Columbiana Health and Rehabilitation, LLC, et al. v. Statewide Health Coordinating Council et al.

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REL: 1/11/13 Notice: T h i s o p i n i o n i s s u b j e c t t o f o r m a l r e v i s i o n b e f o r e p u b l i c a t i o n i n t h e advance s h e e t s o f Southern R e p o r t e r . R e a d e r s a r e r e q u e s t e d t o n o t i f y t h e Reporter of Decisions, Alabama A p p e l l a t e C o u r t s , 300 D e x t e r A v e n u e , M o n t g o m e r y , A l a b a m a 3 6 1 0 4 - 3 7 4 1 ((334) 2 2 9 - 0 6 4 9 ) , o f a n y t y p o g r a p h i c a l o r o t h e r e r r o r s , i n o r d e r t h a t c o r r e c t i o n s may b e made b e f o r e t h e o p i n i o n i s p r i n t e d i n Southern R e p o r t e r . ALABAMA COURT OF CIVIL APPEALS OCTOBER TERM, 2012-2013 2110719 Columbiana H e a l t h and R e h a b i l i t a t i o n , LLC, e t a l . v. Statewide H e a l t h C o o r d i n a t i n g C o u n c i l e t a l . Appeal from Montgomery C i r c u i t Court (CV-11-1255) PER CURIAM. In March ("HealthSouth"), 2011, HealthSouth of p e t i t i o n e d the Statewide Alabama, Health L.L.C. Coordinating C o u n c i l ( " t h e C o u n c i l " ) f o r an a d j u s t m e n t t o t h e S t a t e Plan. The C o u n c i l i s a S t a t e a g e n c y t h a t p r e p a r e s , Health reviews, 2110719 r e v i s e s , and a p p r o v e s t h e S t a t e H e a l t h P l a n . § Ala. Home, I n c . , Code 1975; So. 2d 1179, an agency). that see Ex p a r t e 1184-86 ( A l a . 1988) The State Health " p r o v i d e [ s ] f o r the resources Traylor Nursing to assure 22-4-8(b)(2), ( s t a t i n g t h a t the C o u n c i l i s Plan i s a comprehensive development of h e a l t h programs that 543 quality health services will plan and be a v a i l a b l e and a c c e s s i b l e i n a manner w h i c h a s s u r e s c o n t i n u i t y of care, at reasonable c o s t s , f o r a l l r e s i d e n t s of the s t a t e . " § 2 2 - 2 1 - 2 6 0 ( 1 3 ) , A l a . Code 1975. The State Health p a r t o f t h e A l a b a m a A d m i n i s t r a t i v e Code, see R u l e 410-2-1 e t s e q . , A l a . Admin. Code ( S t a t e H e a l t h P l a n n i n g and Agency); a l l the o p i n i o n are administrative contained HealthSouth i n the sought the rules Development discussed State Health adjustment Plan i s a in this Plan. to the State Health P l a n t o i n d i c a t e t h e n e e d f o r 17 i n p a t i e n t - r e h a b i l i t a t i o n b e d s in Shelby County. At the time, there r e h a b i l i t a t i o n beds i n S h e l b y County. adjustment as a necessary step were no HealthSouth i n i t s plan to inpatientsought later the obtain c e r t i f i c a t i o n t o b u i l d an i n p a t i e n t - r e h a b i l i t a t i o n f a c i l i t y i n Shelby County. Columbiana Health The and proposed adjustment R e h a b i l i t a t i o n , LLC, 2 was a opposed by nursing-and- 2110719 rehabilitation entity; 25 o t h e r nursing-and-rehabilitation e n t i t i e s ; a n d t h e H e a l t h c a r e A u t h o r i t y o f C u l l m a n C o u n t y d/b/a Cullman homes"). Regional Center ( c o l l e c t i v e l y "the nursing 1 Following proposed Medical a public adjustment hearing, to the State the Council approved the Health and Governor Plan, R o b e r t B e n t l e y a p p r o v e d t h e a d j u s t m e n t on S e p t e m b e r 15, 2 0 1 1 . On O c t o b e r 15, 2011, Circuit Court, t h e n u r s i n g homes s u e d , i n t h e Montgomery the Council; the State Health P l