Opinion ID: 4537297
Heading Depth: 3
Heading Rank: 2

Heading: The DOM’s Rationale

Text: ¶80. The relevant change to SPA-015 considers the calculation of the NBV for Methodist. ¶81. As discussed earlier, the DOM recognized that NFSDs generally incur higher costs than other nursing facilities. To compensate Methodist, DOM agreed to adjust Methodist’s reimbursement formula by adding the 328.178 percent payment add-on. To calculate Methodist’s NBV, you start with the “New Construction Value” table in the State Plan. For example, in 2004, the standard nursing facility NBV was $32,475. Methodist’s NBV calculation for 2004 was: $32,475 + ($32,475 × 3.28178) = $139,050.81. ¶82. Continuing this example, Methodist’s NBV calculation over the next several years was approximately as follows: 2005 $36,617 + ($36,617 x 3.28178) = $156,785.94 32 2006 $38,174 + ($38,174 x 3.28178) = $163,452.67 2007 $40,759 + ($40,759 x 3.28178) = $174,521.07 2008 $47,552 + ($47,552 x 3.28178) = $203,607.20 2009 $52,622 + ($52,622 x 3.28178) = $225,315.83 2010 $50,999 + ($50,999 x 3.28178) = $218,366.50 2011 $50,700 + ($50,700 x 3.28178) = $217,086.25 2012 $52,954 + ($52,924 x 3.28178) = $226,638.92 The DOM agreed that this was the formula used to calculate Methodist’s NBV portion of the reimbursement rate from 2004 through 2015.3 ¶83. The Legislature began the revision process in 2012. The Legislature specifically directed Medicaid to “develop a plan” for various reimbursement methodologies, including “a plan providing revisions to the current reimbursement methodology for nursing facility services.” The Legislature also directed that the DOM “shall not implement these plans, but shall submit the plans” to the Legislature for its committees to review. Maj. Op. ¶¶ 9, 57 (emphasis added) (quoting H.B. 421, Reg. Sess., 2012 Miss. Laws ch. 530, § 5). ¶84. It is crucial that we recognize that these plans and revisions were based on suggestions and recommendations from the Committee. The Committee included the “DOM personnel, 3 The 2020 NBV for a standard nursing facility is $102,927, Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) is $123,512, Psychiatric Residential Treatment Facilities (PRTF) is $123,512, and NFSD is $180,122. 33 industry people and other concerned stakeholders.” Maj. Op. ¶ 9. “The Committee reached an agreement on a new reimbursement plan, and the DOM submitted its proposed plan to the Legislature in January 2014.” Maj. Op. ¶ 9. ¶85. The report to the Legislature recommended an update to the “Fair Rental Value calculation.” Among other recommendations, the report suggested the value of a nursingfacility bed be increased to $91,200. The report did not recommend any change to the addon or percentage adjustments the DOM applied to the NBV calculation for ICF/IIDs, PRTFs, Alzheimer’s units, or NFSDs (Methodist). ¶86. The DOM concedes that during the Committee’s evaluation process, Methodist was not specifically evaluated for an adjustment to its property rate because of its unique position as the only NFSD in the state of Mississippi. ¶87. The Legislature accepted this report and passed House Bill 1275 in 2014 session. House Bill 1275 authorized the DOM to “update the . . . fair rental reimbursement system.” H.B. 1275, Reg. Sess., 2014 Miss. Laws ch. 488, § 1 (codified as amended at Miss. Code Ann. § 43-13-117(A)(4)(d) (Rev. 2015)). The Legislature also instructed the DOM to “develop and implement a payment add-on to reimburse nursing facilities for ventilator dependent resident services.” Id. In this last sentence, the Legislature referred to the “payment add-on” for ventilators. The report did not suggest or recommend any change to the “payment add-on for specialized nursing facilities.” Id. ¶88. At this point in the Legislatively mandated revision review, neither the Legislature, 34 the Committee, nor the DOM considered or discussed any possible revision to the NFSD payment add-on factor. ¶89. The DOM admitted that it “first examined the adjusted bed values of specialized nursing facilities, including ICF/IIDs, PRTFs, Alzheimer’s units, and the NFSDs (Methodist)[,]” after it began drafting the changes. Maj. Op. ¶ 11. The DOM could have and should have considered this issue with the Committee and made a recommendation in the Legislative report. It did not. Despite this, it is clear that at this point, Methodist had no reason to believe its NFSD payment add-on factor would change. ¶90. In fact, the DOM confirmed to Methodist that there would be no change, i.e., decrease in its reimbursement rate. In February 2014, the DOM sent a simulation letter to Methodist that explained how its reimbursement would change if the measures reported to the Legislature were enacted. The letter stated that it presented only “estimates” but that it was meant to show the effect of the proposed changes. Methodist was informed that in comparison to its property per diem rate of $57 under the current system, it could expect a new rate of approximately $69.86 under the new system, which the