Justia Government & Administrative Law Opinion Summaries

Hospitals provided emergency medical services to members of the county’s health plan, which is licensed and regulated by the state Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act, Health & Saf. Code 1340. The county reimbursed the Hospitals for $28,500 of a claimed $144,000. The Hospitals sued, alleging breach of an implied-in-fact or implied-in-law contract. The trial court rejected the county’s argument that it is immune from the Hospitals’ suit under the Government Claims Act (Gov. Code 810).The court of appeal reversed. The county is immune from common law claims under the Government Claims Act and the Hospitals did not state a claim for breach of an implied-in-fact contract. The county does not contest its obligation to reimburse the Hospitals for the reasonable and customary value of the services; the issue is what remedies may be pursued against the county when the reasonableness of the reimbursement is disputed. The Knox-Keene Act provides alternative mechanisms to challenge the amount of emergency medical services reimbursements. A health care service plan has greater remedies against a private health care service plan than it does against a public entity health care service plan, a result driven by the Legislature broadly immunizing public entities from common law claims and electing not to abrogate that immunity in this context. View "County of Santa Clara v. Superior Court" on Justia Law

Respondent K.C. appealed a circuit court decision ordering her to involuntary admission to the New Hampshire Hospital (NHH) for a two-year period, to be discharged when clinically appropriate. On appeal, respondent contended NHH presented insufficient evidence at the hearing to support the circuit court’s order. Respondent was diagnosed with bipolar I disorder with manic, psychotic features. She had contacted police in the previous year 300-400 times, believing someone was hacking her phone and “rerouting her to people in black ops.” She had two active protective orders preventing her from contacting her ex-husband and another man, and there was outstanding criminal complaints from her violating those orders. Respondent was admitted to NHH, whereupon she was evaluated by psychiatrists, and the decision was ultimately made to have her committed. Finding no reversible error in the circuit court’s order, the New Hampshire Supreme Court affirmed, finding the evidence presented at respondent’s hearing was sufficient on which to have her involuntarily committed. View "In re K.C." on Justia Law

The Supreme Court reversed the judgment of the trial court denying ResCare Health Service's request for a declaratory judgment, holding that ResCare sufficiently pleaded its declaratory judgment request.ResCare, which operates intermediate care facilities in Indiana for individuals with intellectual disabilities, petitioned for administrative reconsideration after an auditor with the Indiana Family & Social Services Administration’s Office of Medicaid Policy and Planning (FSSA) adjusted cost reports to prevent ResCare from recovering costs for over-the-counter medicines under Medicaid. An ALJ granted summary judgment for ResCare. The trial court affirmed the agency's final decision. The Supreme Court reversed, holding (1) ResCare did not need to file a separate complaint for a declaratory judgment; (2) ResCare sufficiently pleaded its declaratory judgment claim; and (3) ResCare's patients did not have to be joined to the litigation before the declaratory judgment request could be considered. View "ResCare Health Services Inc. v. Indiana Family & Social Services Administration" on Justia Law

The Supreme Court affirmed the judgment of the court of appeals affirming the decision of the circuit court to overturn a final order of the Secretary of the Cabinet for Health and Family Services dismissing an administrative action against Appalachian Hospice Care, Inc., holding that there was no error.At issue on appeal was whether the Secretary erred in concluding that a non-lawyer's request for an administrative hearing on behalf of a corporate entity constitutes the unauthorized practice of law requiring dismissal of the administrative action. The lower courts answered the question in the negative. The Supreme Court affirmed, holding that there was no unauthorized practice of law in this case. View "Cabinet for Health & Family Services v. Appalachian Hospice Care, Inc." on Justia Law

The Fifth Circuit affirmed the district court's grant of summary judgment in favor of the HHS Defendants in an action challenging HHS's risk-adjustment program, implemented under the Patient Protection and Affordable Care Act (ACA), and repromulgation of the 2017 and 2018 rules. In this case, Vista Health Plan, a health insurance company in Texas, was assessed risk-adjustment fees that exceeded its premium revenue, causing the company to cease operations.After determining that it has jurisdiction over the appeal, the court concluded that the 2017 and 2018 Final Rules adopted by HHS were not impermissibly retroactive under Landgraf v. USI Film Prods., 511 U.S. 244, 268 (1994). The court also concluded that HHS's failure to follow the Administrative Procedure Act's notice-and-comment procedures in its repromulgation of the 2017 Final Rule was at worst harmless error. Rather, the new rule actually maintained the settled expectations of insurers covered by the previous version of the rule. Finally, the court concluded that Vista's other issues on appeal regarding the administrative record before the district court, Chevron deference as to HHS's interpretation of the governing law, and the district court's "sua sponte" summary judgment on Vista's regulatory taking claim lack merit. View "Vista Health Plan, Inc. v. United States Department of Health and Human Services" on Justia Law

