Thomas & Lewin Associates, Inc. v. Texas Health and Human Services Commission

Court of Appeals of Texas·Decided June 6, 2019·No. 03-17-00463-CV·Published

Opinion

TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN

NO. 03-17-00463-CV

Thomas & Lewin Associates, Inc., Appellant v.

Texas Health and Human Services Commission, Appellee

FROM THE DISTRICT COURT OF TRAVIS COUNTY, 98TH JUDICIAL DISTRICT NO. D-1-GN-13-003744, HONORABLE RHONDA HURLEY, JUDGE PRESIDING

MEMORANDUM OPINION

Appellant Thomas & Lewin Associates, Inc. filed a petition for judicial review of a final order of the Appeals Division of the Texas Health and Human Services Commission (HHSC). The order sustained certain cost adjustments that the HHSC made in an informal review of Appellant’s mandatory cost reports filed in compliance with HHSC regulations. See 1 Tex. Admin. Code § 355.722(j)(2) (2019) (Texas Health & Human Servs. Comm’n, Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers). In a final order, the trial court granted the HHSC’s plea to the jurisdiction and, to the extent necessary, granted the HHSC’s motion for summary judgment. For the following reasons, we affirm the trial court’s order granting the HHSC’s plea to the jurisdiction.

BACKGROUND

Appellant provides long-term care for persons with mental retardation or related conditions under a contract with the State of Texas in the HCS program funded by Medicaid. As an HCS provider, Appellant is required to file annual cost reports with the HHSC. See id. In 2010, the HHSC issued Appellant a letter stating that it intended to recoup $80,528 from Appellant based on adjustments the HHSC made to the undisputed actual costs incurred and reported on Appellant’s 2006 cost report. See id. (j)(5) (outlining cost adjustment and recoupment procedures). Appellant requested informal review of the HHSC’s recoupment decision, specifically requesting review of particular “lines” of its 2006 cost report. See id. §§ 355.110(c) (2019) (Texas Health & Human Servs. Comm’n, Informal Reviews and Formal Appeals), 355.722(b) (“A provider who disagrees with HHSC’s exclusion or adjustment of items in cost reports may request an informal review and, when appropriate, an administrative hearing as specified in § 355.110 of this title (relating to Informal Reviews and Formal Appeals).”). After the informal review, the HHSC reduced its recoupment demand to $63,611. See id. § 355.722(j)(5) (requiring HHSC to notify providers of any adjustments to recoupment amount after informal review of initial recoupment determination).

The HHSC attached an appendix to its Informal Review Decision outlining the various lines affected by its adjustment to the recoupment amount. Appellant requested a formal hearing before an administrative law judge (ALJ) with the HHSC’s Appeals Division, taking issue with several lines of the cost report that the HHSC had adjusted in its informal review. See id. § 355.110(d) (providing that “interested party who disagrees with the results of an informal review . . . may file a formal appeal”).

The ALJ conducted the formal hearing on September 14, 2012, but announced no rendition of judgment on the merits in open court. On May 24, 2013, the ALJ signed a “Final Order.” The Final Order made the following relevant Findings of Facts and Conclusions of Law:

Finding of Fact 7. On November 17, 2010, HHSC notified Appellant that it had completed the Informal Review and reduced the amount that it would recoup to $63,611.00.

Finding of Fact 11. At the hearing Appellant and HHSC stipulated that only line 181 remained at issue.

Finding of Fact 12. Line 181 represented Staff Expenses - Case Managers Salaries and Wages. A portion of the salaries and wages reported on line 181 were for related party wages.

Finding of Fact 17. The allowable non-related party hourly wage rate for employees who work as Case Managers was $16.99 per hour in 2006.

Finding of Fact 18. Appellant showed that non-related parties provided 40% or more of the hours worked as Case Managers, thereby allowing Appellant to calculate the related party’s reportable hours at the rate of $16.99.

Finding of Fact 19. HHSC adjusted line 181 of Appellant’s 2006 Cost Report to reflect the allowable rate of pay for related party employees.

Finding of Fact 20. HHSC properly adjusted line 181 of Appellant’s Cost Report to reflect the allowable rate of pay for related party employees.

Conclusion of Law 2. The proper rate of pay for Appellant’s related party’s reportable hours in 2006, was $16.99.

Conclusion of Law 3. HHSC correctly adjusted Appellant’s 2006 Cost Report to reflect the proper calculation of the rate of pay for related parties.

The Final Order then concluded:

IT IS ORDERED that the Informal Review of adjustments to Appellant’s 2006 Cost Report IS SUSTAINED and that HHSC IS AUTHORIZED to recoup $5,400.00 from Appellant for adjustments to its 2006 Cost Report.

Neither the HHSC nor Appellant filed a motion for rehearing with the Appeals Division taking issue with the Final Order or any of its findings of fact or conclusions of law. See id. § 357.498(c) (Texas Health & Human Servs. Comm’n, Final Orders and Rehearing) (2019) (“A party must file any motion for rehearing . . . on or before the 20th day after the final order is presumed received.”); see also BFI Waste Sys. of N. Am. v. Martinez Envt’l Grp., 93 S.W.3d 570, 578 (Tex. App.—Austin 2002, pet. denied) (holding that to preserve error, complaining party’s motion for rehearing must set forth particular finding of fact, conclusion of law, ruling, or other agency action that party asserts was error and legal basis upon which claim of error rests).

On August 22, 2013, the HHSC filed with the Appeals Division a “Motion for Order Nunc Pro Tunc” seeking to amend the Final Order to change its incorrect recitation of the date of the hearing and amount of recoupment ordered. In its motion, the HHSC argued that the ALJ made a clerical error in memorializing the recoupment amount to which the HHSC was entitled because, in sustaining the Informal Review Decision’s adjustment of Appellant’s costs, the ALJ “upheld all of HHSC’s adjustments” and, therefore, “affirmed the adjusted recoupment of $63,611.00 specified in HHSC’s [I]nformal [R]eview Decision of November 17, 2010.” On August 27, 2013, the ALJ signed an “Order on Motion for Judgment Nunc Pro Tunc,” ordering that “a Judgment Nunc Pro Tunc be entered as it appears in the attached and corrected final order, entitled: NUNC PRO TUNC FINAL ORDER.” The attached Nunc Pro Tunc Final Order (NPT Order) was identical to the

original Final Order except for its modification of the recited hearing date and the amount of recoupment authorized in the concluding sentence:

IT IS ORDERED that the Informal Review of adjustments to Appellant’s 2006 Cost Report IS SUSTAINED and that HHSC IS AUTHORIZED to recoup $63,611.00 from Appellant for adjustments to its 2006 Cost Report.

On September 16, 2013, Appellant filed with the Appeals Division a Motion for Rehearing challenging the NPT Order “changing the ordered recoupment from the amount of $5,400.00 contained in the Final Order issued in this cause on May 24, 2013 to the amount of $63,611.00.” See 1 Tex. Admin. Code § 357.498. Appellant’s motion contended that the Appeals Division “lost jurisdiction of this matter on May 24, 2013, the expiration of the time for filing a motion for rehearing on the Final Order . . . [and] the Nunc Pro Tunc Final Order is therefore invalid.” The motion also challenged Findings of Fact 16–20 and Conclusions of Law 2 and 3. When its motion for rehearing was overruled by operation of law, see id. (e) (providing that, if judge does not rule on motion for rehearing within 45 days after date final order was mailed, motion is overruled by operation of law), Appellant filed a petition for judicial review in the district court seeking review of the NPT Order and a declaratory judgment that the NPT Order was void.

Appellant filed a motion for summary judgment on its declaratory-judgment claim.

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