Grand Oak Nursing Home, Inc. v. Commonwealth

541 A.2d 800, 116 Pa. Commw. 453
CourtCommonwealth Court of Pennsylvania
DecidedAugust 11, 1986
DocketAppeals Nos. 3251 C.D. 1983 and 577 C.D. 1984
StatusPublished
Cited by7 cases

This text of 541 A.2d 800 (Grand Oak Nursing Home, Inc. v. Commonwealth) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Grand Oak Nursing Home, Inc. v. Commonwealth, 541 A.2d 800, 116 Pa. Commw. 453 (Pa. Ct. App. 1986).

Opinion

Memorandum Opinion by

Judge Blatt,

In these consolidated appeals Grand Oak Nursing Home, Inc., (petitioner) challenges an order of the Executive Deputy Secretary (Secretary) of the Department of Public Welfare (Department) which disallowed certain reimbursable costs in the calculation of Grand Oaks per diem reimbursement rate.1

Grand Oak was purchased in 1980 and, pursuant to Medicaid Assistance regulations, was determined to be eligible for reimbursement for depreciation on its captial assets and for interest attributable to finance charges incurred in financing its $2,000,000 purchase price.2 These allowances were factored into the calculation of the per diem rate at which reimbursement is made by the Department for the care of Medicaid patients. The depreciation taken by the previous owners totaled $636,833 and the facility’s adjusted basis or “book value” was consequently reduced by that amount, [456]*456resulting in an adjusted basis of $1,363,167. The issue presented here is whether or not the pertinent regulations in effect at the time authorized the Secretary to limit the interest to be reimbursed to that attributable to the adjusted basis, and, therefore, to disallow reimbursement for the interest attributable to that portion of the purchase price which exceeded the adjusted basis.

The pertinent regulations in effect at the times relevant to this matter were set forth in the Manual for Allowable Cost Reimbursement for Skilled Nursing and Intermediate Care Facilities (Manual), which provides, in pertinent part:

IV. Standards for general and selected costs.

The Department shall determine providers allowable costs in accordance with the following:

(a) The Departments Manual for Allowable Cost Reimbursement for Skilled Nursing and Intermediate Care Facilities and,

(b) The Medicare Provider Reimbursement Manual (HIM-15), except that where the Departments Manual and the HIM-15 differ, the Departments Manual shall govern.

* * * *

D. Other Cost items.

9. Depreciation allowance.

Depreciation on capital assets ... is an allowable cost subject to the following conditions:

* * *

f. The cost basis for depreciable assets of a facility purchased as an ongoing operation shall be the lesser of the purchase price or the fair market value . . . and less any straight line depreciation by the prior owner.

* H= * *

10. Interest allowance.

a. Necessary and proper interest on both current and capital indebtedness is a capital cost. . . .

[457]*457b. Interest incurred on a loan made to satisfy a financial need of the facility will be recognized. . . .

c. Interest applying to mortgages on the property and plant . . . will be recognized. The total mortgages on which interest is allowed may not exceed the lesser of at least two independent appraisals of the mortgaged property. . . .

8 Pa.B. 2832-2838 (October 14, 1978) as amended by 10 Pa.B. 3107 (July 26, 1980).3 The HIM-15 referred to above, pertinently provides:

INTEREST ON LOANS IN EXCESS OF ASSET VALUE, ACQUISITION AFTER JULY 1970

A. Where a loan is obtained to finance the purchase of a facility or a tangible asset that is acquired after July 1970, and the purchase price exceeds the . . . cost basis, . . . interest expense on that portion of the loan used to finance the excess is not considered reasonably related to patient care and is not allowable. Medicare Provider Reimbursement Manual (HIM-15), §203.

The petitioner preliminarily contends that the Secretary was obliged to accept an administrative interpretation of the regulations which allowed reimbursement for the excess interest. This interpretation had been made by a hearing examiner whose decision the Secretary reversed in issuing the order here concerned. It argues that the Secretary’s review of a hearing examiner’s decision should be limited to considering whether or not there was substantial evidence to support the examiner’s decision, and that the Secretary could not, without explanation, substitute his interpretation of the regulations in place of the examiner’s. No [458]*458authority supports such an assertion, however, and we decline to impose such a limitation upon the Secretary. It is the agency head, or his or her designated representative, not the hearing examiner, who is authorized to interpret Department regulations. Section 403(b) of the Public Welfare Code, Act of June 13, 1967, P.L. 31, as amended, 62 P.S. §403(b). See also Westmoreland Manor v. Department of Public Welfare, 91 Pa. Commonwealth Ct. 155, 496 A.2d 1282 (1985) (declining to accept proposition that the Secretary lacked the authority to reverse hearing officers interpretation of grandfather clause) and Northwestern Institute of Psychiatry v. Department of Public Welfare, 99 Pa. Commonwealth Ct. 213, 513 A.2d 495 (1986) (provider appeals are conducted pursuant to 1 Pa. Code §§35.1-35.251, which limit hearing examiners fact finding powers to proposals and recommendations).

The petitioner next contends that the Secretary’s interpretation constitutes an arbitrary and capricious disregard of the evidence presented, asserting that Section IV-D-10-c of the Manual unambiguously limits the total of mortgages on which interest is allowed to the lesser of at least two appraisals of the mortgaged property and equipment. It argues, therefore, that there was no ambiguity as to the interest limitation intended to be applied and that no reference need have been made to the provisions of Section 203 in HIM-15.

We must observe, of course, that an agency’s interpretation of its own regulations is entitled to great deference and is controlling unless it is clearly erroneous or inconsistent with the regulation itself or with the underlying legislative requirements. Michael Manor, Inc. v. Department of Public Welfare, 88 Pa. Commonwealth Ct. 583, 490 A.2d 957 (1985). Section IV clearly indicates that allowable costs should be determined using both the Manual as well as the HIM-15 unless there is a [459]*459conflict between the two. We discern no impropriety or inconsistency, therefore, in the Departments reading the more specific, restrictive interest limitations of the HIM-15 together with the general limitations set forth in Section IV-D-10-c of the Manual, which appears merely to set a “cap” on the total interest to which a facility may be entitled. Accordingly, we see no conflict between the two provisions, and the Manuals cap on allowable interest does not indicate that all costs within such an amount are necessarily allowable or that other limits may not be established. We further note that a number of other limits were imposed under Section IVD of the Manual. Section IV-D-9-k, for example, precluded the allowance of excess interest related to bed costs above $22,000.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Suburban Manor/Highland Hall Care Center v. Commonwealth
680 A.2d 867 (Supreme Court of Pennsylvania, 1996)
Segal v. Department of Public Welfare
603 A.2d 668 (Commonwealth Court of Pennsylvania, 1992)
West Virginia University Hospitals, Inc. v. Casey
885 F.2d 11 (Third Circuit, 1989)
Grandview Health Homes, Inc. v. Commonwealth
552 A.2d 720 (Commonwealth Court of Pennsylvania, 1988)
Grand Oak Nursing Home, Inc. v. Commonwealth
540 A.2d 265 (Supreme Court of Pennsylvania, 1988)
Grand Oak Nursing Home, Inc. v. Commonwealth Department of Public Welfare
540 A.2d 265 (Supreme Court of Pennsylvania, 1988)

Cite This Page — Counsel Stack

Bluebook (online)
541 A.2d 800, 116 Pa. Commw. 453, Counsel Stack Legal Research, https://law.counselstack.com/opinion/grand-oak-nursing-home-inc-v-commonwealth-pacommwct-1986.