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Society of New York Hospital v. Axelrod

Appellate Division of the Supreme Court of New York, First Department
Jul 10, 1990
163 A.D.2d 142 (N.Y. App. Div. 1990)

Opinion

July 10, 1990

Appeal from the Supreme Court, Westchester County (Peter P. Rosato, J.).


In a previous article 78 proceeding brought in Albany County, petitioner challenged a freeze imposed on PDN rates. Special Term in Albany annulled the rates as being irrational and remanded the case, directing respondent Commissioner to recompute the PDN rates pursuant to Public Health Law § 2807 (2) (b).

Respondent recalculated petitioner's 1981 through 1983 PDN rates and calculated rates for 1984 and 1985. New maximum allowable payments for petitioner's PDN services were established. Notably, the operating component of the 1979 rate, which became the basis for all succeeding rate years, was based on the costs incurred by petitioner in 1972.

Petitioner administratively appealed these new rates, contending that it should be entitled to its "pure cost" rate. The rate review officer determined that the issues raised were limited to the PDN reimbursement methodology and thus, since no factual issues were raised, a hearing was not required. The instant litigation ensued. Petitioner raises the same issues raised before the trial court.

Petitioner contends that respondent was required to formulate a rule or regulation before setting the new PDN rates. However, a regulation is required only where the agency's decision-making discretion is subject to a fixed, uniform principle. (See, e.g., Matter of Sunrise Manor Nursing Home v. Axelrod, 135 A.D.2d 293, 296-297.) Here, respondent specifically recalculated petitioner's PDN rates to conform to the criteria of Public Health Law § 2807 (2) (b), in accordance with a prior judicial decree. Public Health Law § 2807 (2) (b) did not require respondent to exercise his rule-making powers for waiving the outpatient cap and establishing a new maximum allowable payment for a specified service. The sole requirement was that the maximum allowable payment be "in accordance with the foregoing [statutory] criteria and such other criteria as he deems appropriate". (Public Health Law § 2807 [b].) Hence, as a respondent did not set PDN rates pursuant to a fixed, uniform schedule nor did he set rates applicable to all PDN services, respondent was not required to promulgate a rule or regulation before he set PDN rates for petitioner.

Petitioner also urges that the method for setting the PDN rates was arbitrary and capricious since the 1979 rate was based on 1972 cost data. While petitioner has not identified the costs or services which might have justified a different rate-setting method (see, Matter of Bassett Hosp. v. Axelrod, 127 A.D.2d 260, 263), there was a sufficient passage of time to raise an issue as to the reasonableness of using 1972 cost data. We deem it appropriate to remand to the Commissioner on this issue.

Concur — Kupferman, J.P., Ross, Ellerin, Wallach and Smith, JJ.


Summaries of

Society of New York Hospital v. Axelrod

Appellate Division of the Supreme Court of New York, First Department
Jul 10, 1990
163 A.D.2d 142 (N.Y. App. Div. 1990)
Case details for

Society of New York Hospital v. Axelrod

Case Details

Full title:SOCIETY OF NEW YORK HOSPITAL, as Operator of the New York Hospital …

Court:Appellate Division of the Supreme Court of New York, First Department

Date published: Jul 10, 1990

Citations

163 A.D.2d 142 (N.Y. App. Div. 1990)
557 N.Y.S.2d 363

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