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Crofton Convalescent Center, Inc. v. Department of Health & Mental Hygiene
991 A.2d 1257
Md.
2010
Check Treatment

*1 201 Moreover, that, the record granting shows addition to $1,000 PBJ to of Appellee, imposed District Court a fine ($650 of was “suspended”). which Comm’r Motor Vehi- of Lee, (1969), cles v. Md. 44 255 A.2d this made it Court ... imposition “clear that the a fine or pecuniary penalty of payable may to the State done only be if [trial court] there is a ‘conviction’which necessarily requires finding a of guilt.” Id. at A.2d at 47. We that TA therefore hold 16-812(a)(l)(i), § requires “disqualify” that the Administration Appellee driving “from a commercial motor vehicle for a period of 1 year” because-as the term “conviction” defined in the applicable state and law-Appellee federal has been § “convicted” of violation of TA 21-902. REVERSED;

JUDGMENT CASE REMANDED TO THE CIRCUIT COURT THAT THE WITH DIRECTIONS CIRCUIT COURT ENTER A JUDGMENT AFFIRMING THE THE ACTION OF MOTOR VEHICLE ADMINIS- TRATION; COURT, IN COSTS AND THE THIS IN CIR- COURT, CUIT BE TO PAID BY APPELLEE.

991 A.2d 1257 CENTER, CROFTON CONVALESCENT INC. v. HYGIENE,

DEPARTMENT OF HEALTH & MENTAL NURSING HOME APPEAL BOARD. Sept.Term,

No. 32 2008.

Court of Appeals Maryland.

April 8, 2010. probation conditions "discharge” § obtains CP under 6- 220(g). *3 (Diane Ober, Kaler, Festino L. Sollins Schmitt Howard MD), Baltimore, brief, Shriver, for Petitioner. on Grimes & Gansler, Davis, Atty. F. (Douglas Asst. Gen. Atty. Mark J. MD), Baltimore, brief, Respondent. Maryland, Gen. C.J., HARRELL, BELL, ARGUED BEFORE ADKINS, BARBERA, BATTAGLIA, GREENE, JOHN (Retired, JJ. specially assigned), C. ELDRIDGE *4 BARBERA, Judge. whether, Maryland

In the Code of this case we decide under (“COMAR”) 10.09.10.10,1 provider that a Medicaid Regulations swap agreement an interest rate payments pursuant made 10, noted, are to Title all references to COMAR 1. Unless otherwise regulations governing the Chapter Subtitle which contains federally Hygiene’s approved reim- Department of Health and Mental nursing plan for facilities. bursement can claim reimbursement of those payments as mortgage interest.

The petitioner, (“Crofton”), Crofton Convalescent Center a nursing facility certified to provide medical care through the Maryland (“Medicaid”). Medical Program Assistance Crofton entered that, into a financing arrangement through the use of an interest rate swap agreement, exchanged the variable interest rate on Crofton’s a fixed rate. Crofton then submitted the according made swap agreement (“swap payments”) mortgage inter- est for reimbursement from respondent Depart- (“DHMH”). ment of Health DHMH, and Mental Hygiene however, disallowed Crofton’s claim that paid under its swap agreement was a expense reimbursable under CO- MAR. appealed

Crofton DHMH’s decision to Nursing Home (“the Appeal Board”), Board which appeals hears from provid- ers participating Maryland’s Medicaid program, which ultimately affirmed DHMH’s decision. Crofton then peti- judicial tioned for review in the Circuit Court for Baltimore City, which reversed the Board’s decision. appeal, On panel divided held, the Court Special Appeals in unreported opinion, that the swap payments not were reim- bursable. that,

Crofton argues because the financing arrangement that included the swap agreement was incidental to refinanc- ing Crofton’s mortgage, the Court of Special Appeals erred when it determined that the swap payments were not mort- gage payments. For follow, the reasons that we hold the Board applied the proper definition of mortgage interest and that Crofton’s swap payments do not qualify as mortgage interest under that definition. therefore We affirm judgment of the Court of Special Appeals.

I. provides nursing services, other medical part, through Maryland’s (“Med- Medical Assistance Program

206 by funded ieaid”), partially program is a state which Center, Inc. v. Nursing Dep’t Liberty government. federal 941, 433, 438, A.2d 624 330 Md. Hygiene, Mental Health and in the (1993). participate [federal] a state elects 943 “When by approval for it and submits prepares program, medicaid ... a state Financing Administration Health Care the federal of medical assistance provision for the plan medicaid v. Mill- Medicaid Jackson Act[.]” the federal complies with (2002). 1034, “If the 580, stone, 575, A.2d 1037 Md. 801 qualifies then the state plan, the state approves agency federal will government the federal whereby funding, for federal the cost of the medicaid to 50% of up the state reimburse 1037. at 801 A.2d at Id. program.” by DHMH. is administered program Maryland’s Medicaid and state Pursuant to federal A.2d at 1037. Id. at nursing reimburses law, program Maryland Medicaid care, including of medical costs patient-related homes for care. See necessary patient on loans Act, §§ 1396 et 42 U.S.C.A. Security Title XIX of Social (2009 (2008); Md.Code (2006); §§ 430-456 42 C.F.R. seq. Article; the Health 15-103, §§ 15-105 of General Repl.Vol.), statutes Medicaid Maryland et The seq. 10.09.10 regulations of rules and with the promulgation DHMH charge 15-103, §§ See providers. the reimbursement govern status as Article. Crofton’s the Health General 15-105 of it to State reimburse entitles Maryland provider Medicaid DHMH. ments, are issued which partici- to a provider reimbursement DHMH denies When considers the Board Program, Medicaid Maryland’s pating arises out of present case appeal. provider’s reimburse the that DHMH request of Crofton’s Board’s denial its refinancing subsequent made Crofton mortgage.