a n n i n g and The o t h e r n u r s i n g - a n d - r e h a b i l i t a t i o n e n t i t i e s are Shelby R i d g e A c q u i s i t i o n C o r p o r a t i o n d/b/a S h e l b y R i d g e N u r s i n g Home; GGNSC B e s s e m e r , L L C , d/b/a G o l d e n L i v i n g Meadowood; GGNSC Birmingham, L L C , d/b/a G o l d e n L i v i n g Riverchase; GGNSC Hueytown, L L C , d/b/a G o l d e n L i v i n g Hueytown; C i v i c C e n t e r Health and Rehabilitation, LLC; South Health and R e h a b i l i t a t i o n , LLC; Oak K n o l l H e a l t h a n d R e h a b i l i t a t i o n , L L C ; N o r t h w a y H e a l t h a n d R e h a b i l i t a t i o n , L L C ; S o u t h Haven H e a l t h and R e h a b i l i t a t i o n , L L C ; C o r d o v a H e a l t h a n d R e h a b i l i t a t i o n , LLC; L e g a c y H e a l t h a n d R e h a b i l i t a t i o n o f P l e a s a n t G r o v e , L L C ; Talladega Healthcare Center, Inc; American Health C o r p o r a t i o n d/b/a T e r r a n c e Oaks C a r e a n d R e h a b i l i t a t i o n C e n t e r ; A m e r i c a n H e a l t h C o r p o r a t i o n d/b/a Oak T r a c e C a r e a n d R e h a b i l i t a t i o n Center; Prime Health Enterprises, L L C , d/b/a G o o d w a t e r H e a l t h C a r e C e n t e r , L L C ; P r e f e r r e d H e a l t h H o l d i n g I I d/b/a R i d g e w o o d H e a l t h c a r e C e n t e r ; USA H e a l t h c a r e d/b/a C u l l m a n , LLC; USA H e a l t h c a r e d/b/a LTC, L L C ; USA H e a l t h c a r e d/b/a W o o d l a n d V i l l a g e , L.L.C.; H a l e y v i l l e H e a l t h C a r e C e n t e r , L L C ; H a t l e y H e a l t h C a r e , I n c . ; B a l l H e a l t h C a r e S e r v i c e s d/b/a Cherry Hill; B a l l Health Care S e r v i c e s d/b/a E a s t v i e w Healthcare; Ball Health Care Services d/b/a Arlington R e h a b i l i t a t i o n & H e a l t h c a r e C e n t e r ; a n d GGNSC T r u s s v i l l e , L L C , d/b/a G o l d e n L i v i n g T r u s s v i l l e . 1 3 2110719 D e v e l o p m e n t A g e n c y ("SHPDA"); A l v a Lambert, the d i r e c t o r of SHPDA; Mary Holcomb, t h e c h a i r o f t h e C o u n c i l ; Bentley. been The n u r s i n g improperly injunctive a trial, adopted, relief certiorari. homes a l l e g e d t h a t and they the adjustment had sought or, alternatively, and Governor declaratory a writ o f mandamus o r H e a l t h S o u t h i n t e r v e n e d as a d e f e n d a n t . the c i r c u i t court entered erred Following a judgment i n f a v o r o f t h e d e f e n d a n t s , a n d t h e n u r s i n g homes a p p e a l e d t o t h i s On a p p e a l , and court. t h e n u r s i n g homes f i r s t a r g u e t h a t t h e C o u n c i l i n adopting the adjustment a d j u s t m e n t i s a c t u a l l y an i m p r o p e r l y because, they say, the adopted " r u l e " under t h e A l a b a m a A d m i n i s t r a t i v e P r o c e d u r e A c t , § 41-22-1 e t s e q . , A l a . Code 1975 ( " t h e A A P A " ) . I t i s undisputed that the Council d i d not adopt t h e adjustment pursuant t o t h e r u l e m a k i n g procedures o f t h e AAPA. a rule without § Thus, i f t h e a d j u s t m e n t i s i n s u b s t a n c e a c t u a l l y under t h e AAPA, the Council erred by adopting f o l l o w i n g t h e r u l e m a k i n g p r o c e d u r e s o f t h e AAPA. 41-22-5, procedures (stating statutory A l a . Code o f t h e AAPA); that an provision agency 1975 (discussing § 41-22-20(k)(1), action i s subject 4 made the See rulemaking A l a . Code 1975 i n violation to