Rural Health Collaborative of S. Ohio, Inc. v. Testa (Slip Opinion)

2016 Ohio 508, 50 N.E.3d 486, 145 Ohio St. 3d 430
CourtOhio Supreme Court
DecidedFebruary 16, 2016
Docket2014-0963
StatusPublished
Cited by14 cases

This text of 2016 Ohio 508 (Rural Health Collaborative of S. Ohio, Inc. v. Testa (Slip Opinion)) is published on Counsel Stack Legal Research, covering Ohio Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rural Health Collaborative of S. Ohio, Inc. v. Testa (Slip Opinion), 2016 Ohio 508, 50 N.E.3d 486, 145 Ohio St. 3d 430 (Ohio 2016).

Opinions

Per Curiam.

{¶ 1} This is an appeal by the tax commissioner from a decision of the Board of Tax Appeals (“BTA”), which granted a charitable-use exemption to a facility in Adams County that provides dialysis services. The property is owned by appellee, Rural Health Collaborative of Southern Ohio, Inc. (“Rural Health”), and operated under lease by Dialysis Clinic, Inc. Rural Health applied for the exemption, which the tax commissioner denied, relying primarily on this court’s holding in Dialysis Clinic, Inc. v. Levin, 127 Ohio St.3d 215, 2010-Ohio-5071, 938 N.E.2d 329. The BTA reversed, concluding that the property qualified under R.C. 5709.121(A)(2) because Rural Health itself qualified as a charitable institution.

{¶ 2} On appeal, the tax commissioner argues both that Rural Health does not qualify as a charitable institution and that the Dialysis Clinic decision precludes exemption under the standards set forth in R.C. 5709.121. We conclude that the BTA’s finding that Rural Health is a charitable institution is both reasonable and lawful, and we therefore affirm the finding. But we hold that the BTA’s grant of exemption under R.C. 5709.121 was premature, because the BTA did not fully analyze the claim under R.C. 5709.121(A)(1). We therefore vacate the BTA’s grant of exemption, and we remand for further proceedings consistent with this opinion.

Factual Background

The property at issue

{¶ 3} The property at issue is two acres, improved with a one-story brick building, located in the Ohio Valley Local School District in Seaman in Adams County. The land was donated, and the building was constructed with funds that Rural Health received through a federal grant.

The owner: Rural Health Collaborative of Southern Ohio, Inc.

{¶ 4} At the time it was formed in 2001, Rural Health had four directors. The members were three nonprofit county hospitals for Adams, Brown, and Highland counties — Brown later withdrew when it became a for-profit hospital — plus a nonprofit organization that provides physicians to underserved areas throughout Ohio. Rural Health’s purposes focus on promoting health-care initiatives in [432]*432southern Ohio. Rural Health has no staff; its directors and the staff of the members carry out Rural Health’s activities.

{¶ 5} Rural Health’s directors discuss medical needs in the region from the perspective of the member institutions and apply for grants to supply services without charge. Grant-funded programs that Rural Health has conducted include a tobacco-cessation program, a women-and-children-uninsured program focusing on pregnancy care, a diabetic-education program, and a managed-care grant used to assess the impact of managed care on providers. Blood drives are another activity organized by Rural Health. As of the time of the BTA hearing, none of the grant-supported programs was still being implemented.

{¶ 6} One need identified early by the board of directors was for more convenient dialysis services than the member institutions were able to provide. In particular, reducing travel times was important because patients feel increasingly ill on their way to dialysis treatments, which they must undergo every two to three days. Also, the treatments, which last three to four hours, leave patients feeling exhausted.

{¶ 7} To address this need, Rural Health resolved to establish a dialysis clinic; it received the donation of land, obtained a grant to construct the building, and identified Dialysis Clinic, Inc. (“DCI”), as the provider of dialysis services to operate the clinic.

The lease agreement

{¶ 8} Rural Health and DCI entered into a contract entitled “commercial lease agreement” on August 30, 2005. The agreement assigned maintenance and repair duties to Rural Health as landlord, required that utility payments be made by DCI as tenant, and created a mutual liability-insurance obligation. The original lease term ran for five years beginning July 1, 2005; an addendum provided for a new five-year term running from 2010 to 2015. The rent was initially set for three years at $53,556 annually, payable in monthly installments. In the fourth year, the annual rent increased to $71,412, with subsequent increases at three-year intervals based on the Consumer Price Index. In 2012, however, the parties adjusted the lease to postpone rent escalations after DCI incurred operating losses at the site.

