Sierra Vista Regional Medical Center v. Bonta

In Sierra Vista Regional Medical Center v. Bonta' (2003) 107 Cal.App.4th 237, the Court concluded that the Guidelines "did not intend intensive, intermediate, and continuing levels of care all to be considered as part of intensive care." (Sierra Vista, supra, 107 Cal.App.4th at p. 252.) It reasoned that if section 1255.5, subdivision (f) meant what the hospital proposed, it would conflict with the Guidelines. (Sierra Vista, supra, at p. 252.) The court opined that the statute's reference to comprehensive and intensive care in section 1255.5, subdivision (f) "merely reflects the Legislature's desire, consistent with the Guidelines' recommendations, to ensure a hospital which provided intensive care services also provided all other levels of services required to care for all contingencies of newborn health." (Sierra Vista, supra, at p. 252.) In essence, Sierra Vista equated intensive care newborn nursery services with intensive care in section 1255.5, subdivision (f) and held that neither includes intermediate and continuing care. In Sierra Vista Regional Medical Center v. Bonta' (2003) the hospital in Sierra Vista provided four levels of care in its neonatal intensive care unit. Under the hospital's policies and procedures, the nursing ratios were: level one--4:1 ratio; level two--to 3:1 ratio; level three--2:1 ratio; level four--1:1 ratio. The auditor concluded that levels one and two were subintensive care units that were part of routine care, and services in those subintensive care units could only be reimbursed at the general rate. The hospital argued that Health and Safety Code section 1255.5, subdivision (f) "allowed it to provide 'intermediate' and 'continuing' care in its neonatal intensive care unit, levels of care which do not require the minimum 1:2 nursing ratio." (Sierra Vista, supra, 107 Cal.App.4th at p. 250.) In other words, the hospital claimed it should be paid the higher rate for care at levels one and two. Because the hospital could not prove the levels of care it provided in its neonatal intensive care unit, the auditor reduced payment for all neonatal intensive care unit days to the general all-inclusive rate down from the higher intensive care rate. Sierra Vista held that the payments were property reduced. (Sierra Vista, supra, 107 Cal.App.4th at p. 243.)