Opinion ID: 454901
Heading Depth: 1
Heading Rank: 4

Heading: the responsibility of local governments for providing

Text: PUBLIC EDUCATION 20 The PRRB also determined that the costs of the educational services are not reimbursable because local school districts, not the providers, are responsible for furnishing public education. According to the Secretary, Brown v. Board of Education, 347 U.S. 483, 74 S.Ct. 686, 98 L.Ed. 873 (1954), and its progeny delineate a federal policy of exclusive state and local government responsibility for public education and thus preclude the imposition of the costs of providing these services on the Medicare system. 4 This argument is erroneous for several reasons. First, it begs the question because it assumes that the services provided by Vista Hill are simply education of the sort at issue in Brown. The Secretary gives us no indication why the local school districts should be deemed responsible for providing the educational treatment at issue here and, in fact, conceded during oral argument that if the education programs constitute medically necessary services, the costs of those programs would qualify as routine costs reimbursable under Medicare. 21 If we were to accept the Secretary's argument, we would be forced to conclude that local school districts are responsible for all necessary medical costs incidental to providing education for psychiatrically hospitalized children, although the determination of when local school districts must bear these costs and what services they must provide is made by the treating hospitals and physicians. The Secretary offers no statutory or other authority for this proposition. In the absence of persuasive authority we would be reluctant to reach a conclusion that would have so significant an impact upon local government. 5 22 Moreover, the uncontroverted evidence in the record indicates that neither the states nor the local school districts are in fact providing the medically related educational programs at issue here. If the states and local school districts did in fact provide these services, Medicare reimbursement would be precluded whether or not they were required to do so. See 42 U.S.C. Sec. 1395y(a)(3) (1982); 42 C.F.R. Sec. 405.312 (1984). Providers may not receive payment for services furnished by a governmental entity. In contrast, there does not seem to be any statutory or other authority for the proposition that if local school districts are responsible for providing these services, but fail to live up to their responsibility, the services are not reimbursable under Medicare. 6 23 Vista Hill concedes that the state and local school districts do, in fact, assist in the provision of educational services by supplying some teachers and some materials. However, Vista Hill seeks Medicare reimbursement only for those portions of the educational treatment expenses that it incurs as a result of its provision of services over and above those provided by the local school districts. Vista Hill does not seek reimbursement for the salaries of teachers or the cost of materials that are provided by the school districts. It asks merely that Medicare assume its share of the costs of, for example, (1) the specially trained teachers that the school districts do not supply, (2) the personnel necessary to provide educational services over the summer when public schools do not function, and (3) the specialized facilities and supplies that are not made available by the public school districts. The fact that states and local school districts provide certain components of the medically necessary educational services to the young Vista Hill patients has no bearing whatsoever on Medicare's obligation to bear its share of the cost of the other components. 24 There is no legal basis for the PRRB's conclusion that reimbursement for the educational services at issue is barred because it is the responsibility of local school districts to provide the services. To the extent that the Board's determination is based on that conclusion, we find it to be contrary to law. Accordingly, we cannot affirm the PRRB's denial of reimbursement on the second ground on which it relied in reaching its decision.