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TEMPLE UNIVERSITY - COMMONWEALTH SYSTEM HIGHER EDUCATION AND HOSPITAL ASSOCIATION PENNSYLVANIA v. PENNSYLVANIA DEPARTMENT PUBLIC WELFARE AND HELEN B. O'BANNON (10/26/79)

decided: October 26, 1979.

TEMPLE UNIVERSITY - OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION AND THE HOSPITAL ASSOCIATION OF PENNSYLVANIA, ON BEHALF OF ITSELF AND THEMSELVES AND ALL OTHERS SIMILARLY SITUATED, PLAINTIFFS
v.
PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE AND HELEN B. O'BANNON, SECRETARY, PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE, DEFENDANTS



Original jurisdiction in case of Temple University -- of the Commonwealth System of Higher Education and the Hospital Association of Pennsylvania, on behalf of itself and themselves and all others similarly situated v. Pennsylvania Department of Public Welfare and Helen B. O'Bannon, Secretary, Pennsylvania Department of Public Welfare.

COUNSEL

James H. Stewart, Jr., with him Nauman, Smith, Shissler & Hall, Matthew M. Strickler, and Ballard, Spahr, Andrews & Ingersoll, for plaintiffs.

John A. Kane, Assistant Attorney General, for defendants.

President Judge Bowman and Judges Wilkinson, Jr., Rogers, Blatt, DiSalle, Craig and MacPhail. Judges Crumlish, Jr. and Mencer did not participate. Opinion by Judge Blatt.

Author: Blatt

[ 47 Pa. Commw. Page 23]

Temple University and the Hospital Association of Pennsylvania (plaintiffs) initiated this equity action against the Department of Public Welfare (DPW) seeking to enjoin the implementation of certain DPW regulations. We have previously disposed of the DPW's preliminary objections, Temple University v. Department of Public Welfare, 30 Pa. Commonwealth Ct. 595, 374 A.2d 991 (1977) (Temple II), and before us now is the plaintiffs' motion for summary judgment.

[ 47 Pa. Commw. Page 24]

Specifically at issue is the DPW's policy regarding the reimbursement of hospitals for expenses incurred in caring for Medical Assistance patients for whom some care is necessary but for whom acute care in a hospital is unnecessary and for whom space cannot be found in available skilled nursing or intermediate care facilities.

Previous DPW regulations had allowed it to deny reimbursement or to authorize reimbursement in whole or in part when such misutilization of facilities occurred. We held, however, in Department of Public Welfare v. Temple University, 21 Pa. Commonwealth Ct. 162, 166, 343 A.2d 701, 704 (1975) (Temple I), that:

     where a patient may no longer be in need of continued acute hospital care but does need some lower level care, . . . it would be an abuse of administrative discretion to deny reimbursement to hospitals which have diligently put forth every effort to locate, without success, an appropriate lesser care facility. . . .

Subsequently, the DPW adopted the regulation now in dispute, which provides as follows:

Except as noted below, Medical Assistance payments are not made to hospitals either for specific non-covered services and procedures or for prolonged ...


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