Good Neighbor Care Centers, Inc. v. Minnesota Department of Human Services

428 N.W.2d 397, 1988 Minn. App. LEXIS 777, 1988 WL 83698
CourtCourt of Appeals of Minnesota
DecidedAugust 16, 1988
DocketC5-88-612
StatusPublished
Cited by8 cases

This text of 428 N.W.2d 397 (Good Neighbor Care Centers, Inc. v. Minnesota Department of Human Services) 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
Good Neighbor Care Centers, Inc. v. Minnesota Department of Human Services, 428 N.W.2d 397, 1988 Minn. App. LEXIS 777, 1988 WL 83698 (Mich. Ct. App. 1988).

Opinion

OPINION

LANSING, Judge.

Respondent Department of Human Services (DHS) imposed a 20% reduction of medical assistance payments on relator Good Neighbor Care Center (GNCC) and other nursing homes represented by relator Care Providers, Inc., based on their practice of charging private paying residents the rates they anticipated would result from pending appeals of DHS approved rates. A contested case proceeding followed, and GNCC and Care Providers appeal the decision of the Commissioner of DHS granting summary disposition upholding DHS’s action.

FACTS

Relator Care Providers of Minnesota is a trade association representing some 250 state-licensed nursing homes, including 27 operated by GNCC, which are certified to participate in the federal Medicaid program (known as Medical Assistance (MA) in Minnesota). Minnesota’s Equalization Law, Minn.Stat. § 256B.48, subd. 1 (1986), requires nursing homes to charge private paying residents the same rates paid for the care of MA residents. Pending constitutional challenges to the law, members of Care Providers’ predecessor organization were permitted to charge higher rates to private paying residents, placing the amount over the MA rate in escrow. The nursing homes’ constitutional challenge failed. See Minnesota Ass’n of Health Care Facilities v. Minnesota Dept. of Public Welfare, 742 F.2d 442 (8th Cir.1984), cert. denied, 469 U.S. 1215, 105 S.Ct. 1191, 84 L.Ed.2d 337 (1985). According to amici Minnesota Board on Aging, Minnesota Senior Federation, and Minnesota Alliance for Health Care Consumers, numerous problems arose in returning escrowed funds. A 1986 law compelled return of those funds by July 1, 1986. See 1986 Minn.Laws ch. 420, § 16.

The implementation of the Equalization Law has remained problematic, particularly in the determination of MA rates. Rates paid to nursing homes are based in part on the nursing home’s allowable operating costs, as determined by DHS. Those determinations have resulted in frequent ap *400 peals, exacerbated by a 1983 legislative enactment “overhauling” the rate-setting mechanism. Because of the volume of appeals and DHS’s inadequate staffing, rate appeals frequently take years to resolve, although the backlog is now diminishing.

Many of the appeals result in higher MA rates, which nursing homes are permitted to charge retroactively to their private paying residents. See Minn.R. 9549.0080, subp. 4. However, by the time the appeals are resolved, private paying residents may have died or become insolvent, making “most, if not all” retroactive charges uncol-lectible, although some can be recovered as bad debt expenses.

Because of this problem, in early 1986 GNCC began charging its private paying residents the rate it sought on pending appeals, placing the excess over the MA rate in escrow accounts until the appeals were resolved. By letter of January 22, 1986, DHS informed GNCC that the practice violated the Equalization Law, and that DHS would take action if the violation continued. Counsel for GNCC responded that the practice was legal.

When subsequent correspondence did not resolve the problem, in March 1986 DHS began serving “Notices of Agency Action” on nursing homes, including those operated by GNCC. The notices gave the nursing homes 20 days to correct the violation, after which DHS would reduce their MA payment rate by 20% until the violation was corrected. The notices also informed the nursing homes that they could request a contested-case hearing within 20 days, but that the 20% reduction would remain in effect despite a pending appeal. The notice contained the name and telephone number of a DHS staff member to contact if there were any questions.

Although it admitted that it was charging private paying residents more than the approved MA rate, GNCC immediately requested a contested case hearing and also an expedited hearing on its MA rates. DHS set a contested case hearing, but disputed that GNCC was entitled to an expedited hearing on its rate appeals. GNCC subsequently agreed to stop charging more than the MA rate in return for withdrawal of the DHS Notice of Agency Action.

The contested case was scheduled to decide these issues: (1) whether GNCC’s charging practices violated the Equalization Law; (2) whether GNCC was entitled to expedition of its rate appeals; (3) whether DHS’s interpretation and implementation of various provisions of the Equalization Law constituted invalid, unpromulgat-ed rules; and (4) whether DHS’s enforcement activity violated due process. DHS moved for summary disposition on the ground that there were no genuine issues of material fact and it was entitled to summary disposition as a matter of law.

The AU recommended summary disposition, holding that GNCC’s charging practices violated the Equalization Law, but that DHS’s interpretation of the law to allow imposition of the 20% rate reduction pending appeal constituted an invalid, unpro-mulgated rule. The AU ruled in favor of DHS on the other claims.

The Commissioner adopted the AU’s decision in favor of DHS, and also held that DHS’s interpretation of the rate reduction provision did not constitute an unpromul-gated rule. Because the statute requires DHS’s enforcement activity, the Commissioner concluded that the due process issues constituted a challenge to the validity of the statute which she was without authority to address.

GNCC and Care Providers appeal by writ of certiorari.

ISSUES

1. Does GNCC’s practice of charging private paying residents anticipated post-appeal rates violate the Equalization Law?

2. Do DHS’s interpretation and implementation of the Equalization Law constitute invalid, unpromulgated rules?

3. Is DHS’s interpretation of the Equalization Law invalid as unreasonable?

4. Does the imposition of rate reductions during the pendency of an appeal violate procedural due process?

*401 5. Does the interpretation of the Equalization Law to preclude charging anticipated post-appeal rates constitute an unconstitutional taking?

ANALYSIS

Under Minn.Stat.' § 14.69 (1986), this court may reverse or modify the agency’s decision if it violates constitutional provisions, exceeds the agency’s statutory authority or jurisdiction, is made on unlawful procedure, is affected by error of law, or is arbitrary. Similar to Minn.R.Civ.P. 56, Minn.R. 1400.5500(K) provides for summary disposition of a contested case if “there is no genuine issue as to any material fact.” Although this court will defer to DHS’s decision on matters within its technical expertise, this deference does not extend to questions of law. See G. Beck, L. Bakken & T. Muck, Minnesota Administrative Procedure § 13.4.1 (1987) (“Beck”).

I

Under the Equalization Law, a nursing home is not eligible to receive medical assistance payments unless it refrains from:

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Cite This Page — Counsel Stack

Bluebook (online)
428 N.W.2d 397, 1988 Minn. App. LEXIS 777, 1988 WL 83698, Counsel Stack Legal Research, https://law.counselstack.com/opinion/good-neighbor-care-centers-inc-v-minnesota-department-of-human-services-minnctapp-1988.