Morning View Care Center-Fulton v. Ohio Department of Human ServicesMorning View Care Center-Fulton v. Ohio Department of Human Services
{¶ 1} Plaintiff-appellant, Morning View Care Center-Fulton (“MVCC-Ful-ton”), appeals from a judgment of the Franklin County Court of Common Pleas in favor of defendants-appellees, the Ohio Department of Human Services (now the Ohio Department of Job and Family Services), Jacqueline Romer-Sensky (former director), and Barbara Edwards (a deputy director), in their respective official capacities (collectively “ODJFS”). A judgment entry dated August 3, 2001, incorporated the trial court’s written decision granting summary judgment to ODJFS and dismissing MVCC-Fulton’s complaint for declaratory and injunc-tive relief in connection with the handling by ODJFS of its application for a Medicaid reimbursement rate adjustment as provided in R.C. Chapter 5111 and Ohio Adm.Code Chapter 5101:3.
{¶ 2} MVCC-Fulton is an intermediate care facility for the mentally retarded located in Morrow County and licensed by the state of Ohio. It is among several such facilities in the state owned by a common management group, Morning View Care Centers, operated by Dearth Management, Inc. MVCC-Fulton’s 33 beds are certified to participate in federal Medicaid programs administered by ODJFS. MVCC-Fulton and ODJFS have been parties to a series of provider agreements
{¶ 3} This case involves financial circumstances related to MVCC-Fulton’s effort to downsize the capacity of its principal facility and to develop four 8-bed group homes to which former residents of the 65-bed home were transferred as each new building became ready for occupancy. The Ohio Department of Mental Retardation and Developmental Disabilities (“ODMRDD”) initially approved the development request in September 1993. The process of constructing the smaller group homes and transferring residents took place during calendar years 1996 and 1997, 1 but licensing changes were not effective until June 1, 1998. Annual provider agreements from September 1, 1995 through August 31, 1998 (extended to October 31, 1998) identified MVCC-Fulton’s certification as a 65-bed intermediate care facility. More recent agreements indicate a certification for 33 beds.
{¶ 4} The request for rate reconsideration, which pertains only to the main facility, was dated December 29, 1998, and was expressly grounded in “extreme hardship” under
{¶ 5} MVCC-Fulton suggested that fixed capital costs such as depreciation, amortization, interest expenses, and leasing costs for both real estate and equipment remained constant after the transfer of beds and, thus, caused an increase in the per diem cost per bed that was not adequately addressed by the reimbursements paid during fiscal years 1998 (July 1, 1997 to June 30, 1998) and 1999 (July 1, 1998 to June 30, 1999). MVCC-Fulton asserted that in spite of its aggressive attempts to reduce indirect costs, the size of the main facility and the continuing needs of its residents rendered it unable, during the period for which the rate adjustment was sought, to achieve a reduction proportionate to the number of beds eliminated as the result of the downsizing. Disparity between those costs and the reimbursements received during that period caused additional financial hardship according to the application for relief. MVCC-Fulton acknowledged that the expenditures allocated to capital and indirect costs exceeded the cost ceilings then in effect for those categories.
{¶ 7} ODJFS reviewed the documentation and then requested additional information to explain certain issues the department identified within the initial request. The agency asked for clarification of the time period for which relief due to extreme hardship was being sought and confirmation of the facility’s 1998 calendar year resident census. The department also asked for the following: (1) a copy of an operational plan detailing steps taken to prepare for downsizing; (2) a copy of a transition/downsizing budget; (3) a clearer explanation of the relationship between home office costs and the downsizing effort; (4) more detailed staffing information for both the main facility and the new group homes; (5) drawings of the facilities showing changes in usage and associated costs on a square-foot basis; (6) copies of lease agreements, depreciation schedules, and bank statements reflecting interest expense and principal debt; (7) more precise explanation of the figures presented under certain specific accounting codes; (8) copies of budgets for the 1998 and 1999 fiscal years; and (9) any other pertinent documentation reflecting the hardship.