This case arose out of South Carolina's termination of Planned Parenthood's Medicaid provider agreement. The district court granted a preliminary injunction, concluding in relevant part that the individual plaintiff had demonstrated that she was likely to succeed on her Medicaid Act claim since the free-choice-of-provider provision conferred a private right enforceable under 42 U.S.C. 1983 and South Carolina had violated that provision by terminating Planned Parenthood's Medicaid provider agreement. The Fourth Circuit affirmed the district court's decision. The district court then issued a permanent injunction, which South Carolina now challenges in this appeal.The Fourth Circuit first concluded that this case presents a live case or controversy and rejected South Carolina's claim of mootness. Even assuming that the court were free to reexamine its precedents, the court declined to do so in this case. Rather, the court concluded that its previous decision was handed down as a matter of law and resolved the precise legal issue upon which South Carolina now seeks review.The court reaffirmed its prior decision, concluding that the free-choice-of-provider provision confers on Medicaid recipients an individual right enforceable under section 1983. The court stated that the statute plainly reflects Congress's desire that individual Medicaid recipients be free to obtain care from any qualified provider and it implements this policy in direct and unambiguous language. In this case, all three Blessing factors in determining whether a statute creates a private right enforceable under section 1983 are met. Furthermore, the Medicaid Act does not evince Congress's intent to specifically foreclose a remedy under section 1983. Finally, the Supreme Court's decision in O’Bannon v. Town Court Nursing Center, 447 U.S. 773 (1980), does not undermine the court's analysis. The court refused to nullify Congress's undeniable desire to extend a choice of medical providers to the less fortunate among us, individuals who experience the same medical problems as the more fortunate in society but who lack under their own means the same freedom to choose their healthcare provider. View "Planned Parenthood South Atlantic v. Kerr" on Justia Law

Three teaching hospitals challenged the denial of Medicare reimbursements. At that time, a teaching hospital could obtain reimbursement only by incurring “substantially all” of a resident’s training costs. Because the teaching hospitals had shared the training costs for each resident, the government denied reimbursement. The denials led the teaching hospitals to file administrative appeals. While they were pending, Congress enacted the Affordable Care Act (ACA), which created a new standard for reimbursement. The parties disagreed on whether the ACA’s new standard applied to proceedings reopened when Congress changed the law. The agency answered no, and the district court granted summary judgment to the agency. Finding no reversible error in that decision, the Tenth Circuit affirmed. View "St. Francis Hospital, et al. v. Becerra" on Justia Law

The Fifth Circuit denied defendants' motion for a partial stay of the district court's preliminary injunction enjoining the Department of Defense, United States Secretary of Defense Lloyd Austin, and United States Secretary of the Navy Carlos Del Toro from enforcing certain COVID-19 vaccination requirements against 35 Navy special warfare personnel and prohibiting any adverse actions based on their religious accommodation requests. Specifically, defendants seek a partial stay pending appeal insofar as the injunction precludes them from considering plaintiffs' vaccination statuses "in making deployment, assignment and other operational decisions."The court weighed the Mindes abstention factors and determined that this dispute is justiciable. However, the court concluded that defendants have not carried their burden to warrant the issuance of the stay. The court agreed with the district court that defendants have not shown a compelling interest to deny religious accommodations under the Religious Freedom Restoration Act of 1993 to each of the 35 plaintiffs at issue. Rather, the "marginal interest" in vaccinating each plaintiff appears to be negligible and thus defendants lack a sufficiently compelling interest to vaccinate plaintiffs. The court also concluded that the preliminary injunction does not irreparably damage the Navy and the public; partially staying the preliminary injunction pending appeal would substantially harm plaintiffs; and issuance of the requested stay would disserve the public interest. View "U.S. Navy SEALs 1-26 v. Biden" on Justia Law

The Supreme Court held that Fla. Stat. 120.68(3), which entitles a party to a presumptive stay upon the appeal of an agency decision that "has the effect of suspending or revoking a license," does not apply to an agency decision to administratively withdraw an incomplete renewal license application.When Ybor Medical Injury and Accident Clinic, Inc. (the clinic), applied to the Agency for Health Care Administration (AHCA) to renew its expiring license the AHCA invited the clinic to supplement its application, which was incomplete. After the clinic failed to do so, AHCA administratively withdrew the incomplete renewal license application from further consideration. The AHCA appealed and sought a presumptive stay under section 120.68(3). The court of appeals granted the presumptive stay. The Supreme Court quashed the decision below, holding that the appeal of an agency’s withdrawal decision does not trigger the statute’s presumptive stay provision. View "Agency for Health Care Administration v. Ybor Medical Injury & Accident Clinic, Inc." on Justia Law

The Supreme Court affirmed the judgment of the circuit court denying the petition for a permanent writ of prohibition filed by the Missouri Department of Health and Senior Services, holding that the circuit court did not err in denying the writ.After the Department denied the applications filed by Kings Garden Midwest LLC seeking two medical marijuana cultivation facility licenses Kings Garden requested that the Department provide complete and unreacted copies of successful cultivation license applications in discovery. The administrative hearing commission (AHC) granted the motion to compel. The Department filed a petition for a writ of prohibition seeking to bar enforcement of the AHC's order. The circuit court denied the writ. The Supreme Court affirmed, holding that because the plain language of allows confidential information to be used for purposes of appealing the Department's decision to deny a license, the AHC did not err in sustaining Kings Garden's motion to compel. View "State ex rel. Department of Health & Senior Services v. Slusher" on Justia Law