Lackawanna-Susquehanna-Wayne Mental Health & Mental Retardation Program v. Commonwealth

560 A.2d 915, 127 Pa. Commw. 45, 1989 Pa. Commw. LEXIS 439
CourtCommonwealth Court of Pennsylvania
DecidedJune 21, 1989
Docket1949 C.D. 1988
StatusPublished

This text of 560 A.2d 915 (Lackawanna-Susquehanna-Wayne Mental Health & Mental Retardation Program 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
Lackawanna-Susquehanna-Wayne Mental Health & Mental Retardation Program v. Commonwealth, 560 A.2d 915, 127 Pa. Commw. 45, 1989 Pa. Commw. LEXIS 439 (Pa. Ct. App. 1989).

Opinion

CRAIG, Judge.

The Lackawanna-Susquehanna-Wayne Mental Health and Mental Retardation Program (Program) appeals an order of the Director of the Office of Hearings and Appeals of the Department of Public Welfare (DPW) holding that (1) *47 the requirement that a minimum occupaney rate of 85 percent be used to calculate reimbursement units for fee-for-service (per diem) funding of Community Residential Rehabilitation (CRR) programs applies to the Program; (2) money donated to the county in response to the Program administrator’s letter of solicitation, and given to the Program by the county, is income to the Program; and (3) reimbursement for expenditures related to the administrator’s enrollment in a doctoral program is not authorized.

The Program is a provider of mental health and mental retardation services in the three-county area. In 1984, DPW’s Office of Operations Review conducted an audit of the Program for a four-year period ending on June 30, 1984.

Three of the findings contained in the Operational Audit Report are the subject of the Program’s appeal. Those findings are: (1) $18,726 (reduced by stipulation to $10,499) in CRR expenditures for the 1981-82 fiscal year are not eligible for DPW financial participation; (2) the Program failed to report donations and gifts totalling $30,152 as income; and (3) a $19,327 reimbursement, received by the Program from DPW and the participating counties for the administrator’s post-graduate education, is not authorized by DPW regulations or Program policies. The effect of implementing these findings is that a greater amount of local county funds will be required by the Program to provide services.

On November 20, 1986, an Attorney Examiner conducted a formal hearing on the Program’s appeal, and recommended a decision holding that DPW properly disallowed $10,499 of reimbursement based on a published 85 percent occupancy rate factor, but that DPW erred in disallowing both the $30,152 in donations, which DPW characterized as contributions to the Program, and the $19,327 in expenditures related to the administrator’s enrollment in a doctoral program.

The Program’s appeal to DPW’s Office of Hearings and Appeals followed. On July 14, 1988, the director of the Office issued an order adopting the examiner’s recommen *48 dation as to the reimbursement, but rejecting the donation and education recommendations, thereby affirming all three disallowances in the audit findings. The Program now appeals the same three findings to this court.

1.

The first issue is whether DPW properly disallowed $10,499 in reimbursements as a result of adhering to an 85 percent minimum occupancy rate, published in a Mental Health Bulletin, to calculate reimbursement unit amounts for CRR programs. If reimbursement unit amounts are calculated by assuming that at least 85 percent of service units are occupied, the unit amounts are necessarily lower than they would be if a lower occupancy rate were used as the cost devisor. The Program had used an actual occupancy rate (81% in this case) to calculate per diem reimbursement unit amounts at its CRR facility, thus reaching a unit amount higher than the amount which would be produced by an 85% rate.

Section 201(2) of the Mental Health and Retardation Act of 1966 1 authorizes DPW “[t]o make ... and enforce all regulations necessary and appropriate to the proper accomplishment of the mental health and mental retardation duties and functions imposed by this act.” Under the legal authority of section 201(2), the County Mental Health and Mental Retardation (MH/MR) Fiscal Manual provides that “[rjates or fees per unit of service may be published as a Departmental bulletin by the Department for selected services.” 55 Pa.Code § 4300.115(a).

DPW’s Mental Health Bulletin No. 6100-80-02, adopted on December 5, 1980, set forth the following with regard to fee-for-service funding of MH-CCR programs:

CRRS’ funded on August 26, 1980, and any new CRRS’s funded in the future may be program funded for the start-up year and the first full year of operation. In all other instances, CRRS’s must be funded on a fee-for-service basis by County Programs.
*49 County programs shall negotiate contracts with CRR providers for unit rates. In these negotiations, the County shall use, as a minimum, an average annual occupancy rate of 85%.
For CRR programs provided directly by County programs, expenditures shall be reported on a “per unit” basis in the annual expenditure report and occupancy shall conform to the 85% or higher requirement.
This policy is in conformance with the current 6100 MH/MR Program Fiscal Manual which was written prior to the establishment of MH-CRRS. The provisions of this policy will be specifically incorporated in the next revision of the 6100 Regulations.

In mid-1979, the Program contracted with Allied Services for the Handicapped (Allied) to provide community residential services at a fixed rate. The parties renewed their agreement in 1980 (the first full year of service). On July 1, 1981, the Program and Allied entered into a fee-for-service contract. Although the parties did not execute the 1981-82 contract until the middle of the year,, the second full year of service began on the first day of 1981. Therefore, DPW’s requirement of CRR’s being funded on a fee-for-service basis applied to the Program for the entire 1981-82 fiscal year.

The Program contends that DPW abused its discretion by strictly applying the 85% occupancy rate because DPW later abandoned the policy when it revised the Title 6100 Regulations (See 55 Pa.Code §§ 4300.1-4300.161), and because DPW provided an additional $37,000 to the Program.

Although the revised MH/MR Fiscal Manual includes no required occupancy rate, a regulation “does not operate retroactively simply because some of the facts pertinent to its application came into existence prior to its effective date.” Mountain Rest Nursing Home, Inc. v. Department of Public Welfare, 73 Pa.Cmwlth. 42, 45, 457 A.2d 600, 602 (1983). Regardless of DPW’s independent decision to increase its allocation for the Program, and the subsequent change in DPW’s policy, Bulletin 6100-80-02 *50 states the applicable fee-for-service requirements for the 1981-82 fiscal year. Hence, DPW properly disallowed the $10,499 in expenditures claimed for that year.

2.

The second issue is whether donations to Lackawanna County, and given by the county to the Program, constitute income to the Program, thereby reducing the financial participation by DPW.

The audit report states that during the fiscal years 1981-82 and 1982-83, the Program failed to report “at least $30,152 of donations and/or gifts from seven (7) organizations that were contracted service providers to the L-S-W Counties MH/MR Program.” The report concludes that the donors intended the money to be given to the Program.

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560 A.2d 915, 127 Pa. Commw. 45, 1989 Pa. Commw. LEXIS 439, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lackawanna-susquehanna-wayne-mental-health-mental-retardation-program-v-pacommwct-1989.