Gargano v. Lee Alan Bryant Health Care Facilities, Inc.
2012 Ind. App. LEXIS 273
| Ind. Ct. App. | 2012Background
- FSSA administers RCAP, which provides room, board, and minimal supervision to eligible residents who cannot live at home.
- RCAP eligibility requires Medicaid or SSI, impairment, and cost-structure below licensed facilities, with forbidden asset transfers.
- Prior to 2003, RCAP reimbursement was facility-specific; in April 2003 a uniform per-diem rate was adopted, later raised to $49.35.
- Budget pressures led the State Budget Agency to direct reserves and cuts; in 2009 RCAP announced a moratorium on new applications starting December 1, 2009.
- After the moratorium, several RCAP applications were denied; Providers sued for declaratory and injunctive relief claiming unlawful suspension and improper rate setting.
- Trial court entered judgment in favor of Appellees; held the moratorium unlawful and calculated damages and improper rate, prompting appellate review.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the December 1, 2009 moratorium violated separation of powers | Bryant contends courts may enforce RCAP mandates. | Gargano argues agency budget discretion controls funding decisions. | Moratorium not unlawful; agency may limit admissions within appropriation. |
| Whether RCAP reimbursement rates from 2003-2009 were unlawful | Providers claim rates must be based on actual costs with growth factors. | Rates may be set by agency rules, including upper limits, without identical cost-basis. | Rates not unlawful; remand for consistency with statutory framework. |
Key Cases Cited
- Lee Alan Bryant Health Care Facilities, Inc. v. Hamilton, 788 N.E.2d 495 (Ind.Ct.App. 2003) (agency discretion in RCAP funding within statutory framework)
- Center Tp. of Marion Cnty. v. Coe, 572 N.E.2d 1350 (Ind.Ct.App. 1991) (statutory requirements do not automatically mandate benefits; process governs)
- Ballew v. Town of Clarksville, 683 N.E.2d 636 (Ind.Ct.App. 1997) (standard for reviewing administrative decisions; credibility not reweighed)
- Guardianship of Phillips, 926 N.E.2d 1103 (Ind.Ct.App. 2010) (foundations for review of factual findings and de novo legal review)
- M.K. Plastics Corp. v. Rossi, 838 N.E.2d 1068 (Ind.Ct.App. 2005) (standard of review and interpretation of statutes)
- Shriner v. Sheehan, 773 N.E.2d 833 (Ind.Ct.App. 2002) (statutory interpretation and deference to legislative language)
- Elmer Buchta Trucking, Inc. v. Stanley, 744 N.E.2d 939 (Ind. 2001) (statutory meaning and legislative intent in interpretation)
- Cook v. Atlanta, Ind. Town Council, 956 N.E.2d 1176 (Ind.Ct.App. 2011) (statutory interpretation and plain meaning rule)
- Bol in v. Wingert, 764 N.E.2d 201 (Ind.Ct.App. 2002) (reaffirmation of statutory interpretation principles)
- St. Vincent Hosp. and Health Care Ctr., Inc. v. Steele, 766 N.E.2d 699 (Ind. 2002) (interpretation of health care-related statutory provisions)