Family Redirection Institute, Inc. v. Commonwealth of Virginia, etc.Family Redirection Institute, Inc. v. Commonwealth of Virginia, etc.
against him was seized in violation of the Fourth Amendment.” (emphasis added)); see generally 1 LaFave, supra § 1.6(c), at 248. In addition to the firearms discovered in Ross‘s residence, the record contains photos of Ross holding what appears to be a firearm prior to the search. After the search, Ross made statements concerning those photos. Because the trial court dеnied the motion to suppress, the court did not address what the proper scope of a suppression order would be if one had been entered. We will not address this issue for the first time on appeal. “While the conclusions we have reached require us to reverse the [trial] court‘s ruling” that Ross‘s “constitutional rights were not violated, those conclusions do not determine the sсope of the suppression order (if any) to be entered.” United States v. Acosta-Colon, 157 F.3d 9, 21 (1st Cir. 1998) (citing United States v. Crews, 445 U.S. 463, 474, 100 S.Ct. 1244, 1251, 63 L.Ed.2d 537 (1980)).
Usha Koduru, Assistant Attorney General (Kenneth T. Cuccinelli, II, Attorney General; Rita W. Beale, Deputy Attorney General; Kim F. Piner, Senior Assistant Attorney General, on brief), for appellee.
Present: FRANK, HUMPHREYS and KELSEY, JJ.
KELSEY, Judge.
The Virginia Department of Medical Assistance Services (DMAS) ordered Family Redirection Institute, Inc. (FRI) to reimburse the Commonwealth for payments madе to FRI. Contesting this reimbursement order, FRI appealed to the circuit court under the Virginia Administrative Process Act (VAPA),
I.
DMAS administers the federal and state funded Medicaid Program. See
The qualification pertinent to this case is the QMHP, which DMAS regulations define as “a clinician in the human services field who is trained and experienced in providing psychiatric or mental health services to individuals who have a psychiatric diagnosis.”
In 2000, and again in 2007, DMAS and FRI entered into agreements authorizing FRI to participate in the DMAS program. The agreements stated that DMAS would pay FRI for its servicеs on the conditions that FRI “keep such records as [the Virginia Medical Assistance Program (VMAP)] determines necessary regarding payments claimed for providing services under the State Plan” and “comply with all applicable state and federal laws, as well as administrative policies and procedures of VMAP as from time to time amended.” App. at 655-56. DMAS also provided FRI with a Community Mеntal Health Rehabilitative Services Manual, which stated: “Providers will be required to refund payments made by Medicaid if they are found to have billed Medicaid contrary to law or regulation, failed to maintain any record or adequate documentation to support their claims, or billed for medically unnecessary services.” DMAS Community Mental Health Rehabilitative Services Manual сh. VI, at 2 (rev. June 6, 2003).
Following a utilization review by a DMAS auditor, DMAS requested reimbursement for services provided by four FRI employees who lacked sufficient periods of clinical experience at the time of the services billed and were thus unqualified mental health workers. As the enabling statute requires, DMAS
FRI appealed the final agency decision to the circuit court. The court entered an order affirming DMAS‘s decision to obtain reimbursement for all four FRI employees. The court‘s order stated that DMAS‘s interpretation of
II.
On appeal, FRI argues the circuit court should have found DMAS‘s decision “arbitrary and capricious” because DMAS imposed unwritten “documentation requirements” upon FRI to prove the clinical experience of its four employees. Appellant‘s Br. at 2. FRI adds that the circuit court‘s final order (which includes a statement that DMAS cannot enforce unwritten standards) demonstrates why its holding (which finds DMAS properly requested reimbursement for thе four unqualified FRI workers) was plainly wrong. Id. On several levels, we disagree.
A. VAPA & THE LIMITED NATURE OF JUDICIAL REVIEW
Under the VAPA, the circuit court reviews an agency‘s action in a manner “equivalent to an appellate court‘s role in an appeal from a trial court.” Mattaponi Indian Tribe v. Commonwealth, 43 Va.App. 690, 707, 601 S.E.2d 667, 676 (2004) (citations omitted), aff‘d in relevant part sub nom. Alliance to Save the Mattaponi v. Commonwealth, 270 Va. 423, 621 S.E.2d 78 (2005). “In this sense, the General Assembly has provided that a circuit court acts as an appellate tribunal.” Laurels of Bon Air, LLC v. Med. Facilities of Am. LIV Ltd. P‘ship, 51 Va.App. 583, 591, 659 S.E.2d 561, 565 (2008) (quoting Gordon v. Allen, 24 Va.App. 272, 277, 482 S.E.2d 66, 68 (1997)).