reversal i t upon of a judicial 2110719 review). In pertinent part, agency regulation, t h e AAPA d e f i n e s standard, or a " r u l e " as statement a p p l i c a b i l i t y t h a t implements, i n t e r p r e t s , or p o l i c y . " a rule considered S i m i l a r l y , the State Health a rule i n that procedures. plan a rule of general or p r e s c r i b e s law § 4 1 - 2 2 - 3 ( 9 ) , A l a . Code 1975. i s also The "amendment" o f under t h e AAPA. Id. P l a n s t a t e s t h a t an "amendment" t o i s subject t o t h e AAPA's rulemaking R u l e 4 1 0 - 2 - 5 - . 0 4 ( 2 ) ( c ) , A l a . A d m i n . Code (SHPDA). The n u r s i n g homes a r g u e t h a t t h e a d j u s t m e n t i s a r u l e they "[e]ach s a y , i t amended R u l e 410-2-4-.08(3), because, A l a . A d m i n . Code (SHPDA) ("the i n p a t i e n t - r e h a b i l i t a t i o n r u l e " ) , w h i c h c o n c e r n s the need methodology rule establishes f o r i n p a t i e n t - r e h a b i l i t a t i o n beds. a "region" inpatient-rehabilitation for beds, 12 i n p a t i e n t - r e h a b i l i t a t i o n each r e g i o n . are as t h e p l a n n i n g seven counties. stating the there Under t h e i n p a t i e n t - r e h a b i l i t a t i o n regions, and Shelby County, each adjustment, region consists the subject which is a need rule, of there several of the adjustment i n The n u r s i n g homes indicated 5 regarding b e d s p e r 100,000 p e o p l e f o r t h i s case, i s l o c a t e d i n Region I I I . that that area That the need argue for 17 2110719 inpatient-rehabilitation beds i n S h e l b y County, inpatient-rehabilitation r u l e by changing t h e p l a n n i n g from the region -- Region I I I -- amended t h e t o the county -- area Shelby County. The C o u n c i l a d o p t e d t h e a d j u s t m e n t p u r s u a n t t o R u l e 4102-5-.04(2)(a), rule"). A l a . Admin. Code In pertinent part, (SHPDA) the adjustment "adjustment" t o the State Health ("the adjustment rule defines an P l a n as f o l l o w s : "(a) P l a n A d j u s t m e n t -- I n a d d i t i o n t o s u c h o t h e r c r i t e r i a t h a t may be s e t o u t i n t h e [ S t a t e Health Plan], a requested m o d i f i c a t i o n or exception, to the [ S t a t e H e a l t h P l a n ] , o f l i m i t e d d u r a t i o n , t o p e r m i t a d d i t i o n a l f a c i l i t i e s , beds, s e r v i c e s , o r e q u i p m e n t t o a d d r e s s c i r c u m s t a n c e s a n d meet t h e i d e n t i f i e d needs o f a s p e c i f i c c o u n t y , o r p a r t thereof, or another s p e c i f i c planning region that i s l e s s t h a n s t a t e w i d e and i d e n t i f i e d i n t h e S t a t e Health Plan." The nursing prohibiting a homes interpret county-based the adjustment adjustment regarding rule as inpatient- r e h a b i l i t a t i o n s e r v i c e s ; t h e n u r s i n g homes e m p h a s i z e t h a t t h e inpatient-rehabilitation rule establishes a "region" p l a n n i n g area f o r such s e r v i c e s . the Council's county-based changed t h e p l a n n i n g disagree. as t h e The n u r s i n g homes a r g u e t h a t adjustment i n fact impermissibly a r e a from t h e r e g i o n t o t h e county. "'[L]anguage We u s e d i n an a d m i n i s t r a t i v e r e g u l a t i o n 6 2110719 should be given understood i t s natural, plain, ordinary, and commonly m e a n i n g , j u s t as l a n g u a g e i n a s t a t u t e . ' " Ex Wilbanks H e a l t h Care S e r v s . , Inc., 986 So. 2d 422, parte 427 (Ala. 2007) ( q