Justice BEATTY:
In this cross-appeal, we consider the central question of whether the South Carolina Workers' Compensation Commission ("the Commission") was required to promulgate a new regulation in order to change the fee payment schedule for ambulatory care centers. Because we find the Commission's actions were specifically authorized by an extant regulation and did not implicate the requisite private right to warrant due process protections, we reverse the portion of the circuit court's order finding that a new regulation was necessary to effectuate the Commission's change to the fee payment schedule. Accordingly, we affirm in part and reverse in part.
In this action, several ambulatory surgery centers and their trade association (collectively "Surgery Centers") challenged
Under the South Carolina Workers' Compensation Act, the medical fees charged claimants by physicians and hospitals are subject to the submission and approval by the Commission. S.C.Code Ann. § 42-15-90 (1985).
The Commission currently publishes three schedules of maximum allowable payments: (1) Payments for Physicians' Services, known as the Medical Services Provider Manual, first published in 1953; (2) Payments for Inpatient Hospital Services, first published in 1984; and (3) Payments for Outpatient Services, including those services provided by Surgery Centers, first published in 1997.
25A S.C.Code Ann. Regs. 67-1304 (Supp.2009) (emphasis added).
The Commission set the interim discount amount at 12.1 percent during a Commission business meeting in 1997, rather than by regulation. As a result, all outpatient bills would be discounted 12.1 percent and payment would be made at an amount no higher than 87.9 percent of the charged amount.
In November 2004, the Commission convened its Hospital Advisory Committee (Advisory Committee) to discuss, among other things, the establishment of a new schedule of maximum allowable payments for hospital outpatient services and ambulatory surgical centers pursuant to Regulation 67-1304(A), to replace the interim discount amount adopted in 1997. The Advisory Committee met six times over an eighteen-month period. An additional subcommittee was formed and met twice more to fully collect and analyze data related to the schedule.
On June 19, 2006, the Advisory Committee issued its report, recommending revisions to the existing schedules for payments. The Advisory Committee recommended the maximum allowable payments be no more than 140 percent of the
On September 29, 2006, Surgery Centers filed this action challenging the Commission's revised schedule for maximum allowable medical payments under the Administrative Procedures Act (APA)
The Commission appealed and filed a petition for supersedeas with the Court of Appeals to stay the pendente lite injunction. A single judge denied this petition. The Commission then sought full panel review of the denial of its request for supersedeas. After the single judge's decision was affirmed by the full panel, the Commission withdrew its appeal of the circuit court's enjoinment of the new payment schedule. In turn, the Court of Appeals dismissed the appeal.
Subsequently, both parties filed motions for summary judgment. At the hearing on these motions, the parties agreed the underlying facts were not in dispute and the matter presented solely a question of law to be decided by the circuit court.
In prefacing its order, the circuit court stated the "[t]he question before the Court is whether or not the Commission followed the proper procedures established by the laws of the State of South Carolina or complied with the due process clause of the South Carolina Constitution." In answering this question, the circuit court granted each party's motion for summary judgment in part and denied it in part.
Specifically, the court held section 1-23-310(3) of the South Carolina Code, defining a "contested case" that requires a
Despite this holding, the court found the Commission was required to promulgate a new regulation that would be subject to the review and approval of the General Assembly. In reaching this conclusion, the court reasoned "the Constitution provides some requirement of notice and an opportunity to be heard in this matter, and that the Commission must adopt a regulation in accordance with the APA." Thus, the court found "[s]uch regulation will provide the type of due process rights required by law and to which [Surgery Centers] are entitled." Furthermore, the court concluded that "a specific regulation was required in order to implement changes to R. 67-1304." The court explained that "[s]uch regulation would contain a defined procedure whereby the methodology for these payments would be established as has been done in Regulations 67-1302 and 1303."
