Bonta

SIMI VALLEY ADVENTIST HOSPITAL v. Bonta

Good Law
81 Cal. App. 4th 346·96 Cal. Rptr. 2d 633
Court of Appeal of CaliforniaJune 29, 2000B117712California3,155 words

Opinion

Opinion

Berle, J.

In this consolidated appeal, six hospitals challenge the trial court’s denial of their petitions for writ of mandate with respect to the State Department of Health Services’s methodology in computing certain elements of Medi-Cal reimbursement. The judgment is affirmed as to the untimeliness of the administrative appeals regarding certain specific claims for reimbursement. However, since the trial court failed to rule on the legitimacy of department regulations relating to the methodology of reimbursement calculations, the case must be reversed and remanded.

Procedural History and Factual Background

Under the Medi-Cal legislative scheme, California grants financial assistance to beneficiaries who are unable to afford medical services and care. The Medi-Cal program (Welf. & Inst. Code, § 14000 et seq.), administered by the State Department of Health Services (the Department), is an implementation of the federal Medi-Care plan ( 42 U.S.C. §§ 1396 -1396v). Pursuant to Medi-Cal, participating health care providers, such as hospitals, receive reimbursement directly from the Department for providing medical care to Medi-Cal beneficiaries. (Welf. & Inst. Code, § 14000 et seq.;…

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