{¶ 8} MVCC-Fulton responded in detail and specifically asked for an adjusted rate of $173.95 per patient per day based on the information included in its three-month cost report. A rate of $146.45 per patient per day was actually in effect during the same period. The total request was for approximately $734,354 in additional reimbursements for the two fiscal years addressed. After receiving this March 1, 1999 response to its request for additional information, ODJFS not only reviewed the financial data furnished but also performed its own calculations
{¶ 9} Based upon this analysis of all cost centers and a recalculation of allowable bed days during calendar year 1997, the period upon which the original rate for fiscal 1999 was determined, ODJFS granted a rate increase of $12.48 per diem, retroactively effective July 1, 1998. The approved adjustment amounted to a total increased reimbursement of approximately $222,456 for fiscal 1999 only. Relief for fiscal 1998 was denied because the application was deemed not timely for that year.
{¶ 10} Over the signature of Director Romer-Sensky, ODJFS issued a 15-page report, with attachments, explaining the decision to grant a lesser adjustment than had been requested. Relying upon the language in
{¶ 11} MVCC-Fulton requested that the department reconsider its decision to grant partial relief only. MVCC-Fulton argued that where a rate adjustment is requested on grounds of extreme hardship, the department has the discretion to grant reasonable and appropriate reimbursement of the added costs of downsizing without regard to whether a government mandate or circumstances beyond the provider’s control precipitate the hardship. Under that standard, the provider argued that an adjustment in the full amount requested is justified. ODJFS did not revise its initial award. MVCC-Fulton then filed its complaint in the Franklin County Common Pleas Court instituting the action from which this appeal is taken.
{¶ 12} MVCC-Fulton sought both declaratory and injunctive relief as to alleged violations by ODJFS of it rights under the Fifth and Fourteenth Amendments to the United States Constitution; Sections 1396 and 1983, Title 42, U.S.Code; Sections 1 and 2, Article I, Ohio Constitution;
{¶ 13} On September 14, 2000, the trial court dismissed several of those claims pursuant to
{¶ 14} The trial court found with respect to the state-law claims for an adjustment to the rate paid during fiscal 1998 that MVCC-Fulton did not request relief in a timely fashion and, therefore, ODJFS was entitled to judgment as a matter of law on any hardship alleged to have been experienced during that period. Finally, while recognizing that
{¶ 15} Appealing from that adverse judgment, MVCC-Fulton presents a single assignment of error for this court’s consideration:
{¶ 16} “The trial court erred in granting summary judgment in favor of appellees and against appellant when there remained genuine issues of material fact and movants were not otherwise entitled to judgment as a matter of law.”
{¶ 17} For the reasons that follow, we affirm the trial court’s judgment as to the due process claims brought by MVCC-Fulton pursuant to Section 1983, Title 42, U.S.Code, and as to the claims for relief under state law that relate to fiscal 1998. As to the claims for relief under state law for fiscal 1999, however, we find that MVCC-Fulton produced evidence in opposition to the motion for summary judgment sufficient, when viewed most favorably to it as the nonmoving party, to establish the existence of genuine issues of material fact to be litigated. We, therefore, reverse the trial court’s judgment in the latter respect.
{¶ 18} The Medicaid program is a source of federal funding designed to supplement state reimbursement to providers of medical and long-term care services to the poor.
Wilder v. Virginia Hosp. Assn.
(1990),
{¶ 19} Ohio has a prospective cost-related system of reimbursement under which the annual costs for services in the calendar year ending prior to the effective date of a current rate are utilized to calculate that rate.
Ohio Academy of Nursing Homes, Inc. v. Creasy,
supra. In this case, for example, the rate of reimbursement paid to MVCC-Fulton during fiscal 1998 was based upon its cost reports for calendar 1996, and the rate for fiscal 1999 was calculated from calendar 1997 cost reports. Absent one or more of the circumstances mentioned in
{¶ 21} “ ‘Reasonable’ means that a cost is an actual cost that is appropriate and helpful to develop and maintain the operation of patient care facilities and activities, including normal standby costs, and that does not exceed what a prudent buyer pays for a given item or services. Reasonable costs may vary from provider to provider and from time to time for the same provider.”
