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MARGARET CAMPION v. COMMONWEALTH PENNSYLVANIA (08/12/88)

decided: August 12, 1988.

MARGARET CAMPION, PETITIONER
v.
COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, RESPONDENT



Appeal from the Order of the Department of Public Welfare in the case of Appeal Of: Philadelphia Psychiatric Center -- Re: Margaret Campion (Admitted 10/22/86) Case No. 5110241.

COUNSEL

Ellen J. Feinberg, Hayt, Hayt & Landau, for petitioner.

Mary Frances Grabowski, Assistant Counsel, for respondent.

Judges MacPhail and Palladino, and Senior Judge Barbieri, sitting as a panel of three. Opinion by Judge Palladino.

Author: Palladino

[ 118 Pa. Commw. Page 539]

Margaret Campion (Petitioner) appeals from an order of the Department of Public Welfare (DPW) denying Philadelphia Psychiatric Center (Provider) reimbursement for the psychiatric hospitalization of Petitioner. For the reasons which follow, we must dismiss this appeal because Petitioner lacks standing to bring it.

There is no dispute as to the underlying facts in this case. Petitioner is a categorically needy medical assistant recipient. She was admitted to Provider for psychiatric treatment on October 22, 1986 and discharged on December 5, 1986. Prior to this admission, Petitioner had been hospitalized for inpatient psychiatric treatment at Provider from July 1, 1986 until September 2, 1986. The medical necessity of Petitioner's hospitalizations is not contested.

According to DPW regulation, Petitioner is eligible for 60 days of medically necessary inpatient psychiatric services each benefit period. 55 Pa. Code ยง 1151.21(b). This regulation provides that a "recipient's benefit period does not begin until the recipient has not received inpatient psychiatric hospital care from either a public or private psychiatric hospital for at least 60 days." Id.

[ 118 Pa. Commw. Page 540]

Petitioner, because of the hospitalization for psychiatric treatment until September 2, 1986, would not be eligible for another 60 days of such services until at least November 2, 1986.

Provider did not attempt to claim payment from DPW for the inpatient services it provided Petitioner from October 22, 1986 through November 2, 1986, requesting only reimbursement for services provided from November 2, 1986 through December 5, 1986. DPW denied payment on the basis that Petitioner was not eligible for a benefit period beginning November 2, 1986 because she had not remained out of a psychiatric hospital for at least 60 days.

Provider appealed DPW's denial of payment. A fair hearing was held May 15, 1987. The hearing examiner recommended denial, determining that payment for an inpatient psychiatric treatment is precluded when there has not been a 60 day period, following a previous admission, in which the recipient was not an inpatient.*fn1 On September 8, 1987, DPW adopted the hearing officer's recommendation denying ...


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