Justia Government & Administrative Law Opinion Summaries

The Supreme Court held that a reimbursement cap imposed by the Tennessee Department of Finance and Administration's Division of TennCare, the state agency tasked with administering the federal Medicaid program in Tennessee, was a "rule" within the meaning of the Uniform Administrative Procedures Act that should have been promulgated through the notice-and-comment process.Emergency Medical Care Facilities, P.C., a corporation compromised of private healthcare professionals who provide emergency-department services to TennCare enrollees, brought this action against TennCare alleging that TennCare's decision to impose a $50 cap on the amount that Emergency Medical and other healthcare professionals could recover from TennCare for certain treatment provided to TennCare enrollees was a rule and that TennCare violated the Tennessee Uniform Administrative Procedures act (UAPA) by implementing the cap without rulemaking. The chancery court granted summary judgment in favor of Emergency Medical. The court of appeals reversed, concluding that the $50 cap fell within the so-called "internal-management exception" to the UAPA. The Supreme Court reversed, holding that the $50 cap was a rule under the UAPA and should have been promulgated through notice-and-comment rulemaking. View "Emergency Medical Care Facilities, P.C. v. Division of Tenncare" on Justia Law

The Federally Supported Health Centers Assistance Act (“FSHCAA”) provides that health centers receiving funding under Section 330 of the Public Health Service Act (“PHSA”) may be deemed Public Health Service (“PHS”) employees. Plaintiffs alleged that Defendants violated their duty to report a court-ordered Lane County Mental Health patient’s refusal to comply with the terms of his probation. Plaintiffs alleged they were injured as a result of Defendants’ failure to report a patient’s repeated failures to comply with his mental health treatment plan. Defendants contended that they were entitled to Section 233 immunity. The district court held that Section 233 immunity did not apply to Defendants and remanded to state court.   The Ninth Circuit reversed the district court’s order remanding to state court Plaintiffs’ action alleging negligence and wrongful death claims against federally funded community health centers and their employees (“Defendants”), and remanded to the district court to enter an order substituting the United States as the defendant and deeming the action as one brought under the Federal Tort Claims Act. The panel first addressed whether there was jurisdiction to review the district court’s remand order. Ordinarily, a remand order is not reviewable on appeal, except for cases removed pursuant to 28 U.S.C. Section 1442. The panel agreed with Defendants that Section 233 immunity did not turn on who brings the claim, but rather on whether the conduct giving rose to the claim arose out of the Defendants’ performance of “medical, surgical, dental or related functions.” View "SAM FRIEDENBERG, ET AL V. LANE COUNTY, ET AL" on Justia Law

Middle schooler A.K. struggled with suicidal ideation for many years and attempted suicide numerous times, resulting in frequent emergency room visits and in-patient hospitalizations. A.K.’s physicians strongly recommended she enroll in a residential treatment facility to build the skills necessary to stabilize. Despite these recommendations and extensive evidence in the medical record, United Behavioral Health (“United”) denied coverage for A.K.’s stay at a residential treatment facility beyond an initial three month period. Her parents appealed United’s denial numerous times, requesting further clarification, and providing extensive medical evidence, yet United only replied with conclusory statements that did not address the evidence provided. As a result, A.K.’s parents brought this lawsuit contending United violated its fiduciary duties by failing to provide a “full and fair review” of their claim for medical benefits. Both sides moved for summary judgment, and the district court ruled against United. The issue this case presented for the Tenth Circuit's review was whether United arbitrarily and capriciously denied A.K. medical benefits and whether the district court abused its discretion in awarding A.K. benefits rather than remanding to United for further review. The Court ultimately concluded United did act arbitrarily and capriciously in not adequately engaging with the opinions of A.K.’s physicians and in not providing its reasoning for denials to A.K.’s parents. The Court also concluded the district court did not abuse its discretion by awarding A.K. benefits outright. View "D.K., et al. v. United Behavioral Health, et al." on Justia Law

