*1 313 however, agreement; appellee’s its upheld prosecutor, Each into an ineffectiveness deal bargained-for to cast a attempt rings claim hollow. illegal operation and multifaceted sum, conduct appellee’s Superior episode; criminal single constitute
did not episode. with an enterprise an incorrectly confused failing raise was not ineffective counsel Consequently, claim would have been because the appeal § 110 on direct 125, Pa. Tilley, v. Commonwealth unfounded. See (counsel (1991) failing 575, cannot be ineffective A.2d claim). of the reverse the order meritless We to assert Superior Court. relinquished.
Jurisdiction and BAER SAYLOR NEWMAN Justices Justice concur in the result.
Department of Public (H.B.), Appellee. Hospital Treatment Network Texas Appeal M.D. Docket 2003. Nos. 195-97 Supreme Pennsylvania. Court of
Argued Dec. Aug.
Decided *3 Loux, Leisch, Esq., John Esq., Doris M. Eichenwald Helene Kane, of Public Philadelphia, Department for the Esq., A. Welfare. Vilim, Maddox, Philadelphia, Esq., Guy Esq., P.
M. Robin Network. Hospital for Devereux Texas Treatment NEWMAN, CAPPY, C.J., CASTILLE, NIGRO, BEFORE: SAYLOR, LAMB, EAKIN and JJ.
OPINION Justice NIGRO. consider in these allowance cases granted appeal
We
reversing
erred in
three
whether
Commonwealth Court
of Pub-
Department
Appellant
administrative decisions
(“DPW”)
pay-
Medical Assistance
lic
which denied
Welfare
Facili-
Texas
Hospital
Devereux
Treatment
Appellee
ments
(“Devereux”)
rendered to
ty
for certain care
K.C., K.T.,
following
H.B. For
rea-
juveniles,
three
and
sons,
part
part.
we affirm in
reverse
among
that provides,
is a Texas treatment
the recom
things,
psychiatric services. On
inpatient
other
of Human Services
Philadelphia Department
mendation of the
(“DHS”),
Court of
Philadelphia
orders
K.T.,
Pleas, K.C.,
H.B.
to Devereux
were sent
Common
adjudi
after
been
inpatient
having
treatment
psychiatric
*4
Act,
§§
6301-
Pa.C.S.
cated
under
Juvenile
delinquent
Thereafter,
for the treat-
sought payment
6365.1
Devereux
long-term psychiatric
was
services on
1. K.C.
admitted to Devereux for
26, 1997,
eighteen years
had been
when he
old and
March
was
disorder, polysubstance abuse
diagnosed
post-traumatic
and
with
stress
26, 1997, when
depression.
Devereux on March
K.T. was admitted to
suffering
depen-
years
polysubstance
from
he was nineteen
old and
Devereux on
psychotic
and
H.B. was admitted to
dence
a
disorder.
from,
1998,
21,
suffering
eighteen years
January
when he
old and
was
Assistance
Pennsylvania’s
from
Medical
ment
DPW under
appealed
denied the claims. Devereux
Program, but DPW
Appeals.
and
Hearing
Bureau
the denials DPW’s
case,
Hearing
Officer recom
hearings
After
each
Hearing
Specifically,
be denied.
appeal
mended
each
payment
had
for
correctly
that DPW
denied
Officer concluded
only
payment
regulations
permit
and
because DPW
K.C.
is no
out-of-state services when there
non-emergency
for
here,
and
alternative
the record
comparable in-state
there was no in-state
competent
devoid of
evidence
similarly concluded
Hearing
alternative.2 The
Officer
treatment,
for
payment
had
denied
K.T.’s
properly
DPW
that a
is not
regulations
provider
“are clear
because
for
who
days
recipients
to reimbursement
entitled
here,
an
of care” and
appropriate
alternate
level
that K.T. was
for treat
stipulated
Devereux had
“appropriate
during
at an
the relevant
time
ment
alternate level
care”
Adjudication,
K.T.
6.3
period. Hearing Officer’s
adopted
and
Hearing
Appeals subsequently
The Bureau of
cases,
in all
recommendations
three
Hearing
Officer’s
things,
symptomalogy
auditory
among
depressive
other
hallucina-
tions.
correctly
Hearing
that DPW had
denied
2. The
Officer further stated
payment
respect to K.C. and H.B. because Devereux was not
long-term inpatient psychiatric
when
entitled to bill for
services
it had
Program
only
approved
participate
in the Medical Assistance
been
(defining
private psychiatric hospital.