The court, however, concluded that Surgery Centers "do not have any `property' interest or rights in the payment schedule established by the Commission and are not entitled to any due process rights on those grounds." In so ruling, the court rejected Surgery Centers' contention that a property right was established by the mere fact the revised payment schedule could potentially reduce its earnings by 4.4 million dollars. Notwithstanding this ruling, the court found Surgery Centers would be "afforded appropriate due process protections by the
Following the issuance of this order, both parties filed motions for reconsideration pursuant to Rule 59(e) of the South Carolina Rules of Civil Procedure. With the exception of the correction of a scrivener's error, the court denied each party's motion in full.
Both parties appealed the circuit court's order to the Court of Appeals. Upon request of the parties, this Court certified the appeal from the Court of Appeals pursuant to Rule 204(b) of the South Carolina Appellate Court Rules.
Although Surgery Centers articulate several issues, they essentially argue the circuit court erred in concluding that they were not entitled to due process protections concerning the implementation of the Commission's revised payment schedule. Specifically, Surgery Centers claim the Commission's actions constituted a "contested case" under the APA, thus, warranting the APA hearing procedures. Additionally, Surgery Centers assert they have a substantive property interest in the payment schedule process and that, in turn, Article I, Section 22 of the South Carolina Constitution required the Commission to give notice and provide an opportunity to be heard before adopting the Advisory Committee's recommended schedules.
In contrast, the Commission contends the circuit court erred in holding Surgery Centers had a due process right to have any revision of the payment schedules promulgated in a regulation, while at the same time holding Surgery Centers had no property interest in the payment schedule established by the Commission.
For reasons that will be more thoroughly explained, we agree with the circuit court's findings that Surgery Centers did not establish a right to a "contested case" hearing under the APA and did not have the requisite property interest to invoke our state's constitutional due process protections. We disagree, however, with the circuit court's fundamental holding
Initially, we believe the circuit court correctly held Surgery Centers did not establish the necessary independent right to a "contested case" under section 1-23-310(3) of the APA.
Significantly, Surgery Centers failed to set forth any specific argument establishing that the Commission's actions fell within the ambit of criteria required for a "contested case." Although they reference the term in their brief, Surgery Centers do not identify the necessary South Carolina or Federal law that would warrant their entitlement to a "contested case" hearing. See Triska v. Dep't of Health & Envtl. Control, 292 S.C. 190, 355 S.E.2d 531 (1987) (recognizing that a "contested case" does not exist where there is no requirement deriving from South Carolina or Federal law that there be an opportunity for a hearing).
Furthermore, we do not believe nor do Surgery Centers expressly argue that the Commission's actions involved "ratemaking" or "price fixing" as required by section 1-23-310(3), which defines a "contested case" as "a proceeding including, but not restricted to, ratemaking, price fixing." S.C.Code Ann. § 1-23-310(3) (2005). As the circuit court correctly noted, the "Commission does not determine how much a regulated utility must charge to its customers, or conversely, how much the utility's customers must pay." Moreover, unlike in public utility or regulated industry cases, there is no such statute in the instant case that clearly creates a requirement for a hearing. Cf. S.C.Code Ann. § 58-27-870(A) (Supp. 2009) (providing that Public Service Commission "must hold a public hearing concerning the lawfulness or reasonableness of the proposed changes" in electric rates); S.C.Code Ann. § 58-9-540(A) (Supp.2009) (stating Public Service Commission "shall ... hold a hearing concerning the lawfulness or reasonableness of the [telephone utility] rate or rates").
Our conclusion, however, is not dispositive of this appeal. Instead, we must still consider whether Surgery Centers,
Unlike the circuit court, we do not believe the Commission was required to promulgate a new regulation and provide Surgery Centers an opportunity to be heard before adopting the Advisory Committee's recommended schedules. Rather, we find the Commission's actions were specifically authorized by existing Regulation 67-1304 and did not implicate the requisite private right to warrant the due process protections of Article I, Section 22 of the South Carolina Constitution.
