Leopoldstadt, Inc. v. Commissioner of the Division of Health Care Finance & Policy

436 Mass. 80
CourtMassachusetts Supreme Judicial Court
DecidedFebruary 11, 2002
StatusPublished
Cited by17 cases

This text of 436 Mass. 80 (Leopoldstadt, Inc. v. Commissioner of the Division of Health Care Finance & Policy) is published on Counsel Stack Legal Research, covering Massachusetts Supreme Judicial Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Leopoldstadt, Inc. v. Commissioner of the Division of Health Care Finance & Policy, 436 Mass. 80 (Mass. 2002).

Opinion

Cordy, J.

The plaintiffs, Leopoldstadt, Inc., doing business as Favorite Nurses; the American Staffing Association (ASA); and the Massachusetts Association of Nursing Agencies (MANA), all provide, or work with providers of, temporary nursing personnel to medical facilities.3 These providers of temporary nursing personnel are referred to interchangeably as temporary nursing agencies (TNAs), or nursing pools. The plaintiffs filed a complaint in the county court seeking declaratory and injunctive relief regarding the Commonwealth’s setting of the maximum hourly rates that TNAs are permitted to charge to medical facilities for temporary nursing personnel. A single justice of this court denied the plaintiffs’ request for an injunction and reserved and reported the case to the full court.

The plaintiffs contend that (1) the wage cap component of G. L. c. 118G, § 7 (Section 7), and of the rate setting regulations, 114.3 Code Mass. Regs. §§ 45.00,4 are invalid because the wage cap is either inapplicable or unconstitutional; and (2) the division of health care finance and policy (division) violated the procedural and substantive mandates of the enabling statutes in adopting the rate regulations by, among other things, failing to calculate the rates on an individualized basis; establishing final rates without collecting financial reports from all of the TNAs; calculating a “median profit factor” instead of a “reasonable return on equity”; interpreting the statutory phrase “wages and benefits allowed” to permanent nursing [82]*82personnel as “wages and benefits paid” to such personnel; and failing to consult with the Department of Public Health (department).

We conclude that the division did not adopt the challenged regulations in conformity with the requirements of the enabling statutes. Accordingly, we hold that they are invalid, and we order the division to establish interim rates as provided by Section 7 and to recalculate final rates in compliance with Section 7, G. L. c. Ill, § 72Y (Section 72Y), and this opinion.

Background.

In 1988, in response to a perceived shortage of nurses and other health care workers in the Commonwealth, the Legislature enacted Section 72Y, which provided for the registration and regulation of TNAs. St. 1988, c. 164, § 128. The purpose of Section 72Y was to ensure an adequate and stable supply of nursing services for residents of licensed long-term care facilities by (1) discouraging staff from leaving permanent positions to take more flexible and higher-paying temporary jobs; and (2) ensuring that nursing homes did not pay excessive amounts for temporary staff, which would deplete funds necessary for resident care.

Pursuant to Section 72Y, the rate setting commission (commission)5 promulgated 114.3 Code Mass. Regs. §§ 45.00 in November, 1988. The regulations set forth “the methodology for determination of reasonable rates of payment for services provided by [TNAs]” that were registered with the department, the methods by which each TNA could request rate changes, and the standards that the commission would use to approve or reject those requests. 114.3 Code Mass. Regs. §§ 45.01, 45.03 (1989).

Between 1992 and 2000, the supply of muses was deemed to be sufficient to meet the demand, rate setting was suspended, and the market determined nursing pool rates. However, the division anticipated that “ [i]f a severe nursing shortage develops, or if temporary nursing service prices to health care providers rise faster than reasonable in a competitive market, [83]*83the Division will propose regulatory amendments to establish the methodology for determining reasonable rates of payment for services provided by temporary nursing services.” 114.3 Code Mass. Regs. § 45.03 (1997).

On March 21, 2000, the division sent out a report to each of the 184 TNAs registered with the department, requesting administrative and financial information for the fiscal year ending December 31, 1999, including information about hours, revenue, administrative costs, and income (cost reports). The TNAs were required to complete and return the cost reports to the division by May 1, 2000. After extending the deadline for completion and return of these reports, the division received sixty-five completed cost reports. Approximately fifty TNAs did not return cost reports because they were no longer doing business in Massachusetts. Thus, of the approximately 134 registered TNAs still doing business in Massachusetts, the division obtained cost reports from less than one-half of them.

In May, 2000, the Massachusetts Extended Care Federation (Federation), an association representing the interests of nursing homes in Massachusetts, sued the division in the Superior Court seeking declaratory relief and an injunction ordering the division to set interim rates for TNAs. In their complaint, the plaintiffs asserted that market conditions and, in particular, low unemployment created staffing shortages for nursing homes. This made nursing homes more dependent on TNAs to maintain adequate staffing levels, which in turn caused the TNAs to raise the rates charged to nursing homes and increase the wages paid to temporary nursing personnel. On June 7, 2000, the motion judge allowed the Federation’s motion for injunctive relief, ordering that:

“[A] preliminary injunction issue enjoining [the] defendants from failing and refusing to forthwith issue interim rates for nursing pools, said rates to remain in effect until such time as cost reports requested of nursing pools by the defendants are complete and the defendants have exercised their authority under G. L. c. Ill, § 72Y, and G. L. c. 118G, § 7, by establishing reasonable rates for services provided by nursing pools registered with the Department of Public Health, taking into consideration the factors outlined in these statutes.”

[84]*84The division did not appeal from this order, but adopted emergency regulations, 114.3 Code Mass. Regs. §§ 45.00 (2000), which froze the rates charged by nursing pools at the rates charged as of June 1, 2000.6 On August 31, 2000, the division proposed amendments to the emergency regulation that set new rates for TNAs. On October 13, 2000, and January 29, 2001, the division held hearings relating to these proposed rate regulations.7

Section 7 and Section 72Y require that the division consider three factors in determining the hourly rates that TNAs can charge to health care facilities. First, the division must consider the wages and benefits that the TNA pays to the temporary nursing personnel that it supplies to health care facilities. Section 7 limits the wage and benefit component by requiring that “the portion of the rate attributable to wages and benefits shall not exceed the prevailing wages and benefits allowed for permanent medical personnel of the same type at such health care facilities.” Second, the division must consider the reasonable administrative expenses that the TNA incurs. Third, the division must provide the TNA a reasonable return on equity.

In setting the wage and benefit component of the proposed rates, the division took the median hourly wages and benefits paid by nursing home facilities in 1999, and adjusted this figure upward by 6.67 per cent a year for inflation based on the general rate of inflation in the economy during the years 1999 and 2000.8

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Bluebook (online)
436 Mass. 80, Counsel Stack Legal Research, https://law.counselstack.com/opinion/leopoldstadt-inc-v-commissioner-of-the-division-of-health-care-finance-mass-2002.