St. Alphonsus Regional Medical v. Ada County
Annotate this CaseAn indigent patient was admitted to St. Alphonsus Regional Medical Center (St. Alphonsus) on October 7, 2017, and continued to receive treatment in the hospital until she was discharged on January 12, 2018. During her stay, St. Alphonsus filed a third-party medical indigency application on her behalf, and later filed two additional requests for payment of services. The Board of Ada County Commissioners (the Board) approved payment for dates of service from October 7 until October 10, 2017, but denied payments for services provided from October 11 until December 31, 2017, relying on the opinion of the Ada County Medical Advisor that the services provided on those dates were not “medically necessary” under the definition in Idaho Code section 31-3502(18)A(e). St. Alphonsus appealed the Board’s initial determination, but the final determination upheld the denial for payment beyond October 11. Upon St. Alphonsus’ petition, a district court reversed the Board’s decision, finding that the services “currently available” to a patient were to be considered as a “necessary medical service.” The Board argued “there did exist options for the Patient to proceed to rehabilitation at a facility other than St. Alphonsus, but for the Patient’s lack of funding.” Furthermore, the Board asserted that Idaho Code section 31-3502(18)A(e) is unambiguous in that “[t]here is no wording in [sub]section (e) of the statute that limits the ‘most cost-effective services’ to services that the Patient can afford to pay for.” After review, the Idaho Supreme Court determined the Board exceeded its statutory authority in denying St. Alphonsus reimbursement for providing medically necessary services. “The Board’s denial of payment was not based on substantial evidence and prejudiced St. Alphonsus’ substantial right to compensation for services rendered to an indigent patient.”
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