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.

Thomas & Lewin Associates, Inc. v. Texas Health and Human Services Commission

Court of Appeals of Texas, Third District, Austin

June 6, 2019

Thomas & Lewin Associates, Inc., Appellant
v.
Texas Health and Human Services Commission, Appellee

          FROM THE DISTRICT COURT OF TRAVIS COUNTY, 98TH JUDICIAL DISTRICT NO. D-1-GN-13-003744, HONORABLE RHONDA HURLEY, JUDGE PRESIDING

          Before Chief Justice Rose, Justices Goodwin and Baker.

          MEMORANDUM OPINION

          Thomas J. Baker, Justice.

         Appellant Thomas & Lewin Associates, Inc. filed a petition for judicial review of a final order of the Appeals Division of the Texas Health and Human Services Commission (HHSC). The order sustained certain cost adjustments that the HHSC made in an informal review of Appellant's mandatory cost reports filed in compliance with HHSC regulations. See 1 Tex. Admin. Code § 355.722(j)(2) (2019) (Texas Health & Human Servs. Comm'n, Reporting Costs by Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Providers). In a final order, the trial court granted the HHSC's plea to the jurisdiction and, to the extent necessary, granted the HHSC's motion for summary judgment. For the following reasons, we affirm the trial court's order granting the HHSC's plea to the jurisdiction.

         BACKGROUND

         Appellant provides long-term care for persons with mental retardation or related conditions under a contract with the State of Texas in the HCS program funded by Medicaid. As an HCS provider, Appellant is required to file annual cost reports with the HHSC. See id. In 2010, the HHSC issued Appellant a letter stating that it intended to recoup $80, 528 from Appellant based on adjustments the HHSC made to the undisputed actual costs incurred and reported on Appellant's 2006 cost report. See id. (j)(5) (outlining cost adjustment and recoupment procedures). Appellant requested informal review of the HHSC's recoupment decision, specifically requesting review of particular "lines" of its 2006 cost report. See id. §§ 355.110(c) (2019) (Texas Health & Human Servs. Comm'n, Informal Reviews and Formal Appeals), 355.722(b) ("A provider who disagrees with HHSC's exclusion or adjustment of items in cost reports may request an informal review and, when appropriate, an administrative hearing as specified in § 355.110 of this title (relating to Informal Reviews and Formal Appeals)."). After the informal review, the HHSC reduced its recoupment demand to $63, 611. See id. § 355.722(j)(5) (requiring HHSC to notify providers of any adjustments to recoupment amount after informal review of initial recoupment determination).

         The HHSC attached an appendix to its Informal Review Decision outlining the various lines affected by its adjustment to the recoupment amount. Appellant requested a formal hearing before an administrative law judge (ALJ) with the HHSC's Appeals Division, taking issue with several lines of the cost report that the HHSC had adjusted in its informal review. See id. § 355.110(d) (providing that "interested party who disagrees with the results of an informal review . . . may file a formal appeal").

         The ALJ conducted the formal hearing on September 14, 2012, but announced no rendition of judgment on the merits in open court. On May 24, 2013, the ALJ signed a "Final Order." The Final Order made the following relevant Findings of Facts and Conclusions of Law:

Finding of Fact 7. On November 17, 2010, HHSC notified Appellant that it had completed the Informal Review and reduced the amount that it would recoup to $63, 611.00.
Finding of Fact 11. At the hearing Appellant and HHSC stipulated that only line 181 remained at issue.
Finding of Fact 12. Line 181 represented Staff Expenses - Case Managers Salaries and Wages. A portion of the salaries and wages reported on line 181 were for related party wages.
Finding of Fact 17. The allowable non-related party hourly wage rate for employees who work as Case Managers was $16.99 per hour in 2006.
Finding of Fact 18. Appellant showed that non-related parties provided 40% or more of the hours worked as Case Managers, thereby allowing Appellant to calculate the related party's reportable hours at the rate of $16.99.
Finding of Fact 19. HHSC adjusted line 181 of Appellant's 2006 Cost Report to reflect the allowable rate of pay for ...

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.