In reaching this conclusion we must examine Regulation 67-1304 by utilizing the well-established rules of statutory construction. "The cardinal rule of statutory construction is to ascertain and effectuate the intent of the legislature." Hodges v. Rainey, 341 S.C. 79, 85, 533 S.E.2d 578, 581 (2000). If a statute's language is plain and unambiguous, and conveys a clear and definite meaning, there is no occasion for employing rules of statutory interpretation and the Court has no right to look for or impose another meaning. Miller v. Doe, 312 S.C. 444, 447, 441 S.E.2d 319, 321 (1994).
As a threshold matter, we note that Surgery Centers have never asserted that Regulation 67-1304 was promulgated in violation of their due process rights. Thus, this extant regulation is controlling as to the authority allocated to the Commission.
Based on our review of this regulation, the plain and unambiguous terms authorize the Commission to establish a fee payment system applicable to Surgery Centers. Significantly, subsection A of the regulation, states "The Commission shall develop a prospective payment system." 25A S.C.Code Ann. Regs. 67-1304 (Supp.2009) (emphasis added). This legislatively-endorsed mandate permits the Commission to act without the need for additional approval.
Furthermore, we find the circuit court's reliance on section 1-23-110 of the South Carolina Code to be misplaced. In its order, the circuit court concluded that section 1-23-110 "establishes a requirement for a public hearing for proposed
We do not interpret section 1-23-110 as being the source for which Surgery Centers have a right to have a regulation promulgated. Rather, the statute merely provides for the procedures that must be followed whenever a regulation is otherwise mandated. Based on our reading of the statute, we discern nothing that establishes when a regulation is required for changes to the Commission's fee payment schedule for ambulatory surgery centers.
Finally, we hold the protections provided by our state Constitution are inapplicable in the instant case. Under our state Constitution, due process in the administrative context has been established by Article I, Section 22.
S.C. Const. art. I, § 22 (emphasis added).
In explaining this provision, we have stated, "[i]n recognition of the increasing number of governmental powers delegated to administrative agencies, South Carolina Constitution article I, § 22 was added to the 1895 Constitution in 1970 `as a safeguard for the protection of liberty and property of citizens.'" Ross v. Med. Univ. of S.C., 328 S.C. 51, 68, 492 S.E.2d 62, 71 (1997) (quoting Final Report of the Committee to Make a Study of the South Carolina Constitution of 1895, p. 21 (1969)).
Although our appellate courts have not always used the term "due process rights" when discussing Article I, Section 22, we have consistently indicated that the protections provided under this section are the equivalent of those afforded by the Due Process Clause of our state and federal Constitutions. See, e.g., Kurschner v. City of Camden Planning Comm'n, 376 S.C. 165, 171, 656 S.E.2d 346, 350 (2008) (citing Article I, Section 22 and stating "[p]rocedural due process imposes constraints on governmental decisions which deprive individuals of liberty or property interests within the meaning of the Due Process Clause of the Fifth or Fourteenth Amendment of the United States Constitution. The fundamental requirements of due process include notice, an opportunity to be heard in a meaningful way, and judicial review." (citation omitted)); Harbit v. City of Charleston, 382 S.C. 383, 393, 675 S.E.2d 776, 781 (Ct.App.2009) (citing Amendments V and XIV of the United States Constitution and Article I, Section 22 of the South Carolina Constitution and stating "[t]he fundamental requirements of due process under the United States Constitution and the South Carolina Constitution include notice, an opportunity to be heard in a meaningful way, and judicial review").
Given the absence of distinction in our jurisprudence, we conclude a traditional due process analysis is required to assess whether the Commission's actions deprived Surgery Centers of constitutionally-protected interests.