See 55 Pa.Code
1151.2
"private psychiatric hospital”
providing
...
acute
as an institution
basis.)
inpatient
psychiatric
on an
This determina-
short-term
tion,
services
however,
Court,
by the Commonwealth
was later reversed
regulations, private psychiatric hospi-
explained that under DPW’s own
long-term inpatient psychi-
payment
receive
tals were authorized to
services, provided
were rendered to individuals
atric
that those services
age
twenty-one.
Hosp.
Texas Treatment Network
under the
1037,
(Pa.Commw.2002)
Dep't
Welfare,
Public
797 A.2d
1151.43).
appealed
(citing
DPW has not
the Common-
thus,
regard
we will not
wealth Court’s decision
this
address
portion of the Commonwealth Court’s decision here.
26, 1997,
March
but Devereux was
3. K.T. was admitted to Devereux on
provider
inpatient psychiatric
approved Medical Assistance
not an
27,
August
Accordingly,
only sought
until
services
August
payment
provided
for services
from
1997 until K.T.’s dis-
charge on October
*5
(the
Secretary
Department
of the
of Public Welfare
“Sec-
retary”) upheld the Bureau’s orders.
on April
2003, the Commonwealth Court reversed all three orders
denying payment.
Hosp.
Texas Treatment Network
(Pa.Commw.2002).
Public
Dep’t
Welfare,
Under section of the Juvenile a child is to delinquent, may found the court commit to a the child facility for delinquent operated children under supervi- sion or of direction the court or other public authority and 6352(a)(3). approved by DPW. Pa.C.S. commit- Such treatment, ment shall be “best suited to the child’s supervi- rehabilitation, 6352(a) sion and welfare.....”42 Pa.C.S. added). case, (emphasis In this the Court Common Pleas of Philadelphia County found and to [K.C.] [H.B.] be delin- children, quent and committed them Devereux’s a facility, facility supervised by public authority a and approved by Thus, DPW. the court determined that facility Devereux’s was “best suited” treat and If [K.C.] [H.B.]. commitment facility Devereux’s was “best suited” to the treatment [H.B.], then, needs certainly, [K.C.] Devereux’s facili- ty provided better access to they the care needed and was only facility equipped provide type they care needed.
Because DPW erred that it concluding impossible was to determine from the record that Devereux provided better access to the care that [K.C.] and needed or that [H.B.] Devereux’s only facility equipped to provide type required, [K.C.] [H.B.] DPW erred denying payment services rendered [K.C.] [H.B.] on that basis. (footnotes omitted).
Id. (emphasis 1042 in original). Court, appeal
On to this DPW contends that the Common wealth in requiring Court erred it to utilize Medical Assistance funds to pay K.T., for Devereux’s treatment K.C. and such when treatment did not qualify for reimbursement under regulations. DPW Significantly, way challenges DPW no trial the court’s authority under the Juvenile Act to order juveniles the placed Rather, three be at Devereux. it merely argues that funds other than Medical Assistance funds must pay placement.4 used 6352(a) Act,
Under Section of the Juvenile a court author ized to commit a child to children, for delinquent alia, provided, inter is “best suited to the treatment, child’s supervision, rehabilitation and welfare.”5 repeatedly 4. Devereux states in its brief to this Court DPW takes position only that the trial authority place court had the H.B. and K.C. at Devereux if "it also determined that no inside Pennsylvania 7-8; appropriate.” was more Devereux’s Brf. at see id. at See, plainly misrepresents this position. e.g., DPW's (“No DPW's Brf. at 18 suggest juvenile facts of record that the court’s DHS, disposition, orders of any directed way inappropriate were in Act.”). under the Juvenile 6352(a)(3) provides 5. Section in full: § Disposition delinquent child (a) General Rule.—If the delinquent child is found to be a child the may following court make disposition of the orders of determined protection to be public consistent with the of the interest and best treatment, rehabilitation, supervision, suited to the child’s and wel- fare, shall, disposition appropriate to the individual circum- case, stances provide of each child's protec- balanced attention to the community,
tion of the imposition accountability for offenses development committed and the competencies to enable the child responsible productive become a community: member of the ordered, 6352(a). such a commitment When
