Matter of St. Margaret's Ctr. v Novello
Annotate this CaseDecided on January 10, 2005
Supreme Court, Albany County
In the Matter of St. Margaret's Center, by the CENTER FOR THE DISABLED CORPORATION and ST.MARGARTE'S HOUSE AND HOSPITAL FOR BABIES, , Petitioner(s),
against
Antonia Novello, M.D., as Commissioner of Health of the State of New York; and Director of the Budget of the State of New York, Respondent(s).
525-02
Ruffo, Tabora, Mainello and McKay, P.C.
Raul A. Tabora, Jr., Esq.
Attorneys for Petitioner
311 Great Oaks Boulevard
Albany, New York 12203
Eliot Spitzer, Attorney General
Office of the Attorney General
(Lisa Ullman, Esq., Assistant Attorney General)
Attorneys for Respondent
The Capitol
Albany, New York 12224
Thomas J. McNamara, J.
Petitioner has moved to reargue a decision of the court awarding judgment to respondent dismissing the petition. The proceeding was brought to challenge the Medicaid reimbursement rate established by the Department of Health (DOH) for the DayLight program for the years 1999 and forward. DayLight is an Adult Day Health Care Program operated by petitioner for individuals over the age of 21.
A "motion for leave to reargue pursuant to CPLR 2221 is addressed to the sound discretion [*2]of the court and is properly granted upon a showing that the court overlooked or misapprehended the facts and/or the law or mistakenly arrived at its earlier decision." (Peak v Northway Travel Trailers Inc., 260 AD2d 840).
The determinative issue raised by the petition was whether the DOH acted irrationally in setting the maximum daily reimbursement rate for DayLight program participants by employing a weighted regional average for non-speciality skilled nursing facilities as the proxy rate. Petitioner contends that because the DayLight program provides fundamentally distinct services to a fundamentally distinct patient mix, the proxy rate should be based on a weighted regional average computed by reference to speciality facility rates. The court dismissed the petition based upon petitioner's failure to satisfy its burden of producing some comparative evidence between it and the other peer-group members (non-speciality skilled nursing facilities versus speciality facilities) to demonstrate that its inclusion in that particular group was irrational.
The motion to reargue is based on the assertion that the court resolved the matter by reference to an issue, the absence of comparative evidence, not contested by respondent. According to petitioner, the critical issue raised by the petition was not whether the DayLight program is specialized and distinct from geriatric programs but whether DOH's interpretation of the law is unduly restrictive. The interpretation of law to which petitioner refers is the position taken by DOH that in setting reimbursement rates for adult day health care programs it is guided exclusively by Laws of 1994, chapter 170, section 448 which establishes the maximum daily rates of payment to residential health care facilities for adult day services. That law limits payment to 65 % of the sponsoring facilities residential health care facility per diem rate on January 1, 1990 or for facilities without such a rate, such as petitioner, to a 1990 weighted regional average per diem rate. As noted in the court's original decision, respondent set petitioner's rate using a weighted regional average per diem rate.
Petitioner argues that section 448 must be read in pari materia with the provisions in Public Health Law §2708(3). The latter section requires the DOH to set reimbursement rates for nursing homes at a level that is "reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities." When read together, petitioner argues, the DOH must take into account petitioner's speciality status in setting the ceiling.
In dismissing the petition, the court jumped over the issue of whether the DOH is required to consider Public Health Law §2708(3) in setting maximum daily rates of payment to residential health care facilities for adult day services. Instead, the court dismissed the petition on the basis that even if the DOH was required to consider Public Health Law §2708(3) petitioner had failed to establish that "the population it serves necessitates more complex treatment programs, more expensive equipment, medications, and treatment such that it cannot be placed in the same peer group as other adult day health care facilities because the reimbursement rate would not be reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities'".
Though the rates for speciality facilities are calculated differently form those of skilled nursing facilities, it does not necessarily follow that in setting a reasonable and adequate reimbursement rate for an adult day care program associated with a speciality facility that rate must be based on a weighted regional average computed by reference only to speciality facility rates. This is particularly true where, as here, the adult day care program is also associated with a 20 bed [*3]adult nursing facility as well as a 38 bed speciality pediatric facility. Nonetheless, because respondent did not reach that issue in setting petitioner's reimbursement rate, petitioner was not required to address it in this proceeding. Consequently, it was improper for the court to dismiss the petition on that basis. Accordingly, the court will grant reargument and address the question of whether respondent acted in an arbitrary and capricious manner in setting petitioner's reimbursement rate because it failed to factor into its determination the considerations in Public Health Law §2708(3).