This Case was million on Crofton’s the term $4.2 loan. To on the payment a balloon bringing due expiring, to refi- sought making payment, the balloon avoid nance mortgage through a fixed rate loan. Crofton con- *6 bids, (“the sidered several including a bid from M & T Bank Bank”) for a loan with a 6.55% fixed Seeking interest rate.2 rate, an even lower Crofton entered negotiations with the Bank, produced which then a financing package that consisted of a million term loan with an interest rate of $4.2 LIBOR3 $500,000 plus percent, one a term loan at an interest rate of plus LIBOR one a percent, “swap agreement” trading the variable interest rate on the two term loans for a fixed interest rate of 5.5% based amount,” on a million “notional both of $4.7 quoted which terms we next explain. basic, vanilla,”

A “plain swap agreement “is a contract between two ... parties, exchange to or ‘swap’ cash flows at intervals, specified by calculated reference to a particular rate or Ward, index.” See S. Lawrence Bryan Polk & M. A Guide to the “Regulatory No Man’s Land” Over-The-Counter of (2007). 397, Interest Rate 124 Swaps, Banking L.J. 399 The commonly employed swaps] “[m]ost rate [interest are fixed/floating swaps rate which the counterparty pays first intervals, designated the second at specific a amount of inter- est based on a fixed interest multiplied” by agreed rate principal Somer, amount called the “notional” amount. Stuart A Survey & Legal Regulatory Issues Relevant to Interest of (1992). 4 Swaps,

Rate DePaul Bus. L.J. 387 Concurrent- ly, the second counterparty pays the first counterparty based floating rate, LIBOR, on a such as applied to the notional amount. Id. The notional amount is used to solely calculate the interest exchanged is not between parties. Thrifty Oil Co. v. Bank America Nat’l Trust of Ass’n, (9th Cir.2002) and Sav. 310 F.3d (adopting (S.D.Cal.2000)), 249 B.R. 537 modified, Thrifty Oil Co. v. Bank financing, 2. At the time of the the fixed rate offer loan came from First National subsequently bought Bank. M & T Bank a successor to First National Bank. Rate, 3. LIBOR stands for London Interbank Offered "a well-known measuring index in the financial markets interest rates.” First Citizens Co., (7th Nat’l Bank Princeton v. Cincinnati Ins. 200 F.3d of Cir.2000). Ass’n, 1039, 1043 322 F.3d Trust and Sav. America Nat’l issue). Cir.2003) en- (9th counsel fee (addressing fluctuations interest rate hedge against a party ables to of one debt instrument streams exchanging payment “interest are the same another, obligations debt where both for those Somer, at 387. supra amount.” Co., Court of of the Ninth Circuit panel a Thrifty Oil rate five-year hypothetical Appeals explained A and B: Counterparties between (1) interest rate pay floating A Counterparty agrees (2) ...; agrees B Counter-party [sic] to LIBOR equal (3) rate; base counterparties both a 10% fixed interest pay agree notional amount and a million their on $1 upon If is 9% com- semiannually. LIBOR make payments *7 B period, Counterparty payment of the first mencement =(.5) H $1 H $5,000. (10%-9%) These million A: pay must every and continue as LIBOR fluctuates payments vary net rise, If of the interest rates swap. for the term six months B, im- payor, the fixed-rate Counterparty the of position For it receives increase. the proves because of the next beginning to 11% at the if LIBOR rises example, B payment receives net Counterparty payment period, A, $5,000 position Counterparty the Conversely, from A. when interest rates fall. improves floating-rate payor, the value under position positive The retains party whose nega- money’ party ‘in while a with considered swap is money.’ tive value is considered ‘out 1191-92. 310 F.3d at documented a confirma- swaps typically rate are

Interest The master Id. at 1192. agreement. and a master tion by agreement prepared a standard form is often (“ISDA”). Association Swaps International and Derivatives swap case, the Bank memorialized In Crofton and Id. this by separate agreement accompanied master an ISDA Pursuant to amortization schedule.4 confirmation and swap amount 'amortizing' rate is a whose notional "An 4. Co., Thrifty during Oil specified intervals its term.” declines at refinance its agreed to Crofton financing package, plus rate of LIBOR variable interest a term loan with a with the Bank rate with the variable one and then percent period, relevant time During the a fixed rate of 5.5%. 5.5%, and thus however, rates were below the variable interest pay swap agreement required was under Crofton rate plus percent If the LIBOR one the Bank. difference to 5.5%, paid have the variable Crofton would had been above amounts, have reimbursed and the Bank would rate loan difference, inter- effectively bringing Crofton’s for the Crofton interest rate. down to the 5.5% est back treated the accounting system, Crofton Under Crofton’s which are payments, swap payments re- 10.09.10.10.C. Crofton costs under COMAR reimbursable providers reimburse for which DHMH should ports costs (“allowed DHMH reviews costs”), year. DHMH each fiscal disallowing costs that are the costs reports adjusts regulations. laws and applicable under the not reimbursable LLP, Gunderson, to review hired Clifton DHMH adjustments. to recommend report 2002 cost Crofton’s review, determined that Crof- Clifton Gunderson Based on its for reimbursement. eligible were not ton’s the costs. DHMH disallowed Accordingly, Litigation Board, to the which referred the decision appealed Hearings for a to the Office of Administrative appeal *8 an Administrative Law evidentiary hearing before contested (“ALJ”).5 findings his recommended The ALJ issued Judge subject swap agreement was to an Crofton’s F.3d at 1193 n. 5. monthly at the same rate as the amortization schedule that declined principal owed on Crofton’s two term loans. total balance may provider challenging elect the manner 5. A a DHMH decision appeal. 10.01.09.03D. A considers the COMAR which the Board solely appeal provider may request Board consider the based that the materials; materials and an informal oral based on written on written evidentiary hearing. presented a full argument; at or based on evidence argue appeal evidentiary provider an at a full chooses to Id. When law, pay- of fact and conclusions of that the interest finding grounds ment should have been reimbursed on the that the part were of an integrated mortgage transac- tion and interest are payments allowable costs. The based, ALJ’s decision in part, following findings was on the fact:

