Opinion
No. 75-618
Decided January 21, 1976.
Department of Public Welfare — Medical assistance plan — Payments for intermediate care level patients in skilled nursing facilities — Applicable rate — Am. Sub. H. B. 1086, construed.
APPEAL from the Court of Appeals for Franklin County.
Appellants are operators of skilled nursing homes in Ohio and participants in the federal Medicaid Program. Under this program, federal matching funds are provided in accordance with Section 1396 et seq., Title 42, U.S. Code, to states which establish plans for medical assistance to needy persons. Ohio has such a medical assistance plan, administered by the Department of Public Welfare (D.P.W.).
The federal program recognizes two different types of health-care facilities. A skilled nursing facility (SNF) is one which can provide skilled nursing care on a daily basis, or other skilled rehabilitation services. Section 1396d (f), Title 42, U.S. Code. An intermediate care facility (ICF) is one licensed under state law to provide health care on a regular basis to individuals who require care and services above the level of room and board, but below that of a hospital or SNF. The term "ICF" includes hospitals and SNFs which meet those requirements. Section 1396d (c), Title 42, U.S. Code.
In 1973, the appellee, D.P.W., placed a number of patients requiring only intermediate care in appellants' skilled nursing facilities. During the first six months of 1973, payments by the state for the services provided to those patients were governed by Am. Sub. H.B. 1086 (134 Ohio Laws 2422), adopted December 30, 1972, and superseded by Am. Sub. H.B. 86, as of July 1, 1973. Am. Sub. H.B. 1086 permitted payment of up to $15.50 per-patient-per-day to skilled nursing facilities, and up to $12.50 per-patient-per-day to intermediate care facilities. Appellee contends that under Am. Sub. H.B. 1086 payments to skilled nursing facilities for intermediate care level patients should depend upon the level of care needed by the patient, whereas appellants contend that payments should depend upon the type of facility providing the care. In other words, the issue is whether appellants should have received up to $15.50 a day, or only up to $12.50 a day, for each intermediate care level patient placed in a skilled nursing facility.
Appellee offered payment at the lower rate, and appellants sought a writ of mandamus in the Court of Appeals requiring that payment be made at the higher rate. The writ was denied, and the cause is now before this court upon an appeal as of right.
Messrs. Kohnen Kohnen and Mr. Ralph B. Kohnen, Jr., for appellants.
Mr. William J. Brown, attorney general, and Mr. Geoffrey E. Webster, for appellee.
The sole issue presented in this case involves the construction of Am. Sub. H.B. 1086, which was effective during the first six months of the calendar year 1973 (the last six months of the state's fiscal year).
Section 3 of Am. Sub. H.B. 1086 provided, in pertinent part:
"* * * payments to nursing homes, including qualified public facilities, from subsidies 401-501 through 401-525, inclusive, for vendor nursing home care in the last half of fiscal year 1973 shall be made for all eligible recipients at reasonable costs up to: fifteen dollars and fifty cents a day for patients requiring care in homes meeting federal requirements for skilled nursing care; twelve dollars and fifty cents a day for patients requiring nursing care in homes, or a distinct part of such home, meeting state or federal requirements for intermediate nursing care; eight dollars a day for patients requiring rest home care. The Department of Public Welfare shall pay reasonable costs: for patients requiring skilled nursing care up to sixteen dollars a day per patient during fiscal year 1974 and up to seventeen dollars a day per patient during fiscal year 1975; for patients requiring intermediate nursing care up to thirteen dollars and fifty cents a day per patient during fiscal year 1974 and up to fifteen dollars a day per patient during fiscal year 1975; for patients requiring rest home care up to eight dollars a day per patient during fiscal years 1974 and 1975."
The following words of Section 3, Am. Sub. H.B. 1086, are at issue:
"* * * payments to nursing homes * * * shall be made for all eligible recipients at reasonable costs up to: fifteen dollars and fifty cents a day for patients requiring care in homes meeting federal requirements for skilled nursing care * * *."
Appellants contend that those words mean: payments of up to $15.50 a day are to be made for patients in skilled nursing homes, if they require care. The D.P.W. argues, to the contrary, that those words mean: payments of up to $15.50 a day are to be made for patients in skilled nursing facilities, if they require the level of care given in such facilities.
The parties have cited various maxims of statutory application and construction and have delved into the history of Am. Sub. H.B. 1086. The General Assembly might plausibly have effected the statutory purpose in either way, and indeed the parties agree that an earlier version of this statute plainly adopted one view, and a later version just as plainly adopted the other. The General Assembly has used similar grammatical construction on other occasions (see R.C. 3720.01 and 5123.31), but those occasions are of no great assistance herein.
The Court of Appeals examined these issues in a careful opinion, the reasoning of which need not be repeated at length.
We hold that the ordinary sense of the words "patients requiring care in homes for skilled nursing care" refers to the actual level of care needed by the patient, as the D.P.W. contends. That reading is reasonable and grammatical. It presumes a normal sentence order in which the phrase "in homes * * * for skilled nursing care" refers to the immediately preceding word "care," rather than to the prior word "patients." If the statute had stated "patients, requiring care, in homes * * * for skilled nursing care" or "patients requiring care, in homes * * * for skilled nursing care," we would be inclined to agree with the appellants, but it did not.
The words and phrases of a statute are to be read according to the rules of grammar (R.C. 1.42), and, in so reading this statute, we agree with the Court of Appeals that appellants' argument must fail.
The judgment of the Court of Appeals is affirmed.
Judgment affirmed.
O'NEILL, C.J., RUTHERFORD, STERN, W. BROWN and P. BROWN, JJ., concur.
HERBERT and CELEBREZZE, JJ., concur in the judgment.
RUTHERFORD, J., of the Fifth Appellate District, sitting for CORRIGAN, J.
A writ of mandamus should not issue where the respondent does not have a clear legal duty to perform the act demanded. The duty in the instant case is, obviously, anything but clear.
Courts of Appeals, and this court, should not countenance the substitution of constitutional mandamus for declaratory judgment. The former is still an extraordinary remedy, the traditional uniqueness of which should not be eroded in the name of expediency.
The judgment of the Court of Appeals should be affirmed, but upon the basis that mandamus is not an available remedy under the instant circumstances.
CELEBREZZE, J., concurs in the foregoing concurring opinion.