Field Home-Holy Comforter v. Commissioner of the New York State Department of Health

200 A.D.2d 927, 606 N.Y.S.2d 925, 1994 N.Y. App. Div. LEXIS 605
Appellate Division of the Supreme Court of the State of New York·Decided January 27, 1994·Published·Cited by 3 cases

Opinion

—Crew III, J.

Appeal from a judgment of the Supreme Court (Cardona, J.), entered November 12, 1992 in Albany County, which granted petitioner’s application, in a proceeding pursuant to CPLR article 78, to annul determinations of respondents establishing petitioner’s 1986 through 1991 Medicaid reimbursement rates.

[928]*928Petitioner is a nonprofit nursing home facility currently located in the City of Peekskill, Westchester County, and a participant in the Medicaid reimbursement program. At issue on this appeal is the manner in which petitioner’s 1986 through 1991 Medicaid reimbursement rates were calculated. Prior to January 1986, Medicaid reimbursement rates were calculated on the basis of allowable costs incurred in a prior year — the base year — limited by cost ceilings determined by comparison to peer group facilities and increased by a trend factor to account for inflation. Adjustments to account for wage differentials among different facilities were made through the use of various peer groups, including one based upon the geographic region in which a particular facility was located. Under the methodology then existing, there were two geographic peer groups: the downstate region, which included facilities located in Bronx, Rockland, Westchester, Putnam, Nassau, Suffolk, Kings, New York, Richmond and Queens Counties, and the upstate region, which included all other counties in the State.

On January 1, 1986, the Department of Health (hereinafter DOH) implemented a new Medicaid reimbursement methodology, known as the Long Term Care Case Mix Reimbursement System, which determines a facility’s per-patient, per-diem Medicaid rate based upon four cost components: direct, indirect, noncomparable and capital (see, 10 NYCRR 86-2.10 [b] [1] [ii]). This new methodology, inter alia, altered the manner in which wage differentials among the different facilities were treated and, insofar as is relevant to this appeal, changed the composition of the regional groupings. Specifically, DOH replaced the downstate and upstate groupings with 16 regional groupings, each containing one or more contiguous counties (see, 10 NYCRR 86-2.10 [c], [d], [m]). Under the former methodology, petitioner, which was then located in Bronx County, was placed in the downstate regional grouping. The implementation of the new methodology and petitioner’s move to Westchester County in 1986 resulted in petitioner being grouped with other facilities located in Westchester and Rockland Counties.

Petitioner commenced the instant CPLR article 78 proceeding to challenge two aspects of its 1986 through 1991 Medicaid reimbursement rates. Specifically, petitioner contends that respondents placed it in an inappropriate regional group for purposes of calculating the direct and indirect cost components of its 1986 through 1991 reimbursement rates and, further, contests respondents’ promulgation and application of [929]*929a recalibration regulation, which reduces the direct component of a facility’s rates by a factor of between 0% and 3.035% (see, 10 NYCRR 86-2.31 [a]), to its 1987 through 1991 reimbursement rates.

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Field Home-Holy Comforter v. Commissioner of the New York State Department of Health, 200 A.D.2d 927, 606 N.Y.S.2d 925, 1994 N.Y. App. Div. LEXIS 605 (N.Y. Ct. App. 1994).

200 A.D.2d 927 (Field Home-Holy Comforter v. Commissioner of the New York State Department of Health) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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