As noted above, petitioner argues that the provisions in Laws of 1994, chapter 170, section 448, which respondent relies on in setting reimbursement rates for adult day care programs and the provisions in Public Health Law §2708(3) are in pari materia and should be read together. Respondent contends that section 448 is the exclusive legislative authority for setting such rates.
In pari materia means upon the same matter or subject (McKinney's Cons Laws of NY, Book 1, Statutes, § 221, p 374) and statutes which are in pari materia must be construed with reference to each other (Matter of American Tel. & Tel. Co. v New York State Tax Comm., 93 AD2d 66, 73). However, the general rule that the meaning of a statute may be determined from its construction in connection with other statutes in pari materia is resorted to only in search of legislative intent and cannot be invoked where the language of the statute is clear and unambiguous (McKinney's Cons Laws of NY, Book 1, Statutes, § 221, p 376). Here, a review of section 448, its predecessor, Laws of 1992, chapter 41, section one, and the regulatory provisions which implement the laws, shows that the legislative intent is clear.
Section 448 provides: "Notwithstanding any inconsistent provision of law or regulation to the contrary, maximum daily rates of payment, excluding the allowable costs of transportation, to residential health care facilities for adult day services provided in a 24-hour period on or after July 1, 1992 to persons eligible for payments made by state governmental agencies determined in accordance with article 28 of the public health law shall be sixty-five percent of the sponsoring facility's residential health care facility per diem rate on January 1, 1990, or for facilities without such a rate a 1990 weighted regional average per diem rate, with the operating cost component trended to the rate period by the trend factor applicable to the sponsoring facility, except for adult day services provided to persons with acquired immune deficiency syndrome and other human immunodeficiency virus related illnesses which shall be reimbursed based on a price not to exceed $160 per 24-hour period established by the commissioner of health by regulation."
Section 448 was enacted to amend the Laws of 1992, chapter 41, section one. The amendment left the predecessor section essentially intact but added the provision requiring the use of a weighted regional average per diem rate for facilities without a residential health care facility per diem rate on January 1, 1990. The amendment also added the provision regarding adult day services provided to persons with AIDS.
The regulations which implement the legislative directives in section 448 are found in 10 NYCRR §86-2.9. Section 86-2.9, as a whole, was added to the regulations in October 1979. The [*4]first amendment of the regulation, following the October 1992 enactment of the Laws of 1992, chapter 41, section one, came in April 1992. Thereafter, the regulation has been amended three times: in October 1993 subsection e was amended; in November 1994 subsection a was amended and in November 1994 subsection g, the provision dealing with adult day services provided to persons with AIDS, was added. Regulatory implementation of the two provisions added by section 448 in 1994 are found in subsections f (weighted regional average) and g (adult day services provided to persons with AIDS).
The history of the regulation shows that subsection f has not been amended at anytime after section 448 was enacted. Therefore, it follows that DOH was using a weighted regional average to set the proxy rate prior to 1994 when section 448 was enacted. It can be presumed that when the Legislature enacted section 448 it was aware of the provision in subsection f of the regulation. Consequently, by enacting section 448 with the provision calling for the use of regional weighted averages, the Legislature was clearly indorsing the policy reflected in subsection f of the regulation, the same policy that was applied in determining the reimbursement rate challenged here.
Furthermore, in enacting section 448 the Legislature made special provision for adult day services provided to persons with AIDS but not for adult day service programs associated with speciality facilities. The failure to make a special provision for the latter group evinces a legislative intent that they not be treated differently from other programs.
Inasmuch as the intent of the Legislature in enacting section 448 is clear, it is unnecessary to resort to the earlier enacted Public Health Law §2807 as an aid in construing the meaning of the law. Furthermore, given that the policy applied in determining petitioner's reimbursement rate is consistent with that intent, respondent actions cannot be characterized as arbitrary and capricious or contrary to law. Accordingly, upon reargument the court adheres to its earlier determination dismissing the petition.
All papers including this Decision and Order are returned to Respondent's attorneys. The signing of this Decision and Order shall not constitute entry or filing under CPLR 2220. Counsel is not relieved from the applicable provisions of this rule with regard to filing, entry and Notice of Entry.
This memorandum shall constitute both the Decision and Order of this Court.
SO ORDERED.
ENTER.
Dated:Saratoga Springs, New York
January 10, 2005
_________________________________________
Thomas J. McNamara
Acting Supreme Court Justice
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