Stormont-Vail Regional Health Center v. Shalala

947 F. Supp. 1526, 52 M.S.P.R. 463, 1996 U.S. Dist. LEXIS 17902, 1996 WL 699383
CourtDistrict Court, D. Kansas
DecidedOctober 16, 1996
DocketNo. 95-4168-SAC
StatusPublished

This text of 947 F. Supp. 1526 (Stormont-Vail Regional Health Center v. Shalala) is published on Counsel Stack Legal Research, covering District Court, D. Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Stormont-Vail Regional Health Center v. Shalala, 947 F. Supp. 1526, 52 M.S.P.R. 463, 1996 U.S. Dist. LEXIS 17902, 1996 WL 699383 (D. Kan. 1996).

Opinion

MEMORANDUM AND ORDER

CROW, District Judge.

The plaintiff brings this action under the Administrative Procedures Act, 5 U.S.C. § 701, et seq., seeking judicial review of final decisions by the Department Health and Human Services Provider Reimbursement Review Board (“PRRB”) and the Administrator of Health Care Financing Administration (“Administrator”). The decisions being appealed adjust Medicare reimbursements for interest expense. The plaintiff Stormont-Vail Regional Health Center (“Stormont Vail”) contends the defendant erred in reducing reimbursements for Stormont-Vail’s claimed interest expense by the investment income earned in 1986 and 1987 from what Stormont-Vail alleges was its funded depre[1528]*1528ciation accounts. The Secretary moves for summary judgment arguing the adjustments were required by law. (Dk. 7).1 The plaintiff responds in opposition asking the court to deny the defendant’s motion and to overturn her decision. (Dks. 10 and 11). The court considers the case to have been fully briefed as contemplated by D.Kan. Rule 83.7.

STATUTORY AND REGULATORY BACKGROUND

Overview of Program

The Medicare Act, 42 U.S.C. § 1395, et seq., funds medical care of the aged and the disabled. Stormont-Vail, as a qualified “provider of services” under the Medicare Act, is entitled to reimbursement for the “reasonable cost” of hospital services furnished to Medicare beneficiaries. The term, “reasonable cost,” is defined as “the cost actually incurred, excluding therefrom any part of incurred cost found to be unnecessary in the efficient delivery of needed health services, and shall be determined in accordance with regulations establishing the method or methods to be used, and the items to be included....” 42 U.S.C. § 1395x(v).

Providers ordinarily receive their Medicare reimbursements through private organizations, typically insurance companies, who contract with the Secretary and are known as fiscal intermediaries. 42 U.S.C. § 1395h. Under this system, the intermediary makes interim payments approximating the provider’s actual costs. 42 C.F.R. § 413.64. At the end of a cost reporting year, the provider files an annual cost report. 42 C.F.R. § 413.20. The intermediary then audits the annual cost report, determines the total amount of reimbursements due, and adjusts retroactively the payments based on the difference between the interim payments and the reimbursements due. 42 C.F.R. §§ 405.1803 and 413.64.

The intermediary issues a notice to the provider that sets forth the amotmt of the reimbursement, explains the intermediary’s determination, and informs the provider of its right to a hearing and appeal. If the provider is dissatisfied with the intermediary’s determination, the provider has 180 days to request a hearing before the Provider Reimbursement Review Board (“Board”). Sixty days after the Board’s decision, the Secretary acting through the Administrator of the Health Care Financing Administration (“HCFA”) may affirm, reverse, or modify the decision. 42 U.S.C. § 1395oo(f)(l); 42 C.F.R. § 405.1875. Providers may seek judicial review of the decision of the Board or the Administrator pursuant to the applicable provisions of the APA 42 U.S.C. § 1395oo(f)(l).

Applicable Medicare Payment Law

Pursuant to her authority under 42 U.S.C. § 1395x(v)(l)(A), the Secretary has adopted regulations providing that “[njecessary and proper interest on ... capital indebtedness is an allowable cost,” 42 C.F.R. § 413.153(a)(1). Thus, such interest expense is reimbursable to the extent it was “necessary and proper.” To be “necessary,” the interest expense must meet the three-part test set out in 42 C.F.R. § 413.153(b)(2) (1986):

(i) Incurred on a loan made to satisfy a financial need of the provider. Loans that result in excess funds or investments would not be considered necessary;
(ii) Incurred on a loan made for a purpose reasonably related to patient care; and
(iii) Reduced by investment income except if such income is from gifts and grants, whether restricted or unrestricted, and that are held separate and not commingled with other funds. Income from funded [1529]*1529depreciation or a provider’s qualified pension fund is not used to reduce interest expense.

The last of these three elements is the only one at issue here.

The Secretary encourages providers to conserve funds for the replacement of depre-ciable assets. 42 C.F.R. § 413.134(e). “As an incentive for funding, investment income on funded depreciation will not be treated as a reduction of allowable interest expense.” Id. Besides this regulation, the Secretary has issued program instructions on these accounts and collected them in the Provider Reimbursement Manual (“PRM”). The PRM at § 226.4 defines depreciation funding as “the practice of placing funds, including nonborrowed reserves and sinking funds, in a segregated account(s) for the acquisition of depreciable assets used in rendering patiént care or for other capital purposes related to patient care.” Such funds “must be placed in readily marketable investments of the type that assures the availability and conservation of the funds.” PRM § 226. The following are other requirements for funded depreciation accounts (“FDA”) taken from PRM § 226:

A. Approval. — The action to fund depreciation must be approved by the appropriate managing body of the provider, ..., in accordance with the needs and objectives of management.
B. Provider’s Records. — The fund or funds must’ be clearly designated in the provider’s records as funded depreciation accounts.
C. Restrictions. — Funded depreciation must be available ... on an as needed basis for the acquisition of the provider’s depreciable assets used to render patient care, or for other capital purposes related to patient care.
D. Investment or Transfer.

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Bluebook (online)
947 F. Supp. 1526, 52 M.S.P.R. 463, 1996 U.S. Dist. LEXIS 17902, 1996 WL 699383, Counsel Stack Legal Research, https://law.counselstack.com/opinion/stormont-vail-regional-health-center-v-shalala-ksd-1996.