Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Cedars Nursing Care Center v. Maine Department of Health and Human Services

Superior Court of Maine, Cumberland

February 29, 2016

CEDARS NURSING CARE CENTER d/b/a THE CEDARS, Petitioner
v.
MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES, Respondent and THE AROOSTOOK MEDICAL CENTER/ AROOSTOOK HEALTH CENTER, Intervenor

ORDER

Roland Cole, Chief Justice, Superior Court

Before the court is petitioner's motion to take additional evidence and supplement the record and its motion to stay the notice and briefing schedule. For the following reasons, the court denies the motion to take additional evidence and grants the motion to stay.

I. FACTS

Respondent is the state agency responsible for implementing Maine's Medicaid program, known as MaineCare. Pursuant to this duty, respondent classifies nursing facilities into one of three Peer Groups for purposes of reimbursement. Petitioner operates a nursing facility in Portland, and intervenor Aroostook Health Center (AHC) operates a nursing facility in Aroostook County. Both facilities participate in MaineCare.

Respondent has classified petitioner's facility as Peer Group II. On January 8, 2015, respondent issued a decision changing AHC's classification from Peer Group II to Peer Group III. Petitioner received a copy of respondent's decision on May 8, 2015 in response to a Freedom of Access Act request. By letter dated June 12, 2015, counsel for petitioner requested from respondent review of its January 8 decision. Respondent denied petitioner's request on June 24, 2015 on the grounds that the request was untimely and petitioner lacked standing.

Petitioner filed a Rule 80C petition on June 16, 2015 and an amended petition on July 14, 2015. Petitioner seeks (1) a declaratory judgment that respondent erred in changing AHC's classification to Peer Group III and (2) a permanent injunction preventing respondent from changing AHC's classification to Peer Group III and directing respondent to continue reimbursing AHC as a member of Peer Group II. Petitioner contends that respondent's January 8 decision will reduce the median costs used for calculating reimbursement of Peer Group II nursing facilities and will likely decrease the overall amount of MaineCare reimbursement available for nursing facilities that are not in Peer Group III.

On August 24, 2015, the court denied respondent's motion to dismiss and ordered respondent to file the administrative record within 30 days. Respondent filed the record on September 25, 2015. The court issued a briefing schedule on September 28, 2015. Petitioner filed its motion to take additional evidence and supplement the record and its motion to stay the briefing schedule on October 5, 2015. Respondent filed a motion in opposition on October 23, 2015, and AHC filed a motion in opposition on October 26, 2015.

II. DISCUSSION

A. Motion to Take Additional Evidence

"Except in limited circumstances, judicial review of an agency decision 'shall be confined to the record upon which the agency decision was based.'" Martin v. Unemployment Ins. Comm'n, 1998 ME 271, ¶ 8 n.6, 723 A.2d 412 (quoting 5 M.R.S. § 11006(1)) (citation to footnote only). A party may, however, request that the reviewing court take additional evidence or order the taking of additional evidence as provided by 5 M.R.S. § 11006(1). M.R. Civ. P. 80C(e). Under section 11006(1), the court may order the taking of additional evidence before the agency if it finds that the additional evidence is necessary to deciding the petition for review, or it may allow leave to present additional evidence if the evidence is material to the issues presented and could not have been presented or was erroneously disallowed in the proceedings before the agency. 5 M.R.S. § 11006(1)(B) (2015). "The Administrative Procedure Act leaves it to the discretion of the trial court to determine whether additional evidence is necessary to complete the record." Murphy v. Bd. Of Envtl. Prot, 615 A.2d 255, 260 (Me. 1992).

Petitioner argues that the record contains mostly respondent's "rules, licenses, and other generic material" and is missing "testimony, analysis, or other evaluation" of the impact of respondent's decision on other nursing facilities, including petitioner. (Pl's Mot. Addt'l Evid. 2-3.) Specifically, petitioner wishes to supplement the record with the following additional evidence: (1) transcripts of testimony explaining the MaineCare reimbursement and rate setting process to be provided by, at a minimum, petitioner's CFO, the director of respondent's Division of Audit, and a financial analyst in respondent's Rate Setting Unit; (2) respondent's internal emails and memoranda relating to its January 8 decision and any impact on nursing facilities other than AHC; and (3) any documentation showing the assignment of nursing facilities to each of the Peer Groups and any changes of those assignments. (Id. at 4-5.)

Petitioner's proffered evidence is not necessary or material because the only issue properly before the court is whether respondent erred in denying petitioner's June 12 request for administrative review. The Administrative Procedure Act (APA) entitles any person who is aggrieved by final agency action to judicial review in Superior Court. 5 M.R.S. § 11001(1) (2015). "Final agency action" means a "decision by an agency which affects the legal rights, duties or privileges of specific persons, which is dispositive of all issues, legal and factual, and for which no further recourse, appeal or review is provided within the agency." 5 M.R.S. § 8002(4) (2015). Respondent's January 8 decision cannot be final agency action because further review of that decision was available within the agency. See 10-144 C.M.R. ch. 101, § 140.1.2(1) (2014) (providing administrative review of agency decisions); 10-144 C.M.R. ch. 101, § 1.21-1 (2014) (same). Indeed, petitioner's June 12 letter requested administrative review of the January 8 decision. Respondent's denial of that request on June 24 left petitioner with no further review within the agency, and it is from that decision that petitioner appeals to this court. See 10-144 C.M.R. ch. 101, § 140.1.2(4) (2014) (authorizing judicial review of administrative review); 10-144 C.M.R. ch. 101, § 1.214(A) (2014) (same).

In its June 24 decision, respondent denied petitioner's request for review on the following grounds: (1) the request was untimely under both section 140.1.2(1) and section 1.21-1 because it was filed beyond the respective 30 and 60 day appeal periods; (2) petitioner lacked standing under section 140.1 because it was not the facility to which the January 8 decision issued; and (3) petitioner lacked standing under section 1.21-1 because it was not aggrieved by the decision. The court's review is confined to these issues. See 5 M.R.S. ยง 11001(1) (allowing judicial review of final agency action); M.R. Civ. P. 80C(a) (same). Petitioner's proffered evidence, which challenges the merits of respondent's January 8 decision, is not necessary or ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.