letter correctly described as a 22.56 percent increase. Again, at this point, Methodist had no reason to believe its NFSD payment add-on would change. ¶91. Further, in November 2014, Medicaid provided online training sessions to help long-term-care providers, like Methodist, understand the proposed reimbursement changes. Richard Lefoldt was a reimbursement consultant for Methodist, and he participated in these sessions. Lefoldt testified that there was no mention of any change to the existing 328.178 35 percent payment add-on to Methodist’s NBV. Lefoldt testified about the training slides the DOM presented online. These slides indicated that the general NBV would increase to $91,200. The slides also indicated that while that would be the new-bed value for nursing homes, $299,298 would be used for “NF – Severely disabled,” i.e., for Methodist. Finally, Lefoldt testified that this figure was consistent with the 328.178 percent payment add-on that had been used since 2004. Once again, at this point, Methodist had no reason to believe its NFSD payment add-on would change. ¶92. On December 18, 2014, Medicaid published newspaper notices of the changes to its long-term-care reimbursement methods—SPA 15-004. The published notice announced the changes, including five changes to the “Property Rate calculation.” These included the NBV increase to $91,200. But the notice did not mention any further change to the NBV specifically for Methodist or for the NFSDs. Again, at this point, Methodist had no reason to believe its NFSD payment add-on would change. ¶93. In fact, neither the hearing officer, the executive director, the chancellor, nor the majority can identify exactly when the SPA 15-004 first included the language that decreased Methodist’s payment add-on from 328.178 percent to 175 percent. The majority determined that it was one of the last changes to the SPA 15-004 before it was submitted for approval. Maj. Op. ¶ 11.4 4 This finding by the majority contradicts its conclusion later in the analysis of the notice issue that Methodist either knew or should have known of the change. There is no evidence in the record that clearly indicates when the DOM advised Methodist of any change in its NBV and the payment add-on when that would be changed by SPA 15-004. 36 ¶94. Instead, Methodist offered the only evidence about when the DOM decided to make this change. The metadata in the Microsoft Word document of the publication of SPA 15-004 indicated that the DOM had changed SPA 15-004 to reduce Methodist’s NFSD payment add-on from 328.178 percent to 175 percent on the same day as publication of the notice. A DOM employee made this change and reduced the NFSB payment add-on from 328.178 percent to 175 percent (under SPA 15-004, Methodist’s NBV was $91,200 × 1.75).5 ¶95. This revision was not presented to, discussed with, or vetted by the Committee or the Legislature. This revision was not provided to Methodist. In 2004, the DOM and Methodist worked together to set this payment add-on. Based on the Legislature’s directions, the DOM clearly should have presented this proposed change to the Committee, the Legislature and, at least, Methodist. Furthermore, this change was contrary to the DOM’s simulation letter and the training slides. Actually, the simulation letter and the training slides told Methodist to expect a modest increase of $12 to its per diem rate. ¶96. The question here is whether the DOM made this change in an arbitrary and capricious manner. As discussed above, the fact that the DOM did not submit this change to the Committee, the Legislature, or Methodist certainly creates a question as to the DOM’s rationale and intentions. As in 2004, it would have been easy for the DOM to disclose this 5 The hearing officer found this was a misreading by Medicaid of its own plan: the same provision that called for “adjustment to the new bed value” for Methodist also stated that an “adjustment to the new bed value of 37.20% will be made for licensed Alzheimer’s units.” Because that meant the Alzheimer’s units would receive a 37.20 percent add-on to the regular new-bed value, it was likewise necessary to read the language to mean an add-on (not multiplier) for Methodist. 37 change and meet with Methodist to discuss this proposed change. Methodist would have been given an opportunity to change the DOM’s decision. More importantly, industry professionals would have been given an opportunity to comment on this change. This appears to be the clear intent of the Legislature. ¶97. I move to the DOM’s rationale for the change. The DOM claims that it began drafting the amendments to the State Plan in November and December 2014. The draft amendments were to reflect the recommendations reached by the Committee and the report to the Legislature. But at this point, for the first time, the DOM decided to look at the new-bed values of the ICF/IID, PRTF, and NFSD categories of nursing facilities. ¶98. With respect to the NFSD category, the DOM became concerned that as a result of the rebased