Opinion
No. CV 04-0527402 S
September 29, 2005
MEMORANDUM OF DECISION
Factual Background
Manchester Health Center, Inc. d/b/a Crestfield Rehabilitation and Fenwood Manor (hereinafter "Manchester") is a nursing home facility which participates in the Title XIX Medicaid program and which receives reimbursement payments from the Department of Social Services (hereinafter "DSS"). Pursuant to C.G.S. Sec. 17b-340, DSS annually calculates the per diem Medicaid reimbursement rate for nursing homes. On November 6, 2001, DSS set Manchester's per diem reimbursement rate for state-aided residents at $177.53, effective July 1, 2001. On November 12, 2001, pursuant to C.G.S. Sec. 17b-238(b) Manchester filed a timely request for a hearing to seek review of the rate that had been set on November 6, 2001. No other documentation was filed by Manchester within 90 days after the November 6, 2001 setting of the rate.
On February 4, 2003, DSS forwarded to Manchester correspondence reflecting that it was rejecting a request for a $9.11 per diem increase of the $177.53 rate that was currently in effect and also advised Manchester that it had increased the rate to $181.03, effective as of January 1, 2003. On February 5, 2003, Manchester filed a timely request for a rehearing as to the Medicaid rate for January 1, 2003 though June 30, 2003. On May 1, 2004, within 90 days of the notification as to the January 1 to June 30, 2003 rate, Manchester filed a four-page "Appeal Letter" which specifically addressed in detail many of the items that had been included by DSS in its February 4 letter. CT Page 13272-al
Thereafter, in response to DSS's motion to dismiss both rehearing requests, after full briefing, the hearing officer rendered a decision dismissing Manchester's request for a hearing on the July 1, 2001 rate on the ground that Manchester had failed to comply with C.G.S. Sec. 17b-238(b) by not providing a detailed written description of all items of aggrievement within ninety days. The hearing officer denied the motion to dismiss as to the request for a hearing on the July 1, 2003 rate.
Instead of accommodating itself to the offer to proceed to a full hearing on the 2003 rate, Manchester moved for a stay/continuance of consideration of that matter on the basis that the 2001 rate needed to be addressed on appeal before that 2003 rate could be appropriately considered. The stay/continuance was granted and this administrative appeal was filed.
Issues
Manchester asserts that its filing on November 12, 2001 was sufficient to satisfy the requirement of C.G.S. Sec. 17b-238(b) and that its May 1, 2003 letter satisfied the requirements of the statute as to both of the per diem rates it was appealing.
Standard of Review
The well-established standard of review of an agency decision is that the court is to defer to the statutory construction applied by the administrative agency and to give considerable weight to the factual and discretionary determinations of the agency. Connecticut Light Power Co. v. Texas-Ohio Power, Inc., 243 Conn. 635, 642 (1998). As to pure questions of law, the standard of review is broader, resting upon whether the agency acted unreasonably, arbitrarily, illegally or in abuse of its discretion Id. 243 Conn. at 642. Moreover, if the question of law has not previously been the subject of judicial scrutiny, no deference is due the agency and judicial review is plenary. Id. 243 Conn. at 642.
The issue in the present case requires the CT Page 13272-am interpretation of a statutory provision that, heretofore, has not been adjudicated, consequently, the latter standard is applicable.
Discussion
C.G.S. Sec. 17b-238(b) requires that any request for a hearing be completed within ten days of the rate notice and that a detailed written description of the aggrieved items be filed no later than ninety days of the rate notice. The statute does not require two separate documents to be filed, however, it does permit two separate filings, so long as they are timely. The issue, therefore, is whether the November 12, 2001 filing by Manchester satisfies the "detailed written description" requirement of the statute. The statute at issue was amended by Public Act 95-351 to include the provisions for a rehearing effective after July 1, 1996, and the requirement that the facility file a "detailed written description" of the items of aggrievement. The amended statute does not define "detailed written description," and the legislative history of the public act does not provide any guidance in the interpretation of that term.
C.G.S. Sec. 17b-238(b) provides, in pertinent part: "Any institution or agency to which payments are made under sections 17b-239 to 17b-246, inclusive and sections 17b-340 and 17b-343 which is aggrieved by any decision of said commissioner may, within ten days after written notice thereof from the commissioner, obtain, by written request to the commission, a rehearing on all items of aggrievement. On and after July 1, 1996 a rehearing shall be held by the commissioner or his designee, provided a detailed written description of all such items is filed within ninety days of written notice of the commissioner's decision.