Instead, “when the appellant challenges a judgment call on a topic on which ‘the agency has been entrusted with wide discretion by the General Assembly,’ we will overturn the decision only if it can be fairly characterized as ‘arbitrary or capricious’ and thus a ‘clear abuse of delegated discretion.’ ” Citland, Ltd. v. Commonwealth ex rel. Kilgore, 45 Va.App. 268, 275, 610 S.E.2d 321, 324 (2005) (citation omitted). “This standard recognizes the larger premise that, before any legal question can be answered, an a priori question must first be asked—who has the authority to decide. It is the one question that precedes all others.” Boone, 52 Va.App. at 62, 660 S.E.2d at 708.
We generally review legal questions de novo. That is certainly the case when we interpret statutes.3 But we take a very different approach to interpreting administrative regulations. When authorized by the General Assembly to issue regulations, an agency acts securely within its delegable authority to interpret those regulations if it does so reasоnably and in a manner consistent with the legislative directive. We thus afford DMAS “great deference” in its administrative “interpretation and application of its own regulations.” Finnerty v. Thornton Hall, Inc., 42 Va.App. 628, 634 n. 2, 593 S.E.2d 568, 571 n. 2 (2004) (quoting Dep‘t of Med. Assistance Servs. v. Beverly Healthcare, 41 Va.App. 468, 481, 585 S.E.2d 858, 865 (2003)); cf. Bd. of Supervisors v. State Bldg. Code Tech. Review Bd., 52 Va.App. 460, 466, 663 S.E.2d 571, 574 (2008) (noting limits to such deference).
B. THE CIRCUIT COURT‘S FINAL ORDER
With these principles framing our review, we next turn to the language of the circuit court‘s final order. FRI reads in it a fatal inconsistency. According to FRI, the order endorses FRI‘s main argument that DMAS was enforcing “documentation rеquirements” not clearly stated in its regulations. Despite this purported endorsement, the order rules in DMAS‘S favor on the merits with respect to all four FRI employees. FRI argues we should affirm the circuit court‘s reasoning and reverse its holding. We think just the opposite is true. It seems to us the better approach is to affirm the court‘s holding and ignore its allegedly inconsistent reasoning.
To begin with, we are not at all confident of FRI‘s reading of the court‘s statement that DMAS‘s interpretation of
We acknowledge the conceptual gap between what the court said and what it did seems rather wide, particularly considering the statement of facts adoрted by the court. See supra n. 2. Mitigating that concern, however, is the basic tenet that an appellate court “reviews judgments, not statements in opinions.” California v. Rooney, 483 U.S. 307, 311, 107 S.Ct. 2852, 2854, 97 L.Ed.2d 258 (1987) (per curiam) (citation omitted); see also Chevron U.S.A. Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837, 842 n. 8, 104 S.Ct. 2778, 2781 n. 8, 81 L.Ed.2d 694 (1984). When the issue on appeal involves a matter of law reviewed de novo, the “question before an appellate Court is, was the judgment correct, not the ground on which the judgment professes to proceed.” McClung v. Silliman, 19 U.S. (6 Wheat.) 598, 603, 5 L.Ed. 340 (1821).
In this cаse, the question before us is exactly the same as the one before the circuit court: Did DMAS interpret or apply its regulations in a manner that arbitrarily and capriciously required FRI to reimburse DMAS for prior Medicaid payments for the four unqualified employees? We can answer this legal question without attempting to tease out of the circuit court‘s statements various enigmatic meanings allegedly favorable or disfavorable to its holding.
C. DMAS REGULATIONS & FINAL AGENCY DECISION
DMAS regulations define a QMHP as “a clinician in the human services field who is trained and experienced in providing psychiatric or mental health services to individuals who have a psychiatric diagnosis.”
DMAS applied these definitions to the four disputed FRI employees and found that each lacked the required amount of
clinical experience to be qualified as a QMHP at the time the services were rendered. This decision should not stand, FRI contends, because underlying it are unwritten “documentation requirements” nowhere spelled out in the regulations. Appellant‘s Br. at 9. We disagree.
To us, the record shows nothing more than DMAS looking for contemporaneous written evidence to support FRI‘s claim that its employees had bona fide clinical experience before being billed as QMHPs. It is understandable DMAS would do so. FRI provided DMAS with multiple, inconsistent versions of the employees’ resumes and copies of their diplomas and first-aid certifications. To the extent any supervised on-the-job training occurred, none of it was adequately documented. We can hardly fault DMAS for considering the presence or absence of documentary evidence relevant to its decision.
