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COA reverses in favor of FSSA in provider payment dispute

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The Indiana Court of Appeals held that a trial court erred in ruling in favor of health care providers regarding payments from the state’s Residential Care Assistance Program.

In Michael A. Gargano, in his official capacity as Secretary of the Indiana Family and Social Services Administration, et al. v. Lee Alan Bryant Health Care Facilities, Inc., et al., No. 49A02-1105-PL-449, the appellants contended that the trial court violated separation of powers when it found that the Family and Social Services Administration and Division of Aging had acted unlawfully in refusing to accept RCAP applications after Dec. 1, 2009.

The FSSA had notified providers that relied on RCAP funds in October 2009 that due to budgetary constraints affecting all state agencies, the RCAP would not be accepting new applications effective Dec. 1, 2009. Following that date, a number of applications for the RCAP submitted by individuals admitted to providers’ facilities were denied.

The COA declined to hold that FSSA and the DOA may not exercise or perform conventional administrative and executive steps of directing or redirecting allotted funds in order to meet the directives of the State Budget Agency, and therefore reversed the trial court’s award of damages to providers.

The appellants also claimed that the court erred in ordering them to recalculate reimbursement rates paid to RCAP providers. The trial court had ordered the state agencies in 2011 to recalculate reimbursement amounts from 2003 to 2009.

Citing Indiana Code 12-10-6-2.1, subsection (g), the COA held that “a prenegotiated payment rate is predicated on a reasonable cost related basis with a growth of profit factor in accordance with generally accepted accounting principles and methods and written standards and criteria as established by the division.” RCAP providers had been paid the upper rate limit and therefore were not entitled to additional reimbursement, nor were the reimbursement rates unlawful, the COA held.

The Court of Appeals remanded for proceedings consistent with its opinion.

 

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  1. From his recent appearance on WRTV to this story here, Frank is everywhere. Couldn't happen to a nicer guy, although he should stop using Eric Schnauffer for his 7th Circuit briefs. They're not THAT hard.

  2. They learn our language prior to coming here. My grandparents who came over on the boat, had to learn English and become familiarize with Americas customs and culture. They are in our land now, speak ENGLISH!!

  3. @ Rebecca D Fell, I am very sorry for your loss. I think it gives the family solace and a bit of closure to go to a road side memorial. Those that oppose them probably did not experience the loss of a child or a loved one.

  4. If it were your child that died maybe you'd be more understanding. Most of us don't have graves to visit. My son was killed on a state road and I will be putting up a memorial where he died. It gives us a sense of peace to be at the location he took his last breath. Some people should be more understanding of that.

  5. Can we please take notice of the connection between the declining state of families across the United States and the RISE OF CPS INVOLVEMENT??? They call themselves "advocates" for "children's rights", however, statistics show those children whom are taken from, even NEGLIGENT homes are LESS likely to become successful, independent adults!!! Not to mention the undeniable lack of respect and lack of responsibility of the children being raised today vs the way we were raised 20 years ago, when families still existed. I was born in 1981 and I didn't even ever hear the term "CPS", in fact, I didn't even know they existed until about ten years ago... Now our children have disagreements between friends and they actually THREATEN EACH OTHER WITH, "I'll call CPS" or "I'll have [my parent] (usually singular) call CPS"!!!! And the truth is, no parent is perfect and we all have flaws and make mistakes, but it is RIGHTFULLY OURS - BY THE CONSTITUTION OF THIS GREAT NATION - to be imperfect. Let's take a good look at what kind of parenting those that are stealing our children are doing, what kind of adults are they producing? WHAT ACTUALLY HAPPENS TO THE CHILDREN THAT HAVE BEEN RIPPED FROM THEIR FAMILY AND THAT CHILD'S SUCCESS - or otherwise - AS AN ADULT.....

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