An analogy can be found between the requirements of C.G.S. Sec. 17-238b and the requirements of the practice book as to the filing of an appeal of a trial court decision. In the initial appellate papers, a "preliminary statement of issues" is required. P.B. Sec. 63-4. In the appellate scenario, the "preliminary statement of issues" notifies the opposing party and the Appellate Court of the "issues to be presented on appeal," the areas of contention. In the appellate scenario, it is only in the briefing of the issues that the opposing party and the Appellate Court are apprised of the factual and legal rationale for the appellant's contentions that the lower court erred in its decision making. (P.B. Secs. 67-1 et seq.) Similarly, in the statute at issue, C.G.S. Sec. 17-238(b), provision is made for an initial notification of the issues — the items of aggrievement. The statute then requires a "detailed written description" of the claimed items of aggrievement. The statute envisions an initial notification of a claim that an error has occurred, and CT Page 13272-an that the facility asserting this error apprise the opposing side and the decision-maker of the reasons proffered to substantiate the claimed error. This second requirement calls for, at a minimum, the listing and discussion of the factual and/or legal bases for the claimed error.
In its November 12, 2001 notification, Manchester's request for a rehearing specifies that it is seeking redress for the rate set for the period of July 1, 2001 through June 30, 2002 and Manchester gives a lengthy list of potential bases for the claimed error. Manchester does not provide, however, any detail as to the bases for the claimed error. Indeed, in the letter itself, Manchester admits the "generality" of the notice and attempts to leave the door open for other potential grounds for complaint. "Generality" is certainly very different from "detailed." The November 2001 communication does nothing whatsoever to educate the decision-maker and the respondent to the details of the claimed error. For example, although Manchester contends that there is error based in the "disallowances," in the November 2001 communication, just which disallowances are referred to and the reason that they are not appropriately applied is absent from the notice. The same is true as to "calculations," and "effects of the fair rental system."
The applicable text of the November 12, 2001 communication provides:
Subject to a reservation of rights to amend this notice by modification of the following, the initial items of aggrievement are based upon the determination of the rate pursuant to General Statutes, Section 17b-340, as amended by Section 24 of Public Act 95-160, and regulations promulgated pursuant thereto, including but not limited to, all disallowances arising from classifications, guidelines, inflationary controls and other cost adjustments, calculations of efficiency adjustments, effects of the fair rental system and return on equity, calculations of physical and speech therapy expense disallowances, calculations of the efficiency limitation and statistics including, but CT Page 13272-ap not limited to the deflator lag and inflation factors, prior and current year average real wage growth percentages, median State rate, efficiency floors, and rates of return, and all other factors considered by the commissioner in establishing the aforesaid reimbursable rate.
Without limiting the generality of this reservation, the facility specifically notes that if the reimbursement system utilized to compute the rate(s) set for state aided (Medicaid/Title XIX) patients for the July 1, 2001 through June 30, 2002 rate year is determined to be in violation of any applicable law by any court of competent jurisdiction, the facility specifically reserves the right to claim that it is aggrieved by any such violation of law and the resulting rate(s) and that a higher rate should have been applicable to the July 1, 2001 through June 30, 2002 rate year.
In interpreting a statute, the plain and ordinary meaning of the words used, as well as their natural and usual sense, should be employed. Gural v. Fazzino, 45 Conn.App. 586, 588 (1997). The term "detailed" is defined as "marked by abundant detail or by thoroughness in treating small items or parts," and the word "detail" is defined as "extended treatment of or attention to particular items . . ." Merriam-Webster Online, September 2005. Synonyms for the word "detailed" are: "blow-by-blow, circumstantial, full, itemized, minute, particular, particularized, thorough." Roget's II, The New Thesaurus, Expanded Edition, 1988. The November 2001 request for rehearing does not contain any thoroughness in the treatment of the items of complaint, nor extended treatment or attention to particular items. Instead, it advises, generally, and generally only, of the potential issues to be heard. CT Page 13272-ao
Manchester did not provide a timely detailed written description as to the July 1, 2001 rate.
Additionally, although Manchester did provide a timely, detailed account of its position with regard to the issues it had as to the 2003 rate, that document does not suffice for the 90-day statutory requirement as to the 2001 rate setting.
Consequently, the Hearing Officer's decision is affirmed.
BY THE COURT,
Epstein, J.