Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Greenbrier Hospital, LLC v. Azar

United States District Court, E.D. Louisiana

February 25, 2019

GREENBRIER HOSPITAL, LLC
v.
ALEX M. AZAR, in his official capacity as Secretary of Health and Human Services

         SECTION “L” (3)

          ORDER AND REASONS

         Before the Court are cross-motions for summary judgment. Having considered the parties' briefs and the applicable law, the Court now issues this Order and Reasons.

         I. BACKGROUND

         Plaintiff Greenbrier Hospital, LLC (“Greenbrier”), a Medicare-certified inpatient psychiatric facility in Covington, Louisiana, seeks judicial review of a decision from the Administrator of the Centers for Medicare and Medicaid Services (“CMS”). Greenbrier contends that the Administrator applied the wrong legal standard in determining the appropriate reimbursement rate for its cost report beginning on January 1, 2008.

         1. Structure of Medicare Reimbursement

         CMS is the operating component of the Department of Health and Human Services charged with administering the Medicare program. CMS pays hospitals participating in the Medicare program through a fiscal intermediary or Medicare Administrative Contractor (MAC). Inpatient psychiatric facilities (IPFs) like Greenbrier are required to file annual cost reports (an accounting of its operating and capital-related costs that should be allocated to Medicare) with their responsible MAC. The cost report is reviewed and subject to audit by the MAC, which then issues a Notice of Program Reimbursement (NPR) reflecting the final determination of the total amount due to the provider. The MAC's decision may be appealed to the Provider Reimbursement Review Board (PRRB), and the Administrator of CMS may, at its own option, review the PRRB's decision.

         2. Regulatory Background

         The Tax Equity and Fiscal Responsibility Act (“TEFRA”) of 1982 exempted IPFs from the payment methodologies that applied to ordinary hospitals. IPFs, therefore, were paid on a “reasonable cost” basis. In 1999, Congress passed the SCHIP Balanced Budget Reform Act, which required the Secretary to develop and implement a per diem prospective payment system for IPFs (“IPF-PPS”). The Secretary issued a final rule establishing the IPF-PPS in November 2004. The final rule provided for a three-year transition period, during which the IPF would receive blended payments comprised of an increasing percentage of the PPS rate and a decreasing percentage of the TEFRA rate each year.

         Due to a clerical error, when CMS issued the final rule for the transition period, it incorrectly used summertime dates. The rule published on November 15, 2004 provided:

§ 412.426 Transition period.
(a) Duration of transition period and composition of the blended transition payment. Except as provided in paragraph (c) of this section, for cost reporting periods beginning on or after January 1, 2005 through June 30, 2008, an inpatient psychiatric facility receives a payment comprised of a blend of the estimated Federal per diem payment amount, as specified in § 412.424(c) and a facility-specific payment as specified under paragraph (b).
(1) For cost reporting periods beginning on or after January 1, 2005 and on or before June 30, 2006, payment is based on 75 percent of the facility-specific payment and 25 percent is based on the Federal per diem payment amount.
(2) For cost reporting periods beginning on or after July 1, 2006 and on or before June 30, 2007, payment is based on 50 percent of the facility-specific payment and 50 percent is based on the Federal per diem payment amount.
(3) For cost reporting periods beginning on or after July 1, 2007 and on or before June 30, 2008, payment is based on 25 percent of the facility-specific payment and 75 percent is based on the Federal per diem payment amount.
(4) For cost reporting periods beginning on or after July 1, 2008, payment is based entirely on the Federal per ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.