Wilbanks Health Care Services, Inc. v. Medicaid Agency

986 So. 2d 411, 2006 Ala. Civ. App. LEXIS 630, 2006 WL 2987931
CourtCourt of Civil Appeals of Alabama
DecidedOctober 20, 2006
Docket2050132
StatusPublished
Cited by1 cases

This text of 986 So. 2d 411 (Wilbanks Health Care Services, Inc. v. Medicaid Agency) is published on Counsel Stack Legal Research, covering Court of Civil Appeals of Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wilbanks Health Care Services, Inc. v. Medicaid Agency, 986 So. 2d 411, 2006 Ala. Civ. App. LEXIS 630, 2006 WL 2987931 (Ala. Ct. App. 2006).

Opinion

986 So.2d 411 (2006)

WILBANKS HEALTH CARE SERVICES, INC., d/b/a Sylacauga Health Care Center
v.
ALABAMA MEDICAID AGENCY.

2050132.

Court of Civil Appeals of Alabama.

October 20, 2006.

*412 David M. Hunt and Susan V. Simpson of Johnston Barton Proctor & Powell, LLP, Birmingham, for appellant.

*413 Troy King, atty. gen., and William O. Butler III, deputy atty. gen., for appellee Alabama Medicaid Agency.

CRAWLEY, Presiding Judge.

Wilbanks Health Care Services, Inc., d/b/a Sylacauga Health Care Center, a nursing home in Sylacauga (hereinafter referred to as "the nursing home"), appeals from a judgment of the Montgomery Circuit Court affirming a decision by the Alabama Medicaid Agency ("the Agency") to deny reimbursement for certain fees related to the nursing home's purchase and use of computer software.

In September 2001, the nursing home entered into a "Purchase and License Agreement" ("the purchase agreement") to buy computer hardware and software from American HealthTech, Inc. ("AHT"), a software developer for the long-term-care industry. The software was composed of different "modules." For example, a clinical module enabled the nursing home to generate care plans for residents; a billing module allowed the facility to submit electronic bills to agencies such as Medicare and Medicaid as well as to private insurers. The purchase agreement included two types of "software maintenance fees": an hourly fee for on-site and telephone support and a fixed "monthly maintenance fee."

AHT charged the hourly "maintenance fee" for user-initiated maintenance—that is, when, in response to a request by the user, an AHT technician either came to the user's premises or provided the user with telephone consultation to address a computer-software problem. On the other hand, AHT charged a set "monthly maintenance fee" for vendor-initiated maintenance—that is, a fee attributable to the service provided to all users when AHT programmers made periodic updates to the software to enable it to function properly.

The nursing home reported both types of "maintenance fees" as operating expenses, or costs, for which it sought reimbursement on its annual Medicaid cost report. The Agency allowed reimbursement for the hourly maintenance fees, but it denied reimbursement for the monthly maintenance fees. It took the position that the monthly maintenance fee was, in reality, a licensing fee—a part of the purchase price of the software and, thus, a capital expenditure[1] rather than an operating expense.[2]

Upon the denial of reimbursement, the nursing home requested a fair hearing. Following an ore tenus proceeding on November 17, 2004, the fair-hearing officer issued findings of fact, conclusions of law, and recommendations to the commissioner of the Agency. On February 15, 2005, the commissioner adopted the fair-hearing officer's recommendation and entered a final decision denying reimbursement to the nursing home. The nursing home filed a timely petition for review in the Montgomery Circuit Court. On October 3, 2005, the circuit court affirmed the commissioner's decision, and the nursing home timely appealed to this court. The issue on appeal is whether the Agency's decision to treat the monthly maintenance fee as a capital expenditure rather than an operating expense was clearly erroneous, unreasonable, or arbitrary and capricious.

Standard of Review

This court reviews the circuit court's ruling with no presumption of correctness, *414 "since that court was in no better position to review the order of the [Agency] than we are." State Health Planning & Resource Dev. Admin. v. Rivendell of Alabama, Inc., 469 So.2d 613, 614 (Ala.Civ. App.1985).

"Judicial review of the Agency's determination regarding reimbursement is quite limited under the AAPA [Alabama Administrative Procedure Act]. Ala. Code (1975), § 41-22-20(k), provides that the Agency's order is to be taken as prima facie just and reasonable. The circuit court may not substitute its judgment for that of the Agency as to the weight of the evidence. Moreover, the circuit court may reverse the Agency's decision only if substantial rights of [the nursing home] have been prejudiced because the [A]gency action is:
"`(1) In violation of constitutional or statutory provisions;
"`(2) In excess of the statutory authority of the agency;
"`(3) In violation of any pertinent agency rule;
"`(4) Made upon unlawful procedure;
"`(5) Affected by other error of law;
"`(6) Clearly erroneous in view of the reliable, probative, and substantial evidence on the whole record; or
"`(7) Unreasonable, arbitrary, or capricious, or characterized by an abuse of discretion or a clearly unwarranted exercise of discretion.'"

Alabama Medicaid Agency v. Beverly Enters., 521 So.2d 1329, 1331 (Ala.Civ.App. 1987).

The Agency does not directly reimburse nursing homes for purchases of major movable equipment, including computer software, that costs more than $300. See Rule 560-X-22-.14(18), Ala. Admin. Code (Medicaid Agency). The Agency reimburses expenditures for major movable equipment under a "fair rental system" pursuant to Rule 560-X-22-.14(2), Ala. Admin. Code (Medicaid Agency). That rule provides:

"Effective September 1, 1991, a Fair Rental System will be used to reimburse property costs. The Fair Rental System reduces the wide disparity in the cost of capital payments for basically the same service and makes the cost of capital payment fairer to all participants in the program. The Fair Rental System is a rate of return on current asset values and will be used in lieu of depreciation and/or lease payments on land, buildings, and major movable equipment normally used in providing patient care."

The Agency does directly reimburse nursing homes for the cost of maintaining equipment, including computer software. See Rule 560-X-22-.10, Ala. Admin. Code (Medicaid Agency) (providing for direct reimbursement of "management and administrative costs," including costs for "data processing," see Rule 560-X-22-.10(3)(e), Ala. Admin. Code (Medicaid Agency)). The Medicaid regulations contain no definition of "maintenance."

The Agency acknowledges that, as a general proposition, software-maintenance fees are directly reimbursable as operating expenses. The Agency contends, however, that in the present case the fees labeled as "monthly software maintenance" were not routine maintenance expenses reimbursable as operating costs but were, instead, user fees or product upgrades that should be considered part of the overall purchase price of the product and reimbursed under the Agency's fair rental system.

The nursing home contends that the Agency had no reasonable justification for considering the monthly maintenance fees as capital expenditures rather than operating expenses. The nursing home insists *415

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Related

Ex Parte Wilbanks Health Care Services
986 So. 2d 422 (Supreme Court of Alabama, 2007)

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Bluebook (online)
986 So. 2d 411, 2006 Ala. Civ. App. LEXIS 630, 2006 WL 2987931, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wilbanks-health-care-services-inc-v-medicaid-agency-alacivapp-2006.