2020 Ohio 3426
Ohio Ct. App.2020Background
- Peregrine Health Services (two nursing facilities) sought critical-access incentive payments for SFY 2017 under R.C. 5165.15 and 5165.23; ODM denied the payments and denied reconsideration.
- The statutory incentive is a 5% increase to a facility's total per-Medicaid-day rate if the facility meets R.C. 5165.23(A) criteria, including an occupancy rate ≥ 85% as of the last day of the calendar year preceding the fiscal year.
- The sole dispute: how to compute “occupancy rate” — denominator of the occupancy fraction — using (a) licensed beds (ODM’s position) or (b) Medicaid-certified beds actually available/used (Peregrine’s position).
- Peregrine filed a mandamus petition after administrative reconsideration was unavailable by statute; trial was held on an undisputed record.
- The trial court found R.C. 5165.23(A)(2) ambiguous, deferred to ODM’s interpretation (use licensed beds), and denied the writ; the Tenth District affirmed, applying de novo statutory review but deferring to a reasonable agency construction.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether "occupancy rate" in R.C. 5165.23(A)(2) must use Medicaid-certified beds (denominator) rather than licensed beds | Peregrine: "occupancy rate" should be calculated using actual Medicaid-certified beds in service; using licensed beds improperly depresses the rate and thwarts the statute's access purpose | ODM: statute is silent; agency reasonably uses total licensed bed capacity to avoid manipulation and to apply a consistent formula across Chapter 5165 | Court: statute ambiguous; agency reasonably filled the gap by using licensed beds; deference owed to ODM; mandamus denied |
Key Cases Cited
- In re Champaign Wind, L.L.C., 146 Ohio St.3d 489 (2016) (where statute lacks a prescribed methodology, the implementing agency has broad discretion to select a reasonable method)
- State ex rel. Clark v. Great Lakes Constr. Co., 99 Ohio St.3d 320 (2003) (agency statutory interpretation will not be overturned unless unreasonable)
- State ex rel. Cydrus v. Ohio Pub. Emps. Ret. Sys., 127 Ohio St.3d 257 (2010) (mandamus appropriate where no statutory administrative appeal)
- Northwestern Ohio Bldg. & Constr. Trades Council v. Conrad, 92 Ohio St.3d 282 (2001) (agency authority to formulate policy and fill legislative gaps inherent in administering statutory programs)
- State ex rel. Berger v. McMonagle, 6 Ohio St.3d 28 (1983) (elements required to obtain mandamus)
- Regions Hosp. v. Shalala, 522 U.S. 448 (1998) (administrative construction controls if reasonable and fills legislative gaps)
- State v. Cook, 128 Ohio St.3d 120 (2010) (statutes in pari materia should be construed together)