Appeal from the Order of the Department of Public Welfare in case of Appeal of Temple University Hospital in Re: Joseph Giacoponelli.
Matthew M. Strickler, with him Leonard C. Homer, Peter Platten, and, of counsel, Ballard, Spahr, Andrews & Ingersoll, for appellant.
Darius G. C. Moss, Assistant Attorney General, with him Andrea Jacobson Malak, Assistant Attorney General, Barry A. Roth, Assistant Attorney General, and Marx S. Leopold, General Counsel, for appellee.
Perrin C. Hamilton, with him Walter T. Darmopray, and Hamilton, Darmopray & Malloy, for amicus curiae, Northwestern Institute of Psychiatry.
Frederick L. Fuges, with him, of counsel, MacCoy, Evans & Lewis, for amicus curiae, Contributors to the Pennsylvania Hospital.
Brenda C. Kinney, with her James D. Crawford, Frank H. Abbott, and, of counsel, Schnader, Harrison, Segal & Lewis, for amicus curiae, Delaware Valley Hospital Council.
Bruce Eckert, with him James H. Stewart, Jr., and Nauman, Smith, Shissler & Hall, for amicus curiae, Hospital Association of Pennsylvania.
President Judge Bowman and Judges Crumlish, Jr., Kramer, Wilkinson, Jr., Mencer, Rogers and Blatt. Opinion by Judge Blatt.
[ 21 Pa. Commw. Page 164]
In this appeal from an adjudication of the Commonwealth of Pennsylvania, Department of Public Welfare (Department), Temple University of the Commonwealth System of Higher Education (Temple) pursues a challenge to the Department's practice of denying payment to hospitals under the Medical Assistance Program for inpatient hospital care (a) during extended stays caused by the Temple hospital's inability to transfer a patient promptly to a lesser level of care, such as a nursing home or the patient's home, without regard to whether or not such facilities are available to that patient, and (b) for more than 60 days for any one patient in a benefit period.
The case of Joseph Giacoponelli was selected to test these practices and the facts of his case are not contested. Mr. Giacoponelli, a welfare recipient occupying a room in a Philadelphia boarding house, was admitted as an inpatient to the Temple University Hospital on August 18, 1971, suffering from a hip infection. In addition, he suffered from cerebral palsy, had seizures, was mentally retarded, and was almost completely blind. During the initial part of his hospitalization, hip surgery was performed requiring Mr. Giacoponelli to remain bedridden for some time. On September 23 he began to walk with the aid of parallel bars and a walker. He remained in the hospital, however, for a total of 90 days until November 15, 1971.
Mr. Giacoponelli's case was selected for evaluation by the Department's Hospital Utilization Review Committee. Hospital utilization review is designed to promote efficient fiscal and medical utilization of hospital care facilities. Under Departmental Regulation 9421.521 "[w]hen review of a case selected by a Hospital Utilization Review Committee indicates that there has been improper use of hospital facilities or services, a record of the ...