{¶22} The Ohio General Assembly has provided a procedure by which a facility may seek reconsideration of its Medicaid reimbursement rate, but has vested the responsibility to adopt specific rules for establishment of the process to ODJFS.
{¶ 23} “The rules shall provide that the department, through the rate reconsideration process, may increase a facility’s rate as calculated under sections 5111.23 to 5111.28 of the Revised Code if the department, in its sole discretion, determines that the rate as calculated under those sections works an extreme hardship on the facility.”
{¶ 24} The department’s decision at the conclusion of the reconsideration process is not subject to any administrative proceedings under Ohio Adm.Code Chapter 119 or any other provision of the Revised Code.
{¶ 25} As the legislature directed, ODJFS adopted
{¶ 26} The request, in writing, must give a detailed explanation as to why a rate adjustment due to extreme hardship is warranted, including steps taken to address the circumstances outside the rate reconsideration process.
{¶ 27} When an appellate court reviews a case that was concluded at the trial level by summary judgment, it does so de novo, applying the same standards as required of the trial court.
Ryberg v. Allstate Ins. Co.
(2001), Franklin App. No. 00AP-1243,
{¶ 28} Summary judgment is appropriate pursuant to
{¶ 29} The trial court correctly ruled that ODJFS, as an agency, is not a “person” subject to suit under Section 1983, Title 42, U.S.Code. This court previously held that one of the elements of a Section 1983 claim is that the conduct in controversy must be committed by a person acting under color of state law and that the state is not a “person” for purposes of Section 1983.
Mankins v. Paxton
(2001),
{¶ 30} To show that the former director and the deputy director of ODJFS violated its due process rights and that it is entitled to relief under Section 1983, Title 42, U.S.Code, MVCC-Fulton must identify a constitutionally protected property right in a higher adjusted rate than has been granted by ODJFS. That property interest must be based on a legitimate claim of entitlement, created not by the Constitution, but instead by existing rules or understandings from an independent source such as state law that secures certain benefits and that supports claims of entitlement to those benefits.
Drake Ctr., Inc. v. Ohio Dept. of Human Serv.
(1998),
{¶ 31} To justify relief on grounds of procedural due process, MVCC-Fulton must establish not only a legitimate property interest, but also that it was deprived of that interest without a meaningful opportunity to be heard.
Ohio Academy of Nursing Homes, Inc. v. Barry
(1990),
{¶ 32} The essence of substantive due process is the protection from certain arbitrary, wrongful governmental actions irrespective of the fairness of the procedures used to implement them.
S. Health Facilities, Inc. v. Somani
(Dec. 29, 1995), Franklin App. No. 95APE06-826,
{¶ 33} The Ohio Supreme Court has determined that a licensed Medicaid provider has a legitimate property interest in the reimbursement rate provided for it under
{¶ 34} As was true in
Drake Ctr.,
MVCC-Fulton does not challenge the state’s reimbursement system as a whole. Id.,
{¶ 35} We find no compelling reason to distinguish MVCC-Fulton’s substantive due process claims from those of Drake Center.
{¶ 36} We also come to the same conclusion as the trial court with respect to the lack of timeliness by MVCC-Fulton in applying for relief for fiscal 1998. The plain language contained in
{¶ 37} The argument by MVCC-Fulton that another rule vesting the department with discretion to determine the effective date of any rate adjustment granted due to extreme hardship excuses a provider from seeking relief in timely fashion, is not well taken. If the application is not timely filed, it ought not be granted. The other rule that provides for discretion in determining the effective date for relief, if granted, does not apply if an application is denied as untimely. The conclusion by the trial court that ODJFS is entitled to judgment as a matter of law on the claims of MVCC-Fulton that pertain to fiscal 1998 is affirmed.
{¶ 38} As to MVCC-Fulton’s R.C. Chapter 5111 claims for an adjustment of the rate paid to it during fiscal 1999, ODJFS, the party moving for summary judgment, bears the initial responsibility to inform the court of the basis for its motion and to identify those portions of the record that demonstrate the absence of a genuine issue of fact as to a material element of one or more of the nonmoving party’s claims for relief.