10. A separate agreement, swap agreement, interest was into intermediary. entered with a fiscal The swap agreement required payments would convert the float- ing rate term into a fixed 5.5% interest rate. Mortgage paid by 15. Medicaid providers is reim- bursable Medicaid.

17. The part above referenced notes are of a capital total financing includes linked mortgage interest interest. 18. Generally Accepted Under Accounting Principles (“GAAP”), all of the above referenced are bank treated as interest. Board, DHMH filed exceptions with the which then held a hearing parties at which both presented arguments.6 oral

The Board accepted findings ALJ’s except above- mentioned four findings fact.7 The Board determined:

Fact 10. The parties to the loan entered into a separate agreement called an rate agreement, (swap hearing, may designate agency hearing, the Board to conduct but the Board is the ultimate administrative decision maker. See 10.01.09.06, that, (providing COMAR 10.01.09.07 when Board does hearing, hearing not conduct the officer should make recommenda- Board, decision). tions to the which issues the final exceptions findings, 6. If are made to the ALJ’s the Board will hold a hearing exceptions on the including and make the final decision find- 10.01.09.06, ings of fact and conclusions of law. 10.01.09.07. accepted background findings 7. The Board the ALJ’s factual that Crof- nursing facility part ton is a program; of the Medicaid sought mortgage, to refinance its debt with a fixed rate and the Bank and, issue, mortgage; during period offered it a variable rate at variable interest rate was below and therefore 5.5% Crofton was re- quired swap payments. to make *9 the interest Under swap agreement) interest or agreement inter- monthly exchanged parties the two swap agreement, floating or i.e., its variable exchanged est payments, 1 for a fixed interest plus of LIBOR interest rate mortgage 5.5%. rate of providers paid by Medicaid Mortgage

Fact 15. Medicaid, ceilings to certain subject reimbursable exceptions. mortgage 4.2 million dollar T Bank treats the

Fact 17. M & $500,000 agree- note as one mortgage note and the second inter- at the variable monthly payment one requiring ment sepa- as a rate. It treats the est payment. rate, requiring separate independent agreement, Principles Accounting Generally Accepted Fact 18. Under are treated (GAAP), payments referenced interest above However, reimburse- interest. under Medicaid mortgage as rules, and federal controlling, ment is not state GAAP regulations are. concluded that making findings,

After these the Board were not reim- payments swap agreement under the The Board reasoned as follows. bursable.

First, swap agreement the nature of a Board evaluated under it did not meet the payments and determined that conclusion, reaching interest. definition Maryland’s program applies the Board noted that Medicaid interest, definition of which is the federal Medicare “the for the use of borrowed funds. Interest cost incurred the cost incurred for funds bor- current indebtedness is 413.153(b)(1). 42 C.F.R. Because Crofton’s rowed!.]” amount, notional not on paid were interest on a the Board money mortgage agreement, borrowed under a qualify mortgage did not determined that the ad- Then, expressly does not noting interest. Board, on the COMAR swap payments, dress based law, see applicable Board to federal provision that directs the *10 10.09.10.29, concluded that the federal Provider Re- (“PRM”) provision addressing imbursement Manual in- swap 202.2, § terest PRM applied.8 swap payments Under and, therefore, prohibited are the Board affirmed the disallow- swap payments. ance of the petition judicial

Crofton filed a review in the Circuit Court for Baltimore City. Circuit Court reversed the decision, Board’s that the finding mortgage refinanced and the subsequent swap interest rate parts were two of an integrated effectively transaction that converted the swap payments into payments. The court there- fore found that the swap payments were costs for which Crofton was entitled to reimbursement.

DHMH to the appealed Special Court of That Appeals. court first addressed the applicable standard of review of administrative agency rejected decisions and DHMH’s conten- tion that the court should review an agency decision for Instead, “substantial evidence.” the court applied the stan- Care, dard by articulated this Court in Adventist Health Inc. Comm’n, Maryland 103, v. Health Care 392 Md. 896 A.2d 320 (2006), which directs appellate courts to defer to an agency’s interpretation of regulation plainly unless erroneous or inconsistent regulation. with the Id. at 896 A.2d at 330. Co., Then, citing Thrifty Oil 310 F.3d a bankruptcy case that examined interest swap agreements, rate the court concluded swap payments are payments not interest because do not compensate a lender for the any Further, loan of debt. underlying the court determined that the Board appropriately § PRM applied 202.2 because COMAR does not define interest and COMAR that, in provides 10.09.10.29 of any contrary absence state regulation, the regulations reimbursement should be interpret- ed in with conformity applicable federal statutes and regula- § expressly tions. PRM 202.2 denies reimbursement of guide, published by Financing 8. The PRM is a federal the Health Care Administration, that states use to determine whether costs of care will government. be reimbursed the federal re- Appeals of Special Court Accordingly, payments. though Court, holding that even the Circuit versed mortgage, the refinanced incident to made were thus, as a matter a loan and not interest on are such payments. law, mortgage interest are not Center, Inc. v. certiorari, Convalescent granted We 949 A.2d 405 Md. Hygiene, Mental Health & Dep’t of of which the order (2008), following questions, address the we have reversed: facility pursuant nursing care paid by a

