appellate Court, and we transferred the appeal to this court pursuant to Practice Book § 4023, now Practice Book (1998 Rev.) § 65-1, and General Statutes § 51-199 (c). We reverse the judgment of the trial court.

The department first argues that the trial court was without subject matter jurisdiction to hear this appeal because the plaintiff lacks standing.

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Bluebook (online)
709 A.2d 1116, 244 Conn. 378, 1998 Conn. LEXIS 92, Counsel Stack Legal Research, https://law.counselstack.com/opinion/connecticut-assn-of-not-for-profit-providers-for-aging-v-department-of-conn-1998.