Source: http://ri.findacase.com/research/wfrmDocViewer.aspx/xq/fac.20180409_0000066.RI.htm/qx
Timestamp: 2019-10-24 04:09:51
Document Index: 58610933

Matched Legal Cases: ['§ 42', '§ 40', 'art. 19', '§ 40', 'art. 18', '§ 1', '§ 40', 'art. 5', 'art. 5', '§ 40', '§ 40']

FindACase™ | Alpine Nursing Home, Inc. v. State of Rhode Island Executive Office of Health and Human Services
Alpine Nursing Home, Inc. v. State of Rhode Island Executive Office of Health and Human Services
ALPINE NURSING HOME, INC., d/b/a ALPINE REST HOME; BANNISTER OPERATIONS ASSOCIATES LLC, d/b/a BANNISTER CENTER FOR REHABILITATION AND HEALTH CARE; BURRILLVILLE HEALTH CENTER ASSOCIATES LIMITED, d/b/a BAYBERRY COMMONS; BERKSHIRE PLACE, LTD.; BRENTWOOD NURSING HOME, INC.; MEDICAL HOMES OF RHODE ISLAND, INC., d/b/a BRIARCLIFFE MANOR; CHARLESGATE NURSING CENTER; CORTLAND PLACE HEALTH CENTER, INC.; 10 WOODLAND DRIVE OPERATIONS LLC, d/b/a COVENTRY SKILLED NURSING AND REHABILITATION; CRA-MAR CORPORATION, d/b/a CRA-MAR MEADOWS; CRESTWOOD NURSING & REHABILITATION CENTER, INC.; 198 WATERMAN AVENUE, LLC, d/b/a EASTGATE NURSING & REHABILITATION CENTER; 100 WAMPANOAG TRAIL OPERATING COMPANY, LLC, d/b/a ELDERWOOD AT RIVERSIDE; 981 KINGS TOWN ROAD OPERATING COMPANY, LLC, d/b/a ELDERWOOD OF SCALLOP SHELL AT WAKEFIELD AND SCALLOP SHELL NURSING AND REHABILITATION CENTER; PROSPECT CHARTERCARE ELMHURST, LLC, d/b/a ELMHURST EXTENDED CARE FACILITY; ELMWOOD HEALTH CENTER, INC., d/b/a ELMWOOD HEALTH CENTER AND ELMWOOD NURSING & REHABILITATION CENTER; LIFE CARE CENTERS OF AMERICA, INC., d/b/a EVERGREEN HOUSE HEALTH CENTER; THE FRIENDLY HOME, INC.; GRACE BARKER NURSING CENTER, INC., d/b/a GRACE BARKER HEALTH; 333 GREEN END AVENUE OPERATIONS LLC, d/b/a GRAND ISLANDER CENTER; 100 CHAMBERS STREET OPERATIONS LLC, d/b/a GRANDVIEW CENTER; 732 PUTNAM PIKE OPERATIONS LLC, d/b/a GREENVILLE SKILLED NURSING AND REHABILITATION; HARBORSIDE RHODE ISLAND LIMITED PARTNERSHIP, d/b/a GREENWOOD CENTER; HATTIE IDE CHAFFEE NURSING HOME; HEATHERWOOD RI LLC, d/b/a HEATHERWOOD REHABILITATION & HEALTHCARE CENTER; ASLC RI II, LLC, d/b/a HEBERT HEALTH CENTER; 80 DOUGLAS PIKE, LLC, d/b/a HERITAGE HILLS; HOLIDAY RETIREMENT HOME INC., d/b/a HRC CORP.; HOPKINS MANOR, LTD.; 660 COMMONWEALTH AVENUE OPERATIONS LLC, d/b/a KENT REGENCY; SHADY ACRES OPERATIONS LLC, d/b/a KINGSTON CENTER FOR REHABILITATION AND HEALTH CARE; UNITED METHODIST HEALTH CARE CENTER, d/b/a LINN HEALTH CARE CENTER; THE MANSION, INC.; RYAN HEALTH CENTER, INC., d/b/a MORGAN HEALTH CENTER; OAK HILL OPERATIONS ASSOCIATES LLC, d/b/a OAK HILL CENTER FOR REHABILITATION & HEALTH CARE AND OAK HILL REHABILITATION & HEALTH CARE CENTER; OAKLAND GROVE ASSOCIATES, L.P., d/b/a OAKLAND GROVE HEALTH CARE CENTER; ATHENA ORCHARD VIEW LLC, d/b/a ORCHARD VIEW MANOR REHABILITATION AND NURSING CENTER; HARKEN, INC., d/b/a OVERLOOK NURSING HOME; PARK VIEW OPERATIONS ASSOCIATES LLC, d/b/a PARK VIEW CENTER FOR REHABILITATION AND HEALTH CARE; 70 GILL AVENUE OPERATIONS LLC, d/b/a PAWTUCKET SKILLED NURSING AND REHABILITATION CENTER; THE BURRILLVILLE NURSING HOME, INC., d/b/a PINE GROVE HEALTH CENTER; RIVERVIEW NURSING HOME, INC., d/b/a RIVERVIEW HEALTHCARE COMMUNITY; ROBERTS HEALTH CENTRE, INC.; ROYAL MIDDLETOWN NURSING CENTER LLC; ROYAL WESTERLY, LLC; KAR LITTLE BOX, LLC, d/b/a SILVER CREEK MANOR; CPL (SOUTH COUNTY) LLC, d/b/a SOUTH COUNTY NURSING AND REHABILITATION CENTER; ALLEN'S HEALTH CENTER, INC., d/b/a SOUTH KINGSTOWN NURSING & REHABILITATION CENTER; THE SAINT CLARE HOME, d/b/a ST. CLARE-NEWPORT; SUMMIT RI SNF LLC, d/b/a SUMMIT COMMONS REHABILITATION AND HEALTH