Missouri Dept. of Social Services v. Administrative Hearing Com'n, WD

• Decision Date: 24 March 1992
• Docket Number: No. WD,WD
• Citation: 826 S.W.2d 871
• Parties: MISSOURI DEPARTMENT OF SOCIAL SERVICES, Appellant, v. ADMINISTRATIVE HEARING COMMISSION, Respondent. 44550.
• Court: Missouri Court of Appeals

Page 871

826 S.W.2d 871

MISSOURI DEPARTMENT OF SOCIAL SERVICES, Appellant, v. ADMINISTRATIVE HEARING COMMISSION, Respondent.

No. WD 44550.

Missouri Court of Appeals Western District.

March 24, 1992.

Edwin F. Moats and William E. Cornwell, Dept. of Social Services, Jefferson City, for appellant.

Harvey M. Tettlebaum, Husch & Eppenberger, Jefferson City, for respondent.

Before KENNEDY, P.J., and FENNER and BRECKENRIDGE, JJ.

BRECKENRIDGE, Judge.

The Missouri Department of Social Services (DSS) appeals from an order of the circuit court granting the motion of the Administrative Hearing Commission (AHC) to quash a preliminary writ in prohibition. DSS raises seven points of alleged error in this appeal, claiming that the circuit court erred in quashing the preliminary writ in prohibition because: (1) the AHC lacks jurisdiction over the issues raised in Hillhaven's complaints because Hillhaven lacks standing to raise those issues; (2) 13 CSR 70-10.010(7)(D)(4) ¹ bars AHC jurisdiction to review a trend factor; (3) the AHC has no jurisdiction under § 208.156.4 ² to review the trend factor; (4) the AHC has no jurisdiction to review the trend factor because Hillhaven has not satisfied the condition precedent required by Livingston Manor, Inc. v. Department of Social Serv., 809 S.W.2d 153 (Mo.App.1991); (5) the AHC lacks subject matter jurisdiction over the constitutional issues raised in the Hillhaven complaint; (6) the AHC lacks subject matter jurisdiction over the Boran Amendment compliance issue raised in the Hillhaven complaint; and (7) the AHC lacks subject matter jurisdiction over the trend factor effective date issue. The order of the trial court quashing the preliminary order in prohibition is affirmed.

Hillhaven, Inc., a corporation authorized to do business in Missouri, operates a chain of nursing homes. On behalf of eighteen of its Missouri nursing homes, Hillhaven filed eighteen identical complaints with the AHC seeking a hearing before the AHC from the final decision of DSS as contained in letters dated December 28, 1988. These letters notified each of the eighteen complainants of the increase in its Medicaid per-diem reimbursement rate as a result of the trend factor and noted that the effective date of that increase was January 1, 1989. The letter also informed each of the complainants of its right to a hearing before the AHC under § 208.156 and § 621.055.

DSS moved to dismiss for failure of subject matter jurisdiction, but the AHC overruled the motion. After its motion for rehearing was denied, DSS filed its petition in prohibition with the circuit court. On December 19, 1989, a preliminary writ of prohibition was issued. The AHC moved to quash and on February 6, 1991, the circuit court granted the AHC's motion to quash. The order quashing the preliminary writ is an appealable final judgment. State ex rel. Westfall v. Gerhard, 676 S.W.2d 37, 38 (Mo.App.1984).

Prohibition provides litigants with the means to circumvent the normal appellate process and should therefore be employed by the courts judiciously and with exceptional restraint. Derfelt v. Yocom, 692 S.W.2d 300, 301 (Mo. banc 1985). "A writ of prohibition does not issue as a matter of right." Id. The discretionary authority of the court to issue this writ is exercised "when the facts and circumstances of the particular case demonstrate unequivocally that there exists an extreme necessity for preventative action." Id. Two requirements must occur simultaneously before the issuance of such a writ: (1) a showing must be made that the court exceeded its jurisdiction; and (2) the remedy of appeal must not be available to the relator. State ex rel. Degeere v. Appelquist, 748 S.W.2d 855, 856-57 (Mo.App.1988). Where there exists an adequate remedy by appeal, prohibition will not lie. State ex rel. Baldwin v. Dandurand, 785 S.W.2d 547, 549 (Mo. banc 1990). DSS does not make a showing that either of the requirements are satisfied by the facts in the instant case.

DSS does not make any showing that it lacks an adequate remedy by appeal, but focuses on the lack of jurisdiction prong of the test. The only reference DSS makes to the appealability of the proceeding is to state that where a court is wholly lacking in jurisdiction to proceed, appeal is not considered to be an adequate remedy because any action that the court could take would be without authority and the parties involved would suffer from unwarranted expense and delay. State ex rel. T.J.H. v. Bills, 504 S.W.2d 76, 79 (Mo. banc 1974). The AHC, however, is not wholly lacking in jurisdiction.

Section 621.055.1, provides:

Any person authorized under section 208.153, RSMo, to provide services for which benefit payments are authorized under section 208.152, RSMo, may seek review by the administrative hearing commission of any of the actions of the department of social services specified in subsection 2, 3, or 4 of section 208.156, RSMo. The review may be instituted by the filing of a petition with the administrative hearing commission. The procedures applicable to the processing of such review shall be those established by chapter 536, RSMo. The administrative hearing commission shall maintain a transcript of all testimony and proceedings in any review governed by this section, and copies thereof shall be made available to any interested person upon the payment of a fee which shall not exceed the reasonable cost of preparation and supply. Decisions of the administrative hearing commission under this section shall be binding subject to appeal by either party. If the provider of services prevails in any dispute under this section, interest shall be allowed at the rate of eight percent per annum upon any amount found to have been wrongfully denied or withheld. In any proceeding before the administrative hearing commission under this section the burden of proof shall be on the provider of services seeking review.

Section 208.156.4 provides:

Any person authorized under section 208.153 to provide services for which benefit payments are authorized under section 208.152 who is aggrieved by any rule or regulation promulgated by the department of social services or any division therein shall be entitled to a hearing before the administrative hearing commission pursuant to the provisions of chapter 161, RSMo.

These sections give the AHC the jurisdiction to hear the action. Curiously, DSS apparently recognized the AHC's jurisdiction initially in the notification it sent to the facilities concerning the trend factor adjustment. That notification contained the following language:

Please direct any questions concerning the prospective rate as set forth above to this office. If the facility wishes to appeal the prospective rate determination, please direct your appeal to the Administrative Hearing Commission, Truman State Office Building, 301 West High Street, P.O. Box 1557, Jefferson City, Missouri, 65102, under the provisions of Sections 621.055 and 208.156, RSMo 1986 within thirty days of the date of this letter, if the sum in dispute exceeds $500.00. Any questions concerning appeal procedures should be directed to the Administrative Hearing Commission. (Emphasis added).

DSS argues that the AHC's power is co-extensive with the power of DSS so that the regulation which bars DSS from reviewing a trend factor, 13 CSR 70-10.010(7)(D)(4), also bars the AHC from hearing the matter. This assertion is in error. The AHC's jurisdiction is defined by § 208.156 and § 621.055. If, as suggested by DSS, the AHC's jurisdiction were co-extensive with DSS, then any agency that did not wish the AHC to review its decision could avoid that review by drafting a rule or regulation preventing review. DSS does not cite any case law which would support such a proposition. An agency's regulation cannot act as a restriction on the AHC's statutorily set jurisdiction.

In the instant case Hillhaven claims that the DSS decision regarding the trend factor increase was in error. It challenges the decision on several grounds claiming that the trend factor was incorrect as it failed to reimburse reasonable costs as required by § 208.152.1; was violative of both the Missouri...