u o t i n g A l a b a m a M e d i c a i d A g e n c y v. B e v e r l y E n t e r s . , So. 2d 1329, 1332 ( A l a . C i v . App. expressly provides the State Health "specific planned Plan county." by to The region regional basis. the t h a t the The C o u n c i l may meet rule are area, adjustment This the does subject subject not to adjustment r u l e make a d j u s t m e n t s state needs that adjustments rule; to The identified adjustment i n t h i s inpatient-rehabilitation planning 1987)). the 521 of adjustments a services only on c a s e does n o t region to a amend remains the under the i n Health Care made rule. court addressed a similar situation A u t h o r i t y o f A t h e n s v. S t a t e w i d e Health Coordinating Council, 988 2008). So. 2d 574 ( A l a . C i v . App. Athens involved a challenge Health Plan indicating the to need an (plurality adjustment for 60 to opinion). the acute-care beds i n the C i t y o f Madison. The f o r the p l a n n i n g of a c u t e - c a r e h o s p i t a l s e r v i c e s on a wide b a s i s . The State Health Plan State hospital provided county- opponents of the adjustment i n Athens argued 7 2110719 t h a t a d j u s t m e n t s c o n c e r n i n g a c u t e - c a r e b e d s must be made on a county-wide b a s i s , i . e . , that made r e g a r d i n g o n l y a c i t y . case, s u c h a d j u s t m e n t s c o u l d n o t be Thus, l i k e t h e s i t u a t i o n i n t h i s A t h e n s c o n c e r n e d t h e i s s u e w h e t h e r an a d j u s t m e n t may be made t o an a r e a s m a l l e r t h a n t h e p l a n n i n g a r e a d e s i g n a t e d b y the State H e a l t h Plan. In Athens, this court noted that the adjustment rule s p e c i f i c a l l y a l l o w s f o r an a d j u s t m e n t t o meet t h e needs o f "a specific Thus, county, the court or part thereof." concluded that 988 So. 2d a t the Council may 580-81. adopt an a d j u s t m e n t c o n c e r n i n g a c i t y e v e n when t h e p l a n n i n g a r e a f o r a particular type of s e r v i c e i s the county. Similarly, i n t h i s c a s e , t h e C o u n c i l may a d o p t an a d j u s t m e n t c o n c e r n i n g t h e county rule an a r e a s p e c i f i c a l l y although rehabilitation Moreover, the mentioned planning area i n the adjustment for inpatient- services i s the region. " ' t h e i n t e r p r e t a t i o n o f an a g e n c y r e g u l a t i o n b y the p r o m u l g a t i n g agency c a r r i e s " ' c o n t r o l l i n g w e i g h t u n l e s s i t i s p l a i n l y erroneous or i n c o n s i s t e n t with the r e g u l a t i o n . ' " ' " F r a t e r n a l Order Jefferson Cnty., of Police, Lodge No. 64 v. P e r s o n n e l B d . o f [Ms. 1100430, A u g u s t 8 24, 2012] So. 3d 2110719 , Inc. ( A l a . 2012) ( q u o t i n g B r u n s o n C o n s t r . v. C i t y quoting of Prichard, i n turn other & Envtl. 664 So. 2d 885, 890 cases); Servs., (Ala. 1995), see a l s o S y l a c a u g a H e a l t h Care C t r . , I n c . v. A l a b a m a S t a t e H e a l t h P l a n n i n g A g e n c y , 662 So. 2d 265, 268 ( A l a . C i v . App. 1994) (stating that "an a g e n c y ' s interpretation o f i t s own r u l e o r r e g u l a t i o n must s t a n d i f i t i s reasonable, e v e n t h o u g h i t may n o t a p p e a r as r e a s o n a b l e some o t h e r i n t e r p r e t a t i o n " ) . Council thus, d i d not a c t u a l l y they deference. argue, there The nursing "interpretation" the-fact The n u r s i n g homes a r g u e t h a t t h e