Weber Memorial Care Center, Inc. v. Utah Department of Health, Division of Health Care Financing

751 P.2d 831, 78 Utah Adv. Rep. 24, 1988 Utah App. LEXIS 39, 1988 WL 22552
CourtCourt of Appeals of Utah
DecidedMarch 15, 1988
DocketNo. 860342-CA
StatusPublished
Cited by3 cases

This text of 751 P.2d 831 (Weber Memorial Care Center, Inc. v. Utah Department of Health, Division of Health Care Financing) is published on Counsel Stack Legal Research, covering Court of Appeals of Utah primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Weber Memorial Care Center, Inc. v. Utah Department of Health, Division of Health Care Financing, 751 P.2d 831, 78 Utah Adv. Rep. 24, 1988 Utah App. LEXIS 39, 1988 WL 22552 (Utah Ct. App. 1988).

Opinion

OPINION

BENCH, Judge:

Plaintiffs appeal from the final judgment of a trial court affirming the final determination of the executive director of the Utah Department of Health (Department). We affirm.

Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (1983), commonly referred to as the Medicaid Act, establishes a cooperative relationship in which the federal and state governments share the costs of medical services to the needy. If a state elects to participate, it must establish a state plan which complies with statutory and regulatory requirements under the Medicaid Act. Prior to 1980, states participating in the Medicaid program were required to reimburse health care providers for their “reasonable costs.’’ Typically, a provider would submit an accounting of its costs to the Department. The Department would then review these costs on a case by case, charge by charge basis and reimburse those costs deemed reasonable. In 1980, Congress amended the Medicaid Act to allow a flat rate system of reimbursement. Subsection 1396a(a)(13)(A), commonly re[833]*833ferred to as the Boren Amendment, now provides:

A State plan for medical assistance must provide for payment ... of the hospital, skilled nursing facility, and intermediate care facility services provided under the plan through the use of rates (determined in accordance with methods and standards developed by the State ...) which the State finds, and makes assurances satisfactory to the Secretary, are reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities in order to provide care and services in conformity with applicable State and Federal laws, regulations, and quality and safety standards....

Defendant Department is the state agency responsible for administering the Medicaid program in Utah. In 1981, in response to the Boren Amendment and the urging of the Utah Health Care Association, the state legislature directed the Department to organize a committee to develop and propose a flat rate plan for reimbursement under the Medicaid program. Under the plan proposed by the committee, patients who qualify for Medicaid assistance are classified according to the degree of care needed. The health care provider is then paid a statewide flat rate fee per patient per day according to the classification of such patient. The flat rate is modified by a “property differential,” unique to each provider, to account for wide variations in property costs. The flat rate is also adjusted annually to account for inflation and other factors.

The proposed plan was submitted through the statutory rulemaking process. A public hearing was held, and no objection was voiced from the health care industry. The plan was then submitted to the United States Department of Health and Human Services which certified that the plan satisfied all requirements of the law and that all assurances submitted under the requirements of the Medicaid Act were acceptable. The modified flat rate plan became effective July 1, 1981.

Plaintiff Weber Memorial Care Center, Inc. (Weber Memorial) is a long-term health care provider. In September 1981, Weber Memorial acquired the subject facility from Weber County. Plaintiff Chartham Management, Inc. manages the facility pursuant to a contract with Weber Memorial. In 1983, Weber Memorial requested a hearing before the Department to challenge the application of the modified flat rate plan and the classification of patients. Prior to the hearing, the Department filed a motion asking the hearing officer to rule, as a matter of law, that the state plan did not violate federal law and that the plan did not require an examination of Weber Memorial’s costs nor a determination whether this particular facility is efficiently and economically operated. The hearing officer granted the Department’s motion. Consequently, at the administrative hearing which commenced August 3, 1984, Weber Memorial was not permitted to introduce evidence of its costs nor attempt to prove it is efficiently and economically operated.

In his proposed findings, conclusions, and decision, the hearing officer concluded the modified flat rate plan complied with all provisions of federal and state law, and the Department did not act arbitrarily, capriciously, or contrary to law in the development, implementation, and operation of the plan. The executive director of the Department adopted the hearing officer’s findings in her final determination dated June 4, 1985. Weber Memorial filed a petition for review in the Third District Court.1 In a memorandum decision and final judgment, the trial court affirmed, finding “the Executive Director’s final determination was supported by a residuum of legally admissible evidence in the record and was not arbitrary or capricious.” Weber Memorial [834]*834appeals from the trial court’s final judgment.

When a trial court reviews an administrative decision and the court’s judgment is challenged on appeal, this Court reviews the administrative decision as if the appeal had come directly from the agency. Technomedical Labs, Inc. v. Utah Securities Division, 744 P.2d 320 (Utah App.1987). Therefore, it is not necessary to address Weber Memorial’s contention that the trial court applied the wrong standard of review. When reviewing an administrative agency’s interpretation of general questions of law, including acts of Congress, “this Court applies a correction-of-error standard, with no deference to the expertise of the [agency].” Utah Dep’t. of Admin. Servs. v. Public Serv. Comm’n, 658 P.2d 601, 608 (Utah 1983).

On appeal, Weber Memorial first argues that contrary to the executive director’s final determination, the modified flat rate plan does not comply with federal law and regulations. Section 1396a(a)(13)(A) requires the state to find that the rates, which are to be determined by methods and standards developed by the state, reasonably and adequately meet the costs of efficiently and economically operated facilities. The state must also make satisfactory assurances to the federal Department of Health and Human Services. Weber Memorial contends the Department failed to make the necessary findings and assurances that the rates satisfy the statutory requirements. See 42 C.F.R. § 447.253 (1985); Mary Washington Hospital, Inc. v. Fisher, 635 F.Supp. 891 (E.D.Va.1985) (federal law does not require written findings). The committee organized by the Department consisted of a representative from the legislature, a legislative analyst, the president and executive director of the Utah Health Care Association, and a nursing home operator. Prior to selecting the modified flat rate plan, the committee considered several alternative methods of reimbursement.

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Related

Kline Ex Rel. Kline v. Utah Department of Health
776 P.2d 57 (Court of Appeals of Utah, 1989)

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Bluebook (online)
751 P.2d 831, 78 Utah Adv. Rep. 24, 1988 Utah App. LEXIS 39, 1988 WL 22552, Counsel Stack Legal Research, https://law.counselstack.com/opinion/weber-memorial-care-center-inc-v-utah-department-of-health-division-of-utahctapp-1988.