Portland Residence, Inc. v. Steffen

34 F.3d 669, 1994 U.S. App. LEXIS 24257, 1994 WL 481705
Court of Appeals for the Eighth Circuit·Decided September 8, 1994·No. No. 93-3525·Published·Cited by 4 cases

Opinion

BOWMAN, Circuit Judge.

This case arises under the Medicaid program. The plaintiffs filed an action in federal court seeking monetary damages from and declaratory relief against the Commissioner of the Minnesota Department of Human Services, claiming that federal law requires the state of Minnesota to guarantee a specific minimum level of payments to facilities that care for the mentally retarded. The District Court1 granted summary judgment to the [670] Commissioner. Plaintiff Portland Residence, Inc. appeals, and we affirm.

I,

A.

Medicaid (known in Minnesota as “Medical Assistance,” or “MA”) is a joint federal-state program that provides medical and other services to the poor. 42 U.S.C. §§ 1396-1396u (1988 & Supp. IV 1992); Minn.Stat. § 256B.01-.76 (1992 & Supp.1993). Although Minnesota’s participation in Medicaid is voluntary, to receive the substantial federal money offered, Minnesota must comply with the Medicaid Act and all applicable federal regulations. Wilder v. Virginia Hosp. Ass’n, 496 U.S. 498, 502, 110 S.Ct. 2510, 2513-14, 110 L.Ed.2d 455 (1990).

Medicaid requires participating states to offer many specific services. See, e.g., 42 U.S.C. § 1396a(a)(10)(A) (1988 & Supp. IV 1992). Other services are optional. See id. § 1396d(a). Minnesota’s poor receive almost all of the optional services, including intermediate care facilities for the mentally retarded (ICFs/MR). Id. § 1396d(a)(15) (1988); Minn.Stat. § 256B.0625 subd. 2 (1992).

As required by the Medicaid Act, Minnesota has established .a system for establishing payment rates for ICFs/MR. 42 U.S.C. § 1396a(a)(13)(A) (Supp. IV 1992). This system is known as Rule 53. Minn.Rules pts. 9553.0010- 0080 (1993). Before Rule 53 went into effect in 1985, Minnesota ICFs/MR were reimbursed in accordance with the original Medicaid Act for “all reasonable costs” incurred during the preceding fiscal year, adjusted for inflation and projected cost increases. Minnesota’s Medicaid costs swelled colossally under this reimbursement system — in just four years, from 1978 to 1982, ICFs/MR tripled their billings to the state.

To reduce Medicaid costs, as part of the Omnibus Reconciliation Act of 1980 Congress passed the Boren Amendment, the purpose of which was to allow states to develop more efficient payment systems without being smothered by federal oversight. Colorado Health Care Ass’n v. Colorado Dep’t of Social Servs., 842 F.2d 1158, 1165 (10th Cir.1988). By its terms, the amendment applies to services rendered by hospitals, nursing facilities, and ICFs/MR. 42 U.S.C. § 1396a(a)(13)(A). The Boren Amendment changed Medicaid reimbursement procedures so that, in place of the original Medicaid Act’s “all-reasonable-costs” reimbursement standard, the affected facilities were to be paid sums “reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities in order to provide care and services in conformity with applicable State and Federal laws, regulations, and quality and safety standards.” Id.

Minnesota completed its implementation of the Boren Amendment in 1985, when Rule 53 took effect. Rule 53 uses a prospective rate-setting system: a facility’s rates for each “rate year,” which begins October 1, are based on the facility’s allowable costs from its past “reporting year,” which is the preceding calendar year, ending December 31. Minn.Rule pt. 9553.0020 subps. 38, 42. Because twenty-one months elapse between the mid-point of the reporting year and the midpoint of the rate year, the state adjusts the rate for inflation. Minn.Stat. § 256B.501 subd. 3c (1992). As with the plans of all participating states, the Secretary of the United States Department of Health and Human Services (HHS), through the Health Care Financing Administration (HCFA), the federal agency within HHS that administers Medicaid, has approved Rule 53.

Rule 53’s rates cover a facility’s allowable costs if those costs do not increase faster than inflation. To the extent an ICF/MR’s costs increase at a rate higher than the rate of inflation, it will not immediately receive increased reimbursement to cover this difference; instead,, the facility will have to wait out the twenty-one month lag before its reimbursement rates are adjusted so as to reflect its past cost increases. Rule 53’s predecessor, in contrast, allowed reimbursement rates to increase immediately along with increases in ICF/MR costs. Thus, Rule 53’s prospective reimbursement system attempts to control costs by informing an ICF/MR in advance that it will receive a certain rate of reimbursement and that it must either keep its expenses in line with that rate or risk [671] losing the sums it expends in excess of that rate.

B.

Through various corporations, Leonard Jankowski owns numerous business, including several nursing homes and ICFs/MR. Portland Residence, Inc., an ICF/MR owned by Jankowski, has participated in Minnesota’s MA program for many years. These two parties, along with Earl English, a mentally retarded Portland resident, were the plaintiffs in this suit.

Jankowski acquired Hampton Care Center, a nursing home that also participates in Minnesota’s MA program, in 1990. Jankow-ski claims that Hampton was in serious financial straits when he acquired it, and that the facility lost between $600,000 and $700,000 during the first couple of years he owned it.

For some years, Portland has lent substantial sums of money to Jankowski and to his other businesses, including car rental and religious publishing companies. In April 1987 these loans totaled more than $200,000. By 1991, this figure nearly had tripled, to some $550,000 (plus a $20,000 loan that Portland wrote off). More than $300,000 of the $550,000 represents loans from Portland to Jankowski. The record is unclear as to how much Portland gave or lent Hampton.

Minnesota regularly advances funds to facilities such as Portland and Hampton for operating capital. In January 1992 Jankow-ski began claiming that, owing to Hampton’s large losses, Portland’s and Hampton’s financial difficulties had become acute, and he asked the state to advance, against Hampton’s pending MA billings, $60,000 to pay Portland’s salaries. Jankowski presumably sought the advance against Hampton’s billings, rather than Portland’s, because he had assigned away Portland’s receivables to an apparently unrelated company in exchange for a loan on which Portland was to pay from 20 to 36 percent interest.2 The state refused to advance the sums requested by Jankow-ski.

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Portland Residence, Inc. v. Steffen, 34 F.3d 669, 1994 U.S. App. LEXIS 24257, 1994 WL 481705 (8th Cir. 1994).

34 F.3d 669 (Portland Residence, Inc. v. Steffen) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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Portland Residence, Inc. v. Steffen
34 F.3d 669 (Eighth Circuit, 1994)