1. Should securing transaction mortgage financing integrated to an be swap agreement that includes a property real commercial nature integrated to the regard without treated *11 transaction? Nat’l Trust & Sav. Bank Am. Thrifty

2. Does Oil Co. v. Cir.2002) (9th law Ass’n, Maryland establish 310 F.3d 1188 facility nursing a care paid by interest governing whether real facility’s to a that secures pursuant Maryland Medicaid interest under the property mortgage is allowable, reim- mortgage interest regulation making bursed cost?

II. in whether, of a regardless provider’s determine To agreements, and loan “integrate” tent its for reimburse mortgage treats of the term scope examine the ment we must purposes, it in COMAR. “mortgage appears interest” as that the definition argues law, a mort which defines Maryland common by is controlled follows: gage as is property by mortgage

A is secured when: loan mortgagee, to the by mortgagor or conveyed assigned subject conveyance, but legal of an absolute form like that conveyance condition which the to a or proviso upon pay- void, reconveyed, is to be or the estate become secured, with sum mortgagee principal ment to interest, certain; on day and upon nonperformance of this condition, the mortgagee’s conditional estate becomes abso- law, lute at and he may possession take thereof[.] Pence, Norwest Bank 363, 369, Minnesota v. 132 Md.App. (2000) A.2d (quoting Equitable Trust Co. v. Imbesi 249, 253-54, (1980)). 287 Md. 412 A.2d 96 Based on this definition, Crofton argues that whether the swap payments constitute mortgage interest payments under Maryland law hinges on whether the Bank could foreclose on Crofton’s property if Crofton failed to fulfill its swap payment obli- gations. Consequently, Crofton contends that because the swap agreement was secured by Crofton’s property, which was therefore subject to foreclosure upon default, Crofton’s “the interest due Swap under the Agreement was (Emphasis original). interest[.]” Crofton further argues that the Board improperly relied on guidelines PRM’s because the Board only rely should federal statutes and regulations when COMAR is silent. Crofton asserts that COMAR is not silent as to mortgage reimbursement 10.09.10.10C,9 because COMAR 10.09.10.10A,10and 10.09.10.10111explicitly refer mortgage interest and the reimbursement of interest costs associated with refinancing existing debt.

DHMH counters that COMAR does not explicitly refer to swap payments or paid pursuant agree- to a swap moreover, ment. DHMH argues, that without evidence that *12 the agency interest, intended the term mortgage as referenced provides 9. COMAR 10.09.10.10C "[t]he that final Medical Assistance per capital diem investor-operated reimbursement in and non- investor-operated (includ- [mjortgage facilities shall include ... interest).” 10.09.10.10C(3). ing bond provides COMAR "Capital 10.09.10.10A that the cost center includes 10. 10.09.10.10.A(3). ... interest[.]” provides "refinancing existing COMAR 10.09.10.101 of debt is 11. permitted as the only basis for reimbursement calculations to the extent outstanding principal remaining balance existing on the debt existing when ... [t]he debt has ballooned in accordance with 10.09.10.101(1). scheduled date reflected in the debt instrument[.]”

215 cannot COMAR swap payments, include to regulations, in the contends, DHMH swap payments. encompass construed to be accord- interpreted should be instead, 10.09.10.29, which by COMAR required to the PRM ing regulation specific of a language “Except when provides: reimburse- provide Department an intent indicates re- without Program recipients services ment for covered State financial participation, of federal availability gard applicable conformity with interpreted shall be regulations 10.09.10.29. regulations.” statutes and federal a con regulation is interpretation of agency’s An 121, Care, 896 392 Md. at Health of law. Adventist clusion Resources, 385 Md. 331; Natural Dep’t at Kushell v. A.2d (2005). reviewing when 563, 576, 186, Yet even 870 A.2d 193 conclusions, respect must appellate an court legal agency’s an Care, 392 Adventist Health in its field. expertise the agency’s Kushell, 576, A.2d 331; at 870 121, 385 Md. 896 A.2d at Md. at ap interpretation agency’s administrative at 193. “[A]n should agency administers of the statute which plication courts.” reviewing weight by considerable ordinarily given be 572, Noland, 556, 873 A.2d 386 Md. Aviation v. Maryland (2005) (internal omit and citations 1145, quotation marks 1154 Care, 120, Md. at 896 A.2d ted); Health 392 see also Adventist (“Judicial of an administrative of the decision at 330 review nar quite is proceeding quasi-judicial rendered agency “ row.”). owed to an Likewise, deal of deference is great ‘a ” regulation.’ interpretation its own agency’s administrative Care, 119-20, A.2d at 330 at 896 392 Md. Adventist Health 274, 288, King, Auth. 369 Md. Transp. v. (quoting Maryland (2002)). deference, ‘it 1246, “Despite 1254 799 A.2d agen to determine whether our always prerogative within ” Care, Health are correct.’ Adventist conclusions of law cy’s Kushell, 385 Md. at (quoting at 331 at 896 A.2d 392 Md. 193). whether Accordingly, we determine 870 A.2d at with erroneous or inconsistent “plainly are Board’s conclusions 1254 288-89, A.2d at at 799 King, 369 Md. regulation.” Noland, (internal omitted); and citations marks quotation (“[A] court reviewing n. A.2d at 1156 at 574 n. Md. *13 216

must if determine the administrative decision is premised upon (internal an erroneous conclusion of law.” quotation omitted)). marks and citations