NBV of $91,200, NFSDs (Methodist was the only NFSD) would receive a windfall that was inconsistent with the legislative directives and goals of House Bill 421. Thus, the DOM reevaluated Methodist’s multiplier in an attempt to determine what was systematically equitable to all Medicaid providers under the legislative goals presented to the DOM when the process began. ¶99. The DOM reviewed both the ICF/IID and PRTF categories and concluded that a $91,200 base new-bed value would adequately compensate these facilities. Since the base new-bed value was being raised from $52,954 to $91,200 for all facilities, the DOM amended the State Plan to decrease the ICF/IID and PRTF multipliers from 120 percent to 100 percent. But after appeals, the ICF/IID and PRTFs payment add-on were returned to 120 percent. 38 ¶100. Similarly, the DOM evaluated what rate would fairly compensate a NFSD consistent with the compensation rates received by all types of nursing facility providers. The DOM ultimately determined that a fair rental-reimbursement rate for NFSD facilities (Methodist) would be achieved by utilizing a 175 percent multiplier, for a total adjusted new-bed value of $159,600 ($91,200 x 1.75%). ¶101. The DOM offered the testimony of its reimbursement director, Michael Daschbach. He testified that the NBV payment add-on resulted in an excessive payment to Methodist and would be unfair to other providers: Q. And if we pay them $67.89, which is what they’ve asked for, what is the amount—the gross amount that they would be paid? A. I’d have to go back to this other sheet. They would be paid almost a million and a half dollars for their property. Q. And is that more or less than they’ve ever been paid before? A. That would be much higher. That would be almost—it would be a million dollars above their costs annually. Q. And does Medicaid regard that as a fair amount for a property payment for Methodist? A. No. Q. And why is that? A. Because Methodist is the only facility in their class that gets the accelerated payment of 175 percent. This is money that would be spent in other areas. Medicaid is on a finite budget and we’ve responsible to the taxpayers of Mississippi. We can’t just give excess money in one area to the detriment of other areas. I mean, that money can go across multiple programs or other—you know, all kinds of different—you know, it’s not fair to other facilities and it’s not fair to other types of facilities. ¶102. According to Daschbach, the DOM wanted to change Methodist’s NBV payment add- 39 on because it did not believe it was a fair amount for a property payment.6 So, he continued, we should consider what would be a “fair amount for a property payment.” ¶103. Because Methodist was the only facility in this category, the DOM decided to use the historical data it had for Methodist. The DOM claims that the rational to change the NBV payment add-on to a 175 percent multiplier was supported by Methodist’s payment history. ¶104. According to the payment history, the DOM decided that Methodist has already been hugely overcompensated for its capital improvements. After the construction of Methodist’s NFSD was completed in 2004, and as the facility provided services to Medicaid patients throughout the years, the property reimbursement methodology for this facility was treated differently from the property reimbursement formulas applied to other types of nursing facilities. For example, unlike the PRTF or IFC/IID facilities, which had their reimbursement rates periodically adjusted, Methodist’s multiplier was never adjusted, and it remained at 328.178% from 2004 through 2012. By comparison, ICF/IID and PRTF facilities were compensated prior to 2012 at a rate of 120% of the bed value multiplied by the total number of beds in their facilities Alzheimer units were paid the base bed value of all of its beds, plus 37.20% of the bed value for each Alzheimer bed. In part, the different treatment of the property reimbursement rate for NFSD facilities was based on the recognition that it cost more for NFSD facilities to house their patients. Thus, from 2004 until 2012, DOM continued to compensate Methodist at this disproportionately high rate, in part because of its status as the only nursing facility for the severely disabled in the state. 