Department of Social Services v. Our Lady of Mercy Home

803 S.W.2d 72, 1990 Mo. App. LEXIS 1809, 1990 WL 204349
CourtMissouri Court of Appeals
DecidedDecember 18, 1990
DocketWD 42806
StatusPublished
Cited by12 cases

This text of 803 S.W.2d 72 (Department of Social Services v. Our Lady of Mercy Home) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Department of Social Services v. Our Lady of Mercy Home, 803 S.W.2d 72, 1990 Mo. App. LEXIS 1809, 1990 WL 204349 (Mo. Ct. App. 1990).

Opinions

ULRICH, Judge.

Our Lady of Mercy Home (Our Lady) appeals the Circuit Court judgment reversing the decision of the Administrative Hearing Commission (Commission) to grant appellant an increase in its medicaid reimbursement rate. On appeal, Our Lady contends that the circuit court erred in reversing the Commission’s decision to award appellant an increase in its medicaid reimbursement rate due to appellant’s use of an erroneous accounting methodology in developing the base report utilized in computing appellant’s reimbursement rate. The [74]*74judgment is reversed, and the case is remanded to the Circuit Court with directions to enter judgment affirming the Administrative Hearing Commission’s decision.

Our Lady is a long-term care facility authorized under Missouri law to provide nursing home services for medicaid recipients. The Department of Social Services (DSS) is the state agency charged with the administration of the medicaid program pursuant to 42 U.S.C. § 301, et seq., and chapter 208, RSMo 1986. Pursuant to state regulation, DSS reimburses long-term care facilities for services rendered to medicaid recipients. 13 C.S.R. 40-81.-081(2)(b) (1982).1 DSS relies upon a nursing home’s financial report for the fiscal year ending June 30, 1982, to compute the facility’s reimbursement rate. The facility’s 1982 financial report is referred to as the base report. By utilizing the facility’s base report together with certain allowances which reflect economic trends, DSS calculates the facility’s reimbursement rate for the current year.

Pursuant to the regulatory scheme, a long-term care facility may seek an adjustment in its reimbursement rate by applying for informal rate reconsideration with the Director of DSS. 13 C.S.R. 40-81.081(7). The Director, exercising his discretion, refers informal rate reconsideration applications which reflect “significant and extraordinary circumstances” to an advisory committee which reviews them and makes recommendations. C.S.R. 40-81.-081(7)(B)l.d.

Our Lady’s financial report for the fiscal year ending June 30, 1982, which became its base report for the purposes of medicaid reimbursement, was prepared by an accountant that Our Lady had retained since 1957. Our Lady had experienced substantial losses while reimbursed at the rate calculated by relying upon the facility’s base report. Eventually, Our Lady hired an accounting firm with extensive experience in providing accounting services for Missouri medicaid providers.

Our Lady’s new accounting firm determined that the previous accountant had prepared the base report using erroneous data and an inadequately documented means of allocating costs. The new accounting firm determined that the facility’s base report resulted in insufficient medicaid reimbursement to Our Lady. Given the practice of utilizing the base report in calculating reimbursement rates, an inadequate base report presented a continuing detriment to the facility. In response to the information provided by the new accountants, Our Lady applied for informal rate reconsideration with the Director of DSS.

Upon receiving appellant’s request, the Director of DSS determined that a review of appellant’s reimbursement rate was warranted due to “significant and extraordinary circumstances” and referred appellant’s request to the rate advisory committee. The advisory committee recommended that DSS grant appellant a rate increase. DSS rejected the advisory committee’s recommendation and notified Our Lady of its decision not to grant a rate increase.

Appellant contested DSS’ denial of the requested medicaid reimbursement rate increase before the Administrative Hearing Commission. The Commission concluded that Our Lady’s base report was “grossly inadequate.” The Commission further found that the inadequacies in the base report resulted in “significant and extraordinary circumstances” which warranted an increase in appellant’s medicaid reimbursement rate.

DSS appealed the decision of the Commission to the Circuit Court of Cole County, Missouri. The circuit court determined that the accounting methodology employed by appellant’s first accountant did not constitute a “significant and extraordinary circumstance” under Missouri law and reversed the decision of the Commission.

[75]*75Our Lady appeals the decision of the circuit court and contends that the Commission properly determined that it is entitled to a medicaid reimbursement rate increase due to the “significant and extraordinary circumstances” involving the facility’s inadequate base report.

This court is obligated to review the decision of the Commission and not the judgment of the circuit court. First Bank of Commerce v. Labor & Industrial Relations Comm’n, 612 S.W.2d 39, 42 (Mo.App. 1981). Generally, in reviewing the decision of an administrative agency, appellate courts are limited to determining whether the decision is supported by competent substantial evidence upon the whole record, whether it is arbitrary, capricious, or unreasonable, or whether the Commission abused its discretion. M. V. Marine Co. v. State Tax Comm’n, 606 S.W.2d 644, 647 (Mo. banc 1980). However, an administrative agency’s decision based upon the agency’s interpretation of law is a matter for the independent judgment of the reviewing court. King v. Laclede Gas Co., 648 S.W.2d 113, 114 (Mo. banc 1983). In cases such as this, where the pertinent facts are undisputed between the parties, the appellate court will review the matter as a question of law. See M.V. Marine Co., 606 S.W.2d at 647; Central Bank of Clayton v. State Banking Bd., 509 S.W.2d 175, 190 (Mo.App.1974).

The regulation in question here provides that a long-term care facility is entitled to a reimbursement rate increase if the facility experiences “significant and extraordinary circumstances.” Thus, the meaning of “significant and extraordinary circumstances” is relevant. The primary objective in construing statutory or regulatory language is to ascertain the intent of the drafters from the language used and to give effect to that intent if possible. King v. Laclede Gas Co., 648 S.W.2d at 115. In interpreting language, words are to be considered in their plain and ordinary meaning. Id.

The Missouri Supreme Court has previously defined the word extraordinary as something “beyond or out of the common order or rule; not of usual, customary, or regular kind.” Courtney v. Ocean Accident & Guaranty Corp., 346 Mo. 703, 142 S.W.2d 858 (1940). The Commission, in reaching its decision in this case, applied the definition of extraordinary adopted by the Missouri Supreme Court in Courtney. Additionally, in Monroe County Nursing Home District v. Missouri Dep’t of Social Services, 778 S.W.2d 721 (Mo.App.1989), the definition of extraordinary found in Courtney

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Department of Social Services v. Our Lady of Mercy Home
803 S.W.2d 72 (Missouri Court of Appeals, 1990)

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Bluebook (online)
803 S.W.2d 72, 1990 Mo. App. LEXIS 1809, 1990 WL 204349, Counsel Stack Legal Research, https://law.counselstack.com/opinion/department-of-social-services-v-our-lady-of-mercy-home-moctapp-1990.