St. Joseph Hospital v. Leavitt
Opinion of the Court
MEMORANDUM
St. Joseph Hospital (StJoseph) appeals from the final judgment of the district court denying its petition for judicial review of the Provider Reimbursement Review Board’s (PRRB) final decision in favor of the Secretary of the Department of Health and Human Services (Secretary). We affirm the decision of the district court that the Secretary’s determination to deny St. Joseph’s request for an exception to its prospective reimbursement rate was neither arbitrary nor capricious and was supported by substantial evidence. See 5 U.S.C. § 706(2).
To qualify for an exception to its prospective payment rate based on “[ajtypical service intensity,” see 42 C.F.R. §§ 413.182(a), 413.184(a) (2001), St. Joseph was required, among other things, to
In affirming the CMS’s denial of St. Joseph’s request, the PRRB relied, among other things, on the deficiencies in St. Joseph’s documentation. St. Joseph was aware of these asserted faults in its exception request as evidenced by its concession at the PRRB hearing that it failed to specify, in accordance with § 413.184(b)(2)(i), the amount that each nursing employee was paid. The PRRB concluded that St. Joseph’s failure “to submit the requisite nursing personnel cost documentation pursuant to 42 C.F.R. § 413.184(b)(2)(i)” prevented it from qualifying “for an exception.” As such, the PRRB’s decision to deny St. Joseph’s exception request on this ground was supported by substantial evidence, and its refusal to infer or derive the required information from other data submitted by St. Joseph was neither arbitrary nor capricious. See § 706(2); 42 C.F.R. §§ 413.180(f)-(g), ©, 413.184(b)(2)® (2001) (regulations conditioning eligibility for exception request on submission of specified documentation).
St. Joseph argues that it was not provided with adequate notice that its documentation was at issue and was thereby deprived of its due process rights. Because the record belies the factual predicate for this argument, we reject St. Joseph’s contention. Moreover, the regulations clearly establish the duty of an applicant for an exception request to provide specific documentary information, including “documentation on costs of nursing personnel ... showing ... [the][a]mount each employee was paid,” § 413.184(b)(2)(i)(A); see also id. § 413.180(f)~(g), ©.
Because the decision of the PRRB was sufficiently grounded, we do not reach the other bases for rejecting St. Joseph’s appeal identified by the district court and the PRRB.
AFFIRMED.
This disposition is not appropriate for publication and is not precedent except as provided by 9th Cir. R. 36-3.
Reference
- Full Case Name
- ST. JOSEPH HOSPITAL, 110 West Stewart Dr., Orange, CA 92868 v. Michael O. LEAVITT, in his official capacity as Secretary of Health an Human Services
- Status
- Published