CARE CENTER; SUNNY VIEW NURSING HOME, INC.; TOCKWOTTON HOME, d/b/a TOCKWOTTON ON THE WATERFRONT; ASLC OPCO RI I, LLC, d/b/a TRINITY HEALTH AND REHABILITATION CENTER; VILLAGE HOUSE CONVALESCENT HOME, INC., d/b/a VILLAGE HOUSE NURSING & REHABILITATION CENTER; 642 METACOM AVENUE OPERATIONS LLC, d/b/a WARREN SKILLED NURSING & REHABILITATION; WATERVIEW RI SNF LLC, d/b/a WATERVIEW VILLA REHABILITATION AND HEALTH CARE CENTER; WARWICK HEALTH CENTRE, INC., d/b/a WEST SHORE HEALTH CENTER; WESTERLY HEALTH CENTER ASSOCIATES, L.P.; GREENE ACRES HEALTH CENTER, LLC, d/b/a WOODPECKER HILL HEALTH CENTER, Plaintiffs,
STATE OF RHODE ISLAND EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES and STATE OF RHODE ISLAND DEPARTMENT OF HUMAN SERVICES, Defendants. v.
For Plaintiff: Bruce Gladstone, Esq.
For Defendant: Gregory Hazian, Esq.
This matter is before the Court on Plaintiffs'[1]-a group of fifty-nine skilled nursing facilities (Plaintiffs)-appeal of an Administrative Hearing Decision (the Decision) issued by Appeals Officer Jane Morgan (Hearing Officer) in favor of Defendants, the State of Rhode Island Executive Office of Health and Human Services (EOHHS) and the State of Rhode Island Department of Human Services (collectively, the Defendants). Jurisdiction is pursuant to G.L. 1956 § 42-35-15 of the Administrative Procedures Act.
Section 40-8-19 of the Rhode Island General Laws, titled "Rates of payment to nursing facilities" (the Statute) and the Principles of Reimbursement for Nursing Facilities, Attachment 4.19-D to the Rhode Island Medicaid State Plan (the Principles of Reimbursement or the Regulations) govern nursing facility reimbursement rates. The Statute dictates how the reimbursement rates are determined. Long-term care facilities furnish services in accordance with the requirements of the Principles of Reimbursement. The State pays the participating providers of long-term care facility services the amount determined for services furnished by the provider under the Principles of Reimbursement.
The EOHHS is responsible for the management, supervision and regulation of state and federally funded public financial assistance programs, including those for the funding and reimbursement of skilled nursing facilities detailed above. While the Medicaid reimbursement system is rather complex, only the relevant facts regarding the Medicaid reimbursement system need be explained herein.
A brief overview of the Statute's history is instructive. In the Fiscal Year 2014 Budget, the General Assembly declared that nursing home reimbursements would be connected to an "inflation index" which would be set on October 1st of each year. That same year, the General Assembly declared that there would be no rate increase occurring October 1, 2013. Specifically, that year, § 40-8-19(a)(2)(vi) read: "Adjustment of rates by the change in a recognized national nursing home inflation index to be applied on October 1st of each year, beginning October 1, 2012. This adjustment will not occur on October 1, 2013, but will resume on October 1, 2014." P.L. 2013, ch.144, art. 19.[2]
The 2015 Fiscal Year Budget also rescinded the nursing home reimbursement increases scheduled for October of 2014 by deferring increases to April 1, 2015. The statute (§ 40-8-19(a)(2)(vi)) then stated: "Adjustment of rates by the change in a recognized national nursing home inflation index to be applied on October 1st of each year, beginning October 1, 2012. This adjustment will not occur on October 1, 2013, but will resume on April 1, 2015." P.L. 2014, ch. 145, art. 18, § 1.