interpret i s no t h e adjustment r u l e , and interpretation homes argue that of the adjustment r u l e litigation position. We that Council's i s simply an a f t e r - disagree. m e t h o d o l o g y was an i s s u e Council at the hearing Council interpreted adjustment concerning i n this case. the adjustment an a r e a smaller i s due the Whether t h e C o u n c i l may make a c o u n t y - w i d e a d j u s t m e n t d e s p i t e based planning as a region- debated before I t i s evident rule to allow the that the f o r an than the region. The C o u n c i l ' s i n t e r p r e t a t i o n i s c o n s i s t e n t w i t h the p l a i n language o f t h e a d j u s t m e n t r u l e a n d i s due The deference. n u r s i n g homes a l s o a r g u e t h a t t h e a d j u s t m e n t i n t h i s 9 2110719 case i s a r u l e because, interpretation (SHPDA) say, the Council 410-2-4-.08(4)(a), that reporting "[r]egional year should additional A l a . Admin. Code rule occupancy f o r t h e most be a t l e a s t 75% b e f o r e c o n s i d e r a t i o n t o any r e q u e s t s changed i t s The 75% o c c u p a n c y ("the 75% o c c u p a n c y r u l e " ) . provides gives of Rule they f o rplan the recent [Council] adjustments f o r [ i n p a t i e n t - r e h a b i l i t a t i o n ] bed c a p a c i t y . " In t h i s c a s e , t h e r e g i o n a l occupancy f o r i n p a t i e n t - r e h a b i l i t a t i o n beds was b e l o w t h e 75% s t a n d a r d . Council evidently creating Austin interpreted a nonmandatory Indus., the the adjustment, the 75% guideline. occupancy rule as See, e.g., L a m b e r t v. I n c . , 544 F.3d 1192, 1196-97 (interpreting t h e word mandatory). The interpretation Council, In adopting before "should" nursing homes i s incorrect; adopting t o be do rather; this ( 1 1 t h C i r . 2008 permissive not they adjustment, argue Healthcare, I n c . v. W i l l i a m s , C i v . App. 1 9 9 9 ) , t h e n u r s i n g alleged change that argue had that R e l y i n g on the Council's i n i n t e r p r e t a t i o n o f t h e 75% o c c u p a n c y 10 the 751 So. 2d 16 ( A l a . homes a r g u e t h a t c o n s t i t u t e d an i m p r o p e r a d o p t i o n this historically i n t e r p r e t e d t h e 75% o c c u p a n c y r u l e as m a n d a t o r y . Hartford and n o t of a rule. Hartford rule provides 2110719 that " [ w ] h e n an a d m i n i s t r a t i v e its interpretation interpretation administrative rulemaking i t s regulation and changes the new ' s u b s t a n t i a l l y a f f e c t s the l e g a l r i g h t s of,or procedures a v a i l a b l e the of agency s u b s t a n t i a l l y t o , the p u b l i c o r any segment t h e r e o f , ' a g e n c y i s b o u n d t o c o m p l y w i t h f o r m a l AAPA procedures." 751 So. 2d a t 22 (quoting § 41-22- 3(9)(c)). The r e c o r d on a p p e a l does n o t i n d i c a t e t h a t t h e C o u n c i l had p r e v i o u s l y but as interpreted t h e 75% o c c u p a n c y r u l e as m a n d a t o r y changed i t s i n t e r p r e t a t i o n permissive. homes cite In support the language of their of which provides: "Notwithstanding recognizing t h e n e e d f o r an i n p a t i e n t in County, the argument, the adjustment adjustment, Shelby i s found i n t h i s case t o t r e a t t h e r u l e i n Rule itself. 