Gargano v. Lee Alan Bryant Health Care Facilities, Inc.

970 N.E.2d 696, 2012 WL 2053989, 2012 Ind. App. LEXIS 273
CourtIndiana Court of Appeals
DecidedJune 8, 2012
Docket49A02-1105-PL-449
StatusPublished
Cited by7 cases

This text of 970 N.E.2d 696 (Gargano v. Lee Alan Bryant Health Care Facilities, Inc.) is published on Counsel Stack Legal Research, covering Indiana Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gargano v. Lee Alan Bryant Health Care Facilities, Inc., 970 N.E.2d 696, 2012 WL 2053989, 2012 Ind. App. LEXIS 273 (Ind. Ct. App. 2012).

Opinion

OPINION

BROWN, Judge.

The Family and Social Services Administration (“FSSA”), the Division of Aging (the “DOA”), and Residential Care Assistance Program (the “RCAP,” and FSSA, the DOA, and the RCAP, collectively, “Appellants”), appeal the February 15, 2011 judgment of the trial court in favor of Lee Alan Bryant Health Care Facilities, Inc.; Parkeview Residential Care Center, L.L.C.; Parke County Residential Care Center L.L.C.; Westpark Health Care Facilities, L.L.C. (together, “Providers”); Cheryl A. Holland; Ross Fisher; Patrick Zaborski; and Bryan Frison (Providers and individuals, collectively, “Appellees”). Appellants raise three issues, which we revise and restate as whether the court erred in entering judgment in favor of Appellees and against Appellants regarding the partial suspension of the RCAP. We reverse and remand.

BACKGROUND

The DOA is a division of FSSA and administers a variety of programs, including the RCAP, related to certain services for disabled or senior individuals. See Ind. Code § 12-9.1-4-2. Under the RCAP, an individual who is incapable of residing in the individual’s own home may apply for residential care assistance. Ind.Code § 12-10-6-2.1(a) (Supp.2008) (subsequently amended by Pub. L. 143-2011, § 11 (eff. Jul. 1, 2011)); Pub. L. 229-2011, § 19 (eff. Jul. 1, 2011)); Pub. L. 6-2012, § 89 (eff. Feb. 22, 2012)). 1 An individual is eligible for residential care assistance under the RCAP if the DOA determines that the individual is a recipient of Medicaid or the federal Supplemental Security Income program; is incapable of residing in the individual’s own home because of dementia, mental illness, or a physical disability; requires a degree of care less than that provided by a health care facility licensed under Ind.Code § 16-28; can be adequately cared for in a residential care setting; and has not made any asset transfer prohibited under the state plan or in 42 U.S.C. § 1396p(c) in order to be eligible for Medicaid. Id. Residential care under the RCAP, with certain exceptions related to individuals with a mental illness, consists of only room, board, and laundry, along with minimal administrative direction. Ind.Code § 12-10-6-2.1(d); Ind.Code § 12-10-6-5. 2

*699 Prior to April 2003, the DOA established a unique reimbursement rate for each facility provider based upon the facility’s actual costs in providing services under the RCAP and the rates were calculated in accordance with generally accepted accounting principles and methods. 3 In April 2003, the RCAP began providing a uniform or standard per diem reimbursement rate to all facility providers in the amount of $39.35. See 455 Ind. Admin. Code 1 — 3—3(b) (Transferred from the Division of Disability and Rehabilitative Services (460 IAC 1-3.3-3) to the Division of Aging (455 IAC 1-3-3) by Pub. L. No. 153-2011, § 21 (eff. Jul. 1, 2011)). 4 According to the parties, in July 2008 the standardized per diem reimbursement rate under RCAP was changed to the amount of $49.35. 5

At some point, FSSA’s chief financial officer, Megan Ornellas, received notification from a budget analyst with the State Budget Agency that the allotments for FSSA for fiscal year 2010 had been reduced. On September 21, 2009, Anne *700 Murphy, Secretary of FSSA, sent an email message to Faith Laird, Director of the DOA, related to certain constraints regarding FSSA’s fiscal year 2010 biennium budget, explained that the FSSA fiscal year 2010 budget along with the reserve it was expected to return to the State’s general fund at the end of the year was insufficient to support its current operations, 6 and asked Laird to review the division’s budget and report savings measures or projections and a strategy to reduce the division’s budget by $2.8 million. Murphy also indicated that any reductions should be from non-Medicaid programs. On October 2, 2009, Laird sent an email message to Murphy which attached a revised proposed budget and stated that the revision “produces a savings of $2,099,305 to $2,379,805,” that “[w]e have only two large sources of State funds: CHOICE ($48,-765,643) and RCAP ($13,477,844),” and that “[t]he savings achieved in the RCAP program will be by attrition — not permitting any new admissions — but would not require discharge of current participants in the program.” Plaintiffs Exhibit 4. On October 28, 2009, FSSA sent a written notice to Providers and other residential care facilities which received funds from the RCAP stating that due to budgetary constraints currently affecting all state agencies the RCAP would not be accepting new applications effective December 1, 2009, and that the DOA would accept new applications only until the close of business on November 30, 2009.

Following December 1, 2009, a number of applications for the RCAP submitted by individuals admitted to Providers’ facilities were denied. 7

COURSE -OF PROCEEDINGS

Appellees filed an amended verified complaint for declaratory, injunctive and other relief against Appellants in March 2010 alleging that FSSA’s refusal to fund eligible applicants despite having appropriated and allotted funds accessible to the RCAP is directly contrary to the authority granted to FSSA by the legislature under Ind.Code § 12-10-6. 8 Appellees further alleged that the imposition in 2003 of a fixed rate of reimbursement for all providers under the RCAP is a violation of the mandatory requirements of Ind.Code § 12-10-6 which require FSSA and the DOA to determine the rate of reimbursement according to individual provider’s actual costs and accounting for a growth of profit factor.

Appellants filed a motion for summary judgment, which the court denied. Appel- *701 lees filed a motion for partial summary judgment, which the court granted with respect to the determination of the amount of assistance for eligible applicants on or before December 1, 2009 and denied in all other respects. 9

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970 N.E.2d 696, 2012 WL 2053989, 2012 Ind. App. LEXIS 273, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gargano-v-lee-alan-bryant-health-care-facilities-inc-indctapp-2012.