Medicenter Hospital v. Commonwealth, Department of Public Welfare

468 A.2d 1156, 78 Pa. Commw. 610, 1983 Pa. Commw. LEXIS 2157
Commonwealth Court of Pennsylvania·Decided December 2, 1983·No. Appeal, No. 2771 C.D. 1981·Published·Cited by 3 cases

Opinion

Opinion by

Judge MacPhail,

Medicenter Hospital (Petitioner), a skilled nursing facility, has appealed from an order of the Department of Public Welfare (DPW) which dismissed Petitioner’s exceptions to DPW’s audit findings for the fiscal years 1977-78, beginning on July 1, 1977.1 In particular, Petitioner objects to DPW’s refusal to allow Medical Assistance reimbursement for rental payments as a cost item separate from those costs which are subject to certain regulatory ceiling limitations. We affirm.

The facts of this case, as stipulated by the parties, reveal that Petitioner began operating as a skilled nursing facility in 1972. The facility used by Petitioner was leased for an annual rental fee of $206,-809.61 during both of the years 1977-78. Beginning on July 1,1976, DPW implemented the federally mandated2 cost-related method of reimbursing skilled nursing and intermediate care facilities for Medical [612] Assistance services provided.3 Under this system, facilities were to be reimbursed for “allowable costs” subject to certain regional reimbursement ceilings. At all times here relevant reasonable rental expense has been an allowable cost “for leasing of facilities from non-related parties in an arm’s length transaction”. Section IY(D) (14) of the Program Manual, 5 Pa. B. 2933 (1975).4 Rental expense, however, is one of the costs which are subject to the group cost ceilings. Prior to July 1, 1977, depreciation and interest were also considered allowable costs subject to the cost ceiling limitations. Section IY(D)(9) of the Program Manual, 5 Pa. B. 2932 (1975).

On July 1, 1977, DPW amended its regulations to permit facilities to claim depreciation and interest as separate cost items to be excluded from the group ceiling limitations on net operating costs. See Section III(E) of the Program Manual, 7 Pa. B. 2700 (1977).5 The primary beneficiaries of this amendment were owner-operated facilities. Petitioner contends that the failure of DPW to permit rental expense to be excluded also from the cost ceilings is violative of federal statutory law and constitutes a denial of equal protection.

Although not vigorously pursued on appeal, Petitioner first argues that DPW misinterpreted its own regulations when it denied separate reimbursement for rental expense. It is well settled, of course, that an agency’s interpretation of its own regulations is [613] entitled to considerable weight. Orner v. Department of Public Welfare, 44 Pa. Commonwealth Ct. 635, 639, 404 A.2d 452, 454 (1979). We t.bmb it is clear that DPW has reasonably and correctly interpreted its regulations. As of July 1, 1977, the regulations permitted reimbursement for depreciation and interest on capital indebtedness without regard to the group cost ceilings,6 while including rental expense as a cost subject to those ceiling limitations.

Petitioner next argues that, assuming DPW has correctly applied its regulations, then the regulations are violative of Title XIX of the Social Security Act (which provides for the Medicaid system) and regulations promulgated thereunder. We disagree.

Pennsylvania’s Medical Assistance Program is administered pursuant to Section 201 of the Public Welfare Code (Code),7 in association with the federal Medicaid system. Federal statutory law provided during the time pertinent to the instant case, that state medical assistance plans must provide:

effective July 1, 1976, for payment of the shilled nursing facility and intermediate care facility services provided under the plan on a reasonable cost related basis, as determined in accordance with methods and, standards which shall be developed by the State on the basis of cost-finding methods approved and verified by the Secretary.... (Emphasis added.)

42 U.S.C. §1396a(a) (13) (E) (current version at 42 U.S.C. §1396a(a) (13) (A)); see also Section 443.1 of [614] the Code, 62 P.S. §443.1. Moreover, the states are directed “to assure that payments . . . are not in excess of reasonable charges consistent with efficiency, economy, and quality of care. ...” 42 U.S.C. §1396a (a)(30).

Federal case law clearly establishes that under 42 U.S.C. §1396a(a) (13) (E), “Congress intended that the states be afforded considerable latitude in the areas of cost-finding and rate-setting. ...” DeGregorio v. O’Bannon, 500 F. Supp. 541, 546 (E.D. Pa. 1980). The states are free both to define allowable cost items and to set values for the reasonable costs of those items. Alabama Nursing Home Association v. Harris, 617 F.2d 388, 392 (5th Cir. 1980). The Medical Assistance payments need not reimburse for the actual costs a facility incurs in treating eligible patients. Instead, the states may reimburse only for reasonable costs incurred by a facility. DeGregorio, 500 F. Supp. at 547-48. Federal regulations do provide, however, that “[pjayment rates must not be set lower than rates that the agency reasonably finds to be adequate to reimburse in full the actual allowable costs of a facility that is economically and efficiently operated.” 42 C.F.R. §447.302(b) (1978).

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Medicenter Hospital v. Commonwealth, Department of Public Welfare, 468 A.2d 1156, 78 Pa. Commw. 610, 1983 Pa. Commw. LEXIS 2157 (Pa. Ct. App. 1983).

468 A.2d 1156 (Medicenter Hospital v. Commonwealth, Department of Public Welfare) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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