410-2-4-.08(5) anything [Council], the nursing to the The (SHPDA), contrary, rehabilitation hospital through the adjustment p r o c e s s i n September o f 2011, a d j u s t e d t h e p l a n n i n g p o l i c y t o r e c o g n i z e t h e n e e d f o r 17 a d d i t i o n a l r e h a b i l i t a t i o n b e d s t o be located i n Shelby County." homes seem t o a r g u e t h a t its interpretation (Emphasis added.) the Council admitted that The nursing i t changed o f t h e 75% o c c u p a n c y r u l e b y s t a t i n g 11 that 2110719 it "adjusted the planning p o l i c y . " phrase However, as s i m p l y a g e n e r a l d e s c r i p t i o n that a d j u s t m e n t made u n d e r t h e a d j u s t m e n t r u l e . we v i e w this t h e r e was an We do n o t v i e w i t as an " a d m i s s i o n " t h a t t h e C o u n c i l h a d p r e v i o u s l y v i e w e d t h e 75% o c c u p a n c y Insofar changed s t a n d a r d as mandatory. as t h e n u r s i n g homes argue that the Council i t s i n t e r p r e t a t i o n of the adjustment r u l e t o permit a county-based services, adjustment thereby procedures, as unpersuasive. recognizes a rehabilitation regarding requiring held The region in inpatient-rehabilitation i t t o comply Hartford, with that argument inpatient-rehabilitation as the planning area rulemaking rule, is which for inpatient- s e r v i c e s , was a d o p t e d i n 1993. Subsequently, b e f o r e making t h e adjustment i n t h i s case, i t appears t h a t t h e Council made concerning three adjustments to the State inpatient-rehabilitation services. made s u c h a d j u s t m e n t s on a r e g i o n a l b a s i s Regarding the t h i r d case, the parties Health The Plan Council i n 2003 a n d 2009. dispute whether t h e C o u n c i l , i n 2005, made an a d j u s t m e n t t o a p a r t i c u l a r r e g i o n o r to Houston County. On i t s f a c e , that adjustment concerns Houston County, b u t t h e p r o c e e d i n g s i n t h a t case i n d i c a t e t h a t 12 2110719 the Council region, not a c t u a l l y approved not the county. established that an a d j u s t m e n t Regardless, the regarding the nursing Council had the homes have interpreted the adjustment r u l e t o allow f o r only region-based adjustments i n i n p a t i e n t - r e h a b i l i t a t i o n cases b u t changed t h e i n t e r p r e t a t i o n in this case. opponents changed Again, Athens of the adjustment i s instructive. argued that i t s i n t e r p r e t a t i o n by a d o p t i n g city-wide basis rather p l u r a l i t y opinion than on a In Athens, the the Council the adjustment county-wide basis. r e j e c t e d t h a t argument, n o t i n g t h a t had on a The "[t]he r e c o r d does n o t i n d i c a t e t h a t t h e C o u n c i l h a s e v e r i n t e r p r e t e d t h e S t a t e H e a l t h P l a n t o a l l o w f o r o n l y an a c u t e - c a r e - b e d - n e e d adjustment on a county-wide Similarly, i n this case, basis." there 988 i s no So. 2d a t 5 8 1 . i n d i c a t i o n that the C o u n c i l had p r e v i o u s l y i n t e r p r e t e d the adjustment r u l e t o b a r i n p a t i e n t - r e h a b i l i t a t i o n - s e r v i c e s a d j u s t m e n t s on a c o u n t y - w i d e basis. Thus, t h e r e c o r d has c h a n g e d The does n o t i n d i c a t e t h a t the Council i t s interpretation. nursing homes also argue that a r b i t r a r i l y and c a p r i c i o u s l y by a d o p t i n g the Council acted t h e a d j u s t m e n t . Under t h e AAPA, t h e C o u n c i l ' s d e c i s i o n i s s u b j e c t t o r e v e r s a l i f i t 13 2110719 is a r b i t r a r y o r c a p r i c i o u s , among o t h e r 2 0 ( k ) ( 7 ) , A l a . Code 