Harding Pointe, Inc. v. Ohio Dept. of Job & Family Servs.

2013 Ohio 4885
CourtOhio Court of Appeals
DecidedNovember 5, 2013
Docket13AP-258
StatusPublished
Cited by8 cases

This text of 2013 Ohio 4885 (Harding Pointe, Inc. v. Ohio Dept. of Job & Family Servs.) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Harding Pointe, Inc. v. Ohio Dept. of Job & Family Servs., 2013 Ohio 4885 (Ohio Ct. App. 2013).

Opinion

[Cite as Harding Pointe, Inc. v. Ohio Dept. of Job & Family Servs., 2013-Ohio-4885.]

IN THE COURT OF APPEALS OF OHIO

TENTH APPELLATE DISTRICT

Harding Pointe, Inc. et al., :

Plaintiffs-Appellants, : No. 13AP-258 v. : (C.P.C. No. 07CV-150)

Ohio Department of Job : (REGULAR CALENDAR) and Family Services, : Defendant-Appellee. :

D E C I S I O N

Rendered on November 5, 2013

Webster & Associates, Co. LPA, and Geoffrey E. Webster, for appellants.

Michael DeWine, Attorney General, and Rebecca L. Thomas, for appellee.

APPEAL from the Franklin County Court of Common Pleas

T. BRYANT, J. {¶ 1} Plaintiffs-appellants, Harding Pointe, Inc. ("Harding Pointe") and H&G Nursing Home, Inc. dba Adams County Manor ("Adams County Manor"), appeal from a judgment of the Franklin County Court of Common Pleas granting summary judgment in favor of defendant-appellee, Ohio Department of Job and Family Services ("ODJFS"). Because the trial court properly granted summary judgment for ODJFS, we affirm. I. FACTS AND PROCEDURAL HISTORY {¶ 2} Pursuant to R.C. Chapter 5111, the state of Ohio, through ODJFS, reimburses participating nursing homes and other facilities through the Medicaid program for reasonable costs of services provided. Ohio Academy of Nursing Homes v. No. 13AP-258 2

Ohio Dept. of Job & Family Servs., 114 Ohio St.3d 14, 2007-Ohio-2620, ¶ 2. Since July 1993, the state has utilized a prospective payment system whereby it reimburses facilities by paying a per diem rate calculated based on the actual costs incurred by the facilities for a prior period. Id. Until June 30, 2005, the reimbursement rate was established after considering "a combination of allowable per diems established for direct-care costs, 'other protected' costs, indirect-care costs, and capital costs." Drake Ctr., Inc. v. Ohio Dept. of Human Servs., 125 Ohio App.3d 678, 685-86 (10th Dist.1998). {¶ 3} Pursuant to former Ohio Adm.Code 5101:3-3-24(E), when Medicaid- certified beds were added to an existing facility, replaced at the same facility, or subject to a change in provider agreement, ODJFS was required to increase the facility's reimbursement rate for capital costs, based upon a formula set forth in the rule, to account for the costs of the beds that were added, replaced or subject to a change in provider agreement. To effectuate a capital cost rate adjustment, a facility was required to file certain documentation with ODJFS, including a three-month projected cost report with supporting depreciation and amortization schedules. Former Ohio Adm.Code 5101:3-3-24(E)(1)(a)-(e). Former Ohio Adm.Code 5101:3-3-24(E)(2) provided that "[a] rate adjustment pursuant to paragraph (E) of this rule shall be implemented one month after the first day of the month after the department receives sufficient documentation of the costs." {¶ 4} Effective July 1, 2005, 2005 Am.Sub.H.B. No. 66 ("H.B. No. 66") changed Ohio's Medicaid reimbursement system for nursing homes for fiscal year 2006.1 Under H.B. No. 66, capital costs were considered in determining adjustments to reimbursement rates only under specified circumstances. H.B. No. 66, Section 206.66.22(G)(1)(b) provided: (G)(1) A nursing facility's rate established under this section shall not be subject to any adjustments except as follows:

