Renovo Hospital Ass'n v. Commonwealth, Department of Public Welfare

480 A.2d 1260, 83 Pa. Commw. 355, 1984 Pa. Commw. LEXIS 1518
CourtCommonwealth Court of Pennsylvania
DecidedJune 26, 1984
DocketAppeal, No. 304 C.D. 1982
StatusPublished
Cited by2 cases

This text of 480 A.2d 1260 (Renovo Hospital Ass'n v. Commonwealth, Department of Public Welfare) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Renovo Hospital Ass'n v. Commonwealth, Department of Public Welfare, 480 A.2d 1260, 83 Pa. Commw. 355, 1984 Pa. Commw. LEXIS 1518 (Pa. Ct. App. 1984).

Opinion

Opinion by

Judge Barry,

This appeal arises from an order by the Secretary of the Department of Public Welfare (Secretary) which reversed an order of the Office of Hearings and Appeals. A thorough perusal of the record reveals a complex mixture of facts, events and appeal provisions under the Pennsylvania Code.

The petitioner, Renovo Hospital Association t/a Bucktail Medical Center (Bucktail), is licensed by the Pennsylvania Department of Health as a certified provider of medical services under the Pennsylvania Medical Assistance Program (PMAP). PMAP provides payment for medical services rendered by certified health care providers to persons unable to afford them. The Department of Public Welfare (DPW) funds institutional providers, such as Buck-tail, through a two-step process. Providers receive an interim per diem rate for each inpatient day of care rendered by the provider. The interim per diem [357]*357rate reflects the audited per diem costs to care for medical assistance patients in the prior fiscal year.

When the fiscal year concludes, institutional providers must submit a report which indicates the cost to care for medical assistance patients. The report is audited and reconciled with the interim payments made during the fiscal year. The audit and reconciliation thus consist of the interim settlement and final settlement.

The program covers two levels of nursing services —intermediate and skilled. A free-standing nursing facility, an intermediate level facility, receives a reimbursement rate from the program less than the rate received by a hospital-based nursing facility (HBNF), a skilled facility. Bucktail received rates consistent with a free-standing nursing facility. At various times, Bucktail requested classification as an HBNF in order to receive the increased reimbursement rates. These requests constitute the heart of this appeal.

On March 5, 1980, March 6, 1980, and May 27, 1980, Bucktail requested HBNF status under the exception criteria in 55 Pa. Code §9424.6 (b), Skilled Nursing Facility Participation Requirements.1 The [358]*358request was made for the fiscal year July 31, 1979, to June 30, 1980. By letter dated August 15, 1980, the Director of the Bureau of Reimbursement Methods of DPW denied the request because Buck-tail did not satisfy the exception criteria to qualify as an HBNF. On August 28, 1980, Bucktail appealed this decision which was docketed as No. 23-81-25 (HBNF denial appeal).

On October 9, 1980, Bucktail requested a reconsideration of its status. On October 26, 1980, the Director denied this request. On November 26, 1980, Bucktail appealed this decision, docketed No. 23-81-75 (HBNF reconsideration denial).

On February 26, 1981, Bucktail received its Tentative Interim Rate Settlement from DPW which advised Bucktail of an overpayment by PMAP. The Comptroller of DPW informed Bucktail that it had [359]*359thirty days to appeal the interim rate settlement pursuant to 71 P.S. §1710.41.2 On March 24, 1981, Buck-tail appealed the interim rate, docketed No. 23-81-85 (interim rate appeal).

On July 13, 1981, Bucktail received a Final Settlement which indicated that Bucktail had received an overpayment. Bucktail was informed again by the comptroller that it had thirty days to appeal the settlement under 71 P.S. §1710.41. On July 31, 1981, Bucktail appealed this decision, which was docketed No. 23-81-189 (final rate appeal).

The HBNF denial appeal, HBNF reconsideration denial and the interim rate appeal were consolidated by the Director of the Office of Hearings and Appeals (Director). On August 31, 1981, the Director also consolidated the final rate appeal subject to any objection by the parties.3 DPW moved for dismissal of the appeal on the grounds that the appeal was untimely since 1 Pa. Code §35.20 requires an appeal within ten days of notice. On December 16, 1981, the Director denied the motion to dismiss because 55 Pa. Code §1181.101 superseded 1 Pa. Code §35.20, and permitted Bucktail thirty days to appeal.

DPW appealed the order, but a final order issued by the Secretary affirmed the Director’s decision refusing to dismiss the appeal. This decision permitted Bucktail to proceed before the Office of Hearings and Appeals regarding the reimbursement classification as an HBNF. However, on January 13, 1982, pursuant to a request for reconsideration filed by DPW, the Secretary reversed the Director without an [360]*360opinion. On Jannary 20, 1982, the Director informed the parties that the final rate appeal, which had been omitted from the Secretary’s order to reverse would be included in the Secretary’s order. Bucktail petitioned for review of this decision on February 10, 1982.

On October 14, 1982, prior to oral argument of the appeals, the parties entered a joint stipulation before this Court. We remanded the final rate appeal, in part, for further proceedings before the Director regarding certain audit finding issues for the fiscal year ending June 30, 1980.4 The joint stipulation did not address, however, the final reimbursement rate received by Bucktail. Bather, the timeliness of the final rate appeal, along with the same issue raised in the HBNF denial appeal, HBNF reconsideration denial and interim rate appeal, remained subject to this appeal.

The seminal issue here is what is the time period to appeal the denial of HBNF status, and the interim and final reimbursement rates. Chaotic facts and appeal provisions cloud the disposition of the issues. It is necessary, therefore, to properly characterise each appeal by Bucktail in order to apply the appropriate appeal provisions. We first consider the HBNF denial appeal and HBNF reconsideration denial. These appeals involved the denial of Bucktail’s request to be classified as an HBNF.

Bucktail contends that it had thirty days to appeal the denial of HBNF status by DPW under 55 Pa. Code §1181.101, which provides:

[361]*361(a) All nursing facilities have a right to appeal and have a hearing if dissatisfied with the Department’s decision regarding:
(1) the interim per diem rate established by the Department;
(2) the findings of the auditors in the annual audit report;
(3) the determination by the comptroller of the difference between the allowable costs certified by the auditors in the annual audit report, and the total allowance amount as shown on the interim billing; and
(4) the denial or nonrenewal of a provider agreement.
(c) Each appeal must be taken within 30 days of the date that the facility is notified of any of the decisions listed in subsection (a) of this section. Those findings contained in a facility’s audit report which are not appealed by the facility within the 30-day limit shall not be considered as part of any subsequent appeal proceeding.

Bucktail argues 55 Pa. Code §1181.101 is inconsistent with and, therefore, supersedes the General Rules of Administrative Practice and Procedure under 1 Pa. Code §35.20 which provides:

Appeals from actions of the staff.

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Bluebook (online)
480 A.2d 1260, 83 Pa. Commw. 355, 1984 Pa. Commw. LEXIS 1518, Counsel Stack Legal Research, https://law.counselstack.com/opinion/renovo-hospital-assn-v-commonwealth-department-of-public-welfare-pacommwct-1984.