Twining Village v. Commonwealth

564 A.2d 1335, 129 Pa. Commw. 165, 1989 Pa. Commw. LEXIS 660
CourtCommonwealth Court of Pennsylvania
DecidedOctober 13, 1989
DocketNo. 3070 C.D. 1988
StatusPublished

This text of 564 A.2d 1335 (Twining Village v. Commonwealth) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Twining Village v. Commonwealth, 564 A.2d 1335, 129 Pa. Commw. 165, 1989 Pa. Commw. LEXIS 660 (Pa. Ct. App. 1989).

Opinion

COLINS, Judge.

Twining Village, the proprietor of a total life care retirement community, petitions for review of the October 26, 1988 order of the Secretary of Public Welfare granting the Department of Public Welfare’s (DPW) request for reconsideration and reversing an Order of the Director of the Office of Hearings and Appeals (OHA) dated June 26,1984. DPW has filed a motion to dismiss the appeal which, pursuant to order, was argued concurrently with the merits of Twining Village’s petition.

BACKGROUND

Twining Village consists of a skilled nursing care facility (nursing home) and a residential apartment community. As a provider of nursing home services, Twining Village participated in the Pennsylvania Medical Assistance Program. This appeal involves the rate set by DPW for interim payments to Twining Village for the period from July 1, 1982 through June 30, 1983.

Twining Village filed a timely appeal of this interim rate with DPW on March 1, 1983, contesting the amount of interest on capital indebtedness recognized in the interim rate.1 Hearing Officer Mary Dilks issued a recommendation that Twining Village’s appeal be sustained and that DPW be required to recompute the interim rate and allocate interest income in the same manner that interest expense is allocated. In its order of June 26,1984, the Acting Director of OHA adopted this recommendation. DPW filed a timely request for reconsideration with OHA on June 27, 1984.

[168]*168On July 26, 1984 the Executive Deputy Secretary of DPW issued what was termed as a “Preliminary Order Request for Reconsideration.” This order reads in pertinent part:

[a]nd now, this 26th day of July, 1984, a Request for Reconsideration has been filed by the Department and that request mil be considered. However, before making a decision on this request, I am requesting that the appellant provide me in writing of his/her reasons to oppose the Department’s request. Attached to this Preliminary Order is a copy of the Department’s request. In order for me to review the appellant’s reasons, the reasons must be submitted in writing and received by me within ten (10) days from the date of this Preliminary Order. (Emphasis added.)

No further order was issued on the request for reconsideration until October 26, 1988, when a final order was entered by the Secretary of DPW granting reconsideration and reversing the June 26, 1984 order on the merits. A timely petition for review of that order was filed by Twining Village with this Court.2

MOOTNESS

DPW contends that because the final audit and settlement of Twining Village’s rates for the period from July 1, 1982 through June 30, 1983 has been made and no appeal of the final rates was filed, the appeal of the interim rates for that period is now rendered moot. Twining Village counters that although it did not appeal the final rates, DPW’s pertinent regulation at 55 Pa.Code § 1181.101, provides for a separate appeal from the establishment of interim rates. Twining Village cites this Court’s decision in [169]*169Renovo Hospital Association v. Department of Public Welfare, 83 Pa.Commonwealth Ct. 355, 480 A.2d 1260 (1984), in support of its argument that the two appeals are separate and should be considered separately.

Nursing facilities participating in the Medical Assistance Program receive payment from DPW for care provided to eligible recipients. 55 Pa.Code § 1181.1. These facilities are initially reimbursed through interim per diem rates established by DPW. These interim per diem rates are based upon the latest adjusted reported net operating cost of the facility plus an allowance for depreciation and interest. These interim per diem rates must be within the ceilings on net operating costs set by 55 Pa.Code § 1181.66 and remain in effect for no less than 6 months. 55 Pa.Code § 1181.67.

Pursuant to 55 Pa.Code § 1181.69, DPW or the facility makes an annual adjustment based on total audited costs related to the total DPW interim claims for services for the fiscal year. Each facility is required to submit a cost report to DPW within 90 days following the close of the fiscal year.3 DPW audits the cost report4 and the auditors then certify to DPW the allowable cost for the facility as a basis for calculating a per diem and an annual adjustment. Thereafter, based on the auditors’ certification and the interim payments received by the facility, DPW computes adjustments due the facility or due DPW for the fiscal year. DPW then notifies the facility of the annual adjustment due after the audit of the annual cost report.5

In this case, Twining Village disputed the method of calculation, applied by DPW in figuring its interim rates and timely appealed those rates. OHA concluded that DPW had in fact erred in its computation and in its order of June 26, 1984, ordered DPW to recompute those rates. DPW requested reconsideration and a dispute remains as to whether that request was “acted upon” on July 26, 1984 or on [170]*170October 26, 1988. We reserve discussion on that issue to the latter portion of this opinion. However, it is undisputed that in the intervening time period, while a decision on the interim rates was pending, DPW conducted its final audit and settlement of Twining Village’s rates for the fiscal year in question.

DPW now contends that Twining Village’s failure to appeal the final audit and settlement renders the appeal on the interim rates moot. We must disagree and in doing so note that as provided in DPW’s regulations, the computation of any adjustments due a facility or DPW is based upon the auditors’ certification and the interim payments made to a facility. 55 Pa.Code § 1181.74(c). In general terms, we interpret this regulation as indicating that DPW subtracts the interim payments made to a facility from the auditors’ certification of allowable costs for that facility to compute the difference due DPW or the facility.

In this case, Twining Village’s interim rates were in dispute at the time DPW issued the final audit and settlement to Twining Village. We agree with Twining Village that the final audit and settlement was subject to the outcome of the interim rate appeal.

DPW's regulations provide for a separate interim rate appeal. To impose a requirement upon a facility to file an appeal from the final audit and settlement as well as an appeal from the interim rates in order to preserve the interim rate issue is absurd. If we accept DPW’s argument that an interim rate appeal becomes moot if a facility does not file an appeal from the final audit and settlement, we are in effect saying that the interim rate appeal has no purpose, unless, of course, that appeal is resolved prior to the final rate settlement. Although we have no gauge on the time frame within which interim appeals are typically resolved, this appeal, in and of itself, evidences the fact that an interim rate appeal may be yet unresolved years after the final audit and settlement is complete.

DPW’s regulation at 55 Pa.Code § 1181.74 provides for no re-examination of the interim per diem rates during the [171]*171final audit and settlement.

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Related

Renovo Hospital Ass'n v. Commonwealth, Department of Public Welfare
480 A.2d 1260 (Commonwealth Court of Pennsylvania, 1984)
Brookline Manor Convalescent Rest Home v. Commonwealth, Department of Public Welfare
492 A.2d 1207 (Commonwealth Court of Pennsylvania, 1985)
Quincy United Methodist Home v. Commonwealth
530 A.2d 1026 (Commonwealth Court of Pennsylvania, 1987)

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Bluebook (online)
564 A.2d 1335, 129 Pa. Commw. 165, 1989 Pa. Commw. LEXIS 660, Counsel Stack Legal Research, https://law.counselstack.com/opinion/twining-village-v-commonwealth-pacommwct-1989.