6 Interestingly, if we pause here to consider the notice requirement, 42 C.F.R. § 447.205(a) and (c), Westlaw (current through May 21, 2020) required DOM to “provide public notice of any significant proposed change in its methods and standards for setting payment rates for services” and to “[d]escribe the proposed change in methods and standards,” “estimate the increase or decrease expected in annual expenditures (if any),” and “[e]xplain why the agency is changing its methods and standards . . . .” As I will discuss in the next section, the DOM did not provide such notice even though the DOM’s counsel conceded at the hearing that the change “does drop their property rate. It drops it from $67 to roughly $29. It’s a significant drop. There’s no question about that.” 40 Based on Methodist’s Cost Reports, the total cost of construction for Methodist, together with additions through 2016, totaled $13,207,300. Based on the overages in the rate, Methodist was paid back $12,480,220.97 in property reimbursement by Medicaid alone by 2015, assuming only a 175% payment for 2015. It would have been far more, $13,325,936.29, if Methodist’s suggested multiplier of 428.128% had been used for 2015. Based on DOM’s calculations, from the time Methodist opened in 2004 through 2015, Medicaid had already reimbursed Methodist in property payments alone more than the total original costs of constructing the entire facility. This is based only on Medicaid reimbursements and does not include any private pay patients or Medicare reimbursements. Thus, Methodist has recouped almost the entire cost of its facility in a mere 11 years from the property portion of the per diem that Medicaid pays on behalf of Medicaid beneficiaries. Eleven years is an unbelievably fast return on investment as most depreciation tables are based on 30-40 years. Based on these historical numbers and in light of the Mississippi legislature’s directive to tighten the reimbursement methodologies for nursing facilities, DOM could not justify continuing to pay Methodist 428.128% of the newly adjusted base bed value of $91,200, since this would almost double Methodist’s property payment and allow Methodist to receive a windfall that would have paid the total cost of its facility a second time in a mere six years. This is not what the property rate is intended to do. Accordingly, DOM calculated a rate which would continue to compensate Methodist and encourage it to invest in and maintain its facility, but would not continue to provide it an unearned windfall that the other nursing facilities did not receive. This is consistent with the legislature’s removal of the language that required that nursing facilities for the severely disabled be reimbursed as a separate category of nursing facility. ¶105. Based on this information, it is clear that the DOM’s personnel decided that Methodist had been paid enough. But this “paid enough” rationale is not included in the State Plan. The State Plan formula to determine reimbursement, including SPA-015, is based on newconstruction costs and the fair-rental system, which includes a determination as to what is the value of the facility—the cost of constructing a new facility, i.e., NBV. The State Plan 41 reimbursement formula does not support the significant reduction to Methodist based on the DOM’s unilateral conclusion that Methodist has been paid enough. ¶106. The DOM presented no evidence to support the cost of new construction of an NFSD facility. Methodist offered evidence of the current construction cost for an NFSD facility. William Ware, a construction professional, was involved in the original construction of Methodist in 2004. He used industry-cost indexes to estimate that the 2015 construction cost would be $17,717,769. Ware’s testimony supported an actual NBV of $295,286 for Methodist. The DOM’s revised calculation of NBV was $91,200 x 1.75 = $159,600. Thus, the DOM’s revised calculation, based on its conclusion that Methodist had been paid enough, was about half of the actual NBV for Methodist or any other NFSD. Even the hearing officer’s NBV—the 175 percent payment add-on to $91,200 + ($91,200 x 1.75) = $250,800—would be an amount that is 85 percent of the actual NBV.7 ¶107. There is no authority for the DOM’s decision to use payment history and historical construction costs to determine the NBV-reimbursement calculation. In fact, the DOM’s rationale for the reduction in the payment add-on is because Methodist has been reimbursed most or all of its initial building costs incurred in 2004. The DOM’s rationale did not consider the cost of building a new facility. If this were a material consideration, it would (or should) be written into the State Plan, for all facilities, e.g., reduce property rate after startup costs, purchase costs, or construction costs are paid in full. Whether the amount of 7 This is the information that the Committee that consists of industry professionals could have considered. 42 historical reimbursements cover the actual facility costs is not a consideration in Medicaid reimbursement. ¶108. The DOM did not offer any evidence that this payment history versus actual facility costs was used to calculate the reimbursement rate to any other nursing facility in this state. The DOM did not use this rationale to deny the ICF/IDDs its 120 percent multiplier. Rather, that multiplier was restored. ¶109. The DOM’s position ignores that the formula for fair-rental value is intended to promote renovations and improvements to the Methodist facility. Methodist, through its reimbursement rate, must expend capital to keep the facility up-to-date and to prevent it from becoming obsolete. Daschbach testified that “a renovation is basically reducing the age of the facility, and fair rental