Department of Health and Human Services DEPARTMENTAL APPEALS BOARD Civil Remedies Division |
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IN THE CASE OF | |
D.C. Association for Retarded Citizens, |
DATE: May 24, 2001 |
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Health Care Financing Administration
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Docket No.C-00-333 Decision No. CR776 |
DECISION | |
DECISION I grant the motion of the Health Care Financing Administration
(HCFA) to dismiss the request for hearing by the D.C. Association for
Retarded Citizens (Petitioner). I do so because Petitioner no longer has
a right to a hearing in this case. BACKGROUND Petitioner is an Intermediate Care Facility for the Mentally
Retarded (ICF/MR) that participates in the Medicaid program. On January
19, 2000, HCFA sent a notice to Petitioner's administrator in which HCFA
announced its intent to terminate Petitioner's participation in the Medicaid
program on March 19, 2000. HCFA informed the Petitioner that termination
was being imposed because Petitioner had failed to meet federal participation
requirements for ICFs/MR. Petitioner was resurveyed on March 15, 2000, and found
to be in substantial compliance with all participation requirements. Petitioner
filed a request for hearing on March 19, 2000. By letter dated April 4,
2000, HCFA notified the Petitioner that the termination action had been
halted. On September 7, 2000, HCFA filed a motion to dismiss Petitioner's
hearing request, asserting that because HCFA had rescinded the termination
and had not imposed any other remedies, the Petitioner no longer had a
right to a hearing. Petitioner filed a reply brief opposing the motion
to dismiss. ISSUE The issue in this case is whether Petitioner continues
to have a right to a hearing in light of HCFA's decision to rescind the
termination. FINDING OF FACT AND CONCLUSIONS
OF LAW I make the following finding of fact and conclusions of law to support my decision in this case. I discuss my Finding in detail below.
The hearing rights of an ICF/MR are established by federal
regulations. HCFA may impose remedies of denial of payments for new admissions
and termination of a facility's Medicaid agreement. 42 C.F.R. �� 442.117,
442.118. Once HCFA makes a decision to impose such remedies, an ICF/MR
facility then has the right to appeal HCFA's decision. 42 C.F.R. � 498.5
(j). An administrative law judge has authority to hear certain initial determinations by HCFA that are described at 42 C.F.R. � 498.3(b). An appealable initial determination includes:
42 C.F.R. � 498(b)(9). A termination is such an initial determination. However,
there are no provisions in 42 C.F.R. � 498.3(b) or elsewhere in the regulations
for a hearing in a case where HCFA does not determine to impose a remedy
against an ICF/MR. Petitioner argues that a determination by HCFA to cancel
an ICF/MR's approval to participate in the Medicaid program is in and
of itself a determination that creates a right to a hearing. According
to Petitioner, regardless of HCFA's rescission, it has a right to a hearing
as to HCFA's findings that the facility failed to meet program requirements
and HCFA's decision to terminate Petitioner's participation in the Medicaid
program. Petitioner's arguments are unpersuasive. HCFA initially
decided to cancel Petitioner's participation in the Medicaid program.
That determination created a hearing right which Petitioner exercised.
However, subsequently, and prior to the scheduled termination date, HCFA
decided to rescind the determination to cancel Petitioner's participation
in the Medicaid program. That subsequent determination by HCFA extinguished
any hearing right that Petitioner had. Once HCFA made the determination
to rescind all remedies, Petitioner no longer had any right to a hearing.
See Schowalter Villa, DAB CR 568 at 2 (1999), aff'd,
DAB No. 1688 (1999). I note that HCFA's termination action was rescinded
before it went into effect. Petitioner further argues that ICFs/MR and skilled nursing facilities/nursing facilities (SNF/NFs) are distinctly different, and are therefore subject to different treatment under the regulations. Petitioner cites various differences between ICFs/MR and SNF/NFs. For example, ICFs/MR are subject to different survey, certification, enforcement, and remedies than SNF/NFs. Additionally, Petitioner argues that other Departmental Appeals Board decisions (denying petitioners' hearing requests) dealing with the same issue refer to SNF/NFs, and are not applicable to ICFs/MR. Therefore, the Petitioner contends that the 42 C.F.R. Part 498 appeals procedures that apply to SNF/NFs do not apply to ICFs/MR. Petitioner is incorrect. Although Petitioner points out some differences between ICFs/MR and SNF/NFs, those differences are of no consequence here. While it is true that ICFs/MR and SNF/NFs differ in some respects, these differences do not change the appeal rights of an ICF/MR under 42 C.F.R. Part 498. The same appeal rights apply to an ICF/MR as they do a SNF/NF. Absent an adverse determination actually imposed by HCFA, the Petitioner has no more rights to a hearing than a SNF/NF.Based on my review of the plain language of the relevant regulations, the case law, and the arguments advanced by HCFA, I conclude that HCFA's determination to rescind the termination remedy in this case extinguished Petitioner's right to a hearing in this matter. Accordingly, I grant HCFA's motion to dismiss and order this case dismissed. |
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JUDGE | |
Alfonso J. Montano Administrative Law Judge
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