1975. In arguing criteria. § 41-22- that the Council acted a r b i t r a r i l y a n d c a p r i c i o u s l y , t h e n u r s i n g homes c i t e c e r t a i n comments made b y f o u r members o f t h e C o u n c i l a t t h e h e a r i n g on whether t o adopt the proposed adjustment. Of the four members, one member seemed t o d o u b t t h e C o u n c i l ' s a u t h o r i t y t o make t h e a d j u s t m e n t on a c o u n t y - w i d e b a s i s ; one member o p i n e d that the Council seemed d i d n o t have t o suggest beneficial while methodology; Council that also a n d one should be such authority; the adjustment acknowledging member that the Council contravention to the State Health be p r o p e r a n d the regional cryptically "consistent" explanation, would one member and had Plan. stated therefore, acted We have recently State Health Thus, we fail Plan that allowed the adjustment C o u n c i l members d e b a t i n g acted in homes knowingly t h e adjustment and, rule f o r the adjustment t o see t h e r e l e v a n c e the without The n u r s i n g a r b i t r a r i l y and c a p r i c i o u s l y . established that opined, a r g u e t h a t t h o s e comments i n d i c a t e t h a t t h e C o u n c i l v i o l a t e d the State H e a l t h Plan by adopting planning We disagree. found i n this i n the case. o f t h e comments o f t h e t h e a u t h o r i t y t o make t h e a d j u s t m e n t . 14 2110719 Further, we voted 11-7 t o a d o p t t h e There i s no i n d i c a t i o n t h a t t h e comments o f a minority of the Council at the hearing opinions of the majority. adjustment. note that the Council that the Council somehow r e p r e s e n t t h e Thus, t h e n u r s i n g homes' argument knowingly v i o l a t e d the State Health Plan i s b a s e d on a u n s u p p o r t e d f a c t u a l a l l e g a t i o n . The nursing homes also argue that beyond i t s s t a t u t o r y a u t h o r i t y i n adopting text of the adjustment indicates the Council acted t h e a d j u s t m e n t . The that the Council, " r e c o g n i z i n g t h e n e e d f o r an i n p a t i e n t r e h a b i l i t a t i o n h o s p i t a l i n S h e l b y C o u n t y , " made t h e a d j u s t m e n t " t o r e c o g n i z e t h e need f o r 17 a d d i t i o n a l r e h a b i l i t a t i o n b e d s t o be l o c a t e d i n S h e l b y County." The n u r s i n g homes a r g u e t h a t have t h a t a u t h o r i t y t o r e c o g n i z e hospital only i n Shelby County. SHPDA h a s t h e a u t h o r i t y However, § "[p]repare, Plan. the 22-4-8(b)(2) the Council does n o t t h e need f o r a r e h a b i l i t a t i o n The n u r s i n g homes c o n t e n d t o make s u c h i s to r e v i e w , a n d r e v i s e as n e c e s s a r y " t h e S t a t e Health adjustment, the State inpatient-rehabilitation that determination. the Council (Emphasis added.) provides a that Of c o u r s e , b e f o r e Health Plan the Council a d d r e s s e d t h e need f o r s e r v i c e s i n Alabama. 