Evergreen Washington Healthcare Frontier, LLC v. Department of Social & Health Services

287 P.3d 40, 171 Wash. App. 431
CourtCourt of Appeals of Washington
DecidedOctober 23, 2012
DocketNo. 41910-6-II
StatusPublished
Cited by15 cases

This text of 287 P.3d 40 (Evergreen Washington Healthcare Frontier, LLC v. Department of Social & Health Services) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Evergreen Washington Healthcare Frontier, LLC v. Department of Social & Health Services, 287 P.3d 40, 171 Wash. App. 431 (Wash. Ct. App. 2012).

Opinion

Van Deren, J.

¶1 Evergreen Washington Healthcare Frontier LLC appeals the trial court’s dismissal of its [435]*435claims seeking a declaratory judgment of its right to a rate adjustment and a writ of mandamus requiring the Department of Social and Health Services (Department) to adjust its Medicaid reimbursement rates for 2006 and 2007. The Department administers the cooperative federal-state Medicaid program in Washington State. Life Care Ctrs. of Am. v. Dep’t of Soc. & Health Servs., 162 Wn. App. 370, 373, 254 P.3d 919 (2011). As part of that program, the Department compensates Washington State nursing facilities for care they provide to residents covered by Medicaid. Various nursing care facilities, including those owned by Evergreen,1 appeal the trial court’s order dismissing their 2010 complaint for declaratory judgment and writ of mandamus for lack of jurisdiction because they failed to timely file an appeal of the 2006 and 2007 Medicaid reimbursement schedule adjustments under the Administrative Procedure Act (APA), chapter 34.05 RCW. Because Evergreen failed to exhaust administrative remedies that were adequate to address its central claim — that the Department erred in calculating Evergreen’s 2006 and 2007 payment rates — we affirm.

FACTS

I. Nursing Care Facility Medicaid Payment System

¶2 Chapter 74.46 RCW governs the state administration of the nursing facility Medicaid payment system and provides the methodology by which the Department calculates payments to specific facilities. Former RCW 74.46.010 (1998); former RCW 74.46.431 (2008). The Department bases a nursing facility’s overall payment rate on a combination of seven component rates. Former RCW 74.46-.431(1). The Department bases each component rate on a previous calendar year’s cost report as specified by statute. See, e.g., former RCW 74.46.431(4)(a). The Department also annually adjusts the component rates “for economic trends [436]*436and conditions by a factor or factors defined in the biennial appropriations act.” Former RCW 74.46.43l(4)(b), (5)(b), (6)(b), (7)(b). This adjustment factor is commonly known as the “vendor rate increase” (VRI). Clerk’s Papers (CP) at 6 (emphasis omitted).

II. Administrative Review of Facility Payments

¶3 Chapter 74.46 RCW also provides the methods of administrative review applicable to nursing facility payment rates. Former RCW 74.46.780 (1998)2 required the Department to establish an “appeals or exception procedure” allowing nursing facilities to submit additional evidence and receive “prompt administrative review” in payment disputes “with respect to such issues as the department deems appropriate.” The Department’s rule implementing this statute provides that a facility challenging a payment rate “shall request an administrative review conference in writing within twenty-eight calendar days after receiving notice of the department’s action or determination.” Former WAC 388-96-904(1) (2004).3

¶4 A facility dissatisfied with the administrative review conference’s results can request a further adjudicative [437]*437proceeding before the Department’s board of appeals (Board) within 28 days of receiving a decision from an administrative review conference. Former WAC 388-96--904(5),4 (11). Facilities dissatisfied with the Board’s decision “may file a petition for judicial review pursuant to RCW 34.05.570(3) or other applicable authority.” WAC 388-96-904U3).56

[438]*438III. Department’s 2006 and 2007 Component Rate Determinations

¶5 Effective July 1, 2006, the legislature’s 2006 biennial appropriations act set the VRI at 1.3 percent. Laws of 2006, ch. 372, § 209(12). In a June 30, 2006, letter, the Department notified Evergreen of its payment rates effective July 1, 2006, and informed Evergreen that the rates were “subject to administrative review” under former WAC 388--96-904 within the 28-day filing period. CP at 183. The letter included rate computation worksheets with the rates’ descriptions and step-by-step explanations of how the Department calculated each rate. Specifically, the letter provided:

Beginning with July 1, 2006 rates, the Direct Care and Operations component rates are rebased to the 2003 cost report and subject to a [VRI] of 1.3%. Therapy Care and Support Services component rates continue to be based on the 1999 cost report. Allowable costs in Therapy Care and Support Services were adjusted by a 2.1% VRI effective July 2001, a 1.5% VRI effective July 2002, a 3.0% VRI effective July 2003, a 2.4% VRI effective July 2004, and a 1.3% VRI effective July 2005. Effective July 1, 2006, a VRI of 1.3% is applied to Therapy Care and Support Services.

CP at 185. Regarding the four components at issue here, the letter’s individual description of the direct care and operations components reiterated that they “contain[ed]” or were “adjusted” by the “1.3% VRI effective July 2006.” CP at 185-87. Similarly, the letter’s individual descriptions of the therapy care and support services components reiterated that they “contain[ed]” the VRIs for 2001 through 2006. CP at 186-87. Finally, the enclosed direct care and operations component rate worksheets showed the rates’ adjustment by the 1.3 percent VRI. Similarly, the therapy care and [439]*439support services worksheets showed those rates’ adjustment by the 2001 through 2006 VRIs.7

¶6 Effective July 1, 2007, the legislature’s 2007 biennial appropriations act set the VRI at 3.2 percent. Laws of 2007, ch. 522, § 206(2). The Department’s June 29, 2007, letter informed Evergreen of its payment rates effective July 1, 2007, and its ability to seek administrative review within 28 days under former WAC 388-96-904. An enclosure with the letter stated that the direct care, therapy care, support services, and operations component rates were “rebased to the 2005 cost report and subject to a [VRI] of 3.2%.” CP at 238. The letter’s individual rate component descriptions and enclosed worksheets showed the Department adjusted each component rate using only the 3.2 percent VRI.

IV. Life Care Nursing Facilities Litigation

¶7 After being notified of the July 1, 2006, payment rates, various nursing facilities owned by Life Care Centers of America Northwest Division requested an administrative review conference to challenge the Department’s VRI application methodology for those rates.

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Bluebook (online)
287 P.3d 40, 171 Wash. App. 431, Counsel Stack Legal Research, https://law.counselstack.com/opinion/evergreen-washington-healthcare-frontier-llc-v-department-of-social-washctapp-2012.