value is based on the age of the facility. The newer the facility, the higher your property rate’s going to be because your facility is worth more money.” The DOM’s reimbursement rate to the state’s only NSFD is intended to provide sufficient capital for Methodist to renovate and upgrade its facilities to remain a state-of-the-art nursing facility for the severely disabled, and it can provide long-term care for some of Mississippi’s most vulnerable people: the victims of head and spine injuries, patients permanently attached to ventilators, quadriplegics, and others who require total and maximum assistance with most activities of daily living. ¶110. The DOM’s logic is as follows: why pay Methodist (or any other facility that has fully collected what its facility cost to build) anything less than the property payment? That is not how the fair-rental-value system is meant to work. The term “Fair Rental Value” (FRV) is 43 a calculation that compensates facilities for the use of the buildings, grounds, and equipment needed to care for Medicaid residents, explaining why the terms “fair” and “rental” are used. For example, if you have a building that is paid for and you decide to rent the building, you would set the fair-rental value, or the amount of rent, at an amount that a reasonable lessee was ready, willing, and able to pay to lease the building. To establish the rent amount, you could use the current construction costs to build a similar building. You could use comparative sales in the community to decide what a buyer may be willing to pay. Your could also use comparative rentals in the community to see what others were paying for a similar building. The mere fact that the building was paid for and you had covered actual construction or purchase costs from many years ago would not be a factor used to establish the fair-rental value. ¶111. The majority accepts the DOM’s conclusion that Methodist received a “windfall” from these property payments. Yet no facts support that conclusion. The majority states that the DOM merely seeks to analyze the property-payment data that had been collected the past ten years for the state’s only NFSD to check that the NBV adjustment that was agreed upon by the DOM and Methodist in 2004, when Methodist first opened, is adequately reimbursing the NFSD and to reevaluate the NBV adjustment rate if not. Maj. Op. ¶ 28. The DOM and the majority recognize that this was based only on the “data that had been collected.” The actual and correct data would require Methodist to provide the DOM with it’s capital costs and expenditures on the facility since 2004. To determine whether Methodist actually received a “windfall” or was “adequately reimbursed,” the DOM 44 would have to use the correct “property data,” i.e., financial information from Methodist that would show all costs of construction, all costs of improvements, all costs of renovations, all costs of additions, and all amounts that Methodist had invested in the facility. The DOM’s decision was arbitrary and capricious because neither the majority nor the DOM consider the actual or real “property data”; instead, the majority and the DOM only use the “property data” that it chose to use, knowing that such “property data” was not correct or up-to-date but was available. The State Plan only authorized the consideration of fair-rental value. If the DOM wanted to use actual “property data” then the DOM should have engaged in a discussion of the change with Methodist and asked for the actual “property data.” ¶112. The State Plan says that the reimbursement formula is to be based on “new bed value”—the “new construction value per bed.” The State Plan does not authorize the DOM to consider Methodist’s payment history versus actual construction costs. ¶113. Therefore, I am of the opinion that the DOM’s amendment to Methodist’s NBV payment add-on value was arbitrary and capricious. Methodist was held to a different standard, and there is no support for the DOM’s accusation that Methodist is gaining a “windfall.” Indeed, no evidence was presented to support the DOM’s claim that Methodist’s overall costs were being excessively reimbursed. ¶114. This is exactly the type of consideration that the Legislature instructed the DOM to undertake and to report back with its recommendations. The DOM failed to allow the Committee to consider this issue. The DOM failed to notify Methodist of this consideration and give Methodist or other industry professionals an opportunity to present information 45 about this significant issue. There can be no doubt that the DOM’s decision to make this change, at the last minute, under the cover of darkness, and without advising the state’s only NFSD of the proposed change cannot be allowed to stand. III. Whether the DOM violated state and federal laws requiring notice. A. Federal Law Requiring Public Notice ¶115. When a party asserts a lack-of-notice claim, the court should first examine the notice that was required and then compare it to the notice actually given.