Christensen v. Ohio Mulch Supply, Inc.
(Aug. 14, 2001), Franklin App. No. 00AP-1036,
{¶ 39} If ODJFS satisfies this initial burden by presenting or identifying appropriate
{¶ 40} To decide whether ODJFS is entitled to summary judgment on the claims of MVCC-Fulton that the department failed to comply with the requirements of
{¶ 41} Reviewing the
{¶ 42} In opposition to the motion for summary judgment, MVCC-Fulton provides an affidavit by Bert Cummins, C.P.A., and a properly authenticated copy of correspondence from the former director of ODMRDD in support of the application for rate adjustment due to extreme hardship. MVCC-Fulton also relies upon the depositions, with exhibits, of a number of witnesses, the transcripts of which were filed in the trial court record.
{¶ 43} Based upon his experience and his review of the documentation submitted to and considered by ODJFS, the analysis reports created by ODJFS personnel, and the transcripts of deposition testimony by ODJFS employees, Cummins concludes:
{¶ 44} “The result of the Department of Job & Family Services rate reconsideration review (to grant the minimal relief provided to Morning View Care Center) is completely unsupported by any of the data and analysis set forth in its letter to the provider stating its decision, the attachments to that correspondence and any of the other documents prepared by the Department.” Cummins Affidavit, paragraph 11.
{¶ 45} Cummins identifies several specific examples of ODJFS having abused its discretion, including an attempt to calculate an overpayment related to renovations, an audit function, and factor that calculation into the amount of capital relief granted. The witness opines that this calculation is “an abuse” and inappropriate within the context of the rate reconsideration process for determining a rate adjustment based upon extreme hardship. (Cummins Deposition, at 91.) He also questions the department’s emphasis on “MVCC-Fulton’s failure to prepare a transition plan and adequately assess the downsizing feasibility”
{¶ 46} Steven Stanisa, also a C.P.A. and a consultant to the long-term care industry, was deposed as a prospective expert witness on behalf of MVCC-Fulton. His testimony includes his opinion that “the department inappropriately exercised its discretion” in relation to its approval of the hardship request and “failed to reimburse the reasonable cost of the provider” in caring for its residents. (Stanisa deposition, at 15.) The witness identifies the $12.48 per-patient per-day rate adjustment approved as an abuse of discretion inasmuch as he does not believe it to be based upon the costs detailed in the required three-month cost report that accompanied the application. (Stanisa deposition, at 50-51.)
{¶ 47} We recognize that generally a reviewing court will not intrude into areas of administrative discretion for the reason that a rebuttable presumption of validity attaches to actions of administrative agencies.
Ohio Academy of Nursing Homes, Inc. v. Barry,
supra,
{¶ 48} The agency’s interpretation and application of its rules cannot be arbitrary, capricious or otherwise contrary to law, nor can the interpretation and application constitute an abuse of discretion. See
Ohio Academy of Nursing Homes, Inc. v. Barry,
supra,
{¶ 49} Here, the department’s announcement of its decision included the following explanation:
{¶ 50} “In order for ODHS to grant a rate adjustment as a result of a request for rate reconsideration due to extreme hardship, a provider should clearly demonstrate the following:
{¶ 51} “The financial hardship is the result of factors outside the provider’s control}.]
{¶ 52} “The PPS [Prospective Payment System] is failing to respond appropriately to the circumstances presented.
{¶ 53} “MVCC-Fulton’s failure to prepare a transition plan and adequately assess the downsizing feasibility is neither outside the provider’s control nor a failure of the PPS. As such, the failure to effectively plan and analyze the proposed downsizing cannot serve as the basis for relief due to extreme hardship.
{¶ 54} “The basic principles underlying the provisions of OAC Rule 5101:3-3-24(D) was to respond to situations where a provider could not reasonably control and/or the PPS was not responding appropriately. These provisions were in no way intended to protect the operator of a long-term care facility from the risks and responsibilities of operating a business venture. * * *
{¶ 55} “MVCC-Fulton did not fully demonstrate which circumstances either were outside their control, a failure in the PPS, or documented all the cost reduction steps implemented by the provider, along with the associated cost savings with these steps. * * *” January 10, 2001 Depositions Ex. 4, at 14.
