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DELAWARE VALLEY CONVALESCENT CENTER v. FRANK S. BEAL (03/06/78)

decided: March 6, 1978.

DELAWARE VALLEY CONVALESCENT CENTER, INC. D/B/A MEDICENTER -- BRISTOL, PETITIONER
v.
FRANK S. BEAL, SECRETARY OF THE PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE AND THE PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE, RESPONDENTS



Original jurisdiction in case of Delaware Valley Convalescent Center, Inc., d/b/a Medicenter-Bristol v. Frank S. Beal, Secretary of the Pennsylvania Department of Public Welfare and the Pennsylvania Department of Public Welfare.

COUNSEL

Shirley D. Weisman, for petitioner.

Howard M. Snyder, Deputy Attorney General, with him Michael McGinley, Assistant Attorney General, J. Justin Blewitt, Jr., Deputy Attorney General, and Robert P. Kane, Attorney General, for respondent.

President Judge Bowman and Judges Crumlish, Jr., Wilkinson, Jr., Rogers, Blatt and DiSalle. Opinion by Judge DiSalle.

Author: Disalle

[ 34 Pa. Commw. Page 178]

This case comes before us upon a petition for review filed in our original jurisdiction by the Delaware Valley Convalescent Center, Inc., doing business as Medicenter (Petitioner). Presently before us are the preliminary objections filed by the Pennsylvania Department of Public Welfare and Frank S. Beal, Secretary of the Department (Respondents).

Petitioner is a licensed nursing home which provides care services to Medicaid patients pursuant to Subchapter XIX of the Social Security Act, 42 U.S.C.A. ยง 1396 et seq. Petitioner participates in the Pennsylvania Medical Assistance Program (PMAP) under one year contracts which are renewed annually.

On July 1, 1976, Respondents issued regulations setting statewide maximum reimbursement ceilings for nursing facilities which participate in PMAP.*fn1 Petitioner

[ 34 Pa. Commw. Page 179]

    contends that these reimbursement ceilings are unlawful because they are based in part upon the availability of funds and were imposed without adequate discussion at public hearings, all of this being in contravention of the Social Security Act. Petitioner seeks to enjoin the continued application of these ceilings and asks for ancillary damages in the form of a retroactive increase in the rate of reimbursement for the period from July 1, 1976 to September 1, 1977.

Respondents have raised numerous preliminary objections to the petition, but we need discuss only one of these to dispose of this case. Respondents contend that the present action is barred by Petitioner's failure to exhaust an adequate administrative remedy. We agree.

The Department of Public Welfare, by regulation, has provided an opportunity for a hearing to nursing facilities aggrieved by the reimbursement rate set by the Department:

V. Facility appeal procedure. In the event the facility disagrees with the interim per diem rate or annual adjustment established by the Department, the facility may request within 30 days after notification by the Department, an informal or formal hearing ...


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