¶116. The DOM was required to publish notice of the amendment to the State Plan (SPA 15-004) under the requirements of 42 C.F.R. § 447.205. Under subsection (a), DOM was required to “provide public notice of any significant proposed change in its methods and standards for setting payment rates for services.” 42 C.F.R. § 447.205(a). Under subsection (c), the notice must “[d]escribe the proposed change in methods and standards,” estimate the increase or decrease expected in annual expenditures (if any), and “[e]xplain why the agency is changing its methods and standards . . . .” 42 C.F.R. § 447.205(c).
¶117. There is no quotation or cite to any portion of DOM’s published notice. The hearing officer ruled, Methodist complains that it did not have adequate notice that its adjustment would be reduced. However, Methodist was aware that a general increase of 46 new bed values was imminent and that changes to its adjustment percentage were being considered. Notice of the change was properly published. The Notice set forth a comment period. (Exhibit 16) No comments were received. Methodist’s claim that the change was not properly noticed is without merit. The majority concludes that the notice was sufficient because “it is evident from the record that Methodist had actual knowledge that some change to their adjusted NBV was imminent. . . . Methodist either knew or should have known that the manner in which Methodist’s NBV adjustment was calculated was going to change under SPA 15-004. ” Maj. Op. ¶ 48. This is correct. Methodist did have knowledge it would change. As discussed above, the simulation letter advised Methodist that its reimbursement would increase by 22.56 percent. And, the simulation letter did not indicate that there would be any change to the NBV payment add-on. ¶118. The majority then rules that “[t]he DOM’s publication of notice included all of the information it was required to address according to 42 C.F.R. § 447.205 . . . .” Maj. Op. ¶ 49. But SPA-015 does not mention the reduction of Methodist’s NBV add-on. ¶119. The hearing officer and the majority disregard the DOM’s obligation under 42 C.F.R. § 447.205(a) to “provide public notice of any significant proposed change in its methods and standards for setting payment rates for services.” (Emphasis added.) Likewise, they disregard the fact that subsection (c) required the DOM to “[d]escribe the proposed change in methods and standards,” estimate the increase or decrease expected in annual expenditures (if any), and “[e]xplain why the agency is changing its methods and standards.” ¶120. The change in Methodist’s NBV calculation that reduced the payment add-on from 47 328.178 percent to a 175 percent multiplier was significant. In fact, at the hearing, Medicaid’s counsel conceded that the change “does drop their property rate. It drops it from $67 to roughly $29. It’s a significant drop. There’s no question about that.” Despite this, the published notice did not give any reason for Methodist or anyone else to expect a reduction in new-bed value for the state’s only NFSD. ¶121. If we consider what Methodist actually knew or should have known, instead of what the DOM failed to include in the actual notice, we must consider additional facts. Neither the hearing officer, the chancellor, nor the majority cite any evidence to support the conclusion that Methodist had actual knowledge. ¶122. The Committee met and discussed possible draft plans. Shane Hariel, a Certified Public Accountant specializing in healthcare reimbursement, attended the Committee’s meetings on behalf of the Mississippi Health Care Association and chaired the cost subcommittee, which focused on the issue of the new-bed value. He testified that the subcommittee proposed to raise the new-bed value to a realistic market amount and to compensate for this increase by lowering the rate of return on the new-bed value as well as reducing a factor separate from the property payment (the “return on equity payment”). He also testified that the discussion was focused on conventional nursing homes and their construction costs for new beds, not on Methodist’s specialized facility, which Hariel did not recall having even been mentioned in that context. Hariel also testified that he did not recall that anyone from Medicaid ever discussed a change to the NBV payment add-on for Methodist. 