42 Pa.C.S. state and and the provides Public Welfare Code necessary share the costs shall county governments local 704.1, 704.2; § 6306. Howev- 42 Pa.C.S. §§ care. See P.S. for funds under eligible child is er, a committed to the extent to DPW Program pursuant Assistance Medical Pennsylvania’s child or must before such funds be exhausted regulations, local state and from the reimbursement may seek provider 704.2. funds. See P.S. child welfare which is Program, Assistance Pennsylvania’s Medical individuals to certain medical assistance designed provide services, was necessary medical pay cannot afford to who (the Public Code Welfare provisions created of the “Code”),6 requirements in accordance with the The Code Act, seq.7 1396 et U.S.C. federal Medicaid pro of the for administration responsibility vests DPW *7 rules, 403, regula “establishing] § and for see 62 gram, P.S. and as ... for assistance eligibility as to tions and standards 403(b). end, DPW § To that Id. to its nature and extent.” institution, development (3) youth Committing an the child to center, operated delinquent under facility children camp, or other authority public and supervision the court or other the direction or by Welfare.... approved Department the of Public 6352(a)(3). § 42 Pa.C.S. 1967, 31, 13, §§ 441.1-449. 62 P.S. June P.L. as amended 6. Act of "Act”) (the collab- provides for federal-state Medicaid Act 7. The federal Specifically, the Act provision in the of medical assistance. oration Medicaid may participate in the federal provides elect to that states done, submitting for by preparing and program, Pennsylvania has complies with the Act and approval plan that a state Medicaid federal Department Health and regulations by promulgated the federal the 1396a; §§ If § 42 430-456. 42 U.S.C. C.F.R. Human Services. See funding, qualify will for federal plan approved, the state the state assistance state's medical part will of the costs of the cover 1396b(a); 1396d(b). Although § § "states id. program. See 42 U.S.C. formulating of their own in the terms given latitude are considerable requirement limited the plans,” their discretion is medical assistance regulations they "fully comply the federal statutes and must with that 836, Whitburn, (7th 840 governing Cir.1998). program.” v. 153 F.3d the Addis plans things, requires "safe- Among Act that state other and unnecessary ... care and services” guard against utilization of economy, efficiency, payments are with that consistent "assure 1396a(a)(30)(A). § quality care....” 42 U.S.C. that, only- among things, other regulations promulgated has that funds for services Assistance of Medical the use permit 1101.61, specifi- § necessary,” 55 Pa.Code “medically after services psychiatric for inpatient cally prohibit payment for an alter- to “suitable be has been determined patient addition, 1151.48(a)(15). In Id. § or level of care.” type nate only provided will that funds provide regulations to is documentation there out-of-state non-emergency facility “only is the out-of-state verify individual of care provide equipped 1151.50(a)(2)(ii). Id. requires.” Court, DPW contends to this appeal
On apply regula these failing erred Court Commonwealth K.C., H.B. rendered for the services deny payment tions to the Commonwealth regulation specific K.T.8 As the respect claims with resolving Devereux’s considered ie., 1151.50(a)(2)(ii), differs 55 Pa.Code to K.C. and conjunction with Devereux’s it considered from that which K.T., ie., 1151.48(a)(15), respect claims with and H.B. respect K.C. DPW’s claims we will address to K.T.9 regard from its claims with separately deny under the reviewing reimbursement a DPW decision scope of re program, Court's the Commonwealth Medical Assistance rights determining any have whether constitutional view is limited to violated, law or whether essential whether there was an error of been Presbyterian findings supported by evidence. of fact are substantial 23, Welfare, Dep't A.2d Pub. Med. Center Oakmont Servs., (Pa.Commw.2002); Dep’t Inc. v. Public Geriatric & Medical (1992). Welfare, 151 Pa.Cmwlth. 616 A.2d regulations argue of the Significantly, Devereux does not Public clearly *8 or inconsistent with either the here are erroneous issue Pennsylva- Act. See Terminato v. Code or the federal Medicaid Welfare 1287, (An Co., 60, (1994) adminis- A.2d 1293 Nat'l Ins. 538 Pa. 645 nia regulations agency's interpretation of a statute in its "is entitled trative may disregarded if great weight, [although] interpretation the the clearly with the statute interpretation is erroneous or inconsistent regulation promulgated.”); v. Workers’Com- the Caso under which 287, (Sch. Philadelphia), Appeal 576 Pa. 839 A.2d pensation Dist. Bd. 219, ("The (2003) charged interpretation those statute deference, great will be overturned not its execution is entitled Rather, erroneous.”) accepts clearly it the construction is unless such merely they not regulations contends that do relevant as valid and payment here. support denial