Ohio Acad. of Nursing Homes, Inc. v. Ohio Dep't of Job & Family Servs.
| Decision Date | 22 April 2021 |
| Docket Number | No. 20AP-172,20AP-172 |
| Citation | 172 N.E.3d 470 |
| Court | Ohio Court of Appeals |
| Parties | The OHIO ACADEMY OF NURSING HOMES, INC., et al., Relators-Appellants, v. The OHIO DEPARTMENT OF JOB AND FAMILY SERVICES et al., Respondents-Appellees. |
On brief: Webster & Associates, Co., LPA, Geoffrey E. Webster, and Mary L. Pisciotta, for appellants. Argued: Geoffrey E. Webster.
On brief: Dave Yost, Attorney General, and Rebecca L. Thomas, for appellees. Argued: Rebecca L. Thomas.
DECISION
{¶ 1} Relators-appellants, the Ohio Academy of Senior Health Sciences (f.k.a. the Ohio Academy of Nursing Homes, Inc.), Arcadia Acres, Inc., Main Street Terrace Care Center, Inc., Spring Meadows Care Center, Woodstock Care Center, Inc., and Willowood Care Center of Brunswick, Inc., appeal from a judgment of the Franklin County Court of Common Pleas granting the summary judgment motion of respondents-appellees, the Ohio Department of Medicaid and its director (collectively "ODM"), and denying appellants’ summary judgment motion. For the following reasons, we affirm.
{¶ 2} This matter began over 17 years ago when appellants filed an action on November 25, 2003, against the Ohio Department of Job and Family Services and its director1 alleging appellants’ entitlement to immediate Medicaid reimbursement rate adjustments to cover appellants’ increased workers’ compensation costs.
{¶ 3} ODM reimburses participating nursing homes and other facilities through the Medicaid program for reasonable costs of services provided. Ohio Academy of Nursing Homes v. Ohio Dept. of Job & Family Servs. , 114 Ohio St.3d 14, 2007-Ohio-2620, 867 N.E.2d 400, ¶ 2 (" Ohio Academy of Nursing Homes Oh.Sup.Ct. 2007 Decision"). At all times relevant to this appeal, ODM used a prospective payment system whereby it reimbursed facilities using a per diem rate calculated based on the actual costs, including the premiums paid to the Ohio Bureau of Workers’ Compensation ("BWC"), incurred by the facilities for a prior period. Id. at ¶ 2-3. In view of this prospective system, providers were not reimbursed for increased workers’ compensation costs in the initial year they were incurred. Id. at ¶ 4. For several years before 2003, the BWC reduced employers’ premiums by about 75 percent under R.C. 4123.32. Id. at ¶ 3. Then, in May 2003, the BWC informed employers of the decision to eliminate the premium reductions and require employers to pay the full premiums beginning on July 1, 2003. Id. Based on that change, in June and July 2003, appellants requested immediate Medicaid rate adjustments pursuant to R.C. 5111.27(F) and Ohio Adm.Code 5101:3-3-24.1. In August 2003, a bureau chief for ODM sent a letter to appellants’ counsel informing him of ODM's denial of the rate adjustment requests. Three months later, appellants initiated this lawsuit.
{¶ 4} Appellants’ second amended complaint sought declaratory and injunctive relief, and, alternatively, "a writ of mandamus * * * directing and ordering the Defendants to comply with the pertinent provisions of R.C. Chapter 5111 and the rates be recalculated and paid in an amount and manner in compliance with such laws." (Nov. 30, 2004 Am. Compl. at 14.) ODM moved to dismiss pursuant to Civ.R. 12(B)(1), which the trial court granted.
{¶ 5} On appeal, this court determined that "[b]ecause appellants’ mandamus action seeks a specific order directing [ODM] to perform a legal duty, the common pleas court has subject matter jurisdiction." Ohio Academy of Nursing Homes v. Ohio Dept. of Job & Family Servs. , 164 Ohio App.3d 808, 2005-Ohio-6888, 844 N.E.2d 384, ¶ 16 (10th Dist.). Based on appellants’ requested relief, this court held appellants must pursue mandamus relief through a two-step process. First, appellants must seek a writ ordering ODM to exercise its discretion to determine whether a rate adjustment is appropriate. In reviewing such a writ, the court must determine if the necessary predicate to ODM's exercise of discretion exists. If that writ is appropriate, Id. at ¶ 19. A challenge to the exercise of that discretion to determine the amount of any rate adjustment would be pursued in a second writ of mandamus. Id. at ¶ 20.