15 made By m a k i n g t h e 2110719 adjustment, the C o u n c i l , pursuant t o i t s s t a t u t o r y a u t h o r i t y , s i m p l y r e v i s e d t h e S t a t e H e a l t h P l a n t o r e f l e c t t h e need f o r inpatient-rehabilitation services i n Shelby County. The C o u n c i l d i d not exceed i t s s t a t u t o r y a u t h o r i t y i n making t h e adjustment. Finally, Montgomery the nursing homes Rehabilitation ask t h i s Hospital, court I n c . v. to overrule State Health P l a n n i n g A g e n c y , 610 So. 2d 403 ( A l a . C i v . App. 1992) " t o t h e extent necessary i n t h i s case." I n Montgomery R e h a b i l i t a t i o n , the C o u n c i l r e v i s e d t h e S t a t e H e a l t h P l a n t o i n d i c a t e t h e need for 26 r e h a b i l i t a t i o n b e d s i n t h e D o t h a n a r e a . The C o u n c i l m a i n t a i n e d t h a t t h e r e v i s i o n was an a d j u s t m e n t to the State H e a l t h P l a n , b u t o p p o s i n g p a r t i e s a r g u e d t h a t t h e r e v i s i o n was a r u l e u n d e r t h e AAPA. was not a rule on This court concluded that the r e v i s i o n two g r o u n d s : " g e n e r a l l y a p p l i c a b l e " because scope [ t o t h e Dothan area] potential statewide" language and and existing (1) t h e r e v i s i o n i t was " l i m i t e d i n g e o g r a p h i c and [was] n o t a p p l i c a b l e t o a l l rehabilitation (2) t h e r e v i s i o n o f t h e 1988-1992 o r i g i n a l l y adopted." [State "was service providers contemplated Health 610 So. 2d a t 407. 16 was n o t Plan] as i n the i t was 2110719 The n u r s i n g homes a s k t h i s i f necessary, Rehabilitation, geographic-scope ground upon court insofar standard which to overrule as i t expressed i n i t s analysis, the decision was Montgomery i . e . ,the based. is dicta that, regardless, d e c i s i o n i n H a r t f o r d , supra. was that consider above, basis was modified of the p l a i n deference due Hartford, Montgomery language We we s e e no of t h e r e h a b i l i t a t i o n interpretation court Insofar judgment u p h o l d i n g in the c i r c u i t upholding the on t h e r u l e , the court rule, cited adjustment. a l s o r e l i e d on t h e p l a i n l a n g u a g e rule, d e f e r e n c e due t h e C o u n c i l ' s and t h i s as t h e c i r c u i t i n Montgomery that As i n d i c a t e d i s due t o be u p h e l d that r u l e , the of that court's reason t o i n t e r p r e t a t i o n of that note Rehabilitation this of the adjustment the Council's However, t h e c i r c u i t dicta i n Hartford, adjustment and Athens . standard i n Montgomery R e h a b i l i t a t i o n i s o v e r r u l i n g Montgomery R e h a b i l i t a t i o n . the Council's Athens. by the Assuming, w i t h o u t d e c i d i n g , the geographic-scope standard dicta modified first However, n u r s i n g homes f u r t h e r a r g u e t h a t t h e g e o g r a p h i c - s c o p e a court Rehabilitation, the adjustment 17 court's decision i n r e l i e d on t h e a l l e g e d the circuit court's i s due t o be a f f i r m e d on 2110719 other grounds. We affirm Council's the circuit court's judgment upholding the adjustment. AFFIRMED. P i t t m a n , B r y a n , and Moore, J J . , c o n c u r . Thompson, P . J . , c o n c u r s i n t h e r e s u l t , w i t h o u t w r i t i n g . Thomas, J . , d i s s e n t s , w i t h w r i t i n g . 18 2110719 THOMAS, J u d g e , d i s s e n t i n g . I respectfully dissent. I agree w i t h the n u r s i n g that the "adjustment" t o the State Health Plan this case i s actually that i t was subject homes ("SHP") made i n an "amendment" t o t h e SHP a n d , t h u s , to the rule-making Alabama A d m i n i s t r a t i v e Procedure A c t . procedures See H e a l t h Care of the Auth. o f A t h e n s v. S t a t e w i d e H e a l t h C o o r d i n a t i n g C o u n c i l , 988 So. 2d 574, 590 ( A l a . C i v . App. 2009) 19 (Thomas, J . , d i s s e n t i n g ) .

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