of its claims In connection with K.C. and argues that the in concluding Commonwealth Court erred trial the court’s determination under Act placement the Juvenile at was juveniles’ “treatment, “best suited” the rehabilitation, welfare,” supervision, Pa.C.S. satisfy was sufficient to regulatory requirement DPW’s Devereux, there be documentation to verify that an out-of- facility, “only state was the facility equipped provide the type of care that required.” [K.C. and H.B.] Pa.Code 1151.50(a)(2)(ii). agree. We adjudications, both K.C.’s and Hearing H.B.’s the Officer noted that DPW regulations state that Medical Assistance funds not may be used to fund an placement out-of-state unless there documentation to establish that the out-of-state facility “only is the facility equipped to provide type Moreover, requires.” care that the individual Id. in both cases, Hearing Officer concluded that there was no record documentation to support a conclusion that Devereux was the “only facility equipped provide of care that [K.C. require[d].” Id. H.B.] K.C.,
Specifically, the case of Hearing ac- Officer knowledged that had submitted into evidence “a checklist of placement options,” which included over in- fifty state facilities and indicated that at facility, K.C. “was not each accepted for admission age, due to his appropriateness for the because generally being referrals were accepted at Hearing time.” Officer’s Adjudication, K.C. at ¶ (“F.O.F.”) Finding Fact the Hearing Officer noted that the “referral date” for attempted each placement 15, 1998, was September which was well after K.C. was id., from discharged 3,1998. Devereux on January See F.O.F. ¶ 5. As there was no additional evidence submitted that indi- cated options that in-state investigated had been prior either to or Devereux, while placed K.C. Hearing Officer specifically found that there was “no documentation in record that in-state options had been exhausted prior [K.C.]’s an facility.” out-of-state Id. at Moreover, the Hearing Officer stated there had been *9 “no documentation submitted for the record that [Devereux] the only private psychiatric hospital facility equipped pro- type vide the requires required [K.C.] as under 55 1151.50.(a)(2)(ii).” Pa.Code Id.
Meanwhile, in
H.B.,
the case of
the Hearing Officer noted
that the record
contained
“Residential Treatment Facility”
Checklist which “indicated that
40 psychiatric
over
facilities
... had been contacted and were
to provide
unable
prior to
Devereux,”
[H.B.]
his being referred to
but further
stated that the same checklist indicated that
“only acute care
psychiatric facilities” had been contacted. Hearing Officer’s
¶20
Adjudication,
H.B.
added).
F.O.F.
(emphasis
addition, the Hearing Officer explicitly credited the testimony
representative,
DPW’s
Hume,
Dr. John
that “there were
forensic-type psychiatric
[H.B.j’s
facilities
suitable
handle
aggressive personality that were not
contacted
were
located
Pennsylvania----”
Id. at 9. Given this record evi-
dence that potentially suitable in-state facilities had not even
been contacted to
see
they
could accommodate
Hearing Officer ultimately found that the record was devoid of
“documentation that Devereux is
only private
psychiatric
hospital facility equipped
provide
type
of care that
require[d]
[H.B.]
required
under
1151.50.(a)(2)(ii).”
Id.
(emphasis
original).
In reversing the Hearing Officer’s decisions in these two
cases, the Commonwealth Court did not point to any addition-
al evidence that had been
introduced
the parties which
established that Devereux was the only facility adequately
equipped to treat
Rather,
K.C. and H.B.
the court merely
noted that the trial court had committed both boys to Dever-
eux
to section 6352 of
Act,
the Juvenile
42 Pa.C.S.
which only authorizes the court to
juvenile
commit a
an institution that
is “best suited to
treatment,
the child’s
supervision, rehabilitation,
welfare,”
and then reasoned
that “[i]f commitment to Devereux’s facility was ‘best suited’
to the treatment needs of
[H.B.], then,
[K.C.] and
certainly,
Devereux’s facility provided better access to
they
the care
needed and was
only
facility equipped
provide
reasoning,
of care needed.” however, fundamentally flawed. *10 matter, agree
As the Commonwealth an initial we with authority trial that the limitations on the court’s given Court 6352, trial § we that the presume to 42 Pa.C.S. must suited” court that was “best placement concluded Devereux treatment, of rehabilitation and welfare” supervision, “the do not that this determina- agree K.C. and H.B. we that tion is to establish the alone sufficient that the “only facility equipped provide the 1150(a)(2)(h) [juveniles’] (emphasis 55 required.” Pa.Code added).
