Montana Children's Home & Hospital v. Department of Social & Rehabilitation Services

592 P.2d 481, 181 Mont. 78, 1979 Mont. LEXIS 765
CourtMontana Supreme Court
DecidedMarch 16, 1979
DocketNo. 14041
StatusPublished
Cited by2 cases

This text of 592 P.2d 481 (Montana Children's Home & Hospital v. Department of Social & Rehabilitation Services) is published on Counsel Stack Legal Research, covering Montana Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Montana Children's Home & Hospital v. Department of Social & Rehabilitation Services, 592 P.2d 481, 181 Mont. 78, 1979 Mont. LEXIS 765 (Mo. 1979).

Opinion

MR. JUSTICE DALY

delivered the opinion of the Court.

Montana Children’s Home and Hospital (Shodair) and St. Peter’s Hospital, plaintiffs and respondents, sought a declaratory judgment in the District Court of the First Judicial District with respect to their rights under certain contracts between.the hospitals and the Department of Social and Rehabilitation Services (SRS), defendant and appellant. The District Court granted SRS’s motion to dismiss on August 19, 1976, but reconsidered and withdrew its order granting the motion on November 3, 1976. The case was tried before the Honorable Peter G. Meloy, sitting without a jury. He ruled in favor of the hospitals and SRS appeals.

SRS contracted with a number of Montana hospitals to provide certain inpatient hospital services for individuals eligible to receive such services under the federal Medicaid program. The standard contract provided that SRS would reimburse the hospitals on the basis of “reasonable costs.” These costs were to be determined at the end of each fiscal year by Blue Cross of Montana, in compliance with federal guidelines as part of a contract with SRS. In the interim SRS would reimburse the hospitals on the basis of their “standard charges” to the cash-paying general public. At the end of each fiscal year, if the federally defined “reasonable costs” were found to be insufficient, the hospitals could negotiate with SRS for [80]*80a supplemental allowance bringing the total to “full and adequate costs.”

Between 1968 and 1975, there were a number of years in which “standard charges” at both Shodair and St. Peter’s Hospital were less than the later computed “reasonable costs.” SRS has refused to pay the excess of “reasonable costs” over “standard charges” because of this Court’s decision in Montana Deaconess Hospital v. Department of Social and Rehabilitation Services (1975), 167 Mont. 383, 538 P.2d 1021. That suit was certified and maintained as a class action by a number of hospitals with three hospitals names as plaintiffs. The subject matter of the suit consisted of contracts identical to those involved in the instant case.

In Montana Deaconess this court found, among other things, that “full and adequate costs” were synonymous with “standard charges.” However, in that case, the “standard charges” were in excess of “reasonable costs” under the federal guidelines. In the instant case, because the “standard charges” were less than the “reasonable costs,” fudge Meloy found that these plaintiffs were not similarly situated with the hospitals in Montana Deaconess. Therefore, the hospitals were entitled to seek-a declaratory judgment with respect to the contract terms. On September 6, 1977, Judge Meloy entered findings of fact and conclusions of law in favor of the hospitals. Judgment was entered on September 8 and SRS appeals.

The issues presented for our consideration are:

1. Whether Montana Deaconess holds that hospitals are limited to reimbursement on the basis of their “standard charges” even in the event that “standard charges” are less than “reasonable costs.”

2. Assuming Montana Deaconess limits hospitals to the recovery of “standard charges,” whether that decision can bind these plaintiffs if they were not afforded adequate notice of the nature of the Montana Deaconess proceedings..

3. Whether the payment of “reasonable costs” to Shodair for the fiscal year ending in 1975, violates federal Medicaid statutes or regulations.

This is the second time this Court has been asked to construe the [81]*81provisions of a series of form contracts between SRS and most of the state’s hospitals for implementing the federal Medicaid program. See Montana Deaconess Hospital v. Department of Social and Rehabilitation Services (1975), 167 Mont. 383, 538 P.2d 1021. In both cases, the following identical provisions of these contracts are at issue:

“The [name of hospital] will accept reimbursement of inpatient services on the basis of reasonable costs. We will accept standard charges as an interim payment subject to an end of the fiscal year retroactive adjustment. Such adjustments formula will be computed using the guidelines of the Department of Health, Education and Welfare in the ‘Principles of Reimbursement for Provider Costs’ under Title XVIII of PL 89-97. Certain other costs will be included which are allowed under Title XIX of PL 89-97 in effect on July 1, 1969.
“In addition, the hospital will have the opportunity to negotiate with the State Department of Public Welfare for supplemental allowance over and above the allowable costs permitted under Title XVI-II and Title XIX of PL 89-97 if it is shown that the reasonable cost formula as defined by the Federal Government does not provide the hospital with full and adequate costs for providing services to the Title XIX recipients.”

Both sides agree that these contracts establish three measures or levels of reimbursement under the Medicaid program. With respect to the manner of payment, the contracts first provide that interim payments for Medicaid services would be made to the hospitals on the basis of their standard charges. Second, the contracts provide that the payment of standard charges would be “subject to an end of the fiscal year retroactive adjustment” which would be based on a “reasonable cost” formula set forth in guidelines of the Department of Health, Education and Welfare. Finally, the contracts provide that if reasonable costs, as defined by the federal government, were insufficient the hospitals were to be given an opportunity to negotiate with SRS for a supplemental allowance over and above reasonable costs and equal to “full and adequate” costs. The rela[82]*82tionship between these three contractual terms is the focal point of this litigation as it was in Montana Deaconess.

In Montana Deaconess, a class action including as members of the class the plaintiffs herein, the pertinent issue was:

“Whether the term ‘full and adequate costs’ as used in the subject contracts, is synonymous with the term ‘standard charges’ as imposed upon all patients in the hospitals, and thus whether SRS is liable.” 167 Mont. at 384, 538 P.2d at 1022.

Wé concluded that:

“. . .in law, the HEW cannot successfully show that reasonable costs, absent any other special considerations, under Titles XVIII and XIX of Public Law 89-97 (42 U.S.C. § 1396) are not the same, in a nonprofit hospital structure, as standard charges.” 167 Mont. at 387, 538 P.2d at 1024.

SRS has now seized upon this statement. It argues that Montana Deaconess is res judicata as to the current suit and that our conclusion stated above means that in all cases SRS is bound under its contracts to pay only standard charges to the hospitals because “reasonable costs .. . are . .. the same ... as standard charges.” On both counts, we disagree.

In Smith v. County of Musselshell (1970), 155 Mont. 376, 378, 472 P.2d 878

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598 P.2d 1111 (Montana Supreme Court, 1979)

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Bluebook (online)
592 P.2d 481, 181 Mont. 78, 1979 Mont. LEXIS 765, Counsel Stack Legal Research, https://law.counselstack.com/opinion/montana-childrens-home-hospital-v-department-of-social-rehabilitation-mont-1979.