HEARING - U.S. Senate Special Committee on Aging

130
462 6-85 New Developments 10,057
2. That all HCFA documents which include
the coverage criteria found in Bulletin No.
175 are hereby declared void and of no effect,
3. That the defendant notify all HCFA
regional officers, all HCFA Region I
intermediaries and all HCFA Region I Hospitals
that to the extent that HCFA Intermediary
Manual § 3101.11 incorporates Medicare
coverge criteria found in Bulletin No. 175, it
is void and of no effect. Second Recommended
Ruling at 14-15.
The plaintiffs have offered sufficient evidence
to indicate that the Secretary has not taken
sufficient steps to rescind the challenged policy
statement contained in Bulletin No. 175, and
that her officers have placed barriers in front of
those making inquiries concerning Bulletin No.
175. Since the Magistrate's order simply gives
precise effect to the ruling that Bulletin No. 175
is invalid, it is hereby approved.
The plaintiffs have also requested this court
to order the Secretary to notify all Professional
Review Organizations (PROs) in Region I that
Bulletin No. 175 is invalid. Annette Kasabian,
Chief of the Medical Review Branch of the
Region I office of the Health Care Financing
Administration, stated in her affidavit that "by
January 15, 1985, 1PROsJ . .. will have assumed
fal]l Medicare review authority over all Medicare
certified rehabilitation hospitals in
Region I.` [Second Affidavit of Annette
Kasahian.] If the PROs and not the
intermediaries are to be the Medicare reviewers
of future inpatient hospital rehabilitation, then
they should receive notice of the invalidity of
Bulletin No. 175 as well. This is particularly
true since, according to the plaintiffs, the PRO
criteria for rehabilitation hospital coverage
adopt the Intermediary Manual and Bulletin
No. 175 standards.
Therefore, it is ORDERED that the defendant
notify all Professional Review Organizations
in Region I that: (1) Bulletin No. 175 has
been declared invalid by the United States District
Court and that it is no longer in effect; (2)
that to the extent that HCFA Intermediary
M~anual § 3101.11 incorporates Bulletin No.
175, it is void and of no effect. This coui
FURTHER ORDERS that all court-ordered
notification ordered be completed by the Secretary
90 days from the date of this ruling.
The plaintiffs have also requested that the
court require the defendant to notify all claimants
who have been denied Medicare coverage
for inpatient hospital rehabilitation since January
1, 1976 (when Bulletin No. 175 was issued),
or 1980 (when this lawsuit was filed), and to
provide an opportunity for a second de novo
administrative hearing. Since this request has
not been submitted to the Magistrate for consideration,
the court declines to rule on this
request. The court will refer plaintiffs' request
to the Magistrate if the request is made in
motion form.
As amplified and modified by the foregoing,
the Magistrate's Recommended Ruling on
Plaintiffs' Motion for A More Specific Order,
Defendant's Motion to Alter or Amend Class
Certification, and Defendant's Motion for
Reconsideration is accepted and approved.
SO ORDERED.
[ 34,6201 Community Convalescent Center of Naperville, Incorporated v. Aetna Life
and Casualty Company.
PRRB Hearing Dec. No. 85-DZ5, Mar. 19, 1985 (cost reporting period ending Oct. 31, 1982).
Medicare: Space Costs of Physical Therapy Department
Provider reimbursement-Cost data and cost finding-Cost finding schedules-Allocation
of space costs to physical therapy departmnent.-A corridor in the basement of a skilled
nursing facility could not be included by the provider in allocating the space costs of its physical
therapy department. Even though the provider had claimed that the corridor was used exclusively
by physical therapy patients for gait training, substantial evidence demonstrated that the corridor
is a common area that affords equal access to all who use it. The weighting proposed by the
intermediary, resulting in an allowance of a portion of one-half of the corridor space for the time the
physical therapist could have been involved in gait training, was not appropriate according to the
averaging principle generally applied under Reg. Sec. 405.453.
See 6480.
Issuc: Summary ofFacts:
Has the Intermediary properly determined The provider is a skilled nursing facility. The
the space used by the Physical Therapy Depart- provider filed its cost report for the year ended
mient? October 31, 1982, claiming a length of corridor
for use by the Physical Therapy Department. In
the Notice of Program Reimbursement (NPR)
Medic-are and Medicaid Guide s 34,620