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EASTON HOSPITAL v. COMMONWEALTH PENNSYLVANIA (07/29/83)

decided: July 29, 1983.

EASTON HOSPITAL, PETITIONER
v.
COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, RESPONDENT



Appeal from the Order of the Department of Public Welfare in the case of In Re: Appeal of Easton Hospital, Level of Care Appeals, dated August 28, 1981.

COUNSEL

Joel M. Scheer, Fishbone, Refowich & Sheer, for petitioner.

Jeffrey Gonick, Assistant Counsel, for respondent.

President Judge Crumlish, Jr. and Judges Williams, Jr. and Barbieri, sitting as a panel of three. Opinion by Judge Barbieri.

Author: Barbieri

[ 76 Pa. Commw. Page 39]

Easton Hospital appeals here from an order of the Pennsylvania Department of Public Welfare's Office of Hearings and Appeals, which denied Easton reimbursement for care it rendered patients eligible for medical assistance (Medicaid).

[ 76 Pa. Commw. Page 40]

Easton Hospital is an acute care facility which in 1979 sought reimbursement from the Department of Public Welfare (DPW) for care it rendered medical assistance patients. Easton's claim was for patients who were no longer in need of acute care, but through no fault of its own, remained in Easton due to the unavailability of hospital beds in any suitable lower care facilities. After an initial administrative denial of Easton's request for reimbursement, Easton appealed to DPW's Office of Hearings and Appeals. During the interim before hearing, however, Easton requested that its appeal be held in abeyance until our Supreme Court's disposition of Temple University v. Pennsylvania Department of Public Welfare, 47 Pa. Commonwealth Ct. 22, 407 A.2d 92 (1979), aff'd. mem., 490 Pa. 207, 415 A.2d 413 (1980), appeal dismissed, 449 U.S. 1005 (1980), (Temple II), which Easton claimed presented the identical issue raised in its appeal. Our Supreme Court's decision in Temple II, filed June 18, 1980, affirming the decision of this Court, upheld the DPW's position. Thereafter, Easton amended its appeal to DPW's Office of Hearings and Appeals to request payment not at an acute care level, but for that level of care DPW would have been obliged to reimburse had the patient been transferred on the day acute care was no longer necessary; that being either skilled nursing or intermediate care.

DPW filed a motion to dismiss Easton's appeal which the Office of Hearings and Appeals granted, and the present appeal followed.

Easton first contends that Temple II is not dispositive of the present action, since Temple II involved reimbursement at acute care rates, and in the present situation Easton is only asking for the same

[ 76 Pa. Commw. Page 41]

    lower level of care reimbursement DPW would have had to pay another facility had Easton been able to transfer its patients to a certified lesser care facility. We disagree.

In Temple II, Temple University and the Hospital Association of Pennsylvania initiated an equity action against DPW seeking to enjoin the implementation of the regulation ...


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