Accordingly, we conclude Surgery Centers have failed to establish any private right that warrants the protections provided in Article I, Section 22. See 16C C.J.S. Constitutional Law § 1516 (2010) ("[A]n interest in property which is protected by due process arises only when there is a legitimate claim of entitlement, as created and defined by independent sources, and a person clearly must have more than an abstract need or desire for it, and the person must have more than a unilateral expectation of it."); see also Am. Soc'y of Cataract & Refractive Surgery v. Thompson, 279 F.3d 447 (7th Cir. 2002) (holding physicians providing Medicare services had no protected property interest in statutory transition formula used to determine practice expense relative value units as a component of a Medicare physician fee schedule); Painter v. Shalala, 97 F.3d 1351 (10th Cir.1996) (concluding physicians, who voluntarily participated in Medicare program, failed to demonstrate a legitimate property interest in having reimbursement payments calculated in a specific manner).
Our conclusion should not be interpreted as providing the Commission with "unfettered authority" to adjust the reimbursement rate. If Surgery Centers believe that the authorized payment for services rendered is inadequate, they may invoke the due process protections afforded by the Commission. See 25A S.C.Code Ann. Regs. 67-1305 (Supp.2009) (outlining appellate procedures for when a medical provider
Furthermore, to the extent Surgery Centers claim our decision will in essence provide all state agencies with unlimited authority, we find this concern to be unfounded. Given the analysis outlined in the opinion, we emphasize our decision is controlled by specific statutory and regulatory provisions at issue in the instant case. Thus, our holding should not be construed as advocating for state agencies to exceed the authority granted to them by the General Assembly. See Bazzle v. Huff, 319 S.C. 443, 445, 462 S.E.2d 273, 274 (1995) ("An administrative agency has only such powers as have been conferred by law and must act within the authority granted for that purpose."); Captain's Quarters Motor Inn, Inc. v. S.C. Coastal Council, 306 S.C. 488, 490, 413 S.E.2d 13, 14 (1991) (stating that "[a]s a creature of statute, a regulatory body is possessed of only those powers expressly conferred or necessarily implied for it to effectively fulfill the duties with which it is charged").
Based on the foregoing, we affirm the circuit court's findings that Surgery Centers did not establish a right to a "contested case" hearing under the APA and did not have the requisite property interest to invoke our state's constitutional due process protections. We, however, reverse the circuit court's holding that the Commission was required to promulgate a new regulation in order to change the fee payment schedule. In light of our decision, we lift the pendente lite order enjoining the Commission from instituting the new payment schedule.
TOAL, C.J. and PLEICONES, J., concur. HEARN, J., dissenting in a separate opinion in which KITTREDGE, J., concurs.
Justice HEARN:
I respectfully dissent and would affirm the decision of the circuit court. In my opinion, the Workers Compensation
Although both sides agree this issue should be decided as a matter of law, both disagree with the decision of the circuit court. Surgery Centers argue the circuit court erred in finding they did not have the right to a contested case under Section 1-23-310(3).
Section 42-3-30 of the South Carolina Code (1985) requires the Commission to promulgate regulations relating to the administration of the workers' compensation laws of this State. Section 1-23-110 of the South Carolina Code (2005 & Supp. 2009) provides that, before the Commission promulgates a regulation, it must publicize notice of the change, detailing an address where interested persons may submit written comments before the regulations are tendered to the General Assembly. Thus, generally speaking, section 42-3-30 requires
The Commission maintains, and the majority holds, the necessary regulation authorizing its conduct has already been promulgated in regulation 67-1304. Following this reasoning, the Commission's conduct in commissioning the Advisory Committee to study the situation, then subsequently adopting its recommendations, is simply fulfilling the directive of regulation 67-1304, albeit nine years later. Additionally, the Commission cites the affidavit of its Executive Director, Gary Thibault, wherein he stated that since 1984, "in each case where the Commission has established a new or revised schedule of maximum allowable payments for services, the Commission did so by a vote of the Full Commission at a monthly Business Meeting." The mere fact that this practice has existed, without apparent challenge until today, is, in my opinion, not dispositive of its legitimacy.