{¶ 6} The Supreme Court of Ohio affirmed, agreeing that "appellants must seek mandamus relief through a two-step process," and holding that "when a state agency's decision is discretionary and by statute not subject to appeal, an action in mandamus is the sole avenue of relief available to a party challenging the agency's decision." Ohio Academy of Nursing Homes Oh.Sup.Ct. 2007 Decision at ¶ 32. On the "primary issue" before it, the court "fully agree[d]" that "[r]elief through a mandamus action is the sole remedy available to appellants." Id. at ¶ 21.
{¶ 7} Pursuant to the Supreme Court's decision, appellants amended their complaint in September 2007, seeking two writs of mandamus. Appellants first sought a writ requiring ODM to consider whether to approve Medicaid reimbursement to appellants for increased reasonable costs of services provided based on the increase in BWC premiums. Secondly, appellants sought a writ requiring ODM to pay to appellants adjusted reimbursement rates.
{¶ 8} On February 15, 2008, appellants moved for partial summary judgment, arguing they were entitled to the first writ of mandamus because the record demonstrated ODM had a clear legal duty to consider the BWC decision to increase premiums to be a government mandate under the applicable law and to process the rate adjustment request based on that circumstance. Two weeks later, ODM moved for summary judgment on all claims.
{¶ 9} In March 2008, appellants filed a request for a trial by jury. The same month, appellants took the depositions of five employees of ODM and one employee of BWC. Disputes arose regarding the questioning at the depositions, with counsel for ODM instructing witnesses not to answer numerous questions based on the work-product doctrine or attorney-client privilege. Appellants filed motions to compel responses to the questions and for sanctions on March 19 and 25, 2008. Appellants also moved to stay additional briefing on the summary judgment motions until the trial court ruled on the discovery related disputes. In April 2008, the trial court granted this request pursuant to Civ.R. 56(F).
{¶ 10} Nearly eight years later, in January 2016, the trial court granted appellants’ motions to compel, but it delayed resolution of the sanctions requests until the conclusion of discovery. ODM appealed. As to these discovery disputes, this court affirmed in part and reversed in part. State ex rel. Ohio Academy of Nursing Homes, Inc. v. Ohio Dept. of Medicaid , 10th Dist. No. 16AP-102, 2017-Ohio-8000, 2017 WL 4329762.
{¶ 11} On remand, the parties completed their briefing on the pending summary judgment motions. Appellants also filed a motion to compel the resumption of depositions and the production of certain documents. The trial court granted this motion to compel in part and denied it in part. On March 4, 2020, the trial court granted ODM's summary judgment motion and denied appellants’ summary judgment motion. In the trial court's entry awarding summary judgment in favor of ODM, it also denied the requests for sanctions and ruled that all other pending motions were moot.
{¶ 12} Appellants timely appeal.
{¶ 13} Appellants assign the following errors for our review:
{¶ 14} Appellants’ first, second, third, and fourth assignments of error challenge the trial court's disposition of the parties’ summary judgment motions. In their first assignment of error, appellants assert the trial court erred in granting ODM's summary judgment motion based on its determination that because the BWC did not enact or amend a policy appellants were not entitled to the requested rate adjustment. Their second assignment of error alleges the trial court did not apply the appropriate legal standard in reviewing the parties’ motions for summary judgment. Their third assignment of error contends the summary judgment ruling was erroneous because there was no evidence ODM exercised its discretion to determine whether there was a government mandate. And in appellants’ fourth assignment of error, they argue the trial court erred in not adequately considering or granting its summary judgment motion. These four assignments of error lack merit.
{¶ 15} Taken together, appellants’ first four assignments of error present the issue of whether the trial court erred in granting ODM's summary judgment motion and denying appellants’ summary judgment motion. We review the granting of summary judgment under a de novo standard. Coventry Twp. v. Ecker , 101 Ohio App.3d 38, 41, 654 N.E.2d 1327 (9th Dist.1995) ; Koos v. Cent. Ohio Cellular,...
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