FOR PUBLICATION
ATTORNEYS FOR APPELLANTS: ATTORNEYS FOR APPELLEES:
STEVE CARTER J. MICHAEL GRUBBS
Attorney General of Indiana THOMAS F. SHEA
JODY L. DEFORD
FRANCES BARROW
Barnes & Thornburg
Deputy Attorney General Indianapolis, Indiana
Indianapolis, Indiana
INDIANA FAMILY AND SOCIAL )
SERVICES ADMINISTRATION, et al., )
)
Appellants-Defendants, )
)
vs. ) No. 49A05-0203-CV-117
)
AMHEALTH (EVANSVILLE ), INC., et al., )
)
Appellees-Plaintiffs. )
The Indiana Family and Social Services Administration (FSSA) promulgated emergency rules changing Medicaid
reimbursement formulas for nursing homes. A number of nursing homes and the
Indiana Health Care Association (collectively, Amhealth) challenged the rules, and the trial court
entered a declaratory judgment in favor of Amhealth on the basis that FSSA
had not properly adopted the emergency rules. It permanently enjoined FSSA from
enforcing those rules and ordered FSSA to reprocess the nursing homes claims submitted
under the emergency rules. FSSA appeals,
See footnote raising a number of issues.
We address two but find one dispositive: whether budget committee members had
adequate notice of the emergency rulemaking and an opportunity to participate in the
deliberations.
We reverse and remand.
Id. However, that source also notes that under the principles of restitution,
a party who obtains benefits from an improperly issued injunction has a duty
to restore those benefits to those injured by the granting of the injunction.
This remedy is separate from the theory of malicious prosecution and in
the absence of an injunction bond. Id. § 339.
We addressed this question in
Community Care Centers, Inc. v. Sullivan, 701 N.E.2d
1234, 1240 (Ind. Ct. App. 1998), trans. denied 726 N.E.2d 299 (Ind. 1999).
There, we determined the State could obtain restitution from nursing homes that
were reimbursed at a higher rate than they would have been had the
States reimbursement formula not been enjoined to the extent it was. Community
Care had obtained two injunctions, one in state court and one in federal
court, to prevent the States use of certain aspects of its nursing home
reimbursement formula. The injunctions were reversed on appeal and the State brought
an action for restitution. The trial court determined on summary judgment that
the State was entitled as a matter of law to recover the difference
between the sums paid to Community Care under the erroneous injunctions and the
amounts it would have received under the States lawful rate-setting methodology in the
absence of the injunctions[,] id. at 1238, and we affirmed.
We stated:
In situations like the one before us, where a valid government regulation or
procedure has been enjoined and improper payments have been made pursuant to the
subsequently reversed injunction, this type of enrichment in the form of improper payments
has typically been characterized as unjust.
Id. at 1240.
One of the underlying injunctions in that case was preliminary and one was
permanent, indicating the remedy of restitution is available regardless of the nature of
the injunction that is subsequently reversed. Because FSSA is entitled to restitution
from Amhealth for Medicaid overpayments made during the time the emergency rules were
enjoined, we decline to hold that this appeal is moot.
AmRhein v. Eden, 779 N.E.2d 1197, 1206 (Ind. Ct. App. 2002) (citations and
internal quotations omitted).
The trial court determined the regulations were not adopted in conformity with Public
Law 291-2001 section 48 (Section 48), Ind. Code § 4-22-2-19.5, or Ind. Code
§ 12-15-21-12. FSSA asserts the case before us is controlled by the
Walgreen decision, which held the State followed proper procedures in promulgating emergency pharmacy
reimbursement rules, which were promulgated at the same time FSSA promulgated the emergency
nursing home rules at issue here. Amhealth argues that even if the
appeal is not moot, the nursing home rule promulgation process differed enough from
the prescription drug rulemaking process our supreme court approved in Walgreen that the
process used to promulgate the nursing home rules was not proper even under
the Walgreen standards.
(Emphasis supplied.) The legislature explicitly provided that this statute would supplant all
others. Therefore, if the statutes provisions were met, the emergency rule would
be valid. Walgreen, 769 N.E.2d at 164.
See footnote
In the
Walgreen rule promulgation process, the FSSA director testified with regard to
the pharmacy reimbursement rules that she presented the budget committee with a summary
of all pending cost containment rules and advised the committee members of the
likelihood of emergency action. The committee members listened to the information and
asked questions, and there was discussion among the members of the budget committee
about the dispensing fee and reimbursement rate reductions that were the subject of
the emergency pharmacy rules. The director also gave budget committee members a
handout summarizing the status of Medicaid cost containment proposals.
