Department of Human Services v. Muriel Humphrey Residences

436 N.W.2d 110, 1989 Minn. App. LEXIS 208, 1989 WL 14987
CourtCourt of Appeals of Minnesota
DecidedFebruary 28, 1989
DocketCX-88-1920
StatusPublished
Cited by8 cases

This text of 436 N.W.2d 110 (Department of Human Services v. Muriel Humphrey Residences) 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
Department of Human Services v. Muriel Humphrey Residences, 436 N.W.2d 110, 1989 Minn. App. LEXIS 208, 1989 WL 14987 (Mich. Ct. App. 1989).

Opinion

OPINION

RANDALL, Judge.

Appeal from an order of the Commissioner of the Department of Human Services which required appellant to repay $32,-617.33. We reverse.

FACTS

The federal Medicaid or Medical Assistance program is established under Title XIX of the Social Security Act, 42 U.S.C.A. § 1396 et seq. (1983). The purpose of the program is to provide medical and related care to needy persons. The Medicaid program is jointly funded by the state and federal governments, and its administration is subject to both state and federal law and regulations.

Minnesota’s Medical Assistance program is administered by the Department of Human Services (DHS). Minnesota has elected to provide a full range of services, many of which are optional under federal law. One such optional service is residential care for mentally retarded persons. Under federal law, each state establishes its own system for reimbursing intermediate care facilities for the mentally retarded (“ICFs/MR”) for the cost of providing care to medical assistance recipients. Relator, Muriel Humphrey Residences (MHR), is an ICF/MR.

Louise Whitbeck Fraser Community Services, Inc., is a non-profit corporation that serves the educational needs of developmentally handicapped children and adults. The organization started as a home school in 1935, and currently has three major divisions, one of which is MHR. The MHR division was established in 1976. It is composed of three homes on a three-acre site in Eden Prairie. Each of the homes holds 12 residents. The three homes are operated as one facility.

In 1977, the Minnesota Department of Public Welfare licensed MHR to provide residential care and services for 36 mentally retarded males and females, ages 16 and over. At the same time, the Minnesota Department of Health certified MHR for 36 Title XIX intermediate care beds.

When MHR first applied for funding through the State Medical Assistance Plan, *112 it was referred to Thomas L. Neumann, who at the time was an auditor with the Department of Public Welfare, the predecessor of DHS. Mr. Neumann assisted MHR in the preparation and completion of the forms necessary to acquire its interim financing rate, and later its per diem rate. During its years of operation, MHR regularly contacted Mr. Neumann to resolve questions relating to its funding through the State Medical Assistance Program. MHR came to rely on Neumann as an advisor on funding matters when dealing with DHS.

In 1980, at the suggestion of Virginia Presley of DHS, MHR agreed to change its licensing. Presley suggested that MHR change from having one license for a three-unit 36-bed facility, to having separate licenses for each of the three 12-bed housing units which comprised MHR. Various reasons were given as to why MHR should consider the change. The primary reasons were that in the event of a fire or the outbreak of a communicable disease in any one of the buildings, all MHR beds would have to be shut down if the facility had only one license. If each house were licensed separately, such an occurrence in one house would not require closing the two that were unaffected.

MHR representatives were concerned about whether a change in licensing would affect its funding or funding requirements. For the answer to this question, Dr. Robert Kowalczyk, MHR’s Executive Director, testified that he contacted Thomas Neumann. Dr. Kowalczyk described the proposed licensing change to Mr. Neumann and asked whether such a change would have any effect on MHR’s funding or funding requirements. Kowalczyk testified that Neu-mann’s response was that there would be no change. He told Dr. Kowalczyk that funding would continue on the basis of one 36-bed facility; that MHR could continue to file only one cost report; that the change was for licensing purposes only; and there would be no financial impact at all. This information provided by Neu-mann turned out to be incorrect.

MHR’s funding was based, in part, on per diem payments received from DHS and, in part, on payments MHR received for “reserved-bed days.” 1 To determine the per diem rate, DHS rules require an ICF/MR to submit an annual cost report to the Department. The report includes information relevant to the facility’s operational costs. The DHS then determines the facility’s payment rate based on the Department’s review of the cost reports. Once a facility’s rate is established, it bills the Department on a monthly basis for the number of days of patient-residence during the previous month. In a 30-day month, a 12-bed facility with full occupancy would bill for 360 days of reimbursement at the predetermined per diem rate.

Minnesota is one of many states that has chosen to pay ICFs/MR for reserved-bed days. Payment of reserved-bed days is for the benefit of residents. Its purpose is to ensure that the resident will be able to return to the same bed and not be faced with the disruption of moving to another bed upon return to the facility.

The Department has developed a reserved-bed days policy that pays for reserved-bed days only when facilities operate above certain occupancy levels. When occupancy is low, the likelihood that a resident would be unable to return to his or her same bed is minimal. Thus, facilities must have a certain occupancy level in order to qualify for payment for reserved-bed days. The level set by the state is 93 percent for facilities with more than 24 beds. Facilities with 24 or fewer beds may claim reserved-bed days only if they have not had a certified bed vacant within that facility for an entire month. In the billing process, a facility may claim reimbursement for its eligible reserved-bed days. The billing process for reserved-bed days is separate from the process of establishing a facility’s per diem rate.

At the administrative hearing, Neumann testified that he was unaware of the 24- *113 bed or less exception to the 93 percent rule when he advised MHR that its funding would not be affected. Neumann testified that he “vaguely” recalled discussing the issue of a change in licensing for MHR, but had no specific recollection of the conversation. He could not remember talking to representatives of MHR about the effect the licensing change would have on its funding. Neuman also testified that he could only recall “bits and pieces” of his 1980 conversation with Kowalczyk.

Later, on direct examination, Neumann testified that he had “conversations” with MHR, without specifying with whom. According to his testimony, he specifically remembered discussing per diem rate calculation only. Later he testified, regarding the 93% cut-off rate and the 24 or less cut-off rule, that “ * * * I don’t remember specifically talking with them about, I guess, the particular issue at hand * * *.”

At the time of his 1980 conversation with Neumann, Kowalczyk was aware of the state’s policy of funding reserved-bed days only when minimum occupancy levels were met. Kowalczyk had received and read a 1978 Medical Assistance provider bulletin describing State Plan requirements for reserved-bed day reimbursement. The bulletin was mailed to all ICF/MR providers to explain the reserved bed day payment plan. Regarding reimbursement based on facility size and occupancy, the bulletin states:

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Bluebook (online)
436 N.W.2d 110, 1989 Minn. App. LEXIS 208, 1989 WL 14987, Counsel Stack Legal Research, https://law.counselstack.com/opinion/department-of-human-services-v-muriel-humphrey-residences-minnctapp-1989.