48 ¶123. There is simply no evidence to support the majority’s conclusion that “[n]otice of the change was properly published.” Neither the DOM, the hearing officer, the chancellor, nor the majority cites any evidence in the record. Despite this lack of evidence, the chancellor’s order stated, “The published notice [of December 14, 2014,] disclosed the 175% multiplier challenged by Methodist in this appeal.” This is not correct. ¶124. Further, as the majority recognizes the facts support the conclusion that the DOM decided to make this change just before the amendment was filed. Certainly, Methodist cannot have actual or constructive notice of any change that the DOM decided to make just before it was submitted. ¶125. I am of the opinion that the DOM failed to provide the proper public notice. I respectfully dissent from the majority’s conclusion that notice was adequate. B. State Law Requiring Public Notice ¶126. Because the earlier sections indicate my primary reasons to dissent, I do not believe it is necessary to address this issue. But I believe this issue presents a question that needs to be resolved. Is the DOM required to comply with Mississippi’s Administrative Procedures Law? The majority says no; I say yes. ¶127. The Legislature expressly declared the public policy of this State as to Medicaid: “The division is an agency as defined under Section 25-43-3 and, therefore, must comply in all respects with the Administrative Procedures Law, Section 25-43-1 et seq.” Miss. Code. Ann. § 43-13-137 (Rev. 2015). Under Mississippi Code Section 25-43-3.103 (Rev. 2018), a state 49 agency is required to provide its proposed rule changes to the Mississippi Secretary of State’s office so that the public can be notified. The record reflects that the DOM did not file its proposed rule changes with the Secretary of State. ¶128. The DOM argues that the State Plan is not a “rule” under the Mississippi Administrative Procedures Act but is instead a contract between Mississippi and the federal government. Section 25-43-1.102(i) defines a “rule” as “the whole or a part of an agency regulation or other statement of general applicability that implements, interprets or prescribes . . . [l]aw or policy, or . . . [t]he organization, procedure or practice requirements of an agency.” Miss. Code Ann. § 25-43-1.102(i) (Rev. 2018). The term “includes the amendment, repeal or suspension of an existing rule.” Id. ¶129. The State Plan implements, interprets, and prescribes the law and policy of Medicaid reimbursement to providers, and SPA 15-004 amended the previous rule regarding the calculation of NBV for Methodist. Additionally, Section 25-43-1.102(i) has an exception for any “compact or agreement between an agency of this state and one or more agencies of another state or states,” but it does not include an exception for an agreement between a state agency and a federal agency. Clearly the Legislature knows how to describe which agreements are or are not rules, and it did not choose to define “rule” to include state-federal compacts. ¶130. Either the State Plan is a rule or is not. Recently, in Mississippi Division of Medicaid v. Windsor Place Nursing Center, Inc., I noted, “The majority finds no significance that the DOM determined it was necessary to amend the State Plan and the Instructions. The DOM 50 followed the Administrative Procedures Act and the amendments became effective on May 12, 2009.” Miss. Div. of Medicaid v. Windsor Place Nursing Ctr., Inc., No. 2018-SA-01263-SCT, 2020 WL 2487330, at  (Miss. May 14, 2020) (Griffis, J., dissenting) (emphasis added). In that case, the DOM decided the amendments should be submitted under the Administrative Procedures Law. ¶131. Here, the record shows that while the DOM determined it was necessary to amend the State Plan, it did not follow the Administrative Procedures Law. Accordingly, I respectfully dissent from the majority’s opinion and find that the DOM failed to give proper notice as required by the Administrative Procedures Law. ¶132. For these reasons, I respectfully dissent. 51