The Supreme Court dismissed this direct appeal brought by the Iowa Department of Human Services (HDS) from a district court ruling requiring Iowa's Medicaid program to pay for sex reassignment surgery for two transgender adults and affirmed the denial of fees on cross-appeal, holding that the appeal was moot.Petitioners, adult transgender Iowans who were denied preauthorization for sex reassignment surgeries through the Medicaid program, appealed their managed care organization's denial of coverage to DHS. DHS affirmed the denials. The district court reversed, concluding that Iowa Code 216.7(3), an amendment to the Iowa Civil Rights Act (ICRA) violated the guarantee of equal protection under the Iowa Constitution. DHS appealed, but, thereafter, agreed to pay for Petitioners' surgeries. The Supreme Court dismissed the direct appeal as moot and affirmed the district court's order denying any fee award, holding that the court erred in denying Petitioners' request for attorney fees. View "Vasquez v. Iowa Dep't of Human Services" on Justia Law

Appellants Crestwood Behavior Health, Inc. (Crestwood), West Anaheim Extended Care and Extended Care Hospital of Westminster (West Anaheim), and Royale Health Care Center dba South Coast Post Acute (South Coast) (together, appellants) operated skilled nursing facilities serving beneficiaries of the California Medical Assistance Program (Medi-Cal). Respondent Department of Health Care Services (the Department) administered Medi-Cal. As relevant here, the Department also administered the “Skilled Nursing Facility Quality and Accountability Supplemental Payment System” (QASP), which authorized supplemental payments, over and above Medi-Cal reimbursement rates, to skilled nursing facilities meeting certain performance standards. Consolidated appeals challenged the Department’s method for calculating QASP payments. Appellants argued they did not receive all the QASP payments to which they were entitled and blame the alleged underpayment to the Department’s practice of excluding certain Medi-Cal days—known as “special treatment program days” or “STP days”—from its calculations. They sought writs of mandate directing the Department to include STP days in the calculation of QASP payments. The Court of Appeal concurred with the trial court that appellants failed to identify an appropriate basis for writ relief. Appellants sued under Welf. & Inst. Code Section 14170 (a)(1), which did not impose a mandatory or ministerial duty on the Department that could support the issuance of a writ of mandate. And the Court found appellants did not show any abuse of discretion by the Department. Accordingly, the trial court judgment was affirmed. View "Crestwood Behavioral Health, Inc. v. Baass" on Justia Law

President Biden invoked his authority under the Federal Property and Administrative Services Act of 1949 (“Procurement Act”) to direct federal agencies to include in certain contracts a clause requiring covered contractor employees to follow COVID-19 safety protocols, including vaccination requirements, in order for employees to be eligible to work on federal government projects. Plaintiffs sued to enjoin the vaccination mandate. This lawsuit revolved around four documents that comprise the Contractor Mandate: the Executive Order, the Task Force Guidance, the Office of Management and Budget Determination, and the Federal Acquisition Regulatory Council Guidance. The district court granted a permanent injunction against the Contractor Mandate, effective in any contract that either involved a party domiciled or headquartered in Arizona and/or was performed “principally” in Arizona.   The Ninth Circuit reversed the district court’s order granting a permanent injunction and dissolved the injunction. First, the panel held the Major Questions Doctrine—which requires that Congress speak clearly if it wishes to assign to an agency decisions of vast economic and political significance—did not apply. Second, the panel held that even if the Major Questions Doctrine applied, it would not bar the Contractor Mandate because the Mandate is not a transformative expansion of the President’s authority under the Procurement Act. Third, the panel held that the Contractor Mandate fell within the President’s authority under the Procurement Act. Fourth, the panel held that the nondelegation doctrine and state sovereignty concerns did not invalidate the Contractor Mandate. Finally, the panel held that the Contractor Mandate satisfied the Office of Federal Procurement Policy Act’s procedural requirements. View "KRISTIN MAYES, ET AL V. JOSEPH BIDEN, ET AL" on Justia Law

