Court Opinion

ID: 9656154
Source: CourtListenerOpinion
Date Created: 2023-08-23 19:40:18.810236+00
Date Added: 2024-06-11T18:13:29.437771
License: Public Domain

*508ANDERSON, Paul H., Justice
(dissenting).
I respectfully dissent. For the reasons set forth below, I conclude that the Department of Human Service’s (DHS) “not-to-exceed-claims-paid” policy1 as applied to Benedictine comports with the plain meaning of Rule 50. Therefore, the policy is not an interpretive rule that must be promulgated under the Minnesota Administrative Procedure Act, Minn.Stat. ch. 14 (2006) (MAPA). See Cable Communications Bd. v. Nor-West Cable Communications P’Ship, 356 N.W.2d 65.8, 667 (Minn.1984) (“[If an] agency’s interpretation of a rule corresponds with [the rule’s] plain meaning * * * the agency is not deemed to have promulgated a new rule.”). Further, I conclude that the record shows that Benedictine Health System (BHS) has the legal right to use funds in the plan account at its sole discretion. Because BHS has this legal right, Benedictine’s payments to the plan account are essentially payments to a corporate affiliate — BHS. Accordingly, under Rule 50, Benedictine does not incur any medical insurance costs until BHS is liable to a third party for medical or other insurance-related services rendered. Therefore, unlike the majority, I would affirm the court of appeals.

Points of Agreement

While I reach a different conclusion from the majority as to the meaning of Rule 50 and its application to this case, I agree with several aspects of the majority’s analysis. First, I agree that we review the meaning of regulatory language de novo, and when the plain meaning of a regulation is clear, we do not defer to an agency’s interpretation of that regulation. St. Otto’s Home v. Minnesota Dept. of Human Services, 437 N.W.2d 35, 39-40 (Minn.1989) (citation omitted). I also agree that only those costs which are actually “incurred” are allowable historical operating costs, and that under generally accepted accounting principles, a cost is incurred when a liability arises, rather than when an expense is disbursed. See Minn. R. 9549.0020, subp. 25 (2005) (defining “historical operating costs” as “costs incurred”); Minn. R. 9549.0041, subp. 6 (2005) (stating that the accrual method of accounting in accordance with generally accepted accounting principles must be used by facilities in satisfying reporting requirements); Black’s Law Dictionary 20 (8th ed.1999) (stating that under the accrual method of accounting, costs are incurred “when the liability arises, rather than when the * * * expense is * * * disbursed”).
Along with the majority, I conclude that determining when a cost is “incurred” is only one of the tasks we must complete in order to resolve the matter before us. This is so because the parties’ arguments implicate Rule '50’s related organization provision, Minn. R. 9549.0035, subp. 7 (2005).2 I agree that in light of the related organization provision, the critical question *509we must answer is whether Benedictine’s payments to the plan account are more properly characterized as payments to an unrelated organization — CC Systems Corporation (CCS) — or payments to a corporate affiliate — BHS. Our answer to this question is critical because when a nursing facility pays an unrelated organization for a service such as group medical insurance, the facility incurs a cost at the time payment is made. But when a nursing facility pays a corporate affiliate for a service, the facility incurs a cost when and to the extent that the affiliate incurs a cost. Finally, I agree with the majority that when answering the foregoing question, we must view the evidence in the light most favorable to Benedictine, because Benedictine appeals from a grant of summary disposition in favor of DHS.

