Justia Government & Administrative Law Opinion Summaries

As part of a request to receive a higher reimbursement rate, plaintiff Family Health Centers of San Diego (Family Health) submitted a cost report detailing the reimbursable costs incurred by its clinics in providing covered services to Medi-Cal patients. Because the costs were not allowable Medi-Cal costs, Family Health eliminated them from its cost report. As part of an audit, however, defendant State Department of Health Care Services (the Department) determined the costs should not have been eliminated from the cost report. Instead, the Department reclassified the costs to a nonreimbursable cost center, which had the effect of disallowing a proportionate share of the clinics’ administrative overhead costs. Family Health filed an administrative appeal to dispute the audit adjustments, but, after a formal hearing, its appeal was denied. Family Health then filed a petition for a writ of mandate challenging the administrative decision, which also was denied. On appeal, Family Health contended the Department did not establish a proper basis for reclassifying the costs to a nonreimbursable cost center, and that the decision to reclassify the costs was not supported by substantial evidence. Family Health separately argued that a significant subset of the costs should not have been included in the nonreimbursable cost center because they were not costs at all. After review, the Court of Appeal found no reversible error and affirmed the judgment denying the petition. View "Family Health Centers of San Diego v. State Dept. of Health Care Service" on Justia Law

Petitioners Governor Jay Inslee, the State of Washington, the Washington Department of Corrections, and Cheryl Strange, secretary of the Department of Corrections, sought the Washington Supreme Court's accelerated direct discretionary review of an order of the Franklin County Superior Court denying petitioners’ motion to change venue to Thurston County Superior Court in an action brought by respondent Jeffrey Johnson challenging proclamations the governor issued requiring certain state employees to be vaccinated against COVID-19 by October 18, 2021. The merits of the underlying suit were not before the Court. In an order issued on October 11, 2021, the Court determined that mandatory venue for this action was in Thurston County Superior Court under RCW 4.12.020(2), and therefore granted petitioners’ motion for accelerated discretionary review, reversed the order of the Franklin County Superior Court, and remanded to that court with directions to grant petitioners’ motion to change venue without delay. In this opinion, the Court explained the reasoning underlying its order. View "Johnson v. Inslee" on Justia Law

In April 2020, the district court entered a preliminary injunction and provisionally certified nationwide subclasses of ICE detainees with risk factors or disabilities placing them at heightened risk of severe illness and death from COVID-19. The court found that plaintiffs were likely to succeed on claims of deliberate indifference to the medical needs of detainees, punitive conditions of confinement, and violation of the Rehabilitation Act, 29 U.S.C. 794. The preliminary injunction imposed a broad range of obligations on the federal government.The Ninth Circuit reversed, stating that neither the facts nor the law supported a judicial intervention of this magnitude. The plaintiffs did not make a clear showing that ICE acted with deliberate indifference to medical needs or in reckless disregard of health risks. If a particular condition or restriction of pretrial detention is reasonably related to a legitimate governmental objective, it does not, alone, amount to punishment; there was a legitimate governmental objective here, ICE was holding detainees because they were suspected of having violated the immigration laws or were otherwise removable. ICE’s national directives did not create excessive conditions of “punishment.” Rejecting the Rehabilitation Act claim, the court stated that the plaintiffs at most demonstrated that they were subjected to inadequate national policies; they did not show they were treated differently from other detainees “solely by reason” of their disabilities. View "Fraihat v. United States Immigration and Customs Enforcement" on Justia Law

Providers filed suit under 42 U.S.C. 1983 and the Medicaid Act, alleging that the Department violated constitutional and statutory law in retroactively recalculating their Medicaid reimbursement rates for the three-month period of January through March 2016.The Seventh Circuit reversed the district court's dismissal of the Providers' procedural due process claim, concluding that, at this early stage in the litigation, the allegations are sufficient to allege a violation of procedural due process. First, the court explained that the Providers retain a legitimate entitlement to a rate determined according to that formula, and any action to alter the rate must be conducted with due process. In this case, according to the amended complaint, the auditors failed to provide any notice of the alleged deficiencies prior to the final decision, and the Providers had no opportunity to submit additional documentation or other evidence following that decision. The court stated that the burden on the Department in providing such notice is no impediment, given that the procedures are already in the Code. The court explained that the Department need only follow those procedures rather than routinely bypass them. Therefore, in the absence of that basic and fundamental protection against unfair or mistaken findings, the court concluded that the Providers have sufficiently alleged a violation of due process. Accordingly, the court remanded for further proceedings. View "Rock River Health Care, LLC v. Eagleson" on Justia Law

