Oral arg. – COA – Nov. 1, 2017

At 10:30 the COA will hear the case of  CLC of Biloxi d/b/a Community Living Center v. Miss. Division of Medicaid.  This case involves a dispute over Medicaid reimbursement to long term care facilities.  CLC submitted its cost report for fiscal year 2008 and the Department of Medicaid denied reimbursement for CLC’s respiratory therapist (who supplies services to CLC’s tracheostomy patients).  CLC filed an administrative appeal and lost and filed suit in Hinds County Chancery Court where it also lost.

The State Medicaid Plan allows for reimbursement of  a “facility’s direct care costs, therapy costs, care related costs, administrative and operating costs and property costs related to covered service . . .”    CLC argues that its respiratory therapist is covered under therapy costs.   DOM argues that “Under Mississippi’s Medicaid plan, respiratory therapists are not directly enrolled as Medicaid providers themselves; thus, Medicaid cannot directly reimburse respiratory therapists or the healthcare facilities that employ them for services provided to Medicaid beneficiaries on a fee-for-service basis.”

CLC brief

Medicaid brief

CLC reply brief

Watch the argument here

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