Points of Divergence

I disagree with the majority on how we determine whether Benedictine’s payments to the plan account are more properly characterized as payments to CCS or to BHS. I conclude that in order to make this determination, we must focus on the extent of the legal right of BHS, Benedictine’s corporate affiliate, to access and use plan account funds. This focus diverges from the majority’s approach, which is to ask which entity, CCS or BHS, “controls and administers” the plan and plan account. The “controls and administers” language comes from DHS, which stated in its response to Benedictine’s appeal that payments into a “fund reserve” would be “allowable if, among other conditions, the fund [were] controlled and administered by an unrelated party.” But “controls and administers” is an imprecise phrase that tends to obscure the relevant policy concern underlying Rule 50 — that is, that reimbursement rates reflect historical operating costs that correspond to actual liabilities. Actual liabilities necessarily involve the accountability of one party to another. See Black’s Law Dictionary 925 (8th ed.1999) (defining liability as “legal responsibility to another or to society”). Therefore, the proper focus is on whether BHS, as a corporate affiliate of Benedictine, is legally accountable to a party other than itself with regard to its use of plan account funds.
If BHS has the legal right to use plan account funds at its sole discretion, it logically follows that (1) Benedictine’s payments to the plan account are fairly characterized as payments to BHS; and (2) BHS suffers no liability for medical insurance costs until a medical or other insurance-related service is provided and a third party has a corresponding right to payment. Under this analytical framework, Benedictine, as a corporate affiliate of BHS, would not incur the costs of payments it makes to the plan account. Rather, Benedictine would incur the costs that correspond to the enforceable claims of third parties.
When I apply the foregoing framework to the facts of this case, I conclude that even when the evidence is viewed in the light most favorable to Benedictine, BHS has the legal right to use the plan account funds at its sole discretion. First, nothing in the contract between BHS and CCS prohibits BHS from accessing and using the plan account funds for any purpose BHS deems appropriate. Rather, the contract authorizes CCS to exercise day-today management of the plan account funds and to write checks from the account to pay approved claims. It is apparently true that in order to fulfill its duties under the contract, CCS holds all the checks for the plan account. But none of the foregoing facts takes away from BHS’s legal right to use the plan account funds at its sole discretion, should it choose to do so. Nor does the existence of a BHS corporate *510policy take away from BHS’s legal right in this regard, given that under such a policy, BHS is accountable only to itself and can change its policy at will. Finally, I note that the plan account here is neither governed by ERISA nor established in conjunction with a trust, such that BHS’s legal right to use the plan account funds would be subject to legally enforceable constraints.
In sum, I would hold that under the plain meaning of Rule 50 as a whole, if a corporate affiliate of a self-insuring nursing facility has the legal right to use the funds deposited in a self-insurance plan account at the affiliate’s sole discretion, then (1) the nursing facility’s payments to the plan account are essentially payments to its corporate affiliate; and (2) the nursing facility does not incur any allowable operating costs for group medical insurance until its corporate affiliate is itself liable to third parties for medical or other insurance-related services rendered. Accordingly, I would further hold that the Department of Human Service’s policy of disallowing a nursing facility’s payments into a self-insurance plan account under the facts and circumstances of this ease comports with the plain meaning of Rule 50 and therefore is not an unpromulgated rule under MAPA.3

. While the policy at issue may more accurately be termed a "not-to-exceed-claims-submitted” policy for the reason the majority states in footnote 1 of its opinion, I have adopted the majority's "not-to-exceed-claims-paid” terminology for the purposes of consistency.

. Under Minn. R. 9549.0035, subp. 7, costs attributable to services that are directly or indirectly provided to a nursing facility by any related organization are allowable “at the cost incurred by the related organization for the provision of [those] services.’’ It is undisputed that Benedictine and BHS are corporate affiliates and are therefore related organizations under Minn. R. 9549.0020, subp. 38 (2005).

. In support of its conclusion that DHS's "not-to-exceed-claims-paid” policy as applied to Benedictine contravenes the plain meaning of Rule 50, the majority notes that this policy may contradict DHS's "not-to-exceed-premiums” policy regarding self-insurance. I do not see any contradiction between DHS's not-to-exceed-claims-paid policy as applied in cases such as this one, and DHS’s not-to-exceed-premiums policy. A facility that wishes to reduce its health insurance costs by self-insuring is free to do so and to be reimbursed by DHS for the facility’s payments to a plan account — provided the facility establishes its plan and plan account appropriately. Specifically, DHS’s policies are easily reconcilable as long as the funds in a self-insurance plan account are subject to legally enforceable constraints on the rights of the facility and any related organization(s) to use the funds at their sole discretion.