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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. Your article is a good intro the recent amendments to Fed.R.Civ.P. For a much longer - though not necessarily better -- summary, counsel might want to read THE CHIEF UMPIRE IS CHANGING THE STRIKE ZONE, which I co-authored and which was just published in the January issue of THE VERDICT (the monthly publication of the Indiana Trial Lawyers Association).

  2. Thank you, John Smith, for pointing out a needed correction. The article has been revised.

  3. The "National institute for Justice" is an agency for the Dept of Justice. That is not the law firm you are talking about in this article. The "institute for justice" is a public interest law firm. http://ij.org/ thanks for interesting article however

  4. I would like to try to find a lawyer as soon possible I've had my money stolen off of my bank card driver pressed charges and I try to get the information they need it and a Social Security board is just give me a hold up a run around for no reason and now it think it might be too late cuz its been over a year I believe and I can't get the right information they need because they keep giving me the runaroundwhat should I do about that

  5. It is wonderful that Indiana DOC is making some truly admirable and positive changes. People with serious mental illness, intellectual disability or developmental disability will benefit from these changes. It will be much better if people can get some help and resources that promote their health and growth than if they suffer alone. If people experience positive growth or healing of their health issues, they may be less likely to do the things that caused them to come to prison in the first place. This will be of benefit for everyone. I am also so happy that Indiana DOC added correctional personnel and mental health staffing. These are tough issues to work with. There should be adequate staffing in prisons so correctional officers and other staff are able to do the kind of work they really want to do-helping people grow and change-rather than just trying to manage chaos. Correctional officers and other staff deserve this. It would be great to see increased mental health services and services for people with intellectual or developmental disabilities in the community so that fewer people will have to receive help and support in prisons. Community services would like be less expensive, inherently less demeaning and just a whole lot better for everyone.

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