Maricopa County v. Arizona Health Care Cost Containment System

• Court: Arizona Court of Appeals
• Writing for the Court: HATHAWAY; DRUKE
• Citation: Maricopa County v. Arizona Health Care Cost Containment System, 880 P.2d 728, 179 Ariz. 508 (Ariz. App. 1994)
• Decision Date: 05 April 1994
• Docket Number: No. 2,CA-CV,2
• Parties: MARICOPA COUNTY, a political subdivision, Plaintiff/Appellee, v. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM, an agency of the State of Arizona and Leonard J. Kirschner, in his official capacity as Director of the Arizona Health Care Cost Containment System Administration, Defendants/Appellants. 94-0031.

Page 728

880 P.2d 728

179 Ariz. 508

MARICOPA COUNTY, a political subdivision, Plaintiff/Appellee, v. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM, an agency of the State of Arizona and Leonard J. Kirschner, in his official capacity as Director of the Arizona Health Care Cost Containment System Administration, Defendants/Appellants.

No. 2 CA-CV 94-0031.

Court of Appeals of Arizona Division 2, Department B.

April 5, 1994.

Review Denied Sept. 20, 1994.

Richard Romley, Maricopa County Attorney by Sydney K. Davis, Phoenix, for plaintiff/appellee.

Johnston, Maynard, Grant & Parker by Catherine M. Dodd, Phoenix, for defendants/appellants.

OPINION

HATHAWAY, Judge.

This is an appeal by the Arizona Health Care Cost Containment System (AHCCCS) from the trial court's order vacating a decision by AHCCCS. The issue on appeal is whether appellee Maricopa County (Maricopa) is financially responsible for all medical expenses incurred by the "K" family from the time it was erroneously certified as eligible for AHCCCS coverage throughout the following six-month certification period. The superior court determined that it was not. We affirm.

On March 26, 1990, Maricopa County began processing the "K" family's request for AHCCCS certification. It was certified as eligible on April 4, 1990. At that time, Mrs. "K" was hospitalized and incurring continuing medical expenses. The certification period lasted until October 31, 1990. In July 1990, the "K" file was selected for a quality control analysis by AHCCCS pursuant to A.R.S. § 36-2905.02. The AHCCCS Quality Control Analysis Report issued in December 1990, revealed that Maricopa had erroneously certified the "K" family as AHCCCS eligible on April 4, 1990, based upon misinformation about excess income in the amount of $628.86. Between April 4 and 5, 1990, Mrs. "K" incurred further medical expenses in the amount of $687.84. It is undisputed that the erroneous certification resulted from an understatement of income by the "K" family. Both parties agree that the error was not a result of applicant fraud, although it was likewise not an error attributable to Maricopa, and this opinion therefore does not address the situation where improper certification results from county error.

AHCCCS requested reimbursement for all costs incurred during the entire period of certification, April 4, 1990, through October 31, 1990. Maricopa challenged the amount of reimbursement due, arguing that it should only be responsible for costs incurred from April 4, the date of erroneous certification, through April 5, when Mrs. "K" incurred additional expenses sufficient to absorb the excess income. The AHCCCS Challenge Committee ruled against Maricopa's challenge. Maricopa filed a grievance against AHCCCS which was denied. Maricopa then filed a complaint in superior court and obtained a reversal of the administration's decision.

The issue before us is one of statutory interpretation and is therefore a question of law subject to de novo review. Cochise County v. Kirschner, 171 Ariz. 258, 830 P.2d 470 (App.1992). Although administrative interpretations of statutes should be accorded some weight, they are not binding on this court. McLeod v. Chilton, 132 Ariz. 9, 643 P.2d 712 (App.1981), cert. denied, 459 U.S. 877, 103 S.Ct. 172, 74 L.Ed.2d 141 (1982). We conclude that a fair reading of the statute, and one that avoids an absurd result, is that advanced by Maricopa. St. Joseph's Hosp. & Medical Center v. Maricopa County, 130 Ariz. 239, 635 P.2d 527 (App.1981).

A.R.S. § 36-2905.02(A), entitled in part, "county liability for erroneous payments; reimbursement by county," provides, in part:

If the administration ascertains pursuant to this subsection that a person so certified by the county was in fact ineligible or improperly classified when certified or that the county failed to take timely action to discontinue benefits after receiving notice containing cause for ineligibility, the county shall reimburse the system for expenses improperly incurred....

AHCCCS argues that Maricopa is responsible for the expenses improperly incurred for the duration of the certification period, relying on A.R.S. § 36-2905(E)(1), which contains the "spend-down" provision: ¹

Each county shall:

1. Deduct from the calculation of income medical expenses incurred by each applicant for which the applicant is responsible for payment and which are not subject to any applicable third party payments for the twelve months immediately prior to determination of eligibility for classification as a medically needy person under this section. Medical expenses incurred do not include the cost of services provided by a county free of charge or on a subsidized basis.

The "K" family unquestionably incurred sufficient medical expenses within 24 hours of the improper eligibility classification to bring its income within the AHCCCS eligibility parameters. However, as a result of inaccurate income reported by the "K" family, and through no fault of Maricopa, this error went undiscovered until it was reported in the Quality Control Analysis Report in December 1990. The only reason Maricopa is accepting responsibility for payment of the $687.84 incurred between April 4 and 5, is because of the error, not because the "K" family had otherwise applied for or qualified for county assistance. It is this latter situation in which an individual receives county assistance, that the "services provided by a county free of charge" language of A.R.S. § 36-2905(E)(1) addresses, not the circumstances in this...