The Walgreen court noted that the director told the committee about the specifics
and urgency of the anticipated measures, and committee members had an opportunity to
express their views. This, the court held, appears to comply with the
straightforward language of the statute:
[Section 48] assures budget committee members advance notice of agency actions and creates
an opportunity for the members to participate in the deliberations. It does
not, however, condition FSSAs authority to act on approval by the committee, as
certain other statutes do.
Id. at 165.
The trial court in the case before us did not, of course, have
before it the Walgreen standard for review by the budget committee. It
noted that Section 48 does not define review. It therefore relied on
the words common and ordinary meaning and concluded there was no review because
1) the budget committee had never been given a copy of the rules,
2) it had not been given any report, account, or evaluation of the
changes in nursing home reimbursement methods the rules would effect, and 3) there
was no consideration or deliberation whatsoever by the committee.
The trial court found that the committee was not given a copy of
the emergency rules to examine but was instead given two handouts. The
first was a one-page document, one paragraph of which states that a proposed
permanent case-mix reimbursement rule would be published on July 1, 2001, but that
does not describe the changes in reimbursement rates under the rule. (App.
to Br. of Appellants at 14.)
The FSSA director testified that she merely handed the document to the budget
committee members and that there was no discussion of the nursing home rules.
See footnote
While the handouts addressed in the
Walgreen case contained information about the
pharmacy rules and the States intention to adopt them on an emergency basis,
they do not indicate what the proposed nursing home reimbursement rules consist of,
and they merely suggest that emergency rulemaking is contemplated. For example, the
handout indicated a public hearing date, and then stated, Due to requirements under
federal law to provide 45 days prior notice of reimbursement changes for nursing
homes the earliest implementation date, using emergency rulemaking authority, would be September 2001.
(Id. at 35.)
FSSA does not explicitly argue that the budget committee could have reviewed the
proposed rules when it had never been told what those rules were.
Rather, it asserts the requisite review occurred by virtue of the directors Medicaid
update, the handouts she distributed, and the budget committee members awareness for some
time that the Medicaid director predicted a budget shortfall, that the agency anticipated
adopting emergency rules, and that some of the rules would pertain to nursing
facility reimbursement. (Br. of Appellants at 12.)
Amhealth notes that in Walgreen, the committee had been given a handout that
included all of the pharmacy rules; the committee was advised that emergency action
was likely; it listened to the directors information and asked questions; and there
was discussion of the pharmacy rules among members of the committee. So,
it argues, the review that was adequate in the Walgreen case did not
occur with regard to the nursing home rules in the case before us.
While the budget committee review of the nursing home reimbursement rules was minimal
at best, it satisfied the standard articulated in Walgreen. The budget committee
was made aware that, as a result of the budget shortfall, the agency
anticipated adopting emergency rules some of which would pertain to nursing facility reimbursement.
Its members could have commented on or discussed the proposed nursing home
rules at the same meeting where they discussed the proposed pharmacy rules.
Adequate review under the Walgreen standard does not explicitly require that the budget
committee be aware of the content of the proposed rule but only that
it have advance notice of agency actions. Walgreen, 769 N.E.2d at 165.
Nor does it require actual discussion, but only an opportunity for the
members to participate in the deliberations. Id. The trial court therefore
erred when it determined the proposed emergency rules did not receive budget committee
review as required by Section 48.
BROOK, Chief Judge, concurring
I concur in the majoritys reversal of the trial courts judgment for Amhealth.
I write separately, however, to clarify the distinction between a legal claim
of damages premised on a wrongfully issued temporary injunction and an equitable claim
of restitution.
Amhealth correctly contends that FSSA can only recover legal damages resulting from the
wrongful issuance of a temporary injunction but not from the wrongful issuance of
a permanent injunction. See, e.g., Harless v. Consumers Gas Trust Co., 14
Ind. App. 545, 43 N.E. 456 (1896). In the instant case, however,
were we to determine that the trial court wrongfully issued its permanent injunction,
FSSA could nevertheless seek restitution from Amhealth, and the nature of the injunction
at issue would be irrelevant. See Community Care Centers v. Sullivan, 701
N.E.2d 1234 (Ind. Ct. App. 1998) (concluding that FSSA could seek restitution from
appellant based on two wrongfully issued injunctions, one permanent and the other temporary),
trans. denied (1999).
Restitution is described as a return or restoration of what the defendant has
gained in a transaction. As distinct from damages, restitution is an award
made to remedy defendants unjust enrichment rather than plaintiffs loss. Stated differently,
restitution measures the remedy by the defendants gain and seeks to force disgorgement
of that gain.
Rollings v. Smith, 716 N.E.2d 502, 507 (Ind. Ct. App. 1999) (citations and
quotation marks omitted). Thus, FSSAs appeal is not moot because it could
seek restitution if we determine that the trial court wrongfully issued its permanent
injunction.