Northampton County Home v. Department of Public Welfare

629 A.2d 243, 157 Pa. Commw. 191, 1993 Pa. Commw. LEXIS 442
Commonwealth Court of Pennsylvania·Decided July 16, 1993·No. No. 2195 C.D. 1992·Published

Opinion

KELTON, Senior Judge.

Northampton County Home (Petitioner) petitions for review of the September 11,1992 order of the Office of Hearings and Appeals (OHA), Department of Public Welfare (DPW), which denied Petitioner’s appeal from DPW’s disallowance of Petitioner’s claim for Medicaid reimbursement for a portion of its pension fund contribution in fiscal years 1986, 1987, and 1989. We affirm.

The issue on appeal is whether DPW erred in determining that the portion of Petitioner’s pension fund contribution, satisfied by the transfer of funds from the pension fund’s excess interest account to Northampton County’s (the County) annuity reserve account, is not an allowable cost for purposes of Medicaid reimbursement.

We note that our scope of review is limited to determining whether DPW committed an error of law, violated any constitutional rights, and whether its findings of fact are supported by substantial evidence. Messiah Village v. Department of Public Welfare, 118 Pa.Commonwealth Ct. 29, 545 A.2d 956 (1988). As a general rule, DPW’s interpretation of its own regulations is controlling unless it is inconsistent with [193] the plain language of the regulations or the statute under which the regulations were promulgated. The Children’s Hospital of Philadelphia v. Department of Public Welfare, 153 Pa.Commonwealth Ct. 634, 621 A.2d 1230 (1993).

The County has established a retirement fund for its employees, including the employees of Petitioner. In fiscal years 1986 through 1989, the County made its pension fund contributions through a combination of checks drawn from the County’s general fund and journal entries transferring excess interest in the pension fund to the County’s annuity reserve account. A proportional share of the County’s pension fund contribution was made on behalf of Petitioner’s employees.1

In an audit of Petitioner’s cost reports for medical assistance, DPW allowed Petitioner Medicaid reimbursement for its proportional share of the County’s pension fund contributions attributable to the payments by check drawn from the general fund. DPW disallowed reimbursement for that portion attributable to the journal entry transfer of excess interest.

Petitioner appealed the disallowances to the OHA. The OHA, adopting the recommendation of the hearing examiner, denied Petitioner’s appeal. Thus, Petitioner appeals DPW's disallowance of reimbursement for that portion of Petitioner’s contribution drawn from the excess interest account for the fiscal years 1986,1987, and 1989.2 Under the County Pension Law (the Act), the County is required to make annual contributions to the retirement fund.3 The fund is comprised of several accounts provided by statute: the county’s annuity reserve account (CARA), the members’ annuity reserve account, and the retired members’ annuity reserve account. Monies contributed by the County are maintained in the CARA 16 P.S. § 11657.

[194] Pursuant to Section 8 of the Act, all monies and securities in the fund are placed in the custody of the county treasurer. 16 P.S. § 11658. Under Section 4 of the Act, the county retirement board administers the fund. 16 P.S. § 11654.

Section 7(a) of the Act provides that the corpus of the fund shall include all interest earned on the monies contained in the fund. 16 P.S. § 11657(a). Regular interest earned on the •monies in the fund is distributed between the CARA, the members’ annuity reserve account, and the retired members’ annuity reserve account in predetermined amounts. Id. The County places any investment earnings exceeding the amount applied to these accounts in its excess interest account.

Pursuant to Title XIX of the federal Social Security Act, 42 U.S.C. §§ 1396-1396u, federal monies are available to states for the provision of medical assistance in compliance with federal standards. Under the federal regulations, Medicare is required to pay for services provided by skilled nursing facilities on the basis of reasonable costs. 42 C.F.R. § 413.1(b). “Reasonable cost includes all necessary and proper expenses incurred in furnishing services, such as ... premium payments for employee health and pension plans.” 42 C.F.R. § 413.9(c)(3).

DPW, the agency authorized to administer Pennsylvania’s Medicaid program, conducts audits of nursing care facilities and on that basis, reimburses the facility for allowable costs associated with the provision of nursing care services. DPWs regulations provide that allowable cost for nursing care facilities is to be determined subject to the limitations set forth in the DPW manual for allowable cost reimbursement4 and the Medicare Provider Reimbursement Manual (HIM-15).5 55 Pa.Code § 1181.1.

[195] Section 2140.2 of the HIM-15 specifies that “[provider contributions for the benefit of employees under a deferred compensation plan are reimbursable when and to the extent such costs are actually incurred and met by the provider.” According to Section 2140.4 of the HIM-15, such costs may be found to have been “actually incurred,” provided that the provider has made payment in accordance with the following:

Payment must be made by check or other negotiable instrument, cash or legal transfer of assets such as stocks, bonds, real property, etc. Where payment is made by check or other negotiable instrument, these forms of payment must be redeemed through an actual transfer of the provider’s assets within the time limits specified in Section 2305.

See also Section 2142.6(A) of the HIM-15. Also, Section 2142.6(A) requires full liquidation of the provider’s liabilities within a specified time frame.

Further, Section 2142.3 of the HIM-15 provides, specifically in reference to reimbursement of pension contributions, that “[f]unds existing at the discretion of the provider are not considered valid----”

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Northampton County Home v. Department of Public Welfare, 629 A.2d 243, 157 Pa. Commw. 191, 1993 Pa. Commw. LEXIS 442 (Pa. Ct. App. 1993).

629 A.2d 243 (Northampton County Home v. Department of Public Welfare) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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