Although keep we in mind the weight considerable afforded an agency’s interpretation of its regulations, may we not abdicate our responsibility to examine independently the regulations upon which the Board relied deciding Crofton’s “ appeal, to ‘determine if the administrative decision is prem ” ised upon Noland, erroneous conclusion of law.’ 386 Md. 3, at 574 n. 873 A.2d at 1156 n. 3 (quoting United Parcel v. Counsel, People’s 569, 577, 336 226, (1994)). Md. 650 A.2d 230 To do so in present case, we rely must on principles of term, statutory interpretation to determine the meaning of the “mortgage interest” under COMAR. Miller v. Comptroller of 272, 282, Maryland, (2007) (“ 398 Md. 467, 920 A.2d 473 ‘[T]he interpretation of an rule agency governed by the same principles govern ”) the interpretation of a (quot statute.’ ing Maryland Comm’n on Human Relations v. Bethlehem 586, 592-93, Steel 295 Corp., 1146, (1983)). Md. 457 A.2d 1149 “The cardinal rule of statutory interpretation is to ascertain and effectuate the intent of the Legislature.” Ku shell, 576, 385 Md. at State, 870 A.2d at (citing 193 Collins v. 684, 688, 383 Md. 727, (2004)). 861 A.2d 730 “Statutory begins construction with plain language statute, of the ordinary, popular understanding English language dic tates interpretation of its terminology.” Adventist Health Care, 13, (internal Md. at n. 896 A.2d at 333 n. 13 quotation omitted). marks and citations When a statute’s plain language is unambiguous, we need only to apply written, statute as and our efforts to ascertain the legislature’s intent end 333; there. Id. at State, 896 A.2d at Price v. 378, 1221, 1226(2003). 378 Md. 835 A.2d COMAR’s Department of Health and Title, Mental Hygiene Title refers to mortgage interest several times. COMAR address, 10.09.10.10Aand 10.09.10.10C respectively, costs in- cluded a nursing facility’s capital cost center capital eligible costs capital per diem reimbursement. Each *14 inter- costs, “mortgage include which lists allowable provision interest).” 10.09.10.10A(3), COMAR bond (including est 10.09.10.10C(3). clearly express statement Apart from this interest, agree we with the treating bond interest as the of scope mortgage 10 not define Title does Board that (“Definitions”). 10.09.10.01 interest. See COMAR term, of a of definition express The absence however, plain its mean construing us from preclude does not meaning, we consid searching plain for a statute’s ing. When in isolation but not provision of the relevant language er Adven as a whole. statutory scheme within the context 13; 13, Care, 125 896 at 333 n. at n. A.2d Health 392 Md. tist (“We 388, at 1227 do not Price, A.2d 378 Md. at 835 see also context, for from textual ‘adher divorced its read statute not or require permit does meaning to of words ence ” (citations omitted)). from their context.’ isolation of words we plain language, Moreover, construing statute’s when unreasonable, or incon illogical, that are “avoid constructions 387, Price, at 835 A.2d 378 Md. sistent with common sense.” not to may a court “seek construe (acknowledging 1226 at that limit or interpretations forced or subtle the statute with (internal and citations marks application”) quotation extend its omitted). 10.09.10.10C, and

An of COMAR 10.09.10.10A examination (DHMH) in its entirety, compels of Title 10 within the context explicitly are excluded the conclusion definition Title Specifically, interest. from of 10.09.10.29, COMAR directs “Interpretive Regulation,” 10’s DHMH’s intent us, in of evidence of the express the absence regard availability to the feder- reimburse costs “without to “in regulations to State participation,” interpret al financial regulations.” applicable federal statutes conformity with & 10.09.10.29; Dep’t see also Health Mental COMAR Inc., Centre, Nursing Md.App. Hygiene v. Riverview (1995) (“Where does not 657 A.2d COMAR otherwise, of reimburse- principles federal Medicare specify ment, Act, in Medicaid Provider Reimbursement contained control”). (PRM), regulations

Manual and Medicare COMAR 10.09.10.10 no contains indication of the intent DHMH’s reimburse “without regard availability costs of federal therefore, financial participation”; as directed COMAR 10.09.10.29, must interpret we the term “mortgage interest” conformity the applicable authority. with federal 10.09.10.07C(5), turn, specifically directs us to the Medicare Id. regulations guidance.12 (“Following PRM for of the provider’s year, close fiscal or Department its designee shall determine the final per diem rates for that year. fiscal final Appropriate payment adjust- settlement and ments shall be made according the Medicare Provider *15 Manual, 15-1, Reimbursement HCFA Publication and this Center, Liberty see also Nursing chapter.”); 330 Md. at 438- (“[DHMH] 39, 624 A.2d at 943-44 has chosen to a calculate provider’s per diem according ‘final rate’ to the principles established under Title of the Act ... Security XVIII Social the and contained in Medicare Provider Reimbursement Man-

ual ... unless specified by [“PRM”] otherwise chapter.” this (citations omitted)); Centre, Riverview Nursing Md.App. 104 at 598 n. A.2d 657 at 374 n. 3 (explaining that the PRM upon Medicare reimbursement regulations “elaborated 413”). in 42 found Part C.F.R.

