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State Supreme Court rules on Beckley hospital bid to recalculate rates

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BECKLEY, WV -

 

The West Virginia Supreme Court has disallowed a Beckley hospital's bid to force the state to recalculate reimbursement rates for treating low-income and indigent patients, saying there is no statutory basis for the hospital to pursue its claims.
Appalachian Regional Health Care, the Kentucky-based not-for-profit that operates Beckley ARH Hospital, had filed suit in December 2010 against the West Virginia Department of Health & Human Resources and the West Virginia Bureau for Medical Services, claiming the state's Medicaid reimbursement rates were "grossly inadequate."
Appalachian Regional complained the rates were "inadequate to cover the cost of providing service," pointing out they'd been reimbursed just $11.9 million of the $14.7 million it cost them to care for low-income and indigent patients in 2009.
But Circuit Judge James G. Stucky dismissed the suit, saying the hospital had failed to state a claim upon which relief could be granted. In affirming the lower court's order, the Supreme Court ruled that state code doesn't provide "for an express or implied private cause of action by a Medicaid provider for judicial review of reimbursement rates for medical services."
The justices pointed out Beckley ARH had been a willing participant in the reimbursement program.
"Beckley ARH now attempts through this action to create a mechanism for challenging the Medicaid reimbursement rate, under a number of theories...based upon two code sections unrelated to the Department's role in establishing Medicaid reimbursement rates," the opinion noted. "Neither statute directly or indirectly provides for a private cause of action against the Department to address the issue of Medicaid reimbursements."