Casey Ball Supports Coordination, LLC v. Department of Human Services
160 A.3d 278
| Pa. Commw. Ct. | 2017Background
- Casey Ball Supports Coordination, LLC (Petitioner) operated as a Supports Coordination Agency (SCA) under Pennsylvania’s Adult Autism Waiver beginning April 2013 and used HCSIS to document services.
- In October 2013 BAS inspected Petitioner and found missing/insufficient service notes; BAS and Petitioner met January 7, 2014, and BAS issued a Corrective Action Plan (CAP) on January 16, 2014.
- The CAP required Petitioner to amend 247 service notes, return revisions in an Excel file, and enter the amended notes into HCSIS; the deadline was extended to April 30, 2014.
- Petitioner provided the amended notes in Excel by the deadline but did not complete entering them into HCSIS until July 2014.
- Petitioner’s application to enroll as a Supports Coordination Organization (SCO) for the Consolidated and P/FDS Waiver Programs was denied August 25, 2014 due to noncompliance with Chapter 51 regulations and failure to comply with BAS’s CAP.
- An ALJ and the BHA upheld the denial; on appeal to the Commonwealth Court the court affirmed, finding strict regulatory compliance required and that the Department did not abuse its discretion in denying enrollment.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Petitioner substantially complied with BAS’s CAP by submitting amended notes in Excel though not entering them into HCSIS by the CAP deadline | Ball: Substantial performance satisfied CAP; Excel submission met CAP’s purpose of remediating note specificity | DHS: CAP enforcement is regulatory, not contractual; strict compliance (including HCSIS entry) was required | Held: Substantial compliance inapplicable to regulatory CAP; strict compliance required and Petitioner failed to comply |
| Whether the delay in HCSIS entry was a nonmaterial or inadvertent violation that should not bar SCO enrollment | Ball: Delay was immaterial; BAS received all information and suffered no prejudice; equitable relief warranted | DHS: Noncompliance with regulatory CAP supports discretionary denial of enrollment; protections and attestations require full compliance | Held: Delay was material in regulatory context; Department properly exercised discretion to deny enrollment |
| Whether the CAP is a contractual obligation subject to materiality tests (Restatement §241) | Ball: CAP should be assessed under contract principles; any breach was nonmaterial | DHS: CAP stems from statutory/regulatory authority and is not a private contract; contract tests inapplicable | Held: CAP is regulatory; contract principles do not govern, and result would be same even if applied |
| Whether DHS abused discretion or acted in bad faith by denying admission to Waiver Programs | Ball: Denial was unjust forfeiture given subsequent cure and lack of prejudice | DHS: Denial within broad regulatory discretion to refuse provider enrollment; no bad faith shown | Held: No abuse of discretion or bad faith; denial affirmed |
Key Cases Cited
- State College Manor, Ltd. v. Department of Public Welfare, 498 A.2d 996 (Pa. Cmwlth. 1985) (substantial performance doctrine does not excuse noncompliance with substantive regulations)
- Stanton-Negley Drug Co. v. Dep’t of Pub. Welfare, 943 A.2d 377 (Pa. Cmwlth. 2008) (prospective providers have no property interest or entitlement to participate in MA program)
- Cambria Cnty. Home and Hosp. v. Dep’t of Pub. Welfare, 907 A.2d 661 (Pa. Cmwlth. 2006) (standard of review for BHA appeals: substantial evidence, legal correctness, constitutional violation)