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ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN v. COMMONWEALTH PENNSYLVANIA (08/16/89)

decided: August 16, 1989.

ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN, PETITIONER,
v.
COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF PUBLIC WELFARE, RESPONDENT



PETITION FOR REVIEW (DEPARTMENT OF PUBLIC WELFARE).

COUNSEL

Ruth M. Siegel, Post & Schell, P.C., Harrisburg, for petitioner.

Bruce G. Baron, Asst. Counsel, Harrisburg, for respondent.

Barry and Palladino, JJ., and Narick, Senior Judge.

Author: Palladino

[ 128 Pa. Commw. Page 146]

St. Christopher's Hospital for Children (Petitioner) appeals an order of the Pennsylvania Department of Public Welfare (DPW) denying Petitioner's appeal which challenged the amount allowed and the method employed by DPW to determine reimbursements due Petitioner for two pediatric organ transplants for medical assistance recipients. For the reasons stated below we affirm.

The facts before us in this case are as follows. In November of 1984, Petitioner made an oral inquiry as to whether DPW would provide reimbursements for heart and liver transplant procedures under the medical assistance program. On November 19, 1984, DPW confirmed by letter that it would reimburse Petitioner for these procedures under its program exception regulation, and stated that "most transplant procedures are reimbursed at a rate negotiated between our Program Exception Unit and the hospital performing the transplant."

In a letter dated March 6, 1985, Petitioner requested a program exception from DPW for a heart transplant. Petitioner performed the heart transplant on March 19, 1985, without coming to any agreement with DPW as to the method to be employed to calculate the reimbursement. Petitioner, on March 20, 1985, received oral notification that DPW would employ a per diem method to calculate the reimbursement. By a letter dated April 4, 1985, Petitioner received written confirmation of the method to be employed to calculate the reimbursement.

Petitioner made a written request for a second program exception on June 4, 1985. This time the request was for a liver transplant. In a letter dated October 3, 1985, this request was approved, and Petitioner was notified that payment would be made on a per diem basis.

The record reflects that under the formula utilized by DPW, Petitioner received a reimbursement of $46,025 for

[ 128 Pa. Commw. Page 147]

    the heart transplant and $21,724 for the liver transplant. The costs to the Petitioner for these procedures amounted to $91,000 for the heart transplant and $112,259 for the liver transplant.

The following issues are raised by this appeal: 1) whether federal law controls the reimbursement of costs; and 2) whether the method utilized by DPW to determine the ...


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