{¶ 56} The deposition testimony of Barbara Edwards and Harry Saxe is evidence of the extent to which ODJFS focused on the issue whether a mandate, either by direct order or statewide policy, was in effect that required MVCC-Fulton to downsize its primary facility. Susie Weber and Charlene Murphy acknowledged in their deposition testimony that, according to their respective understandings, the department rules do not require submission of transition plans in connection with an extreme hardship application. Also, in her second deposition, Charlene Murphy admitted that the department had not, to her knowledge, previously adjusted the number of patient days from a prior year that
{¶ 57} In the course of completing the required de novo review of the trial court’s judgment, we have considered a significant volume of evidence presented in support of and in opposition to the motion for summary judgment. We conclude from that evidence, viewing it, as we must, most favorably to the nonmoving party, that MVCC-Fulton has sustained its burden to establish the existence of genuine issues of material fact concerning whether ODJFS complied with the requirements of
{¶ 58} Even though the discretion vested in ODJFS by
{¶ 59} The explanation by ODJFS of its actions, together with deposition testimony describing some of the areas of agency focus in its analysis, is evidence that the department applied standards not applicable to the grounds upon which relief was requested. A decision to grant or deny relief requested under extreme hardship provisions should be reached according to the regulations governing that type of relief. To the extent that the agency emphasized issues pertaining to extreme circumstances, governed by
{¶ 60} ODJFS has argued, and the trial court found, that the decision by this court in
Ohio Academy of Nursing Homes, Inc. v. Creasy,
supra,
{¶ 61} In this case, where the issues to be decided require a showing of extreme hardship and a determination whether the existing rate under the prospective payment system responds reasonably to an increase in costs related to the hardship, the correct measure of “reasonable” costs is that provided by the legislature in
{¶ 62} MVCC-Fulton is not necessarily entitled to an adjusted rate equal to its total request. ODJFS would have ignored its responsibility to determine what is reasonable had it simply paid the amount requested.
Worthington Nursing Home, Inc. v. Creasy,
supra,
{¶ 63} Because we conclude that ODJFS is not entitled to judgment as a matter of law on the claims of MVCC-Fulton under state law that the department failed to comply with the requirements of
Judgment affirmed in part, reversed in part and cause remanded.
Notes
. The first group home was opened June 24, 1996, and the others began operations on May 19, September 11, and November 26, 1997, respectively.
. A transition in gubernatorial administrations as well as departmental leadership occurred during the winter months of 1998-1999.
. Depositions of ODJFS employees Harry Saxe, Barbara Edwards, Frank Blair, Susie Weber, and Kevin Carter were conducted on January 10 and 11, 2001. Transcripts of those and later depositions were properly filed in the record during June 2001. Exhibits referred to as "January 10, 2001 Deposition Ex. __” were marked and identified on that date, then referred to in a number of the depositions conducted throughout the discovery proceedings in the trial court.
. The trial court granted the motion to dismiss as to the equal protection claims of MVCC-Fulton under the United States and Ohio Constitutions and as to the Section 1396(a), Title 42, U.S.Code statutory claims alleged under Section 1983, Title 42, U.S.Code. The court denied the motion to dismiss with respect to the procedural and substantive due process claims brought under Section 1983, Title 42, U.S.Code as well as the R.C. Chapter 5111 state law claims.
. Beginning in 1980 there have been five versions of
. Rate reconsiderations because of “extreme circumstances” differ from those due to "extreme hardship” and are addressed by
. "Outlier'' means residents who have special care needs as defined under rule 5101:3-3-25 of the Ohio Administrative Code.
. "Unequivocal” is defined in Webster's Encyclopedic Unabridged Dictionary of the English Language (1996) 1548, as (1) not equivocal, unambiguous, clear, having only one possible meaning; (2) explicit, definite, not merely implied or suggested; (3) absolute, unqualified, not subject to conditions or exceptions; (4) conclusive, unquestionable, not subject to dispute or challenge.