Opinion ID: 4514777
Heading Depth: 3
Heading Rank: 4

Heading: Attachment 4.19-A, Section VI

Text: ¶64. The DOM’s refusal to correct undisputed errors in its rate recalculation must also be viewed under Section VI of Attachment 4.19-A, which provides, Inpatient hospital providers who disagree with an adjustment to their allowable cost or a calculation in the rate setting information may file an appeal with [the DOM]. The following reasons would be grounds to file an appeal with the [the DOM, including]. . . [i]ncorrect data were used or an error made in the rate calculation. (Emphasis added.) ¶65. Section VI of the Plan expressly authorized CMMC to appeal adjustments in its allowable costs or the calculation of its inpatient rate when “incorrect data [was] used or an error made in the rate calculation.” This broad right of appeal contradicts the majority’s conclusion that the DOM cannot correct errors used in its own rate calculations. If such is the case, the majority has erased from the Plan a hospital’s right of appeal. Such cannot be the case. ¶66. For these reasons, I respectfully dissent. I am of the opinion that the decision of the DOM and the chancellor was clearly erroneous, arbitrary, and capricious. Further, the 29 decision of the DOM and the chancellor violated the clear language of the Plan. I would reverse the chancellor’s judgment and remand this case with instructions for the chancellor to consider how the incorrect data affected CMMC’s Medicaid reimbursement and to calculate the reimbursement rate using the correct data. COLEMAN, J., JOINS THIS OPINION. 30