The Eighth Circuit affirmed the district court's grant of summary judgment in favor of HHS and CMS in an action brought by Northport, alleging that a regulation promulgated by CMS through notice and comment rulemaking is unlawful and should be set aside for violating the Administrative Procedure Act (APA), the Federal Arbitration Act (FAA), and the Regulatory Flexibility Act (RFA). The revised HHS regulations (Revised Rule) prohibits long-term care facilities from conditioning the admission of Medicare and Medicaid residents on their agreement to pre-dispute, binding arbitration and gives the residents the right to rescind the binding arbitration agreements, as well as certain other rights.The court concluded that the Revised Rule does not, in words or effect, render arbitration agreements entered into in violation thereof invalid or unenforceable, and thus it does not conflict with the FAA. Furthermore, the Revised Rule represents a reasonable accommodation of manifestly competing interests and is entitled to deference, and thus the district court properly concluded that it is not ultra vires. The court also concluded that the Revised Rule reflects CMS's reasoned judgment in light of competing considerations, and is not arbitrary or capricious. Finally, although CMS failed to provide a factual basis in support of its section 605(b) certification in the Revised Rule, the court concluded that failing to do so was harmless error. View "Northport Health Services of Arkansas, LLC v. U.S. Department of Health and Human Services" on Justia Law

The South Carolina Supreme Court granted petitioners' request for a declaration with respect to Provisos 1.108 and 1.103 of the 2021-2022 Appropriations Act1 were invalid. Proviso 1.108 (enacted June 22, 2021,) was directed to the South Carolina Department of Education for South Carolina's kindergarten through 12th grade (K-12) public schools, and banned face mask mandates at any of its education facilities. Proviso 1.103 permitted school districts to offer a virtual education program for up to five percent of its student population based on the most recent 135 day ADM [(average daily membership)]count without impacting any state funding. For every student participating in the virtual program above the five percent threshold, the school district would not receive 47.22% of the State per pupil funding provided to that district as reported in the latest Revenue and Fiscal Affairs revenue per pupil report pursuant to Proviso 1.3. Although the School District did not require its students to wear masks in its education facilities, it claimed Proviso 1.108 conflicted with local laws regarding mask requirements in schools and placed the School District in an untenable position. In addition, Petitioners claimed the School District reached the five percent cap for virtual enrollment and did not wish to risk losing state funds by exceeding the cap in Proviso 1.103. The School District asked for guidance on its options and obligations regarding face masks and virtual education. Petitioners contended: (1) Provisos 1.108 and 1.103 violate the one-subject rule of article III, section 17 of the South Carolina Constitution; (2) the plain language of Proviso 1.108 permitted the School District to implement and enforce mask mandates in its education facilities if the School District did so with funds not appropriated or authorized in the 2021-2022 Appropriations Act; (3) Provisos 1.108 and 1.103 improperly invade the authority of local school boards; and (4) Provisos 1.108 and 1.103 denied equal protection to students and violated their constitutional right to free public education. The Supreme Court held the provisos were constitutional, and rejected the remaining challenges to the validity of the provisos. View "Richland County School District 2 v. Lucas" on Justia Law

A drug manufacturer cannot distribute a drug in interstate commerce without obtaining the FDA’s approval for the uses listed on the drug’s official label, 21 U.S.C. 355(a). The Act does not prohibit doctors from prescribing FDA-approved drugs for “off-label” use but leaves the regulation of doctors to the states. Hydroxychloroquine is approved to treat malaria, lupus, and arthritis but not to treat COVID-19. In 2020, the FDA relied on then-available data and issued an Emergency Use Authorization, permitting hydroxychloroquine in the federal government’s strategic stockpile to be distributed to treat COVID-19 patients in limited circumstances.The Association, a nonprofit organization with physician members, sued, challenging restrictions barring use of hydroxychloroquine to treat COVID-19 except for hospitalized patients. The Association alleged that these restrictions violated the implied equal-protection guarantee in the Fifth Amendment; violated the First Amendment right to associate by limiting access to medication useful for meeting in groups; and violated the Administrative Procedure Act. The Association alleged an injury to itself: it was considering canceling a conference purportedly due to the restrictions. It also invoked associational standing on behalf of its physician members who could not prescribe hydroxychloroquine for COVID-19.The district court held that none of these injuries plausibly pleaded the Association’s standing to challenge the Authorization. The court dismissed the complaint for lack of subject matter jurisdiction. The Sixth Circuit affirmed. The Associaiton failed to plausibly plead that any member has been injured by the FDA’s actions. View "Association of American Physicians & Surgeons v. United States Food & Drug Administration" on Justia Law