Both the C.F.R. and the PRM define interest cost as “the incurred for the use of borrowed funds.” 42 C.F.R. 413.153(b); § § PRM Only necessary interest, 202.1. howev- er, qualifies an 413.153(a); § allowable cost. 42 C.F.R. § PRM 202.2. necessary Interest is if it a is “incurred on loan need, is made satisfy that to a financial a purpose related [f]or care, patient [i]ncurred a loan that is reduced 413.153(b)(2); investment § income.” C.F.R. PRM 202.2. “The burden of a proof show there is financial for need the borrowing provider.” ... rests with the § PRM 202.2A. 10.09.10.08B(1) provides 12. COMAR also that allowable costs for cov- "according principles ered services are determined to the established Act, Security seq., § under Title of the XVIII Social 42 U.S.C. et Manual, and contained in the Medicare Provider Reimbursement HCFA 15-1, specified by chapter[J” Publication unless otherwise this however, that explicitly provides, “[interest Section 202.2A is swap agreement an interest rate incurred under expense because payment purposes recognized not Medicare agreement under does not incurred such expense need of the a financial satisfy from a loan made result § 202.2A. provider.” following § includes the

To this 202.2A point, illustrate example: a million at variable

Hospital A has bonds $10 patient issued for a 2%. The bonds were prime plus rate of is allowable ex- purpose care related fixed rate prefers The hospital under Medicare. pense awith bank. agreement into a interest rate and enters note is million. The $10 amount the bank a fixed rate of pay will stipulates hospital rate of pay hospital bank variable 12% and the will 2%. prime plus is no at 10% and there year, prime

For first remains hospital. and the For of funds the bank exchange between hospital pays to 8%. The year, prime drops second $200,000 NOT reim- in interest. This interest the bank prime the third year, bursable under Medicare. For $200,000. the hospital to 12%. The bank pays rate increases income for Medicare This is NOT considered investment *16 no on the impact The transaction has reimbursement. the of interest associated with allowability expense the bonds. interest mortgage this does not address

Although example instructive because it example especially the specifically, allowable swap payments substituted otherwise addresses payments. interest that, distinguishes by arguing swap payments

Crofton its agreement, separate A’s which was from Hospital swap unlike bonds, piece swap agreement inseparable the Crofton’s was package the financing package, of an and because integrated the mortgage property, secured Crofton’s refinances mortgage payments. interest swap payments constituted the argues swap payments Crofton further that must be interest “Bank construed as because the Notes, and Crofton intended the Loan and Security Agree- ment, Swap Agreement Interest and Deed of Trust function transaction, singular, as a non-severable not a inde- separate, pendent, agreement,” Maryland stand alone and contract law requires courts to construe contracts in the conformance with Moreover, that parties’ argues Maryland pub- intent. Crofton lic the policy supports treating swap agreement and the related loan one integrated transaction because Crofton swap agreement entered into the an effort to more operate efficiently and to lower fixed Crofton’s costs.

Conversely, agrees DHMH with the finding Board’s swap agreement the was only related Crofton’s loans be- the swap cause enabled Crofton to “exchange interest rates without the modifying terms agreement” loan and fact that in 2002 paid “[t]he interest under and swap both loan does agreements not make the paid swap agreement under the reim- agrees DHMH further bursable[.]” "withthe Board’s determi- only nation that allows reimbursement of interest expenses to refinance existing incurred debt or to obtain a Therefore, new loan. DHMH argues that the Board properly referred to the PRM to determine whether Crofton’s swap payments were allowable costs. are not persuaded

We that Crofton’s intent to integrate swap mortgage agreements overcomes PRM’s clear swap payments, directive that even when incurred in place are expenses, allowable interest not reimbursable Crofton, payments. A” “Hospital Similar into its entered agreement to secure upon a fixed interest rate on bonds which, but swap agreement, for the the provider would have payments. made allowable interest though hypo- Even swap agreement thetical supplants bonds’ variable interest rate, explains the PRM are not bond not thus are reimbursable. The PRM’s analysis Hospital focuses neither intent nor A’s *17 agreement’s effect-replacing variable bond interest rate

221 intent and Consequently, fixed to treat Crofton’s a rate. with in this case of transactions as determinative timing PRM, and we decline Crofton’s with would be inconsistent to do so. invitation ex- governing rules reimbursement of its promulgating elected, in of express the absence DHMH has

penses, specific expense, to reimburse a indication of its intent to the by resort C.F.R. questions reimbursement decide DHMH 10.09.10.29. This is author- PRM. COMAR See 15-103, §§ of the Health General to do. 15-105 ized See Care, A.2d at Article; 392 Md. at Adventist Health authority agencies administrative (recognizing the of 330 “ in order to regulations rules or legislative-type ‘promulgate often, of regulations or will statute. Such rules implement [a] discretionary policy determina- necessity, embody significant Res., ”) v. Natural 335 Md. Dep’t Christ (quoting tions.’ of (1994)). 34, 42 to that owe deference A.2d We Liberty authority. discretionary exercise DHMH’s Cf. 438-39, Center, Md. at 624 A.2d at 943-44 Nursing ‘final authority provider’s to “calculate a (recognizing DHMH’s (citations ... according to omit- per [PRM]” diem rate’ ted)). explicitly encompass have that COMAR does not

We said agreements; consequently, interpretation our of CO- must with the and the PRM. MAR be consistent C.F.R. swap pay- clear of the difference between PRM’s delineation allowable expenses compels ments otherwise under “mortgage conclusion that the term interest” swap payments does not encompass regardless provider’s payments intent to substitute those for otherwise reimbursa- ble interest See COMAR 10.09.10.29. expenses.

