Phoenix Baptist Hospital & Medical Center, Inc. v. Heckler
Phoenix Baptist Hospital & Medical Center, Inc. v. Heckler
Opinion of the Court
Phoenix Baptist Hospital and Medical Center (Hospital) appeals from a summary judgment affirming the determination by the Secretary of Health and Human Services (Secretary) of the Hospital’s reimbursable Medicare costs. The Hospital challenges the Secretary’s treatment of its income from a land investment as a reduction of allowable interest expense under 42 C.F.R. § 405.419(b)(2)(iii). On appeal, the Hospital contends that the Secretary applied the regulations arbitrarily to deny the Hospital the benefit of the interest shelter for investment of funded depreciation. We affirm.
BACKGROUND
Under the Medicare program, established in Title 18 of the Social Security Act, codified at 42 U.S.C. § 1395-1935xx, the federal government reimburses Medicare providers for the reasonable costs incurred in providing covered services to Medicare beneficiaries. 42 U.S.C. § 1395f(b). The Secretary is authorized to promulgate regulations governing cost reimbursement. 42
In 1978, the Hospital paid $80,000 for an option to acquire unimproved land for $455,000. In April 1979, the Hospital’s Board decided to exercise the option and attempted to withdraw $375,000 from the funded depreciation account to pay the balance due on the land. The Arizona Bank, the account’s trustee, however, refused to release the funds for this purpose because the municipal bond agreement that created the account did not permit the proposed use. Because the funded depreciation monies were unavailable, the Board borrowed $375,000 on the hospital’s line of credit from the Arizona Bank. In September 1979, the hospital borrowed $375,000 from the funded depreciation account to repay the bank loan.
In auditing the Hospital’s 1979 cost report, Blue Cross, the Intermediary, determined that land investments lack the liquidity required for investments of funded depreciation. Pursuant to 42 C.F.R. § 405.-419(c)(3), the Intermediary reduced the allowable interest expense for 1979 to adjust for offsets not made in prior years for earnings on the $375,000. On appeal, the Provider Reimbursement Review Board affirmed the Intermediary’s decision.
The Secretary declined to review the Board’s decision and it became a final decision appealable to the district court pursuant to 42 U.S.C. § 1395oo(f). On cross-motions for summary judgment, the district court affirmed the Board’s decision. The court concluded that the Secretary had not acted arbitrarily or capriciously in determining that an investment in land was an inappropriate investment. The court’s conclusion rested principally on the requirement of the Provider Reimbursement Manual, Part 1 (HIM 15) § 226, Medicare and
DISCUSSION
I.
We review de novo the summary judgment entered in favor of the Secretary. State of Alaska v. United States, 754 F.2d 851, 853 (9th Cir. 1985). The Administrative Procedure Act, 5 U.S.C. §§ 701-06 governs judicial review of Medicare reimbursement decisions. We will set aside the Secretary’s decision if we find that it is “arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law____” 5 U.S.C. § 706(2)(A). We give considerable deference to the Secretary’s interpretation of the Medicare scheme. Regents of the University of California v. Heckler, 756 F.2d 1387, 1393 (9th Cir. 1985).
II.
The Secretary interprets 42 C.F.R. § 405.415(e)
The district court affirmed the Secretary’s interpretation on the basis of Provider Reimbursement Review Manual (HIM 15) § 226, as amended. Since this case arose, that Manual was amended to provide that funded depreciation “must be placed in readily marketable investments of the type that assures the availability and conservation of funds.” If the investment does not meet this condition, it does not qualify for the investment shelter under 42 C.F.R. 409.419(b)(2)(iii). The Hospital correctly argues that the Manual, as amended, is not determinative of this appeal. The Manual is a guide for intermediaries in applying the Medicare statute and reimbursement regulations and does not have the binding effect of law or regulation. International Philanthropic Hospital Foundation v. Heckler, 724 F.2d 1368, 1370 (9th Cir. 1984). We, however, review the Board’s decision de novo and affirm on a different ground.
The Secretary’s position that the account should be invested conservatively in liquid assets is reasonable and consistent with the Medicare regulations she administers.
We conclude that the Secretary’s interpretation is consistent with the purpose of the funded depreciation and investment income shelter provisions. It is not unreasonable for the Secretary to deny the Hospital the benefit of the investment income shelter for an inappropriate investment.
Affirmed.
. At all levels of review, the Hospital’s investment was treated as an investment in land. In her brief, however, the Secretary argued that the fund was an investment to pay the intermediary loan used to purchase the land. We proceed under the theory, adopted by the Provider Reimbursement Board and conceded by the government at oral argument, that the funded depreciation was invested in land.
. The Provider Reimbursement Review Board had jurisdiction to review the Intermediary’s audit adjustment because the amount in controversy exceeded $10,000. 42 U.S.C. § 1395oo(a).
. The Board also found that ”[s]ince the investment of land is not related to patient care, the $375,000 cannot be considered an appropriate use of funded depreciation.” The Hospital correctly argues that the Medicare regulations do not require that funded depreciation be invested in assets related to patient care. A contrary interpretation would be nonsensical. Regulation 409.419(c)(3) only requires that funded depreciation ultimately be used for the improvement, replacement or expansion of facilities or equipment. Use of the funded depreciation is not at issue.
. The regulation provides:
Although funding of depreciation is not required, it is strongly recommended that providers use this mechanism as a means of conserving funds for replacement of depreciable assets, and coordinate their planning of capital expenditures with areawide planning activities of community and State agencies. As an incentive for funding, investment income on funded depreciation will not be treated as a reduction of allowable interest expense.
. Administrative agencies are free to announce new principles in an adjudication so long as the decision does not impose undue hardship or circumvent the APA rulemaking provisions. Cities v. FERC, 723 F.2d 656, 659 (9th Cir. 1984). Under this principle, the Secretary can impose a "liquidity” or "marketability" requirement on funded depreciation investments during this adjudication.
Reference
- Full Case Name
- PHOENIX BAPTIST HOSPITAL & MEDICAL CENTER, INC., a nonprofit corporation dba Phoenix Baptist Hospital and Medical Center v. Margaret M. HECKLER, Secretary of Health and Human Services
- Cited By
- 6 cases
- Status
- Published