First,
it
than
we
that
is
more
one
possible
note
thus,
to a
and
facility
juvenile’s
to be “best suited”
needs
does
mean that
merely
is “best suited”
not
because Devereux
equally
is not another in-state
that is
well-suited.
there
(1990)
M.,
In
Pa.
A.2d
755
See
re Tameka
6351(a),
trial
court contem
(noting that under
Pa.C.S.
protection
an “order
best suited
the
plating
disposition
child”
physical,
dependent]
and
mental and moral welfare of [a
schools,
may be
with
of two
effective
options
“equally
faced
needs”)
added). More
(emphasis
both suited to the child’s
over, where,
here,
as
no indication
the
simply
there
options
record that DHS even considered all of the in-state
trial court of such
K.C. and
much less advised the
will not
Commonwealth Court
options,10
presume,
we
as the
below,
in
did
that the trial court
all
available
considered
the
rejected
as
to Dever-
options
explicitly
state
and
them inferior
exhaustively investigate
expect
would
DHS to
all in-state
While one
options
thoroughly
investigation in
document that
cases in
it
anticipating
for an out-of state
Medical Assistance reimbursement
placement,
indicating
it did
simply
there is
no record evidence
so
placements
H.B.’s
We can better
connection
K.C.’s and
here.
its order
understand that failure in KX.'s case
the trial court issued
as
committing
K.C. to Devereux
was even
certified
before
provider
inpatient psychiatric
Under
Medical Assistance
services.
circumstances,
anticipating
those
DHS could
have been
that the
Program
pay
placement,
explain-
would
the
thus
Medical Assistance
ing
compliance
apparent
regarding
its
lack
concern
with DPW
regulations.
is required
trial court
recognize
we
While
eux.11
6352(a)
to [a
“best suited
an order
enter
42 Pa.C.S.
under
rehabilitation,
welfare,”
treatment,
supervision,
juvenile’s]
if it
duty
in that
it has failed
presume
will not
we
parties present
that the
options
only
placement
considers
will be best suited
option
such
that at least one
to it and finds
words,
do not believe
we
other
juvenile’s
to the
needs.
6352 should be
under section
ordering placement
a court
regarding
parties
to cross-examine
required either
or to
available facilities
identify
of their efforts
extent
survey
own exhaustive search
conduct
its
will well
juvenile’s
needs
it concludes
when
options
proposed
at one of
juvenile
placing
an order
served
at that
to the child’s
objects
ho party
facilities and
body
in the
of its
appears to reason
11. The Commonwealth
*11
Devereux to
court determined
opinion
mere fact that the trial
that the
to establish that
H.B.’s needs is sufficient
to K.C.'s and
be "best suited”
options.
Devereux’s Brf. at
potential
See also
all
in-state
it considered
Texas,
("In
the court
issuing
children to
its orders to send the
other,
placement, and no
the Texas
presumably determined that
needs—that
children’s individual
placement
suited to the
the
best
that,
placement,
judgment, no
in
court’s
other
phrase in
states
the
itself
suited;
program is the
Pennsylvania
as well
the Texas
out of
that,
However,
suited.”).
suggests in a
as a
court also
footnote
the
best
matter,
of all available
have been advised
the trial court must
factual
requires
it be advised of all
options,
the statute
because
Specifically,
court notes that
n.
the
Given
we simply cannot
agree
Commonwealth Court that
trial
court’s mere issuance of
the commitment
necessarily
orders here
demonstrated compli
ance with
regulatory
DPW’s
requirement
that all in-state
placement options be exhausted before Medical Assistance
funds could
pay
be released to
for an out-of-state placement.13
emphasize
say
12. We
that this is not to
may simply
that the trial court
stamp
placement upon
rubber
a
parties
agreed.
which the
have
Rath-
er, the court
“independent
must exercise
discretion in the interest of
child,”
M.,
Tameka
580 A.2d at
to determine whether an order
placing
suggested
the child at
one of the
facilities will be best suited
"treatment,
rehabilitation,
supervision,
to the child’s
welfare.”
Pa.C.S. 6352.
Notably,
parties
provisions
have cited to no
in the Juvenile Act
that,
regulations, explicitly
like the DPW
require
options
Moreover,
that in-state
resorting
considered before
placement.
an out-of-state
considered,
there is no
indication
the record that the trial court
independently
either
parties’ urging,
or at the
whether DPW funds
pay
would be available
placements
for K.C.’s and H.B.'s
at Devereux.
