Senior Care Resources, Inc. v. OAC Senior Living, LLC Andrew Berry & Orson Berry

442 S.W.3d 504, 2014 WL 1007783, 2014 Tex. App. LEXIS 2536
CourtCourt of Appeals of Texas
DecidedMarch 5, 2014
Docket05-12-00495-CV
StatusPublished
Cited by7 cases

This text of 442 S.W.3d 504 (Senior Care Resources, Inc. v. OAC Senior Living, LLC Andrew Berry & Orson Berry) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Senior Care Resources, Inc. v. OAC Senior Living, LLC Andrew Berry & Orson Berry, 442 S.W.3d 504, 2014 WL 1007783, 2014 Tex. App. LEXIS 2536 (Tex. Ct. App. 2014).

Opinion

OPINION

Opinion by

Justice MARTIN RICHTER

(Assigned).

Senior Care Resources, Inc. sued appel-lees, OAC Senior Living, LLC, Andrew Berry, and Orson Berry, for libel, business disparagement, and declaratory relief based on statements appellees made in communications to the Texas Department of Aging and Disability Services (DADS) as part of appellees’ acquisition of Medicaid beds in Rockwall County. Senior Care appeals the trial court’s summary judgment granted for appellees, which resulted in a take-nothing judgment on its claims. Because the trial court did not have jurisdiction to hear Senior Care’s request for declaratory relief, we vacate that portion of the trial court’s judgment and dismiss that claim for want of jurisdiction. We otherwise affirm the trial court’s judgment.

BACKGROUND

Introduction

DADS is the state agency designated to administer and monitor human services *507 programs, including Medicaid, for the aging and disabled populations in Texas. See Tex. Hum. Res.Code Ann. § 32.021(a) (West 2013); id. §§ 161.002, 161.071(2) (West 2013); see also Tex. Dep’t of Aging & Disability Servs. v. Sierra Home Care, L.L.C., 235 S.W.3d 835, 837 (Tex.App.-El Paso 2007, no pet.). DADS also licenses and regulates providers of those services, such as nursing facilities, and certifies those nursing facilities that want Medicaid or Medicare reimbursement. See Tex. Hum. Res.Code Ann. § 161.071(6) (DADS’s responsibilities include performing “all licensing and enforcement activities and functions” related to service providers); Tex. Health & Safety Code Ann. §§ 242.031-.074, 242.121-.135 (West 2010 & Supp.2013) (quality standards that apply to nursing facilities); 40 Tex. Admin. Code § 19.1(b) (West 2003); see generally 40 Tex. Admin. Code §§ 19.1-.2326 (West 2003) (nursing facility requirements for li-censure and Medicaid certification). To ensure proper and efficient operation of the Medicaid program, DADS is required to “establish methods of administration and adopt necessary rules.” Tex. Hum. Res.Code Ann. § 32.021(c).

Pursuant to its authority to administer the Medicaid program in Texas, DADS contracts with nursing facilities to provide a certain number of beds for Medicaid patients. 40 Tex. Admin. Code § 19.2322(c). Senior Care operates the Royse City Health and Rehabilitation Center (the Center), which is one of four nursing facilities located in Rockwall County, Texas. The Center has elected to participate in both the Medicaid and Medicare programs. It is licensed to operate 124 beds, seventy-four of which are dually-certified for Medicare and Medicaid; the remaining fifty beds are Medicare only.

DADS is responsible for “controlling the number of Medicaid beds in nursing facilities,” which it does through its “bed allocation” rules and policies. See Tex. Hum. Res.Code Ann. § 32.0213(a)(1); 40 Tex. Admin. Code § 19.2322(a)(3) (“Bed allocation” is the “process by which [DADS] controls the number of nursing facility beds that are eligible to become Medicaid-certified in each nursing facility”). These rules also are designed to “improve the quality of resident care by selective and limited allocation of Medicaid beds”.for which DADS contracts and “to promote competition.” 40 Tex. Admin. Code § 19.2322(b). Since 1985, there has been a moratorium on granting additional Medicaid contracts in an effort to regulate the number of Medicaid beds. See id. § 19.2322(d); Eldercare Props., Inc. v. Tex. Dep’t of Human Servs., 63 S.W.3d 551, 553 (Tex.App.-Austin 2001), abrogated on other grounds, Tex. Dep’t of Protective & Regulatory Servs. v. Mega Child Care, Inc., 145 S.W.3d 170 (Tex.2004). The number of Medicaid beds, however, can be increased through waivers and exemptions granted by DADS. See 40 Tex. Admin. Code § 19.2322(f)-(h).

One type of waiver is the “community needs waiver,” which may be granted if the applicant can show that the current nursing facilities in a community (typically a county, county precinct, city, or ZIP Code) are not sufficient to meet the needs of the community’s Medicaid recipients. Id. § 19.2322(h)(1). An applicant for a community needs waiver is required to submit to DADS a study, prepared by an independent professional with experience in preparing demographic studies, documenting:

(i) an immediate need for additional Medicaid beds in the community;
(ii) Medicaid residents in the community do not have reasonable access to quality nursing facility care; and
(iii) substantial community support for the new nursing facility or beds.

*508 Id. “Waiver applicants who submit false information will not be eligible for a waiver.” Id. § 19.2322(g)(6). 2 An issued waiver based on an applicant’s false information is void. Id.

Events leading to suit

In February 2010, OAC requested a community needs waiver from DADS for the allocation of 120 Medicaid beds for a proposed nursing facility to be built in Rockwall County. Andrew and Orson Berry are the controlling parties of OAC and submitted the waiver-application materials to DADS on OAC’s behalf. The materials included the required demographic study, which was prepared by J. Larry Taylor. In the study, Taylor analyzed the population data for Rockwall County and the existing nursing facilities in the county and concluded (1) there was an immediate need for additional Medicaid beds in the area because the existing facilities were full and (2) Medicaid residents do not have reasonable access to quality nursing facility care because two of the four nursing facilities in the county had “serious issues relating to ‘quality of care,”’ with one of those facilities appearing on a national nursing home watch list. The Center was not one of the two facilities referenced in the study as having “quality of care” issues. OAC also submitted letters in support of its application as required by the regulation. See id. § 19.2322(h)(l)(A)(iii).

Senior Care, through its counsel, sent DADS a letter dated July 27, 2010, opposing OAC’s waiver request and offered “materials for the State’s reflection” as it considered OAC’s waiver application.

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442 S.W.3d 504, 2014 WL 1007783, 2014 Tex. App. LEXIS 2536, Counsel Stack Legal Research, https://law.counselstack.com/opinion/senior-care-resources-inc-v-oac-senior-living-llc-andrew-berry-orson-texapp-2014.