Matter of Longterm Ldg. v. Human Ser., Unpublished Decision (9-30-1999)
Matter of Longterm Ldg. v. Human Ser., Unpublished Decision (9-30-1999)
Opinion of the Court
OPINION
This is an appeal from the Franklin County Court of Common Pleas which affirmed an adjudication order issued by appellee, Ohio Department of Human Services ("ODHS"), concerning an audit of appellant, Longterm Lodging, Inc., d/b/a WeCare Health Facility, for the calendar year 1989. Appellant is a nursing home certified for participation in Ohio's Medicaid Program. This case presents a single legal issue: whether a nursing home's working capital interest income should be offset against its interest expense for the cost of renovations.Appellant prepared and timely filed with ODHS its 1989 Medicaid Cost Report. In it, appellant stated that it had paid $33,941 in interest on renovation loans in that year. Appellant also reported $5,639 in interest income from a bank account on working capital that year.
ODHS conducted a field audit of appellant for the reimbursement period of January 1, 1989 through December 31, 1989. Of the $5,639 earned in interest income, the field auditor offset $1,560 against interest paid to the director of appellant for a loan she made to appellant. Although appellant disagreed with this finding, it did not contest it before the trial court. Subtracting $1,560 from $5,639, left $4,079 in working capital interest income which the field auditor then offset against the interest paid on money borrowed in 1986 and 1988 for renovations to the facility. Appellant challenged that determination.
Appellant requested an adjudication hearing pursuant to R.C.
On June 20, 1997, the director of ODHS issued an adjudication order adopting the findings of fact, conclusions of law, and recommendations of the hearing examiner. In so doing, he ordered appellant to pay a total of $18,729.78 as an overpayment for the 1989 reimbursement period. Appellant appealed to the Franklin County Court of Common Pleas and, on October 22, 1998, the common pleas court issued a decision affirming ODHS. This appeal followed.
On appeal, appellant sets forth the following assignments of error:
I. The Trial Court erred in affirming the order of the Director of Human Services thereby failing to distinguish between the Federal health insurance program (Medicare), created by Title XVIII of the Social Security Act and the joint Federal State medical assistance program (Medicaid), created under Title XIX of the Social Security Act and in failing to give weight to the stipulation that Rules
5101:3-3-17 and5101:3-3-22 , O.A.C., part of the Ohio State Plan of Medical Assistance (Medicaid), had been approved by the Health Care Financing Administration (HCFA).II. The Trial Court erred in affirming the order of the Director of Human Services requiring that $4,079 in interest income on the Provider's working capital be offset against such Provider's "actual cost of interest paid [in 1989] on money borrowed for construction or the purchase of real property, major components of that property and equipment" in the construction of approved renovations in 1986 and 1988, which violates the plain language of Rule
5101:3-3-17 and Rule5101:3-3-22 O.A.C.
As the trial court noted, there is no disagreement concerning the facts of this case. The essence of the parties' dispute is a question of law; namely, the interpretation to be given to agency rules. As such, our review is plenary. PlanetEarth, Entertainment, Inc. v. Ohio Liquor Control Comm. (1998),
In its first assignment of error, appellant asserts that the trial court failed to distinguish between the Medicare and Medicaid programs and failed to give weight to the parties' stipulation. At the administrative hearing, the parties stipulated that Ohio Adm. Code
We assume that appellant is contending that, because it is a Medicaid service provider and does not participate in the Medicare Health Insurance Program, it was error for the trial court or ODHS to look to the federal Medicare Act for guidance in interpreting agency rules. We disagree.
As the hearing examiner observed, "Ohio courts have consistently held that federal administrative and judicial constructions of the same or similar terminology in the federal counterpart statute may supply the technical or particularized meaning of the words or phrases of the section of the Revised Code under construction." (Appendix p. 19 at 9 citing, In re Estate ofMorgan [1981],
ODHS and the hearing examiner have noted that for purposes of Medicare reimbursement, an offset of interest principle is applied when determining reasonable costs which have actually been incurred. See
In its second assignment of error, appellant argues the interest offset violates the express provisions of Ohio Adm. Code
(A) A per-day allowance based upon licensed beds for property costs and equipment during the rate year shall be the actual expenditures for items contained in paragraphs (A) (1) to (A) (6) of this rule * * *.
(1) The allowance directly related to purchasing or acquiring capital assets includes:
* * *
(c) The actual cost of interest paid on money borrowed for construction or the purchase of real property, major components of that property and equipment.
Appellant contends that offsetting interest earned on working capital unlawfully deprives appellant of its right to obtain reimbursement for all ("the actual cost of") the interest it paid on its renovation loans. However, ODHS only reimburses allowable costs to providers. See former R.C.
(G) "Allowable costs" are those costs that are allowable to licensed and certified beds in a facility, which are reasonable and related to resident care (unless otherwise enumerated in Chapter
5101:3-3 ["Coverage and Limitations: Long-Term Care Services"] of the Administrative Code) are those contained in the following reference material, as currently issued and updated, in the following priority:
(1) Title 42 C.F.R. Chapter IV;
(2) The provider reimbursement manual ("HCFA Publication 15-1," previously entitled "HIM 15 Health Insurance Manual"); or
(3) Generally accepted accounting principles.
Appellant contends that, because Ohio Adm. Code
Appellant's position begs the question, however, because the term "actual cost of interest paid" is not defined in the Ohio Administrative Code. When the plain meaning of an agency rule is not apparent, a reviewing court will generally defer to an administrative agency's interpretation of its own rules.Cincinnati City School Dist. v. State Bd. Of Edn. (1996),
As discussed above, appellant construes the phrase to mean gross interest paid to the lender. ODHS takes the position that the phrase refers to net interest, if any, paid on borrowing costs after deducting interest income earned on available funds that, at least in theory, could be used to reduce the amount of funds borrowed.
Here, federal sources support ODHS' construction of the phrase "actual cost of interest paid."
Consistent with these federal sources, we agree with the hearing examiner and the trial court that the phrase "actual cost of interest paid" refers to net interest paid on the renovation loans after offsetting any interest earned on working capital. The second assignment of error is not well-taken and is overruled.
Based on the foregoing, the decision of the Franklin County Court of Common Pleas is affirmed.
Judgment affirmed.
BOWMAN, J., concurs.
BROWN, J., concurs in judgment only.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.