Accordingly, correctly hold that Board relied on the we payments were not PRM determine Crofton’s mortgage under COMAR. reimbursable as that, governs interpre- because the PRM further hold We case, are provider’s tation of COMAR this under CO- not reimbursable *18 10.09.10.10, MAR of a regardless nursing facility’s care intent a and integrate swap agreement a mortgage refinancing into a single transaction.

III. that the ruling governs interpretation Our PRM our of the COMAR 10.09.10.10 obviates need to address the second question presents, Crofton which invokes the correctness of application Thrifty analysis. the Board’s Oil to the We the judgment Special therefore affirm the Court of Appeals ground the sole that the Board referred to properly the PRM to determine that are not reimbursable interest under COMIAR. OF THE

JUDGMENT COURT OF SPECIAL APPEALS AFFIRMED. BE PAID COSTS TO BY PETITIONER. J.,

ADKINS, opinion files joined by dissents and HARRELL, J. ADKINS,

Dissenting Opinion by Judge, HARRELL, which J., joins.

I the respectfully majority’s dissent from holding pay- pursuant are, ments made to a interest rate swap agreement definition, not the “mortgage interest” under Code of (“COMAR”) Maryland Regulations In my 10.09.10.10. view ignores this the holding fundamental nature of transaction Center, (“Crofton”) between Crofton Convalescent Inc. (“First National”). First Bank of Maryland National Examining facts of the transaction reveals that parties a route to complicated simple took reach a result. Crofton sought fixed-rate loan from First National. After initial negotiations, First National offered Crofton a 6.55% loan, fixed-rate which accepted by was not Crofton. Subse- quently, First National a more proposed complicated, two-step First, according transaction. to a varia- paid Second, ble exchanged rate. First National and Crofton rate, difference between the rate and the 5.5% fixed variable The variable role. which was substance, subject to they were form; only existed the 5.5% swap payment, via adjustment, immediate level. Loan Board, parties’ dismantled like the majority, conclusion to reach its in order Agreement, Security from the transaction separate were because loan, not reimbursable and therefore were so, ignored it doing interest.” “mortgage not

they were *19 and borrower. intent of the lender undisputed and clear swap that the reasoning to the Board’s majority defers The be- simply loan from the separate is arrangement sepa- two Crofton make requested that First National cause one for the variable-rate swap, for the and one payments, rate made accommodation bookkeeping This loan. ruling the Board’s basis for is an insufficient

the lender loan integrated of an part were not the existing the refinancing purpose for the agreement made say agreements written parties’ the clear mortgage loan when otherwise. arrange- up sets the Agreement, which

The Master explicitly the states: parties, ment between on the fact that entered into reliance All Transactions are single all Confirmations form Agreement this Master would parties ... and parties between agreement Transactions. any not otherwise enter into or Agreement as “one defined in the Master “Transactions” is this governed by ... that are or will be more transactions ... and the includes the schedule which Agreement, Master exchanged ... be- evidence confirming other documents and Corre- confirming those Transactions.” parties tween “The says: Security Agreement the Loan spondingly, Master into an ISDA the Bank have entered Borrowers and (which ... herein called hereof is dated the date Agreement $4,200,000 Term Note for the ‘Swap Agreement’).” provi- “pursuant that it is issued proves indebtedness sions of’ the Agreement. Loan The Term Note for the $500,000 provision. contains the same

Equally important is the undisputed fact that Crofton sought from the loan, bank a fixed 5.5% turned down the loan, bank’s offer for a 6% and deferred to the proposal bank’s that this more deal complicated would accomplish what Crof- ton sought the first place—a 5.5% loan for capital purposes. Yet the Board concluded as follows:

The ALJ found that the swap agreement was an agreement notes, linked to the above referenced for the [i.e. million $4.7 loan], dollar to ensure that the interest rate was 5.5%. But is exactly what a swap interest rate agreement supposed to do. It allows one of parties to swap the uncertainties or floating variable interest rate for the certainty of a fixed interest rate. Nor is the fact that the interest rate swap agreement includes a notional principal amount [footnote that is the omitted] same as the amount unusual, loan controlling, or change the character of agreement. Most, all, if not swap agreements refer to (i.e. amount that is principal amount of a loan swap agreement’s notional ... principal.) The stated “notional,” amount of principal is because an is a separate, independent, stand alone agree- *20 ment [footnote that modify omitted] does not or exchange the principal short, amount owed on the loan. the swap agreement interest in question, all like interest rate swap agreements, did produce not a new loan or any additional for principal either of the parties to the agree- ment. The swap agreement simply allowed the parties to exchange interest rates modifying without the terms of the mortgage agreement. loan

