Four patients were furnished medical care during the year 1962 by the hospital under public medical care plans mentioned in the margin.
The department took the view that the special nursing services were an ancillary service included in the per diem rate established under G.L.c. 7, § 30K. The hospital in each instance received the AIPD rate for each day that each patient was in the hospital, but claimed also to be entitled to reimbursement of its necessary expenditures for special nursing.
In the Superior Court, upon review under G.L.c. 30A, § 14 (1), the trial judge ruled that the department's decision was "founded upon error of law" and that the AIPD rate did not include special nursing services. No question is now presented or argued concerning the medical necessity of providing special nursing services in each of these cases. We must decide, however, whether reimbursement for such special nursing services is included in the AIPD rate.
2. The department's medical care plan, here applicable, is dated June 1, 1961, and is found in the department's so called State Letter 137, dated July 17, 1961, on p. 13. Under the heading "nursing care," there is no mention whatsoever concerning special nursing services to an aid recipient in a hospital. The somewhat generally expressed plan seems simply to assume, but without saying so, that the AIPD rate includes reimbursement for such services.
The department's State Letter 141, dated January 10, 1962, transmitted revised rate schedules for the medical care plan, which it states "represent all-inclusive in-patient care rendered including drugs and so-called extra services." The AIPD rate listed for Massachusetts General Hospital was $35.92. State Letter 141 appears to have been only a method of incorporating in the department's plan the "certification of all-inclusive per diem hospitalization rates applicable to public assistance patients," dated December 15, 1961, made under § 30K (see fn. 2, supra), by the then acting commissioner of administration. In this certification, the AIPD rate listed for the Massachusetts General Hospital was $35.92, and it was stated, "The rates are effective for all care rendered to patients on and after January 1, 1962, and they represent all-inclusive in-patient care rendered,
The department in effect argues that, in excluding "special nursing services" from the AIPD rate, the commissioner of administration disregarded the provision of § 30K (see fn. 2, supra, at point [B]) that, in determining "such all-inclusive charges and costs, charges for and costs of ancillary services shall be included." We think this position is untenable. The director of hospital costs and finances is directed by § 30K (see fn. 2, at point [A]) to certify certain costs and charges to the commissioner of administration. The statute defines these in very general terms. The director is required (see fn. 2, at point [C]) to act in accordance with a uniform system of hospital accounting, which does not appear in these records.
The trial judge correctly ruled that there was error of law in the decisions of the department.
Each final decree is to be modified to provide that the department's decision is reversed and that the case is remanded to the department with directions to reverse the decision of each local board and to take other appropriate action consistent with this opinion. As so modified each final decree is affirmed.