St. Cloud Hospital v. Sullivan

813 F. Supp. 685, 1993 U.S. Dist. LEXIS 1651, 1993 WL 29180
CourtDistrict Court, D. Minnesota
DecidedFebruary 5, 1993
DocketCiv. No. 4-92-999
StatusPublished

This text of 813 F. Supp. 685 (St. Cloud Hospital v. Sullivan) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
St. Cloud Hospital v. Sullivan, 813 F. Supp. 685, 1993 U.S. Dist. LEXIS 1651, 1993 WL 29180 (mnd 1993).

Opinion

ORDER

DOTY, District Judge.

This matter is before the court on cross-motions for summary judgment. Plaintiff St. Cloud Hospital has asked the court to invalidate a new regulation promulgated by the Secretary of Health and Human Services (“the Secretary”) alleging it is arbitrary and capricious, contrary to congressional intent, and inconsistent with the Medicare Act. The Secretary defends the regulation [687]*687as a valid exercise of his broad discretion under the Medicare Act. The issues have been fully briefed and argued and there are no material facts in dispute. Based on a review of the file, record and proceedings herein, the court grants the Secretary’s motion for summary judgment and denies the plaintiff’s motion for summary judgment.

BACKGROUND

The Medicare Act, codified as Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq., establishes a system of health insurance for the aged and disabled. The Secretary is the federal official responsible for administering the program.

St. Cloud Hospital (“St. Cloud”) is an acute care, nonprofit hospital located in St. Cloud, Minnesota. St. Cloud provides a broad range of health care services to elderly and other persons eligible for Medicare benefits and has been duly certified as a “provider of services” under the Medicare Act. See 42 U.S.C. § 1395x(u).

Under the Medicare Act, hospitals are not reimbursed for actual costs, but are funded under a prospective payment system. Id. § 1395CC.1 The amount of reimbursement a hospital receives for a given service depends on its average standardized amount and the area wage index applicable to the hospital. Both the standardized amount and the applicable area wage index are based, in part, on the hospital’s geographic location.

In 1989, Congress amended the statutory provisions relating to geographic classification by adding section 1886(d)(10) to the Medicare Act. Pub.L. No. 101-239, § 6003(h)(1), 103 Stat. 2154-2156 (Dec. 19, 1989) (codified at 42 U.S.C. § 1395ww(d)(10)). The provision permits a hospital to seek reclassification to a different geographic area for purposes of using the other area’s standardized amount, wage index or both.2 Under the 1989 amendment, all requests for geographic reclassification are decided by the Medicare Geographic Classification Review Board (“the Board”). 42 U.S.C. § 1395ww(d)(10)(C). The Medicare Act does not specify the exact criteria a hospital must satisfy to be reclassified. Rather, it directs the Secretary to promulgate guidelines to be used by the Board in making reclassification decisions. Section 1395ww(d)(10)(D) provides in pertinent part:

(i) The Secretary shall publish guidelines to be utilized by the Board in rendering decisions on applications submitted under this paragraph, and shall include in such guidelines the following:
(I) Guidelines for comparing wages, taking into account occupational mix, in the area in which the hospital is classified and the area to which the hospital is applying to be classified.

42 U.S.C. § 1395ww(d)(10)(D).3 Besides the factors identified in the statute, Congress vested discretion in the Secretary to establish reclassification criteria.

The Secretary published an interim rule containing guidelines for reclassification on September 6, 1990, and a final rule on June 4, 1991. 55 Fed.Reg. 36754 (Sept. 6, 1990); 56 Fed.Reg. 25458 (June 4, 1991), codified at 42 C.F.R. §§ 412.230-236. A hospital qualified for reclassification to an adjacent geographic area if it satisfied certain proximity requirements and its average hourly [688]*688wage was comparable to the average in the adjacent area. 42 C.F.R. § 412.230(a)-(c). A hospital’s average hourly wage was deemed comparable to wages paid in an adjacent area if it was at least 85 percent of the average for the adjacent area. Id. at (e)(1).4 Thus, a hospital meeting the proximity requirement simply had to demonstrate its wages were at least 85 percent of the average hourly wage in the adjacent area to qualify for reclassification.

In the preamble to the interim rule, the Secretary noted it lacked the necessary data to estimate the impact on hospitals and that it was possible the reclassification provisions could create effects that were unintended or costly. 55 Fed.Reg. 36754, 36765 (Sept. 6, 1990). In the preamble to the final rule, the Secretary said he planned to evaluate the propriety of reclassifications under the original guidelines to see if they were either too liberal or stringent. 56 Fed.Reg. 25458, 25470 (June 4, 1991). On August 30, 1991, the Secretary again stated he intended to evaluate the reclassifications made under the original guidelines and, if necessary, propose revisions. 56 Fed.Reg. 43196, 43202 (Aug. 30, 1991).

Using the original guidelines, the Board reclassified 930 hospitals in fiscal year 1992, including more than 843 hospitals reclassified for their wage index. 57 Fed. Reg. 23618, 23632 (June 4, 1992). On average, payments received by each reclassified hospital increased 5,9 percent in fiscal year 1992. Id. The Medicare Act requires any increase in payments via reclassification be “budget neutral.” 42 U.S.C. § 1395ww(d)(8)(D).5 Accordingly, increased payments to reclassified hospitals must be offset by reducing payments to other hospitals. During 1992, higher payments to reclassified hospitals were funded by decreasing payments to urban hospitals nationwide by 1.1 percent. 57 Fed.Reg. at 23632.

To assess whether the wage index reclassifications were operating as intended, the Secretary examined 815 hospitals reclassified for their wage index in fiscal year 1992. 57 Fed.Reg. at 23634-635. The Secretary compared the average hourly wages of the reclassified hospitals and the average hourly wages in their original labor markets. The Secretary found that 36 percent of the reclassified hospitals had wages that were less than the average in the area in which they were located. Id. at 23634. Even though the wage index where, the hospitals were located exceeded the wages they actually paid, the hospitals qualified for reclassification to areas with even higher wages under the original guidelines. The Secretary found another 35 percent of the reclassified hospitals paid wages that were less than 108 percent of the average hourly wage in the area in which they were located. Id. at 23634-635.6

The Secretary concluded the original guidelines reclassified too many hospitals that were not disadvantaged by the wage index in their old area. Id. at 23635. The Secretary stated:

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813 F. Supp. 685, 1993 U.S. Dist. LEXIS 1651, 1993 WL 29180, Counsel Stack Legal Research, https://law.counselstack.com/opinion/st-cloud-hospital-v-sullivan-mnd-1993.