Indiana State Board of Public Welfare v. Tioga Pines Living Center, Inc.

575 N.E.2d 303, 1991 WL 137588
CourtIndiana Court of Appeals
DecidedSeptember 25, 1991
Docket30A04-9006-CV-288
StatusPublished
Cited by20 cases

This text of 575 N.E.2d 303 (Indiana State Board of Public Welfare v. Tioga Pines Living Center, Inc.) is published on Counsel Stack Legal Research, covering Indiana Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Indiana State Board of Public Welfare v. Tioga Pines Living Center, Inc., 575 N.E.2d 303, 1991 WL 137588 (Ind. Ct. App. 1991).

Opinion

CONOVER, Judge.

Defendants-Appellants Indiana State Board of Public Welfare (IBPW), Indiana Department of Public Welfare (IDPW), and Suzanne Magnant, in her capacity as Administrator of the Indiana Department of Public Welfare (collectively, the State), in-terlocutorily appeal the Hancock Circuit Court's entry of a preliminary injunction and class certification of similarly-situated Indiana nursing homes, with Plaintiffs-Ap-pellees Tioga Pines Living Center, Inc., Communicare of Indiana, Inc., d/b/a American Village Retirement Community, Bloomington Convalescent Center, Inc., Meadow Heights Nursing Center, Inc., d/b/a Lincoln Hills of New Albany, et al., as class representatives for class action purposes.

Reversed in part and affirmed in part.

This appeal presents the following issues:

Whether the trial court erred by
1. entering a preliminary injunction ordering the State to escrow monthly the monetary difference between the old and new cost control cap rates for reimbursing Indiana nursing homes under the Medicaid program, and
*305 2. certifying as a class the approximately 785 skilled nursing facilities and intermediate care facilities (nursing homes) in Indiana qualified to receive Medicaid reimbursement payments from the State, with the captioned nursing homes as class representatives for class action purposes under Ind.Trial Rule 28.

The IDPW is charged with the duty of administering the reimbursement of Indiana nursing homes for the care of Medicaid patients. It sets reimbursement rates from time to time, using in part federal guidelines when so doing because the federal government provides matching funds to Indiana to be used for that purpose. Under the regulations promulgated by the State, qualified nursing homes must file annual reports with IDPW-stating their patient care and operating costs. IDPW then determines what costs are allowable for Medicaid reimbursement purposes as to each nursing home. One accounting factor always considered by IDPW when making reimbursement payments has been the amount of any annual increase in patient care costs reported by these qualified nursing homes to IDPW.

Medicaid reimbursement is currently based on a system of allowable costs as defined in the regulations, plus a potential incentive payment to promote efficient operation of participating nursing homes. Prior to 1983, the Medicaid reimbursement rate to each nursing home for annual increases in patient care and operating costs over its previous year's costs was capped at 9% per annum under a federal regulation requiring payment to nursing facilities "on a reasonable cost-related basis." Such facilities were reimbursed retrospectively for whatever reasonable costs they incurred. 42 U.S.C. § 1896a(a)(13)(E) (1976). In 1980, however, as part of the Omnibus Budget Reconciliation Act of that year, the Boren Amendment was enacted by Congress. Its intent was to reduce the level of reimbursement paid by the states to Medicaid-qualified nursing homes to control spiraling health care costs that are notoriously inflationary. See, Charleston Memorial Hospital v. Conrad (4th Cir.1982) 693 F.2d 324, 331, and Ilinois Council on Long Term Care v. Miller (N.D.Ill.1983) 579 F.Supp. 1140, 1147. The Boren Amendment provides a state's reimbursement methodology must yield rates that are "reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities in order to provide care and services in conformity with applicable State and Federal laws, regulations and quality and safety standards." 42 U.S.C. § 1896a(a)(13)(4). IDPW changed its method of Medicaid reimbursement to conform to Boren Amendment requirements in 1988.

In April of that year, acting on the recommendation of its accounting consultants, IBPW attempted to adopt, and IDPW to promulgate, an amendment to the regulations changing the method of capping annual rates by linking them to the preceding three year average of the Gross National Product Implicit Price Deflator. (R. 237). See 470 IAC 5-4.1-9(c)(8). Starting in October, 1983, IDPW began making payments to qualified nursing homes based on the new cap rate, rather than the old 9% one.

Subsequently in P.L. 80-1984, the legislature changed the former "reasonable cost-related basis" standard for reimbursement by adding a new section to the Medicaid reimbursement law, IND.CODE 12-1-7-17.2 (now 17.6), which provided in part

(b) Payment of skilled nursing facility and intermediate care facility services shall, under 42 U.S.C. 1896a(a)(13)(A), be determined in accordance with a prospective, ... payment rate that is reasonable and adequate to meet the costs that are incurred by efficiently and economically operated facilities in order to provide care and services in conformity with state and federal laws, rules, regulations, and quality and safety standards, with a growth or profit factor, as determined in accordance with generally accepted accounting principles, in accordance with rules adopted by the department [of public welfare].

The captioned nursing homes later filed this suit, claiming the new cap rate was not duly adopted and promulgated by the State because the applicable statutory procedure for doing so had not been followed. The suit also sought, among other things, (a) a preliminary injunction to prevent the State from reducing payments under the new cap rate, and (b) class certification of all similarly situated Indiana nursing homes for class action purposes under Ind.Rules of Proc., Trial Rule 28.

After a hearing, the trial court issued a preliminary injunction requiring the State to pay into escrow the difference between *306 the amounts paid to these nursing homes under the new cap rate and that which would have been paid under the old one, a sum estimated to be approximately $4,000,-000 per month. Additionally, the trial court certified the cause as a class action, both as to issues and damages, and ordered - appropriate notification to the class.

The State then filed this interlocutory appeal to challenge the trial court's entry of the preliminary injunction and certification of the cause as a class action. Additional facts, as necessary, appear in the later portions of this opinion.

I

The grant or denial of a preliminary injunction rests within the equitable discretion of the trial court,. Wells v. Auberry (1982) Ind.App., 429 N.E.2d 679, 682, reh. den'd., trams. den'd. The trial court's order will not be disturbed unless it is clearly erroneous, or is the result of an improvident exercise of judicial discretion. Id, We believe issuance of the preliminary injunction in this case was clearly erroneous because the appellees have an adequate remedy at law, and limit our discussion to that principle.

The purpose of a preliminary injunction is to maintain the status guo until the underlying claim can be adjudicated. As Ratliff, C.J. said

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Bluebook (online)
575 N.E.2d 303, 1991 WL 137588, Counsel Stack Legal Research, https://law.counselstack.com/opinion/indiana-state-board-of-public-welfare-v-tioga-pines-living-center-inc-indctapp-1991.