M.,
recognize
We
that in Tameka
dependent
which involved a
child in
special schooling,
hypothesized
need of
this Court
in dicta
juvenile
given
court were
equally
choice between two
effective
schools, one of which
was reimbursable
DPW and one of which was
not, it would be an abuse of discretion for
the court to order
non-reimbursable
recognize
school.
placement decision. Notably, 14. DHS filed an amicus brief in the Commonwealth Court and did not assert that it had options exhausted all of its in-state compliance 1151.50(a)(2)(ii). Rather, with 55 Pa.Code merely it argued that "[e]ven there was some non-compliance technical with applicable regulations,” DPW equitably should estopped be from denying payment for the services rendered to K.C. and H.B. because "reasonably relied” representations on DHS’s that it had been locating "unsuccessful in in-state for these children.” DHS’s Commw. Ct. Amicus Brf. at 16. equitable us, While no similar estoppel argument is now before we compelled feel suggestion to comment that DHS’s that DPW should be pay made to may Devereux because DHS regard- have misled Devereux ing compliance DHS's regulations appears equitable to turn See, estoppel principles 411, Cutaiar, on e.g., their head. 460 Pa. Blofsen (1975) 333 A.2d (equitable 843-44 estoppel applies against party Indeed, misrepresentations). that made equitable from an stand- point, anyone it seems that if pay could be made to Devereux as a result DHS, any misrepresentation by appear it would to DHS. appears argue simply deny it is unfair to it reimbursement for the services it rendered to K.C. and because Medical only legitimate thus, Assistance “is the payment” source of DPW, absent reimbursement compensated will not be its considerable services. Devereux’s Brf. at Significantly, we agree with Devereux paid that it deserves to be for the services it rendered to K.C. and H.B. to the trial court’s commitment Furthermore, way orders. we in no fault Devereux for the lack of *13 contrast, of the In we affirm the order Commonwealth of K.T. DPW pertains insofar as it to the treatment Court this that the Commonwealth Court argues its brief to had to be that Assistance funds concluding erred Medical treatment though to K.T.’s even that pay used for treatment thus, subject not reim- “medically necessary” was not establishing placement options were that in-state record documentation placed at exhausted K.C. and H.B. were Devereux. before here, denying we Devereux reimbursement from regulation, validity plain merely applying are terms of DPW's Moreover, supra even challenge. See n. 9. which Devereux does assuming ignore regulation liberty we that arguendo that were at ability regarding to obtain based on own concerns Devereux’s our elsewhere, it compensation accept we assertion that cannot Devereux's above, any compensation. explained does not other source of As have county clearly provides local the Public Welfare Code governments that state and necessary for children will contribute to the costs of Act, adjudicated delinquent under available fund the Juvenile local, ing existing Federal private, public, from State or “other future Program, merely programs,” including the Medical Assistance they P.S. tapped be are available. 62 first sources that should 704.2; 704.1; M., id. 525 Pa. 580 A.2d see also Tameka (accepting regulations prohibit reimburse question without that DPW concluding schooling dependent ment for child's Montessori county placement). youth pay therefore children and services must Indeed, became the record here clear that before Devereux makes eligible provider certified a Medical Assistance and therefore became Program, DHS apply from the Medical for reimbursement Assistance Villarubia, Testimony Carolyn reimbursed it for its services. See Network, 249a- Executive of the Treatment R.R. at Director Devereux certification, prior (stating 250a Medical Assistance Devereux's DHS); county-funded through placements Supplemental Informa were ¶¶2, 6-7, ("Prior August, R.R. 51a Appellant tion at Pennsylvania provided juveniles services to from through youth agencies.... county with local children and contracts [DHS], Philadelphia, responsible youth agency children and contract.”); Dever which Devereux had a eux, letter from DHS to 5/29/97 (stating approved placement [K.T.] R.R. at 36a DHS “has $362.00 program per rate of retroactive to [Devereux's] into diem 26, 1997”). Moreover, provides March to the extent that the record expected paid to how the trial court Devereux to indication as here, anticipated suggests that the services rendered it court 4/SQ/91 pick up the tab. from Naomi DHS would Post, See Memorandum Kierans, Family Deputy A.J. Chief of Court’s Juvenile Branch to DHS, Community R.R. at 131a Director of Court and Services (requesting Devereux for "special contract" for of K.C. at $362.00). expected per of 9-12 months at a diem rate duration circumstances, apparent are not Under it that if DPW funds these seems placements, DHS or some pay available for K.C.'s and H.B.’s either pay Devereux for other state or local source must its services. According to § 1101.61. DPW. See bursement *14 that trial concluded Court DPW, the Commonwealth for Devereux the need order “obviated court’s placement only that regulations” duly promulgated comply [DPW’s] Pa. 55 