Idaho County Nursing Home v. Idaho Department of Health & Welfare

856 P.2d 1283, 124 Idaho 116, 1993 Ida. LEXIS 143
CourtIdaho Supreme Court
DecidedJuly 28, 1993
DocketNo. 20033
StatusPublished
Cited by1 cases

This text of 856 P.2d 1283 (Idaho County Nursing Home v. Idaho Department of Health & Welfare) is published on Counsel Stack Legal Research, covering Idaho Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Idaho County Nursing Home v. Idaho Department of Health & Welfare, 856 P.2d 1283, 124 Idaho 116, 1993 Ida. LEXIS 143 (Idaho 1993).

Opinion

BENGTSON, Judge Pro Tem.

BACKGROUND

In 1987, appellant, Idaho County Nursing Home (“ICNH”), appealed to the District Court of the Fourth Judicial District from the Final Decision and Order of the Idaho Department of Health and Welfare (the “Department”) entered on February 12, 1987, which disallowed $47,140.67 of costs incurred by ICNH in caring for Medicaid patients.

On appeal, the district court remanded the proceedings to the Department to redetermine whether ICNH was efficiently operated and whether it was entitled to reimbursement of those costs disallowed by the Department in its February 12, 1987, Final Decision and Order. On such remand, the Department determined that the ICNH facility was inefficient and therefore concluded, once again, that ICNH was not entitled to reimbursement of the costs previously disallowed by the Department. The district court thereupon affirmed the decision of the Department disallowing such costs.

ICNH then appealed to this Court from the district court’s decision. Our opinion on rehearing of such appeal, Idaho County Nursing Home v. Idaho Dep’t of Health & [117]*117Welfare, 120 Idaho 933, 821 P.2d 988 (1991), (hereinafter “ICNH I”), sets out the background and the facts relevant to this case in considerable detail and will not be recounted here.

In ICNH I we reversed the decision of the district court and ordered “remand for further proceedings to determine whether [ICNH] was efficiently operated and to what extent its costs above the percentile cap are justified.” ICNH I, 120 Idaho at 940, 821 P.2d at 995.

Upon such remand, the district court, on May 29, 1992, filed its Memorandum Decision ordering that the matter be remanded to the Department stating:

The Supreme Court expressly concluded “we ... remand for further 'proceedings to determine whether Idaho Nursing was efficiently operated and to what extent its costs above the percentile cap are justified.” 120 Idaho [at] 940 [821 P.2d at 995]. (Emphasis added.) The court also observed that “[b]eyond [merely showing that Idaho Nursing had costs which exceeded the percentile cap] the record does not demonstrate or establish that Idaho Nursing was inefficient.” Id.
From such express language, it seems clear to me that the Supreme Court has remanded to this Court, to simply in turn remand to the Department of Health and Welfare so that the agency can properly determine, in accordance with the procedures set forth in the Supreme Court’s decision, whether Idaho Nursing’s costs, above the percentile cap, were incurred inefficiently. Had the Supreme Court intended that judgment be entered for plaintiffs at this time, I believe that it could and would have done so itself.
Accordingly, this matter must be remanded to the Department of Health and Welfare; and

IT IS SO ORDERED.

ISSUE ON APPEAL

In the instant appeal, ICNH states the issue on appeal is whether remand to the administrative agency is appropriate under the facts of this case and Idaho law.”

DISCUSSION

Succinctly, ICNH argues that on remand of ICNH I the district court should have entered judgment in favor of ICNH rather than remanding the matter to the Department. We disagree.

In ICNH I we held:

(A) The Department found as a matter of fact that ICNH was operated inefficiently based solely upon evidence that its per diem patient costs exceeded the percentile cap prescribed by I.C. § 56-103, and noted that under I.C. § 56-110(a) “[a] rebuttable presumption exists with respect to costs above the basic payment that a facility incurring such costs is not economically and efficiently operated ... and that such costs are not reasonable.” However, we also noted that under 16 IDAPA 3.10254.-07(f) reimbursement will be limited to the percentile cap “unless the Provider can demonstrate to the Department of Health and Welfare that his facility was operated efficiently ... and that the costs incurred in excess of the percentile cap were beyond his control;” and that in such case “costs in excess of the cap will be allowed to the extent that they are justified by this pro-cess_” Id., 120 Idaho at 937, 821 P.2d at 992.

(B) That a review of the record demonstrated that section 56-110(a), I.C. statutory presumption was rebutted by ICNH by proof that some of the costs incurred in excess of the percentile cap were beyond its control. We therefore held that the rebutted presumption could not be used to bar reimbursement to ICNH and that the Department’s finding of inefficiency “must be based on some evidence in addition to the (rebutted) presumption to show that the facility was inefficiently operated.” (Parenthetical word added.) Id., 120 Idaho at 939, 821 P.2d at 994. Further, we held that once the statutory presumption has been [118]*118rebutted “the Department must then prove that the facility is inefficiently operated in order to deny payments for those costs that exceed the percentile cap.” Id., 120 Idaho at 939, 821 P.2d at 994.

(C) That since ICNH produced evidence at the departmental hearing sufficient to overcome — or at least “neutralize” — the statutory presumption of inefficient operation, ICNH had made a prima facie case that the costs in excess of the percentile cap were reasonable. 120 Idaho at 938-39, 821 P.2d at 993-94.

Critical to our decision in ICNH I was the fact that the Department’s conclusion of inefficient operation on the part of ICNH was predicated upon the rebutted presumption of inefficiency which, in turn, was based solely upon the facts that the disallowed costs exceeded the percentile cap. The Department made no other findings of fact to support the conclusion that ICNH was inefficiently operated.

We concluded in ICNH I that since the rebutted presumption of inefficiency did not support the Department’s decision, this matter must be remanded “for further proceedings,” 120 Idaho at 940, 821 P.2d at 995, citing Love v. Board of County Comm’rs, 105 Idaho 558, 671 P.2d 471 (1983), appeal after remand, 108 Idaho 728, 701 P.2d 1293 (1985), and I.C. § 67-5215(g).

In Love, this Court agreed with the district court’s conclusion that the findings of fact made by the county commissioners did not support the latter’s decision, and concluded that, pursuant to I.C. § 67-5215(g),1 the matter must be remanded to the county commissioners “for further proceedings.”

The county commissioners in Love had granted a proposed zone change after a public hearing. On appeal, the district court held that as a matter of law the findings of fact by the county commissioners were “insufficient” and reversed the decision of the commissioners.

On appeal by the county commissioners to this Court we held that the pertinent finding of fact by the commissioners was not a finding of fact but rather was a conclusion of law. In footnote 2 to our decision in Love

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856 P.2d 1283, 124 Idaho 116, 1993 Ida. LEXIS 143, Counsel Stack Legal Research, https://law.counselstack.com/opinion/idaho-county-nursing-home-v-idaho-department-of-health-welfare-idaho-1993.