Texas Department of Health v. Texas Health Enterprises, Inc.

871 S.W.2d 498, 1993 Tex. App. LEXIS 3523, 1993 WL 511834
CourtCourt of Appeals of Texas
DecidedDecember 10, 1993
Docket05-92-01322-CV
StatusPublished
Cited by24 cases

This text of 871 S.W.2d 498 (Texas Department of Health v. Texas Health Enterprises, Inc.) 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
Texas Department of Health v. Texas Health Enterprises, Inc., 871 S.W.2d 498, 1993 Tex. App. LEXIS 3523, 1993 WL 511834 (Tex. Ct. App. 1993).

Opinion

OPINION

ROSENBERG, Justice.

The Texas Department of Health (TDH) and the Texas Department of Human Services (Human Services) appeal the trial court’s summary judgment granted to Texas Health Enterprises, Inc. (the nursing home). Appellants, 1 in three points of error, contend that summary judgment is improper because the trial court lacked jurisdiction, rendered an advisory opinion, and did not require the nursing home to exhaust its administrative remedies. We conclude that the trial court properly exercised jurisdiction over this cause. In point of error four, appellants complain that the trial court erred in declaring that Human Services is prohibited from withholding Medicaid vendor payments pending the exhaustion of the nursing home’s administrative appeal. We conclude that Human Services did not have the statutory or contractual authority to withhold contract payments pending an administrative challenge. We overrule appellants’ points of error. We affirm the trial court’s judgment.

The nursing home entered into a Medicaid vendor contract with Human Services, the administrator of the State’s medical assistance program. TDH, the contract compliance review agency, revoked the nursing home’s Medicaid certification after several on-site inspections. TDH decertified the nursing home subject to an informal preter-mination review and a full post-termination due process review. TDH notified Human Services that the nursing home was no longer a qualified Medicaid health-care provider. During the appeals process, Human Services canceled its Medicaid vendor contract with the nursing home. The nursing home sought to enjoin Human Services from suspending Medicaid vendor payments during the pen-dency of its administrative appeal.

In seeking injunctive relief, the nursing home challenged neither the rulemaking nor the enforcement authority of appellants. The nursing home urged that Human Services violated its own regulations prohibiting the withholding of Medicaid vendor payments during the pendency of an administrative appeal. The nursing home sought declaratory relief to prevent the wrongful acts of appellants. The nursing home moved for summary judgment. Appellants did not file a response to the summary judgment motion. The trial court granted summary judgment to the nursing home. Appellants filed a motion for new trial. The trial court denied the motion for new trial. TDH and Human Services now appeal.

The standards of review of the trial court’s grant of a summary judgment are well known. Summary judgment is proper only if the record shows that there is no genuine issue of material fact and that the movant is entitled to judgment as a matter of law. Tex.R.Civ.P. 166a(e); Rodriguez v. Naylor Indus., Inc., 763 S.W.2d 411, 413 (Tex.1989). The rule provides a method for summarily ending a .case that involves only a question of law and no genuine material fact issue. See Gaines v. Hamman, 163 Tex. 618, 358 S.W.2d 557, 563 (1962).

In reviewing a summary judgment record, we apply the following standards: (1) the movant for summary judgment has the burden of showing there is no genuine issue of material fact and that it is entitled to judgment as a matter of law; (2) in deciding whether there is a disputed material fact issue precluding summary judgment, we must take evidence favorable to the nonmov-ant as true; and (3) we indulge every reasonable inference in favor of the nonmovant and resolve any doubts in its favor. Nixon v. Mr. Property Management Co., 690 S.W.2d 546, 548-49 (Tex.1985).

*501 Here, the facts are not in dispute. Accordingly, this is a proper case for a summary judgment. See Gaines, 358 S.W.2d at 563. This case involves a pure question of law: Whether Human Services may withhold Medicaid vendor payments from the nursing home pending the exhaustion of the administrative appeals process challenging either the nursing home’s decertification or the cancellation of its Medicaid contract.

Human Services administers the federally funded Medicaid program, and TDH certifies health-care facilities as qualified Medicaid providers. See Tex.Hum.Res.Code Ann. §§ 32.001-.040 (Vernon 1990 & Supp.1993) (the State’s medical assistance statute). Human Services has the authority to prescribe rules governing the Medicaid program to insure that the needy citizens of this State receive all benefits authorized under the federal program. 2 See Tex.Hum.Res.Code Ann. §§ 22.002, 32.001-.040 (Vernon 1990 & Supp. 1993). Appellants jointly promulgated quality standards to apply to nursing homes in Texas for licensure and Medicaid certification. 3

To insure compliance with certification requirements, TDH conducts periodic visits and yearly inspections of the health-care institutions participating in Medicaid. When a facility does not meet the standards for certification, TDH notifies Human Services of the cited deficiencies. See 40 TexAdmin.Code § 19.2012 (West Supp.1993). Human Services assesses certain penalties, during which time the nursing home has the opportunity to cure the deficiencies. Human Services, based on the severity and scope of the deficiencies, imposes liquidated damages per certified Medicaid bed for every day the facility is out of compliance. See 40 TexAdmin.Code § 19.2012 (West Supp.1993). Once a facility is cited for deficiencies, TDH continues to conduct unannounced inspections to insure compliance. If a third inspection reveals the same deficiencies within eighteen months of the first notification, Human Services will terminate the provider agreement. See 40 Tex.Admin.Code § 19.2012(b)(2)(C) (West Supp.1993).

If a facility’s violations are severe, TDH may immediately revoke the provider’s certification. When TDH decertifies a facility, Human Services, subject to the appellate rights of the provider, cancels the facility provider agreement. See 40 TexAd-min.Code § 19.2012(b)(1)(F) (West Supp. 1993). When the contract is terminated, either through decertification or because of continuing deficiencies, Human Services may suspend vendor payments pending the outcome of the administrative appeal.

The Texas Legislature expressly granted Human Services the statutory authority to cancel a provider’s Medicaid contract after reasonable notice and an opportunity for a hearing. Tex.Hum.Res.Code Ann. § 32.-034(a) (Vernon Supp.1993). Although Human Services may not terminate a contract prior to this hearing, it may withhold payments if the contract grants it the authority to do so. Tex.Hum.Res.Code Ann. § 32.-034(b) (Vernon 1990). 4

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871 S.W.2d 498, 1993 Tex. App. LEXIS 3523, 1993 WL 511834, Counsel Stack Legal Research, https://law.counselstack.com/opinion/texas-department-of-health-v-texas-health-enterprises-inc-texapp-1993.