Source: http://www.leagle.com/decision/In%20FDCO%2020160902720/GRANT%20MEDICAL%20CENTER%20v.%20BURWELL
Timestamp: 2017-06-24 05:18:53
Document Index: 309681926

Matched Legal Cases: ['§ 1395', '§ 1395', '§ 2405', '§ 412', '§ 412', '§ 412', '§ 1395', '§ 412']

GRANT MEDICAL CENTER v. BURWELL | 204 F.Supp.3d 68 (2016) | 42 U.S.C. 1395 HHS: Adverse Reimbursement Review | By ROSEMARY M. COLLYER | Leagle.com
Citing Case 204 F.Supp.3d 68 (2016)
GRANT MEDICAL CENTER, et al., Plaintiffs,
Applicable Law: 42 U.S.C. § 1395 Cause: 42 U.S.C. § 1395 HHS: Adverse Reimbursement Review Nature of Suit: 151 Contract: Recovery Medicare Source: PACER
We conclude that the Department's application of its own regulations in this case cannot be squared with either the plain meaning of the regulations or with the Department's definition of "available bed" set forth in PRM § 2405.3(G). As such, we conclude that the [] decision was arbitrary and capricious.
The Department's attempt to distinguish between a "bed" and an "available bed day" is at odds with the plain meaning of § 412.105(b). Section 412.105(b) states that the number of beds is to be determined "by counting the number of available bed days during the cost reporting period, not including beds or bassinets in the healthy newborn nursery, custodial care beds, or beds in excluded distinct part hospital units, and dividing that number by the number of days in the cost reporting period." 42 C.F.R. § 412.105(b) (emphasis added). Because the regulation specifically lists certain types of beds that are excluded from the bed count, but does not list swing or observation beds, the plain meaning of the regulation suggests that it is permissible to count swing and observation beds. Further, swing and observation beds are not of the same class or type as "beds or bassinets in the healthy newborn nursery, custodial care beds, or beds in excluded distinct part hospital units." Although these beds listed as excluded are ... all non-PPS reimbursable beds, the swing and observation beds at issue in this case are actually used for PPS-reimbursable services more often than not. None of the beds described as excluded may be used primarily for acute inpatient care as the swing and observation beds are. This is because these excluded beds are located in areas of the hospital that, by definition, cannot come within PPS. Had the Department intended to exclude all non-PPS reimbursable beds and services, it could easily have written the regulation to do so.
FootNotes 1. The majority of hospitals are paid the "federal rate," which is the product of the DRG times a base dollar "standardized" amount. 42 C.F.R. § 412.64(g). The standardized amount is roughly an average of operating costs per discharge of all patients for all IPPS hospitals in a given time period. 42 U.S.C. § 1395ww(d)(2)(C).
3. The version of § 412.105(b) that was then effective provided:
(b) Determination of number of beds. For purposes of this section, the number of beds in a hospital is determined by counting the number of available bed days during the cost reporting period, not including beds or bassinets in the healthy newborn nursery, custodial care beds, or beds in excluded distinct part hospital units, and dividing that number by the number of days in the cost reporting period.