353 Mass. 369 | Mass. | 1967
In two cases the hospital seeks judicial determination of issues concerning the promulgation under G. L. c. 7, § 30K (as amended through St. 1963, c. 439, § l),
In the first case, the hospital asked declaratory relief against the Commissioner of Administration (the commissioner). A Superior Court judge made findings and rulings adverse to the hospital’s contentions. From a final decree making declarations in accordance with the findings and rulings, the hospital appeals.
The case arises from the following four actions of the com
The trial judge ruled (1) that the commissioner “having duly established . . . hospital care rates on April 30, 1965, to be effective from January 1, 1965 (for the calendar year of 1965), lacked authority on October 1, 1965, to establish a new and different schedule of rates for the year 1965”; (2) that the “purported certification of . . . [the October 1] rates was without legal effect”; and (3) that the commissioner “was not required to afford the . . . [hospital] an adjudicatory proceeding . . . [or to] hold a public hearing prior to the . . . withdrawal of rates which . . . [he] had no . . . authority to promulgate in the first instance.” These rulings were incorporated in the final decree.
The record does not indicate what evidence was before the commissioner at the February 25 public hearing. Allegations of the present bill not explicitly denied by the commissioner, see Rule 29 of the Superior Court (1954), refer to exhibits annexed to the bill and summarized in the margin.
1. Section 30K (see fn. 2) provides that rates to be paid to the hospitals by public bodies for the care of public patients are to be determined by the commissioner so as (fn. 2, at point [D]) to “reflect reasonable hospital costs or charges made to the general public, whichever is the lower.” In collecting cost data (see fn. 2, at point [B]) a “uniform system of hospital accounting and cost analysis” is to be employed. Items such as depreciation are to be taken into account. The section has been viewed as directing the commissioner to establish compensatory rates of reimbursing hospitals from public funds for their costs in giving care to public patients, so that the hospitals will not be out of pocket for caring for welfare and other public patients, and so that the many nonprofit, charitable hospitals in the Commonwealth (of which the Massachusetts General Hospital is one) will not be obliged to deplete funds held for general charitable purposes for the care of such public patients. See Springfield Hosp. v. Commissioner of Pub. Welfare, 350 Mass. 704, 709-710. The section must be interpreted with this purpose in mind. Obviously the AIPD rate, in a period of rising prices and wages, will not be compensatory if it reflects the lower hospital expenses, including wages and costs of goods, of a period long past instead of the higher costs of the current period in which the hospital is called upon to render services to public patients.
The principal contention now advanced by the Attorney General is that § 30K does not permit the commissioner to
2. The rates certified on April 30, 1965, were not, and did not purport to be, merely tentative, emergency, or temporary rates, like the emergency rates put out on February 4, 1965, which under G. L. c. 30A, § 2 (3), could “not remain in effect for longer than three months unless during that time” notice was given and a public hearing held in accordance with § 2. The April 30 rates were promulgated by the commissioner after a public hearing on February 25, the date of the only public hearing mentioned in the record as held on AIPD rates in 1965. Even if issuing this general regulation was not an “adjudicatory proceeding” under G. L. c. 30A, § 1 (1), a matter which we need not now decide, the hospitals and perhaps various public bodies and boards, in a matter so substantially affecting their interests, were properly given such a public hearing under general principles of
Because the October 1 rates were not validly promulgated, they never became effective. Consequently, there was no obligation to give any notice or to grant a public hearing with respect to the commissioner’s recognition of the invalidity of the October 1 rates, which had no legal effect.
3. What has been said disposes also of the companion
4. In the hospital’s case against the Commissioner of Administration, the final decree is to be modified by striking out paragraphs 2, 3, and 4, and inserting in place thereof a declaration that the commissioner’s rates, intended to become effective October 1, 1965, were not based on adequate new notice and hearing and never took effect as valid regulations. As so modified, the decree in that case is affirmed. In the hospital’s case against the Commissioner of Public Welfare, a final decree is to be entered consistent with the view that the hospital is entitled to reimbursement from the city of Somerville for care rendered in 1965 to Mrs. Cioffi only at the rate established by the Commissioner of Administration on April 30, 1965.
So ordered.
Section 30K, as amended in 1963, reads in part, “The director of hospital costs and finances shall [A] determine from time to time and certify to the commissioner of administration, at least as often as annually, the average all-inclusive per diem charge to the general public for public ward accommodations or their equivalent, the all-inclusive per diem cost of care in such accommodations and the all-inclusive per diem cost of care for all patients of each hospital . . . licensed by the department of public health under . . . [c. Ill, § 71]. In determining such all-inclusive charges and costs, charges for and costs of ancillary services shall be included. . . . [Then follow provisions governing (a) certification when the AIPD cost of care cannot be determined for a hospital, (b) the filing of data by hospitals, and (c) the director’s powers to make examinations of hospital books.] [B] The director shall make his determination as aforesaid in accordance with a uniform system of hospital accounting and cost analysis and shall take into account . . . depreciation and a fair return on invested capital for proprietary hospitals, but shall not include grants-in-aid for which no services are rendered. . . . The commissioner [C] shall certify annually to each of the various departments, boards or commissions of the commonwealth purchasing care in such hospitals ... or reimbursing cities or towns for such care purchased by them, such rates with respect to each such hospital, ... as will [D] reflect reasonable hospital costs or charges made to the general public, whichever is the lower. All departments, boards or commissions of the commonwealth purchasing such service shall pay the rates so certified. The various subdivisions of the commonwealth purchasing hospital care and receiving reimbursement therefor, in whole or in part from the commonwealth, shall pay the hospitals ... for such care at the rates so certified. The commissioner shall also certify [E] at least annually to the department of industrial accidents the all-inclusive per diem cost of care for all patients for each such hospital . . .” (emphasis supplied). The letters in brackets are inserted to permit convenient later reference to the language immediately following such letters, respectively.
For representative hospitals, the rates promulgated on February 4 and those issued on April 30, 1965, appear to be the same. The October 1, 1965, rates were higher in varying amounts as indicated by the following table.
Emergency Rates of Feb. 4, and Rates of October ] Hospital April 30, 1965. 1965. Massachusetts General $42.85 $47.85 Peter Bent Brigham 44.86 51.57 Carney 34.52 39.83 Memorial, Worcester 34.92 35.11 St. Luke’s, Pittsfield 33.91 35.96 St. Elizabeth’s, Brighton 29.96 37.09
One such exhibit is a request (dated August 9, 1965) by_ the commissioner for an opinion of the then Attorney General. Another is the opinion (dated August 30, 1965) of the then Attorney General^ advising that the commissioner could not certify new rates in 1965, once having done so on A.pril 30. A third exhibit was a request (dated September 9, 1965) by the commissioner for reconsideration of the opinion of August 30, 1965, in view of the circumstance that “on April 30, 1965, it was . . . known by everyone concerned . . . that the rates being promulgated did not reflect reasonable hospital costs.”