Sunshine Health Systems, Inc. v. Bowen

842 F.2d 1097, 1988 U.S. App. LEXIS 3528, 1988 WL 23313
CourtCourt of Appeals for the Ninth Circuit
DecidedMarch 22, 1988
DocketNo. 87-6065
StatusPublished
Cited by3 cases

This text of 842 F.2d 1097 (Sunshine Health Systems, Inc. v. Bowen) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sunshine Health Systems, Inc. v. Bowen, 842 F.2d 1097, 1988 U.S. App. LEXIS 3528, 1988 WL 23313 (9th Cir. 1988).

Opinion

FERGUSON, Circuit Judge:

The Secretary of the Department of Health and Human Services (“Secretary”), appeals the district court’s amended final judgment awarding interest to Sunshine Health Systems, Inc. (“Sunshine”), at the rate of 15.875 percent. The Secretary argues that this interest rate is inapplicable to proprietary hospitals such as Sunshine, and that the proper interpretation of the statutory provision requiring payment of interest requires calculation at the rate of 10.583 percent. We agree.

I.

Sunshine originally brought suit against the Secretary, challenging its designation of Sunshine as a “new” hospital for purposes of Medicare reimbursement during the transition period from Medicare’s old cost-based system to its new fixed payment system. The district court agreed with Sunshine, ordered reimbursement under the interim payment system and further ordered that interest be paid at the rate “required by law.” This Court then affirmed the district court’s decisions, ordering interest to be calculated pursuant to 42 U.S.C. § 1395oo(f)(2). Sunshine Health Systems, Inc. v. Bowen, 809 F.2d 1390, 1399 (9th Cir.1987). The district court subsequently amended its original order, awarding the payment of interest at the rate of 15.875 percent.

The Secretary then filed this appeal, contending that the district court’s reading of these provisions was in error, and that the proper rate of interest for proprietary hospitals, such as that operated by Sunshine, is only 10.583 percent.

We have jurisdiction pursuant to 28 U.S. C. § 1291.

II.

Critical to our decision is the legislative history of the statutory and regulatory enactments addressing interest payments and return on equity capital. We address this legislative history first, and then consider its application to the issues raised on appeal.

A.

42 U.S.C. § 1395oo(f)(2), enacted in 1974, authorizes the payment of interest where a party has sought judicial review of an administrative decision of Medicare’s Provider Reimbursement Review Board (“PRRB”). It provides that interest shall be paid at a rate “equal to the rate of return on equity capital established by regulation pursuant to section 1395x(v)(l)(B) of this title and in effect at the time the civil action authorized under paragraph (1) is commenced,” and that the interest is to be awarded by the reviewing court “in favor of the prevailing party.” 1

Section 1395x(v)(l)(B), originally enacted in 1966, provides for reimbursement of the reasonable cost of extended care services provided by proprietary facilities under Medicare. This figure was meant to include return of equity capital at a rate not to exceed one and one-half times the average rates of interest for certain specified debt obligations.2

[1099]*1099The phrase “extended care services” is defined in 42 U.S.C. § 1395x(h) as referring to various items and services furnished by a skilled nursing facility to an inpatient of that facility, and does not include inpatient hospital services provided by proprietary hospitals, such as Sunshine. Thus, this definition left Sunshine ineligible for a return on its equity capital under section 1895x(v)(l)(B).

However, the legislative intent at the time section 1395x(v)(l)(B) was enacted was that “similar or comparable principles in determining reasonable costs for reimbursement of proprietary hospitals” be applied by the Secretary. See Conf.Rep. No. 2317, 89th Cong., 2d Sess. 166, reprinted in 1966 U.S.Code Cong. & Admin.News 3676, 3692-93. Thus, in conformance with congressional intent, the Department of Health and Human Services (“HHS”) issued 42 C.F.R. § 405.429(a)3, which provided for a return on equity capital to all proprietary providers, both skilled nursing facilities providing extended care services, and proprietary hospitals furnishing inpatient hospital services. The rate of return for all providers was set at a percentage equal to one and one-half times the average of the rates of interest on certain public debt obligations.

This case comes before us due to legislation enacted in 1983, 42 U.S.C. § 1395ww, which established the Prospective Payment System (“PPS”) for inpatient hospital services provided by proprietary hospitals. Rather than reimbursing providers on a cost basis for health care services, PPS allows providers to be paid prospectively on the basis of predetermined rates for services. Subsection (g)(2) of the PPS statute provides for reimbursement to proprietary hospitals of equity capital, and requires that the Secretary promulgate regulations allowing such return of equity capital at a rate equal to the average of the rates of interest on certain debt obligations.4

Following enactment of section 1395ww(g)(2), in 1983 HHS amended its prior regulation, 42 C.F.R. § 405.429(a), originally enacted under section 1395x(v)(l)(B). The amendment created a distinction between proprietary hospitals and other proprietary providers offering inpatient hospital services in the rate of return on equity capital to which each was entitled. As amended, regulation 405.-429(a)(l)(iii) set the rate of return for proprietary hospitals at a rate equal to the average of specified interest rates. In contrast, regulation 405.429(a)(l)(ii) kept the rate of return for all other proprietary providers (such as skilled nursing facilities offering extended care), at one and one-half times the average rates.5

In its amended order dated April 20, 1987, the district court awarded interest to Sunshine at the rate of 15.875 percent, using the one and one-half factor. The court’s award was based on its interpretation of 42 U.S.C. §§ 1395oo(f)(2) and 1395x(v)(l)(B), 42 C.F.R. § 405.429, and a “Table of Interest Rates for Proprietary Provider’s Return on Capital for Other Than Inpatient Hospitals] July 1985 through June 1986.”6

[1100]*1100B.

The Secretary argues that Congress intended that the rate of interest payable following judicial review of PRRB decisions match the rate of return of equity capital.

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Related

Fralin v. Kozlowski
447 S.E.2d 238 (Court of Appeals of Virginia, 1994)
Sunshine Health Systems, Inc. v. Bowen
842 F.2d 1097 (Ninth Circuit, 1988)

Cite This Page — Counsel Stack

Bluebook (online)
842 F.2d 1097, 1988 U.S. App. LEXIS 3528, 1988 WL 23313, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sunshine-health-systems-inc-v-bowen-ca9-1988.