necessary” treatment. “medically for permit payment a conclusion Moreover, that such it contends § 1101.61. Code for this disregard complete it was in in because was error duly-promulgated that instruction “long-standing Court’s law, compliance and strict force have the agency regulations (citing Brf. at 14 DPW’s mandatory.” regulations with such Comm’n, 556 Serv. State Civil Pennsylvania Auth. v. Housing (1999); v. 935, Rohrbaugh Pennsylvania 621, 942 Pa. 730 A.2d 1080, (1999); Comm’n, 199, 1085 Pa. 727 A.2d Public Util. (1963)). Zaleski, Pa. 189 A.2d Snizaski based on regard in this arguments DPWs Court’s misunderstanding of the Commonwealth fundamental from a close apparent As is and order. underlying opinion court un opinion, the Court’s of the Commonwealth reading payment to have denied Officer Hearing derstood had that DPW his solely on determination Devereux based type for an “suitable alternate that K.T. had been established 1151.48(a)(15) (permitting of care.” See or level for an alter “suitable for individuals deny payment DPW to care”). on Accordingly, appeal, or level of type nate this limited only whether considered Commonwealth that it had not holding had been correct. determination that, fact, had not “suitable” K.T. been correct and been the trial court’s or of care because an level alternative effect, the Commonwealth remained commitment order have might whether DPW not address or decide Court did on other DPW based deny payment been entitled 1101.61, requires as 55 Pa.Code such regulation, “medically pay only funds be used Assistance Medical necessary” treatment.16 recognize of the Common- this limitation party seems to
16. Neither concluded holding. DPW contends that the court While wealth Court's regardless whether it was compensable the treatment not, see, ("[T]he Common- medically necessary e.g., DPW's Brf. at 15 supplanted pleas order ruled that the common wealth Court circumstances, Under these DPW’s assertion that Commonwealth Court it required order pay K.T.’s treatment spite the fact the treatment was not medically necessary simply incorrect as the merely order deny concluded that DPW could not Devereux’s claim for 1151.48(a)(15). payment Regulation Moreover, DPW does riot take issue with the Commonwealth Court’s 1151.48(a)(15) conclusion that Regulation alone did not provide adequate support for of payment. the denial Accordingly, we affirm the order of the Commonwealth Court insofar as it held could not deny payment for KT.’s treatment based 1151.48(a)(15). Regulation on However, given that the Com monwealth Court did not acknowledge, resolve, much less DPW’s argument the treatment was not compensable *15 because it was medically unnecessary,17 we remand the matter necessity' requirement
the 'medical stay for K.T.’s continued at Dever- eux.”), argues that the court found that the treatment was See, "medically necessary.” ("[T]he e.g., Devereux’s Brf. at 7 Common- that, correctly wealth Court ruled otherwise, until the Common Pleas Court ruled K.T.'s at medically Devereux remained neces- ..."). sary. contentions, contrary parties’ to both the Commonwealth simply argument did not consider DPW’s that K.T.'s medical fact, "medically necessary.” treatment was not it did not even use "medically necessary” the term any point at opinion, in its much less Moreover, attempt interpret presume term. we will that the finding Commonwealth Court’s that K.T. was not "suitable for an type alternate or level of care” due to the existence of the unmodified equivalent commitment order finding is the of that the treatment was Indeed, "medically necessary.” regulations the DPW themselves make inquiry clear that the patient as to whether a is "suitable for an type alternate 1151.48(a)(15) or level of care" to 55 Pa.Code wholly is not inquiry coterminous with the as to whether or not the patient's "medically necessary.” treatment See 55 Pa.Code 1151.48(b) ("[T]he Department pay inpatient will not psychiatric provided facilities for conjunction services or items provi- with the (a) sion of a service or item in physician subsection attending even the hospital review stay committee determines utilization that the medically necessaiy.”) added). (emphasis clearly original 17. DPW denying stated in its payment letter for K.T.’s regulations treatment at prohibited Devereux that the payment because medically the treatment unnecessary. had been Ltr. from DPW 12/1/96 Devereux, ¶ 27a, Likewise, R.R. at 1. DPW argument made the same See, Hearing e.g., to the Hearing Officer. Adjudication, Officer's K.T 3-4; “[wjhether (setting id. forth issue as denying [DPW]was correct in consideration any properly preserved for of that and other argument support payment. could DPW’s denial of reasons, foregoing For the we reverse Commonwealth order it prohibited Court’s insofar as DPW from denying for payment KC.’s and H.B.’s on a lack treatment based documentation that facility Devereux was the only equipped to provide type juveniles the two required. However, we affirm the order insofar it held that not deny could for payment K.T.’s on treatment based a conclusion that K.T. was suitable an alternate or level of care. We nevertheless remand the matter consideration other properly-preserved arguments as to why DPW have been may deny entitled compensation K.T.’s treatment.