The evidence regarding the charitable nature of DCI and the property use

{¶ 9} According to DCI’s indigency policy, the dialysis treatments it provides are “not a charity or gift to patients. DCI retains all rights to refuse to admit and treat a patient who has no ability to pay.” But the testimony presented at the BTA hearing establishes a larger context for understanding this provision.

[433]*433{¶ 10} DCI’s general counsel testified that for Medicare patients, federal regulations generally required DCI to demand and seek to collect the 20 percent portion that is the patient’s responsibility. He added that federal statutes specifically prohibit DCI from waiving the co-insurance.

{¶ 11} In light of the strict Medicare regulations, DCI’s indigency policy was designed to avoid putting the patient through the collection process. The administrator of the Seaman clinic testified that Medicare would “allow us to write those [unpaid amounts] off’ under one of two circumstances: if the clinic “[went] through a reasonable collection process,” or if, alternatively, the clinic made “a fair determination” that the patient was unable to pay.

{¶ 12} When asked about the anticharity language of the indigency policy, DCI’s general counsel explained that the point of the language was to convey that DCI could not provide Medicare patients with charity “in th[e] traditional sense” — i.e., it could not simply accept Medicare payment and waive copays. Reserving the right to refuse treatment is “part of [DCI’s] financial stewardship,” in that DCI must “make it clear that we may have to have some analysis for each patient.” The policy thereby serves in part as a means by which the facility is able to procure the patient’s cooperation in certifying his or her need.

{¶ 13} DCI’s general counsel also testified that the indigency policy reached beyond the Medicare patients because “there’s so many concepts in Medicare that talk about nondiscrimination between payor sources * * * [that] we decided that it was only fair” to apply the policy “to any patient that has a patient responsibility balance and that might need assistance.” DCI encourages uninsured patients to apply for Medicaid; they typically qualify, at least for certain periods of time. When asked whether “DCI limit[s] services to patients for which [it is] fully compensated for those services,” the general counsel answered: “No.”

{¶ 14} Similarly, when asked whether he was aware of any instance when a patient had been refused service for the inability to pay for treatment, DCI’s clinic administrator, answered: “No.” He later reiterated: “At neither clinic, neither at Seaman nor Portsmouth, we’ve never turned a patient away due to inability to pay.” The administrator elaborated that that was part of DCI’s mission and corporate culture: “I’ve worked in health care for over 25 years and I’ve worked with hospitals and other health care organizations, * * * and I’ve never seen a company that walks the talk as far as providing services for all patients as DCI has.”

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Literary Club v. McClain
2020 Ohio 3956 (Ohio Court of Appeals, 2020)
Chagrin Realty, Inc. v. Testa (Slip Opinion)
2018 Ohio 4751 (Ohio Supreme Court, 2018)
Chagrin Realty, Inc. v. Testa
114 N.E.3d 204 (Ohio Supreme Court, 2018)
State ex rel. Farrell v. Indus. Comm.
2018 Ohio 2164 (Ohio Court of Appeals, 2018)
Summer Rays, Inc. v. Testa
2017 Ohio 7901 (Ohio Court of Appeals, 2017)
2350 Morse, L.L.C. v. Testa (Slip Opinion)
2017 Ohio 7800 (Ohio Supreme Court, 2017)
Dialysis Ctrs. of Dayton, L.L.C. v. Testa (Slip Opinion)
2017 Ohio 4269 (Ohio Supreme Court, 2017)
Innkeeper Ministries, Inc. v. Testa (Slip Opinion)
2016 Ohio 5104 (Ohio Supreme Court, 2016)
250 Shoup Mill, L.L.C. v. Testa (Slip Opinion)
2016 Ohio 5012 (Ohio Supreme Court, 2016)

Cite This Page — Counsel Stack

Bluebook (online)
2016 Ohio 508, 50 N.E.3d 486, 145 Ohio St. 3d 430, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rural-health-collaborative-of-s-ohio-inc-v-testa-slip-opinion-ohio-2016.