Opinion ID: 672843
Heading Depth: 3
Heading Rank: 3

Heading: Purpose and Precedent

Text: 29 Perhaps the most convincing argument in favor of choosing the Secretary's reading over that urged by HCA is the preservation of the Medicare Statute's 180-day limitation on reviewing an intermediary's determination of total program reimbursement. Under 42 U.S.C. Sec. 1395oo (a)(3) a provider must present its challenge of the intermediary's original NPR to the Board within 180 days of notice of the NPR. If a provider permits that deadline to lapse, the Statute envisions no further appeal of the intermediary's decision. Nonetheless, HCA urges us to allow an appeal to matters not addressed since the original NPR, despite the fact that the 180-day period to appeal the initial NPR has long since passed. HCA contends that the Secretary must ignore the statutory appeals deadline solely because certain aspects of the NPR have been reopened. We reject that position. To subscribe to HCA's argument truly would frustrate the congressional purpose, plainly evidenced in [the statute], to impose a [time] limitation upon ... review. Califano v. Sanders, 430 U.S. 99, 108, 97 S.Ct. 980, 986, 51 L.Ed.2d 192 (1977). To paraphrase the Califano Court here: Congress' determination so to limit judicial review to the original decision denying [a greater amount of total program reimbursement] is a policy choice obviously designed to forestall repetitive or belated litigation of stale eligibility claims. Our duty [and the Secretary's], of course, is to respect that choice. Id. By preserving the 180-day limitation on appeals from the intermediary's original NPR, the Secretary's reading becomes particularly persuasive. Largely for this reason, this issue-specific reading of appeals rights after reopening has been upheld by a number of courts. See, e.g., Albert Einstein Medical Ctr. v. Sullivan, 830 F.Supp. 846 (E.D.Pa.1992), aff'd, 6 F.3d 778 (3d Cir.1993); Delaware County Memorial Hosp. v. Sullivan, 836 F.Supp. 238 (E.D.Pa.1991); French Hosp. Medical Ctr. v. Shalala, 841 F.Supp. 1468 (N.D.Cal.1993). But see Minnesota Hosp. Ass'n v. Bowen, 703 F.Supp. 780 (D.Minn.1988). In dicta we, too, have looked favorably upon the issue-specific nature of post-reopening appeals under the Secretary's regulations. See Saint Mary of Nazareth Hosp. Ctr. v. Schweiker, 741 F.2d 1447, 1449 (D.C.Cir.1984); Athens Community Hosp. v. Schweiker, 743 F.2d 1, 7-8 (D.C.Cir.1984). 4 As the Supreme Court said in Good Samaritan Hosp. v. Shalala, --- U.S. ----, 113 S.Ct. 2151, 124 L.Ed.2d 368 (1993), [w]e should be especially reluctant to reject the agency's current view which, as we see it, so closely fits 'the design of the statute as a whole and ... its object and policy.'  Id. at ----, 113 S.Ct. at 2161 (quoting Crandon v. United States, 494 U.S. 152, 158, 110 S.Ct. 997, 1001, 108 L.Ed.2d 132 (1990)). 30 We must also reject petitioner's reliance on the Seventh Circuit's holding in Edgewater Hospital, Inc. v. Bowen, 857 F.2d 1123 (7th Cir.), modified, 866 F.2d 228 (1988). In that case a provider had petitioned the intermediary to reopen the NPR with regard to four cost items, one of which was ultimately revised. The court held that the Board had jurisdiction to review not only the modified cost item, but also the other three, because the decision not to modify the other three was itself ... a reconsideration. 857 F.2d at 1135. We need not decide today whether a cost item must be modified on reopening or need only be reconsidered on reopening in order to become appealable to the Board. In contrast to Edgewater, here none of the issues for which HCA now demands expanded Board review were reconsidered on reopening. The reopening here was initiated solely by the intermediary and the intermediary's notices of reopening made no reference whatsoever to the cost items which the provider now wishes to add to its hearing before the Board. 31 Finally, HCA can find no refuge in the agency adjudications it cites. To be sure, a 1973 agency letter proclaimed that [t]he provider may raise any issue with regard to the cost report in the hearing even though a particular issue was not dealt with in the reopening. Department of Health, Education, and Welfare, Social Security Administration, Part A Intermediary Letter No. 73-22 (June 1973), reprinted in Addendum to Appellant's Brief at 17. But this decision predates the creation of the Board and addresses hearings before an intermediary hearing officer--not hearings before the Board. Similarly, the Secretary's current position on the issue-specific nature of reopening appeals is not foreclosed by the HCFA Administrator's decision in St. Mary's Hospital v. Blue Cross/Blue Shield Association, HCFA Administrator Decision (May 19, 1983) (review of Board decision No. 82-71), reprinted in Addendum to Appellant's Brief at 18. In that case the Board had combined a provider's regular appeal from an NPR for one fiscal year with an appeal from the reopening of a cost item for the prior fiscal year. Before the scheduled hearing, the provider sought to expand its appeal from the reopening to include an additional cost item that had not been the subject of reopening. The added cost item involved the same category of costs that the provider was challenging in its regular appeal with regard to the later fiscal year. The Board denied the request to expand the reopening appeal on the basis that the disputed cost item had not been revisited since issuance of the original NPR and that time to appeal determinations settled in the original NPR had run out. The HCFA Administrator reversed. Drawing on 42 C.F.R. Sec. 405.1841(a) and 42 U.S.C. Sec. 1395oo (d), the Administrator concluded that when an intermediary reopens an NPR it is the cost year that is open and not the individual issue. Id. at 3, Addendum to Appellant's Brief at 20. The Administrator noted that a provider may have decided that the legal expense of appealing the [original NPR] outweighed the benefits of an appeal[, but that] with additional amounts in dispute from a revised NPR, an appeal may appear prudent to a provider. Id. at 4, Addendum to Appellant's Brief at 21. In addition, however, the Administrator specifically noted that the disputed cost item at issue in that case could not have been appealed from the original NPR because it did not satisfy the $10,000 jurisdictional threshold. Id. Moreover, since that cost item was already before the Board on another cost year the Administrator found that the facts in this case should not cause any surprise or administrative inconvenience. Id. Finally, the Administrator warned: 32 In another context, the broad wording of the regulation, allowing additional issues to be added to a Board case prior to the hearing [of the reopening appeal], may have to be tempered. A party to an appeal should not be allowed to add totally unrelated issues to the appeal at the last minute. 33 Id. The rule enunciated in this decision, then, was not so broad as to settle the question we confront today. In addition to its explicit caution that rights to appeal from a reopening may have to be tempered in the future, the decision might well be limited to a scenario in which the cost item to be added to the reopening appeal could not have been appealed when the original NPR was issued because it did not satisfy the $10,000 jurisdictional threshold, a situation we do not face here. 5 34 The scope of appeals rights was clarified in a subsequent decision in which the HCFA Administrator expressly held that hearing rights before the Board challenging an intermediary's decision on reopening are issue specific: The 'separate and distinct determination' gives a right to a hearing on the matters corrected by such determination. Thus, a revised NPR does not reopen the entire cost report to appeal. It merely reopens those matters adjusted by the revised NPR. General Hospital of Everett v. Blue Cross and Blue Shield Ass'n, Medicare & Medicaid Guide (CCH) p 35,926 (HCFA Adm'r Decision May 19, 1986), reprinted in Addendum to Appellee's Brief at 27, 28. Thus, in March 1988 when HCA received notice of the intermediary's determination regarding FY 1985, the Secretary's position was clear.