Former did Justice LAMB not participate the decision of this case.
Justice a concurring SAYLOR files and dissenting opinion. Justice EAKIN a dissenting opinion.' files SAYLOR, Justice concurring dissenting. agree
I legal the central propositions advanced DPW, namely, statutory that the for authorization juvenile in DPW-approved offenders medical does not control availability MA Program funding, but rath- er, the separate requirements Program control, the MA *16 therefore, it may necessary be in certain to circumstances compensation [K.T.], to [Devereux] for ... to services rendered due to a delay discharge in necessity”). of Finally, and lack medical when appealed Court, payment the of denial to the Commonwealth argued improper it it deny payment was for DPW to for K.T.’s necessity,
treatment based on a lack of medical see Devereux’s Commw. 19-22, Ct. Brf. at and DPW countered any that Devereux had waived arguments regarding necessity by failing medical to raise them in its involved, questions statement of the event, see Pa.R.A.P. but that in deny DHS payment entitled on that basis. DPW's circumstances, Ct. Commw. Brf. at 10-11. Under these we are at a why loss understand the Commonwealth Court did not either address necessity the issue of medical Hearing or remand the issue to the permit fully. Officer to him to address that issue more funding non-MA-Program- for an source of
pursue alternate see, treatment, in 42 Pa.C.S. part, e.g., in or approved whole of system § a child to fund the cost (establishing welfare or adjudicated necessary dependent care for children who are Act); §§ 62 P.S. 704.1-704-2 delinquent under the Juvenile sys- child (allocating responsibility financial the welfare tem). factors In this cost control regard, strong there are Program funding. Additionally, of MA governing availability certainly in making, although terms of reimbursement decision is court pleas a of in favor of a common degree deference due treatment, do be I not believe that DPW should directing (to it is by bound the determination deemed not in circum- party), extraordinary the absence least view, Rather, my in administrative reim- stances. DPW’s it is upheld procedurally should bursement decision where statutory with constitutional and dic- regular, conformance tates, by substantial evi- grounded findings supported 2See dence. Pa.C.S.
Additionally, majority’s approach I differ with the question reimbursement for Devereux services rendered K.T. this I do distinction between In not view the regard, requirement regulations concerning guiding DPW’s reimbursement, see 55 medical as a necessity prerequisite 1101.61, as non- regulation delineating Pa.Code who inpatient provided recipient care to a compensable days care, see 55 suitable an alternate level 1151.48(a)(15), hearing as material as concerns the Pa.Code DPW) (adopted that K.T. by examiner’s factual determination inpatient did require provided rubric during the time under consideration. Under the period unavailable, MA funds provision, Program simply either so long finding grounded DPW’s substantial evidence. of an regard, suitability this Devereux has conceded the level lack of actual medical reasons alternate of care placement, the continued but has advanced support merely its argument must be deemed to remain legal services even medically necessary purposes MA reimbursement after a coarse of has been prescribed completed treatment *17 alternative, for the suitable and until an unless for continued argument juvenile can be made. While the obligations in relation may have some merit funding (here, Philadelphia Department contracting agency Services) in with general, system or the child welfare Human reimbursement, I would hold that medical MA respect of an alternative level suitability and the necessity practice to medical standards according determined see regulations, provided DPW’s plainly 1101.21, validity of a successful the absence least (an Devereux does not regulation to such effort challenge here). undertake of this join majority’s disposition appeal
I therefore for services rendered K.C. with to reimbursement respect K.T., I as I H.B.; respectfully dissent respect in that situation as well. uphold would DPW’s denial EAKIN, dissenting. Justice Court
I would affirm on the basis of the Commonwealth I opinion. Accordingly, dissent.
855A.2d COMPANY, Appellee, AND FIRE CASUALTY MINNESOTA GREENFIELD, and Arlin Michael Sharon Smith C. J. Individually Smith, The and as Administrators of Angela Smith, Appellants. Estate of C.
Supreme Pennsylvania.
Argued Dec. Aug.
Decided