***

(b) [T]he nursing facility's rate established under this section may be adjusted pursuant to a process established in rules adopted under section 5111.02 of the Revised Code to reflect a

1The state's fiscal year runs from July 1 through June 30. R.C. 9.34. Fiscal year 2006 ran from July 1, 2005 through June 30, 2006. No. 13AP-258 3

change in the nursing facility's capital costs due to any of the following:

(i) A change of provider agreement that goes into effect before July 1, 2005, and for which a rate adjustment is not implemented before June 30, 2005;

(ii) A reviewable activity for which a certificate of need application is filed with the Director of Health before July 1, 2005, costs are incurred before June 30, 2005, and a rate adjustment is not implemented before June 30, 2005;

(iii) An activity that the Director of Health, before July 1, 2005, rules is not a reviewable activity and for which costs are incurred before June 30, 2005, and a rate adjustment is not implemented before June 30, 2005.

{¶ 5} Absent one of these circumstances, nursing homes were paid the same per- diem rate for fiscal year 2006 that they had been paid on June 30, 2005, plus a $1.95 add- on, if applicable. H.B. No. 66, Section 206.66.22(B) provided: (B) Except as otherwise provided in this section, the provider of a nursing facility that has a valid Medicaid provider agreement on June 30, 2005, and a valid Medicaid provider agreement for fiscal year 2006 shall be paid, for nursing facility services the nursing facility provides during fiscal year 2006, the sum of the following:

(1) The rate the provider is paid for nursing facility services the nursing facility provides on June 30, 2005.

(2) Unless the nursing facility is exempt from paying the franchise permit fee, one dollar and ninety-five cents.

{¶ 6} Because it was inconsistent with the reimbursement methodology mandated for fiscal year 2006 under H.B. No. 66, former Ohio Adm.Code 5101:3-3-24 was repealed on February 2, 2006. Six weeks later, on March 30, 2006, 2006 Am.Sub.H.B. No. 530 ("H.B. No. 530") became effective. H.B. No. 530 created a new capital compensation program. As relevant here, H.B. No. 530, Section 606.18.06 provided: (B) The following qualify for per diem payments under this section:

*** No. 13AP-258 4

(3) A nursing facility to which all of the following apply:

(a) The nursing facility does not qualify for a payment pursuant to division (B)(1) of this section.

(b) The nursing facility, before June 30, 2007, completes a capital project for which a certificate of need was filed with the Director of Health before June 15, 2005, and for which at least one of the following occurred before July 1, 2005 * * *;

(i) Any materials or equipment for the capital project were delivered;

(ii) Preparations for the physical site of the capital project, including, if applicable, excavation, began;

(iii) Actual work on the capital project began.

(c) The costs of the capital project are not fully reflected in the capital costs portion of the nursing facility's Medicaid reimbursement per diem rate on June 30, 2005.

(d) The nursing facility files a three-month projected capital cost report with the Director of Job and Family Services not later than sixty days after the later of the effective date of this section or the date the capital project is completed.

{¶ 7} Having outlined the pertinent legislative and administrative background, we set forth separately the factual and procedural histories relevant to Harding Pointe and Adams County Manor, as they are markedly different. HARDING POINTE {¶ 8} Harding Pointe became a Medicaid provider of nursing home services through a change of provider agreement effective June 30, 2005. By letter dated June 20, 2006, Harding Pointe requested a capital cost rate adjustment for fiscal year 2006 pursuant to the June 30, 2005 change in provider agreement. The letter stated that the projected capital cost report required by former Ohio Adm.Code 5101:3-3-24(E)(1) had been filed on May 30, 2005. {¶ 9} By letter dated July 6, 2006, ODJFS denied Harding Pointe's request, averring that it had received the projected capital cost report on June 2, 2005 and, pursuant to former Ohio Adm.Code 5101:3-3-24(E)(2), any rate adjustment would have No. 13AP-258 5

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2013 Ohio 4885, Counsel Stack Legal Research, https://law.counselstack.com/opinion/harding-pointe-inc-v-ohio-dept-of-job-family-servs-ohioctapp-2013.