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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. KUDOS to the Indiana Supreme Court for realizing that some bureacracies need to go to the stake. Recall what RWR said: "No government ever voluntarily reduces itself in size. Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we'll ever see on this earth!" NOW ... what next to this rare and inspiring chopping block? Well, the Commission on Gender and Race (but not religion!?!) is way overdue. And some other Board's could be cut with a positive for State and the reputation of the Indiana judiciary.

  2. During a visit where an informant with police wears audio and video, does the video necessary have to show hand to hand transaction of money and narcotics?

  3. I will agree with that as soon as law schools stop lying to prospective students about salaries and employment opportunities in the legal profession. There is no defense to the fraudulent numbers first year salaries they post to mislead people into going to law school.

  4. The sad thing is that no fish were thrown overboard The "greenhorn" who had never fished before those 5 days was interrogated for over 4 hours by 5 officers until his statement was illicited, "I don't want to go to prison....." The truth is that these fish were measured frozen off shore and thawed on shore. The FWC (state) officer did not know fish shrink, so the only reason that these fish could be bigger was a swap. There is no difference between a 19 1/2 fish or 19 3/4 fish, short fish is short fish, the ticket was written. In addition the FWC officer testified at trial, he does not measure fish in accordance with federal law. There was a document prepared by the FWC expert that said yes, fish shrink and if these had been measured correctly they averaged over 20 inches (offshore frozen). This was a smoke and mirror prosecution.

  5. I love this, Dave! Many congrats to you! We've come a long way from studying for the bar together! :)

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