High Point Hospital v. Surles

218 A.D.2d 874, 630 N.Y.S.2d 391, 1995 N.Y. App. Div. LEXIS 8247
CourtAppellate Division of the Supreme Court of the State of New York
DecidedAugust 3, 1995
StatusPublished
Cited by3 cases

This text of 218 A.D.2d 874 (High Point Hospital v. Surles) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
High Point Hospital v. Surles, 218 A.D.2d 874, 630 N.Y.S.2d 391, 1995 N.Y. App. Div. LEXIS 8247 (N.Y. Ct. App. 1995).

Opinion

—Peters, J.

Proceeding pursuant to CPLR article 78 (transferred to this Court by order of the Supreme Court, entered in Albany County) to review a determination of respondent which disallowed a portion of petitioner’s real estate taxes in calculating its Medicaid reimbursement rate.

Petitioner is a privately owned psychiatric hospital located on 142 acres in the Town of Rye, Westchester County. It is licensed by the Office of Mental Hygiene (hereinafter OMH) pursuant to Mental Hygiene Law article 31. Medicaid reimbursement rates for hospitals licensed by OMH are computed on a per diem basis by dividing allowable costs by allowable patient days (see, 14 NYCRR 577.7; see generally, 14 NYCRR part 577; 42 CFR 413.9).

OMH performed a review of petitioner’s institutional cost reports (see, 14 NYCRR part 552) to determine petitioner’s Medicaid reimbursement rate for 1992. As a result thereof, OMH disallowed certain costs including $264,295 of the $315,295 in real estate taxes paid by petitioner. OMH notified petitioner of such result, contending that such taxes appeared to be unreasonable compared to other private psychiatric hospitals and that such tentative disallowance would be final unless petitioner could provide "substantiation and documentation to support the reasonableness of the amount”. In reply, petitioner contended that the "isolation] [of] one cost center * * * is grossly inequitable [in] the big picture * * * [because petitioner’s] per diem rate * * * is the lowest of all free Psychiatric Hospitals”. It further alleged that the physical setting is necessary for the emotional well-being of the patients served by petitioner. OMH nevertheless finalized its original assessment of petitioner’s 1992 Medicaid reimbursement rate.

After an administrative hearing, the Hearing Officer issued a report which recommended that OMH’s disallowance of a portion of petitioner’s 1990 real estate taxes in its calculation of petitioner’s 1992 reimbursement rate be confirmed. By determination dated June 24,1994, respondent adopted the Hear[875]*875ing Officer’s report and sustained OMH’s determination. Petitioner commenced this CPLR article 78 proceeding which was thereafter transferred to this Court.

Our standard of review is limited to whether the determination below is supported by substantial evidence (see, CPLR 7803 [4]; Matter of Block v Ambach, 73 NY2d 323, 335) and, in such capacity, we will " 'not weigh the evidence or reject the choice made by [such agency] where the evidence is conflicting and room for choice exists’ ” (Matter of Berenhaus v Ward, 70 NY2d 436, 444, quoting Matter of Stork Rest, v Boland, 282 NY 256, 267). Reasonable doubts will be resolved in favor of the administrative determination (see, Matter of Town of Henrietta v Department of Envtl. Conservation, 76 AD2d 215).

In such capacity, we review petitioner’s contention that the payment of real estate costs is a reasonable cost which must be reimbursed pursuant to Federal law. Pursuant to the Boren Amendment (see, 42 USC § 1396a), a State Medicaid plan must provide for the payment of hospital services through rates which are "reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities” (42 USC § 1396a [a] [13] [A]). Reasonable costs are those "actually incurred, excluding therefrom any part of incurred cost found to be unnecessary in the efficient delivery of needed health services” (42 USC § 1395x [v] [1] [A]). The regulations acknowledge that the cost of such services will vary between providers and, provides as follows: "The provision in Medicare for payment of reasonable cost of services is intended to meet the actual costs, however widely they may vary from one institution to another. This is subject to a limitation if a particular institution’s costs are found to be substantially out of line with other institutions in the same area that are similar in size, scope of services, utilization, and other relevant factors” (42 CFR 413.9 [c] [2]). Any items or services substantially in excess of those generally considered necessary for the provision of needed health services would not be allowable (see, 42 CFR 413.9 [c] [3]).

To the extent that petitioner contends that the instant disallowance violates the Boren Amendment, we find no merit. Petitioner raises an issue with respect to a specific disallowance in its own reimbursement rate and fails to proffer any proof that the overall rates are unreasonable and inadequate to meet the costs which must be incurred or that the State Medicaid plan is otherwise deficient (see, Lett v Magnant, 965 [876]*876F2d 251; see also, Portland Residence v Steffen, 34 F3d 669, 674).

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

Related

Daughters of Sarah Nursing Center, Inc. v. Novello
69 A.D.3d 1150 (Appellate Division of the Supreme Court of New York, 2010)
GMR Living Centers, Inc. v. Novello
294 A.D.2d 851 (Appellate Division of the Supreme Court of New York, 2002)
Teresian House Nursing Home Co. v. Chassin
218 A.D.2d 250 (Appellate Division of the Supreme Court of New York, 1996)

Cite This Page — Counsel Stack

Bluebook (online)
218 A.D.2d 874, 630 N.Y.S.2d 391, 1995 N.Y. App. Div. LEXIS 8247, Counsel Stack Legal Research, https://law.counselstack.com/opinion/high-point-hospital-v-surles-nyappdiv-1995.