In the 2016 Fiscal Year Budget, the General Assembly enacted two significant amendments to § 40-8-19. The first amendment provided: "Notwithstanding any law to the contrary, for the twelve (12) month period beginning July 1, 2015, Medicaid payment rates for nursing facilities established pursuant to this section shall not exceed ninety-eight percent (98%) of the rates in effect on April 1, 2015." P.L. 2015, ch. 141, art. 5. Essentially, this amendment (hereinafter, the 98% Provision) provided for a two percent (2%) decrease in the reimbursement rate for a one-year period. Interpretation of this amendment gives rise to this appeal. Additionally, in the same 2016 Fiscal Year Budget, the General Assembly also mandated that the October 1, 2015 rate increase would not occur: "Adjustment of rates by the change in a recognized national nursing home inflation index to be applied on October 1st of each year, beginning October 1, 2012. This adjustment will not occur on October 1, 2013 or October 1, 2015 but will occur on April 1, 2015." P.L. 2015, ch. 141, art. 5.
By a letter dated August 26, 2015, EOHHS imposed the 98% Provision's two percent rate deduction on Plaintiffs, with an effective date of August 1, 2015.[3] See Exhibit 8, Ex. 4 thereto. On June 30, 2016-the end of the one-year period identified in the 98% Provision-EOHHS did not discontinue or adjust the rate. Instead, the rate reduction implemented through the 98% Provision remained in effect until September 26, 2016, [4] when the Assistant Director, Finance and Contract Management, of EOHHS, issued a notice, with an effective date of October 1, 2016, which incorporated Medicaid fee-for-service per diem Nursing Facility Payment rates (the Rate Notice). Notably, when EOHHS issued the new rate in the Rate Notice, it adjusted the rate using the rate in effect on August 1, 2015 as the base rate.[5] Admin. Hr'g Tr. 4, Mar. 24, 2017.
Subsequently, Plaintiffs appealed the Rate Notice, arguing that EOHHS improperly calculated and implemented the rates contained therein. On October 27, 2016, pursuant to § 40-8-21(b), a Rate Review Conference was held before Deputy Medicaid Director Darren McDonald (Director McDonald). On November 22, 2016, Director McDonald issued a decision denying Plaintiffs' rate appeals.
Plaintiffs then timely appealed Director McDonald's decision to the EOHHS Hearing Officer. At the hearings on March 3, 2017 and March 24, 2017, the Hearing Officer undertook the task of determining whether EOHHS, in setting the reimbursement rate for nursing facility payment rates, properly calculated and implemented the rates in accordance with applicable law. Additionally, the parties disputed which date EOHHS should have used in adjusting the rate. Plaintiffs aver that at the conclusion of the 98% Provision's one-year period, the rate should have been restored to the rate in place on April 1, 2015-the rate in effect prior to the 98% Provision. EOHHS posits that it properly calculated the rates based on the rate in existence on August 1, 2015, which reflected the two percent rate cut the 98% Provision established.
Plaintiffs' appeal revolves around interpretation of the 98% Provision. See § 40-8-19(b)(4). At issue is the meaning of the 98% Provision phrase, which reads: "for the twelvemonth (12) period beginning July 1, 2015." Plaintiffs "interpret the language of the [98% Provision] to provide for a retroactive restoration of the rate to that of the higher June 2015 rate, prior to enactment of the [98% Provision.]" Admin. Hr'g Dec. at 4. Essentially, Plaintiffs contend that EOHHS improperly factored the two percent rate reduction into the computation when it calculated rates after June of 2016, rather than using the previously existing higher base rate.[6] Plaintiffs stressed that if the "language is clear on its face, then the plain meaning of the statute must be given effect, " and, as a result, the Hearing Officer impermissibly looked elsewhere to discern legislative intent. See id. at 14-15. Nevertheless, Plaintiffs contend that even in considering legislative intent, "there was no need for the General Assembly to explicitly state that rates would return to normal once the [98% Provision] expired; because the [98% Provision] was embedded in the very statute that established the normal rates." Id. at 17. Similarly, Plaintiffs maintain that adding explicit language providing that "once this expires, existing law will revive itself" was unnecessary because the 98% Provision itself provided an exact time limit of twelve months. Id.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;To the contrary, EOHHS contends that the language of the 98% Provision, as well as the legislative intent and history, does not provide for restoration. Instead, EOHHS asserts that the 98% Provision allows for an increase of the nursing home rate that will exceed ninety-eight percent of the rates in effect on April 1, 2015 only if EOHHS should deem it appropriate at the next rate adjustment. Admin. Hr&#39;g Dec. at 5. Additionally, EOHHS contends that its calculation of the rate for April 1, 2015 and October 1, 2016 was consistent with &sect; 40-8-19 and the Regulations. See id. at 9. EOHHS relies on the legislative history and intent and asserts that it acted in conformity with the statute and the 98% Provision. EOHHS explained that "Petitioners [sic] argument that the Legislature intended for the 2% Per Diem Rate cut to expire is ...