Plaintiff, MSP Recovery Claims, Series LLC (“MSP”) appealed from the district court’s judgment dismissing for lack of standing its putative class action against Defendant Hereford Insurance Company (“Hereford”) and denying leave to amend. MSP has brought several lawsuits around the country seeking to recover from insurance companies that allegedly owe payments to Medicare Advantage Organizations (“MAOs”) under the Medicare Secondary Payer Act (the “MSP Act”). In the putative class action brought here, MSP charges Hereford with “deliberate and systematic avoidance” of Hereford’s reimbursement obligations under the MSP Act.   The Second Circuit affirmed. The court concluded that MSP lacked standing because its allegations do not support an inference that it has suffered a cognizable injury or that the injury it claims is traceable to Hereford. The court also concluded that the district court did not abuse its discretion when it denied MSP leave to amend based on MSP’s repeated failures to cure. The court explained that the plain language of Section 111 provides that when a no-fault insurance provider such as Hereford reports a claim pursuant to Section 111, it does not thereby admit that it is liable for the claim. The statutory context of the section’s reporting obligation and the purpose of the reporting obligation confirms the correctness of this interpretation. Because MSP’s argument that the payments made by EmblemHealth are reimbursable by Hereford rests entirely on its proposed interpretation of Section 111, MSP has not adequately alleged a “concrete” or “actual” injury or that the injury it alleges is fairly traceable to Hereford. View "MSP v. Hereford" on Justia Law

Plaintiffs Clearview Realty Ventures, LLC, JHM HIX Keene, LLC, VIDHI Hospitality, LLC, NAKSH Hospitality, LLC, 298 Queen City Hotel, LLC, ANSHI Hospitality, LLC, 700 Elm, LLC, Bedford-Carnevale, LLC, and Carnevale Holdings, LLC, owned commercial real estate on which they operated hotels, some of which offered restaurant services along with banquet or function facilities. They contended that the COVID-19 pandemic was a “natural disaster” and that their buildings were “damaged” within the meaning of RSA 76:21, I. Plaintiffs sought relief from the New Hampshire municipalities involved: the Cities of Laconia, Keene, and Manchester, and the Town of Bedford. After denial of their applications, they appealed to the superior court in the applicable county. Observing that there were thirteen separate lawsuits pending in six counties, they then filed an assented-to motion for interlocutory transfer without ruling and motion to consolidate to allow the coordinated transfer of the common questions of law to the New Hampshire Supreme Court. In this interlocutory transfer without ruling, the Supreme Court was asked to determine: (1) whether, for purposes of RSA 76:21, the COVID-19 pandemic constituted a “natural disaster”; and (2) if so, whether the buildings owned by the plaintiffs were “damaged” by COVID-19 such that they were “not able to be used for [their] intended use” within the meaning of RSA 76:21, I. The Court answered the second question in the negative. View "Clearview Realty Ventures, LLC v. City of Laconia; et al." on Justia Law

The First Circuit affirmed the order of the district court granting summary judgment in favor of Kent County Memorial Hospital and Michael Dacey, M.D., in his individual capacity and as President of Kent Hospital, and dismissing Richard Gilbert, M.D.'s suit challenging the Hospital Board of Trustees' revocation of Dr. Gilbert's privileges at Kent Hospital, holding that dismissal was proper.In granting summary judgment for Defendants, the district court concluded that Dr. Gilbert had not rebutted the presumption that Defendants were immune from liability in damages under the Health Care Quality Improvement Act (HCQIA), 42 U.S.C. 11101-11152, and immune from suit under Rhode Island state law. The First Circuit affirmed, holding (1) the Board was entitled to HCQIA immunity; and (2) the Board was entitled to immunity under R.I. Gen. Laws 23-17-23(b). View "Gilbert v. Kent County Memorial Hospital" on Justia Law

The Supreme Court reversed the order of the single justice of the appeals court reversing the denial of Plaintiffs' motion for a preliminary injunction and vacated the injunction, holding that the single justice abused her discretion in enjoining Defendants from enforcing their December 2021 amended COVID-19 vaccination policy.Plaintiffs - the Boston Firefighters Union, the Boston Police Superior Officers Federation, and others - filed a complaint challenging Defendants' unilateral amendment of the COVID-19 vaccination policy for all city of Boston employees, seeking declaratory and injunctive relief. The superior court denied Plaintiffs' motion for injunctive relief, but a single justice of the appeals court reversed and ordered the entry of a preliminary injunction. The Supreme Court reversed, holding that the single justice abused her discretion in issuing the preliminary injunction because the potential harm to the city resulting from the spread of COVID-19 clearly outweighed the economic harm to employees. View "Boston Firefighters Union, Local 718, Internat'l Ass'n of Fire Fighters, AFL-CIO v. City of Boston" on Justia Law