Furthermore, "there is a basic presumption that the legislature has knowledge of previous legislation as well as of judicial decisions construing that legislation when later statutes are enacted concerning related subjects." Whitner v. State, 328 S.C. 1, 6, 492 S.E.2d 777, 779 (1997) (citing Berkebile v. Outen, 311 S.C. 50, 426 S.E.2d 760 (1993); 82 C.J.S. Statutes § 316, at 541-42 (1953)). Therefore, absent specific language in regulation 67-1304, or other qualifying statute, that authorizes the Commission to act in the revision of these maximum allowable payment schedules for ambulatory surgery centers without promulgating a new regulation as provided in sections 42-3-30 and 1-23-110, this Court must presume the General Assembly intended the Commission to promulgate a regulation in this matter. Instead, the majority reads a mandate in favor of the Commission that does not expressly exist within the plain and unambiguous terms of regulation 67-1304: instead of adhering to the general rule that all changes in the administration of
Moreover, article 1, section 22 of the South Carolina Constitution, which was adopted by the General Assembly in 1970, provides: "No person shall be finally bound by a judicial or quasi judicial decision of an administrative agency
Final Report of the Committee to Make a Study of the South Carolina Constitution of 1895, p. 21 (1969).
I do not think the rights guaranteed under article 1, section 22 are the same as those classically protected under the Due Process Clause of our State and National Constitutions. See U.S. Const. amend. XIV § 1; S.C. Const. art. V, § 5 (stating no person shall be deprived of life, liberty, or property without due process of law). Even if the Court has referred to the rights under article 1, section 22 as "due process rights," for claims under section 22, we have neither focused on, nor required the existence of a liberty or property interest, in the sense of a prerequisite to the Court's analysis of claims under the Due Process Clause. Stono River Envtl. Prot. Ass'n v. S.C. Dep't of Health and Envtl. Control, 305 S.C. 90, 94, 406 S.E.2d 340,
As stated above, I recognize the right to notice and an opportunity to be heard are typically identifiable with rights incident to the Due Process Clause of the Fourteenth Amendment. See Clear Channel Outdoor v. City of Myrtle Beach, 372 S.C. 230, 235, 642 S.E.2d 565, 567 (2007) ("Due process requires (1) adequate notice; (2) adequate opportunity for a hearing; (3) the right to introduce evidence; and (4) the right to confront and cross-examine witnesses."). However, in this case, the right of Surgery Centers to notice and an opportunity to be heard emanates, not from the Due Process Clause, but from article 1, section 22 of our State Constitution and from section 1-23-110. Therefore, because the rights in this case do not flow from the Due Process Clause, I believe it unnecessary, as the majority has done, to employ a traditional due process analysis to determine whether Surgery Centers' constitutionally protected interests have been deprived. See Sloan v. S.C. Bd. of Physical Therapy Exam'rs, 370 S.C. 452, 483, 636 S.E.2d 598, 614 (2006) (stating in order for due process rights to attach, a party must show that he was arbitrarily and capriciously deprived of a cognizable property interest rooted in state law).
Instead, I would look solely to the process through which the Commission enacted its new prospective payment system for Surgery Centers. In my view, the Commission's actions in forming the Advisory Committee to study, develop, and propose a new prospective payment system for outpatient hospital services and the services rendered by ambulatory surgical centers, and the Commission's subsequent adoption of the Advisory Committee's proposal, all without the proper notice and opportunity to be heard by Surgery Centers, constitute exactly the sort of quasi judicial decision section 22 was intended to address.
Finally, I am not persuaded that the General Assembly intended to provide the Commission with unfettered authority to adjust this reimbursement rate in perpetuity without affording the safeguards which attach to provisions promulgated
KITTREDGE, J., concurs.
S.C.Code Ann. § 42-15-90 (1985). The approval process is outlined in 25A S.C.Code Ann. Regs. 67-1305 (Supp.2009), which provides that a fee dispute between a medical provider and an employer or insurance carrier is referred to the Commission's medical division for final resolution. Any policies or procedures implementing the provisions of section 42-15-90 are governed by the South Carolina Administrative Procedures Act. S.C.Code Ann. § 42-3-185 (1985).
S.C. Const. art. I, § 3.