Reversing a lower court, an Ohio appeals court holds that a nursing home may discharge a resident for nonpayment even though the facility admitted the resident knowing that she might not be able to pay without Medicaid coverage. Dayspring of Miami Valley v. Shepherd (Ohio Ct. App., 2d. Dist., No. 06-CA-113, May 25, 2007).
In January 2004, Nell Shepherd entered Dayspring of Miami Valley, a nursing home, and agreed to be responsible for all charges incurred while a resident there. Mrs. Shepherd was initially denied Medicaid coverage but was subsequently approved for coverage retroactive to August 2004. While Mrs. Shepherd's financial obligations to the home have been met since inception of Medicaid coverage, she accumulated an unpaid balance of $33,026.25 for care prior to August 2004. Dayspring notified Mrs. Shepherd that it was discharging her as a resident due to non-payment of her bill, pursuant to Ohio's nursing home rights statute (R.C. 3721.16).
A hearing officer determined that Mrs. Shepherd had failed to make payment but denied the home's requested discharge, citing equitable exceptions. The hearing officer found that Dayspring was complicit in helping to create the initial balance because it admitted Mrs. Shephard knowing that she might not be able to pay without a successful Medicaid application, which it had notice of and was involved in. "The facility cannot on the one hand help create the debt and then suddenly, upon denial of the Medicaid application expect immediate or full payment," the officer wrote. "The facility must come with `clean hands' which it has not." The trial court affirmed this decision.
The Court of Appeals of Ohio reverses, finding that Dayspring has a right to discharge Mrs. Shepherd from the home pursuant to state statute, which it rules makes nonpayment sufficient grounds for discharge. "[B]y utilizing factors not listed in the statute, the Administrative Code or in case law," the court writes, "the Hearing Officer and trial court have added an additional layer of proof not contemplated by the General Assembly."
To download a full text of this decision in PDF format, go to: https://www.sconet.state.oh.us/rod/newpdf/2/2007-Ohio-2589.pdf.
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