Perhaps not, FRI argues in the alternative, but FRI shоuld have been given prior notice of DMAS‘s need for documentary proof of the employees’ training and qualifications. We question the factual assumption behind this assertion.5 At the formal hearing, FRI‘s executive program director acknowledged that DMAS requested “some records from these employees,” App. at 423, and suggested FRI actually had more documentation availablе: “We could have—we were willing to drive a truck up, if needed, and bring the whole shebang, but we weren‘t told to, unfortunately.” Id. at 424.
that “[w]hile due process may require that parties receive notice and an opportunity to introduce relevant evidence,” there is no case “holding that due process requires agencies to give advance notice of what evidence they intend to credit“); accord ICO Global Commc‘ns (Holdings) Ltd. v. F.C.C., 428 F.3d 264, 268 (D.C.Cir. 2005) (“[T]here is no due process violation if a regulated party acting in good faith is able to identify, with ascertainable certainty, the standards with which the agency expects parties to conform.” (citation and internal quotation marks omitted)).
We also find no basis for FRI‘s complaint that DMAS‘S alleged “documentation requirements,” Appellant‘s Br. at 9, produced insupportable factual conclusions. DMAS found that one employee held a Bachelor‘s degree in Criminal Justice and had prior work experience at QVC, Pizza Hut, and the YMCA before joining FRI. The employee claimed to have been a youth counselor while in high school. DMAS reviewed this work background and concluded: “There is no job description or employment history that would establish [three] years of clinical experience. There is no record of clinical supervisiоn.” App. at 162. Moreover, DMAS found FRI‘s “file documentation was self-serving and non-verifiable,” and thus FRI “failed to carry the burden of proving that [this employee] satisfied the qualifications of a QMHP.” Id.
The other three employees fared no better. For one, FRI relied upon his prior work as a volunteer at a church and community center, but no evidence (written or unwritten) suggested he provided any dirеct services to individuals with mental retardation or illness. For another employee, FRI cited his prior experience as a high school English teacher and a dorm resident assistant in college, but no evidence proved either position involved counseling students with mental health diagnoses. FRI‘s final employee had a Bachelor‘s degree in Sociology, a term of servicе with the United States Army Reserves, and leadership experience in a cadet organization. But, as with the other employees, no evidence proved her background met the definition of “clinical experience” sufficient to be deemed a QMHP. FRI had the burden of proving the qualifications of each employee. Given the paucity of evidence presented by FRI, we cannot hold the record as a whole compels a “reasonable mind” to ”necessarily come to a different conclusion.” Boone, 52 Va.App. at 62, 660 S.E.2d at 708 (emphasis in original) (citation omitted). As we have said before, “DMAS possesses the requisite experience and competence necessary to determine the reimbursement due qualified providers for their reasonable costs incurred while delivering health care services.” Fralin v. Kozlowski, 18 Va.App. 697, 701, 447 S.E.2d 238, 241 (1994). None оf DMAS‘s findings in this case shake our confidence in this principle of factfinding deference.
III.
In short, DMAS did not enforce unwritten documentation requirements by simply noting the presence or absence of written evidence offered in support of FRI‘s claim that all four employees were qualified as QMHPs. Nor did DMAS act irrationally by determining that FRI did not establish their qualifications by a preponderanсe of the evidence. We thus affirm the circuit court‘s judgment upholding DMAS‘s final agency decision.
Affirmed.
Notes
For reasons expressed later in our opinion, see infra at 773-74, we look solely to the court‘s final order as the best evidence of its ruling. See McMillion v. Dryvit Sys., Inc., 262 Va. 463, 469, 552 S.E.2d 364, 368 (2001) (“[T]rial courts speak only through their written orders and ... such orders are presumed to reflect acсurately what transpired.“); Stamper v. Commonwealth, 220 Va. 260, 280-81, 257 S.E.2d 808, 822 (1979) (“[W]e presume that the order, as the final pronouncement on the subject, rather than a transcript that may be flawed by omissions, accurately reflects what transpired.“); Anderson v. Commonwealth, 13 Va.App. 506, 508, 413 S.E.2d 75, 77 (1992) (stating that “[t]ranscripts and statements of facts serve the identical purpose on appeal,” and thus “[f]airness and common sense dictate that policies regarding transcripts аnd statements of facts be reasonably analogous.“).