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COMMONWEALTH PENNSYLVANIA v. TOWN COURT NURSING CENTER (05/21/86)

decided: May 21, 1986.

COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, PETITIONER
v.
TOWN COURT NURSING CENTER, INC., RESPONDENT



Appeal from the Order of the Board of Claims in the case of Town Court Nursing Centers, Inc., No. 652, dated March 2, 1983 and May 22, 1985.

COUNSEL

Bruce G. Baron, Assistant Counsel, for petitioner.

Jeffrey B. Albert, of Counsel: Fox, Rothschild, O'Brien & Frankel, for respondent.

Judges Craig and Barry, and Senior Judge Blatt, sitting as a panel of three. Opinion by Judge Craig.

Author: Craig

[ 97 Pa. Commw. Page 381]

The Department of Public Welfare appeals from an order of the Board of Claims directing DPW to reimburse Town Court Nursing Center, Inc. for nursing services provided to patients eligible for medical assistance from September 3, 1975 to April 14, 1976. We affirm.

[ 97 Pa. Commw. Page 382]

The facts in this case are not in dispute; the parties submitted a stipulation of facts to the Board of Claims.

In 1968, the Department of Health issued a skilled care nursing license to Town Court to begin operation. On November 1, 1973, Town Court entered into a skilled nursing care provider agreement with DPW under the medical assistance program for its 138-bed facility. That agreement was renewed through October 31, 1974.

On September 30, 1974, the Department of Health, Education and Welfare (HEW) decertified Town Court as an eligible Medicare provider effective October 31, 1974.

In October 1974, DPW decertified Town Court as an eligible medical assistance provider effective November 30, 1974. Town Court timely appealed its medical assistance decertification. That appeal stayed the decertification decision of DPW pending recertification or the conclusion of the appeal process.

On September 3, 1975, Town Court opened a new addition to its nursing home facility which increased its bed capacity from 138 to 198. Also on that day, Town Court reapplied with DPW for certification as a skilled nursing care provider eligible for participation in the medical assistance program.

DPW conducted an inspection survey on September 3, 1975, and informed Town Court that its facilities had satisfied the federal requirements under Title 18 and Title 19. The survey team's oral approval of the facility was an accepted practice. After giving oral approval, the survey team began to talk with Town Court management about bringing in relocation patients.

On May 11, 1976, HEW accepted Town Court for participation in the federal Medicare program retroactive to September 3, 1975.

[ 97 Pa. Commw. Page 383]

On May 24, 1976, Town Court and DPW entered into a skilled nursing care provider agreement under the medical assistance program. That agreement was retroactive to September 3, 1975 for the 198-bed facility.

By letter dated July 19, 1976, HEW notified Town Court that its earlier action authorizing Town Court's participation in the Medicare program retroactive to September 3, 1975 was rescinded. The new effective date of its participation in the Medicare program was stated as April 14, 1976.

By letter dated August 3, 1976, DPW notified Town Court that it was amending the term of the 1976 provider agreement to be effective for the period April 14, 1976 through April 30, 1977.

Town Court then filed the reimbursement claim now before us.

The three issues in this case are (1) whether the Board of Claims had subject matter jurisdiction, (2) whether Town Court's claim was timely, and (3) whether the doctrine of estoppel is applicable ...


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