The Supreme Judicial Court held that the Commissioner of Correction's exercise of the "commissioner's certification" provision in Mass. Gen. Laws ch. 18(a) to retain K.J. at Bridgewater State Hospital violated article 30 of the Massachusetts Declaration of Rights.K.J., an adult man who faced criminal charges in the district court and the superior court, was committed involuntarily to Bridgewater. The commitment was subsequently extended. This appeal concerned the medical director of Bridgewater's most recent petition to have K.J. again recommitted for one year under section 18(a). The judge found that K.J. did not require strict custody and therefore, as required by section 18(a), issued an order committing K.J. to a lower security Department of Mental Health (DMH) facility. Despite that order, the Commissioner exercised the "commissioner's certification" provision in section 18(a) to retain K.J. at Bridgewater. The Supreme Judicial Court ordered that K.J. be transferred to a DMH facility, holding (1) the commissioner's certification provision of section 18(a) violates article 30; and (2) the remainder of section 18(a) is capable of separation. View "K.J. v. Superintendent of Bridgewater State Hospital" on Justia Law

South Carolina Attorney General Alan Wilson sought a declaration by the South Carolina Supreme Court concerning the use of facemasks in the public schools of South Carolina during the coronavirus pandemic. The Court construed Proviso 117.190 of the 2021-2022 Appropriations Act relating to public institutions of higher learning, and determined from the language in that proviso that the University of South Carolina was not precluded from issuing a universal mask mandate that applied equally to vaccinated and unvaccinated students and faculty alike. This case involved a different proviso from the 2021-2022 Appropriations Act: Proviso 1.108, relating to public schools serving students grades kindergarten through 12 (K-12). Proviso 1.108 manifestly set forth the intent of the legislature to prohibit mask mandates funded by the 2021-2022 Appropriations Act in K-12 public schools. The Attorney General contended the City of Columbia passed ordinances in direct opposition to Proviso 1.108, mandating masks in all K-12 public schools in the City of Columbia. "While allowing school districts flexibility to encourage one policy or the other, the state legislature has elected to leave the ultimate decision to parents. Conversely, the City of Columbia has attempted to mandate masks for all school children by following guidance from the Centers for Disease Control, which has the effect of disallowing parents a say in the matter." The Supreme Court upheld Proviso 1.108 and declared void the challenged ordinances of the City of Columbia insofar as they purported to impose a mask mandate in K-12 public schools. View "Wilson v. City of Columbia" on Justia Law

Enrollees in the North Carolina State Health Plan for Teachers and State Employees (NCSHP) sued, alleging that NCSHP discriminates against its transgender enrollees by categorically denying coverage for gender dysphoria treatments like counseling, hormone therapy, and surgical care, in violation of section 1557 of the Patient Protection and Affordable Care Act, which prohibits “any health program or activity” that receives federal funds from discriminating against individuals on any ground prohibited by various federal statutes, including Title IX, 42 U.S.C. 18116(a).The Fourth Circuit affirmed the denial of NCSHP’s motion to dismiss, asserting that it was entitled to sovereign immunity under the Eleventh Amendment. NCSHP waived its immunity against this claim by accepting federal financial assistance. Under the Civil Rights Remedies Equalization Act (CRREA), “[a] State shall not be immune under the Eleventh Amendment of the Constitution of the United States from suit in Federal court for a violation of . . . any other Federal Statute prohibiting discrimination by recipients of Federal financial assistance,” 42 U.S.C. 2000d-7. View "Kadel v. North Carolina State Health Plan for Teachers and State Employees" on Justia Law