The Board’s rationale is circular and mischaracterizes this loan transaction. The Board’s thinking goes like this: most using transactions swap agreements loans; involve no actual therefore the Crofton-First National transaction was not a mortgage loan because it included an interest agree- ment. logic This falls apart upon close perusal: classification of the transaction as a mortgage loan does not on depend rate, or is is at a set payable the amount of whether that mort- says is What COMAR by a formula. determined have the Board should So is reimbursable. gage inter- were swap payments whether considered involving swap payments est, most transactions not whether Instead, sweeping the Board made actual loans. involved the undis- ignored swap agreements, about generalization Notes, and Master Loan Agreement, fact puted existing a refinance of an constituted Agreement facility. its operation loan entered into in as the question, at the transaction looking Rather than did, the Board relied on several Judge Administrative Law which indicate that swap agreements, definitions of internet amount is never principal transaction the typical swap using pay- popularity or exchanged.1 possibility no role play securities should ments as investments actually the bank loaned consideration of whether Board’s and whether to a loan money pursuant to Crofton agreement. integral part were an of that no evidence suggestion, there is Contrary Respondent’s swap agreement gamble into the that Crofton entered found as a fact Judge rates. The Administrative Law market that would “swap agreement required a fixed 5.5% floating rate term into convert pay intent that Crofton 5.5% parties’ rate.” The loan is undeniable. capital interest on 10.09.10.10(C) expenses of capital lists five classes “(1) (2) taxes; Property Property which are reimbursable: (4) (3) interest); insurance; (including bond Mortgage interest (5) rental; office costs.” capital capital Net value Central reimburse- provide complex detailed and regulations "While See, Glossary, http://www. InvestorWords.com-Investing 1. e.g., investorwords.com, 12, 2010); (last Investopedia.com, March visited (describing swap agreements http://www.investopedia.com as: "Tradi- *21 security change maturi- tionally, exchange for another to of one (stocks bonds), (bonds), investment ty quality or or because of issues objectives changed. Recently, swaps grown to include have have 12, (last 2010). currency swaps swaps.”) visited March and interest rate procedures formulas,

ment and they provide do not further regarding details capital reimbursable expenses generally or interest in particular.2 majority As the acknowledges, “we may not abdicate our responsibility examine independently regulations upon which the Board relied in deciding appeal[.]” Crofton’s Ma- jority Op., at supra, view, 991 A.2d at 1265-66. In my the majority exactly does this when it accepts the Board’s reliance on the Federal Provider Reimbursement Manual (“PRM”) justify conclusion, Section 202.2A to its because the limitations set forth in that subsection clearly apply do not an integrated loan agreement like this one. PRM Section “DEFINITIONS,” titled provides the details to flesh out the requirement, set forth in PRM Section that a cost will be “[njecessary reimbursable for proper interest on both current and capital It includes a indebtedness[.]” subsection (Section 202.2) on interest, what is considered “necessary” “[ijncurred which says that the interest must be on a loan that is satisfy made to a financial need” of the provider. Subsec- tion A of Section 202.2 addresses by what is meant “financial need,” and it starts out as follows: “When borrowed funds create excess working capital, interest expense on such bor- rowed funds is not an allowable cost.” It in this context that the PRM sets forth example relied by the Board for the proposition that swap interest payments are never reimbursable. The example involves a hospital that has issued bonds, ten million dollars in on which it pays interest bondholders at a liking variable rate. Not the variable rate it pay bondholders, must to the the hospital hedges its risk by bank, into a entering separate agreement with a using notional amount of ten million dollars principal, stipulating 2. "mortgage The Board utilized the by definition of interest” offered Department Hygiene: of Health and Mental "interest is the cost in- curred for the use of borrowed funds.” This is consistent with the "|T|he Dictionary definition of "interest” compensa- in Black’s Law by agreement tion fixed or allowed law for the use or detention of use; money, money by or esp. loss of one who is entitled to its money.” amount owed to a lender return for the use of borrowed (9th 2009). Dictionary Black’s Law ed. *22 fixed rate of 12% and the pay will the bank a hospital that “the prime plus 2%[.]” a variable rate of pay hospital bank will PRM, use of excess this transaction constitutes Under and is therefore not reimbursable. working capital, is to Crofton’s loan. Unlike example applicable This not in exam- loan, agreement interest rate Crofton’s of the because “satisfy provider” does not a financial need ple needed, it ob- capital had the it which hospital already rate it issued the bonds. The tained when separate a third and thus was party, was with the bonds. The borrowing represented by from the apart hospital. to the party any money third bank never lent law, I a matter of Accordingly, wrong, submit that it was Board, language of applying for the tasked with the clear 10.09.10.10, a nurs requires which reimbursement loans, to rest its ing capital home for addressing PRM dissimilar financial decision on the federal bonds. hospital utilized that had issued arrangements give we determinations of law has agency deference “ ‘it within our majority recognizes, always limits. As the prerogative agency’s to determine whether an conclusions ” Care, law are correct.’ Adventist Health Inc. v. Md. Health (2006) Comm’n, 103, 121, Care 392 Md. 896 A.2d Res., 563, 576, Dep’t Kushell v. Natural 385 Md. (quoting (2005)). view, my majority 870 A.2d errs Board’s declining prerogative to exercise its to overrule the interest!,]” “mortgage term misreading unambiguous contained COMAR 10.09.10.10.

Judge joins HARRELL has authorized me to state that he in this dissenting opinion.

Case Details

Case Name: Crofton Convalescent Center, Inc. v. Department of Health & Mental Hygiene
Court Name: Court of Appeals of Maryland
Date Published: Apr 8, 2010
Citation: 991 A.2d 1257
Docket Number: 32 September Term, 2008
Court Abbreviation: Md.
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