Justia Government & Administrative Law Opinion Summaries

The States filed suit raising constitutional challenges to Section 9010 of the Affordable Care Act (ACA) and statutory and constitutional challenges to the Certification Rule. The Fifth Circuit affirmed the district court's ruling that the States had standing to raise their Certification Rule claims; reversed the district court's ruling that the States' Administrative Procedure Act (APA) claims were not time-barred; and dismissed those claims for lack of jurisdiction.On the merits, the court affirmed the district court's judgment on the Section 9010 claims, holding that the Provider Fee is a constitutional tax that does not violate the Spending Clause and that Section 9010 satisfies both the requirements under the Tenth Amendment doctrine of intergovernmental tax immunity. In this case, the Provider Fee does not discriminate against states or those with whom they deal because it is imposed on any entity that provides health insurance (with certain exclusions). Furthermore, the legal incidence of the Provider Fee does not fall on the states because Congress expressly excluded states from paying the fee. However, the court reversed the district court's judgment that the Certification Rule violated the nondelegation doctrine, holding that HHS did not unlawfully delegate to a third party its authority to approve state managed-care organization (MCO) contracts. Accordingly, the court rendered judgment in favor of the United States. Because neither the Certification Rule nor Section 9010 are unlawful, the court vacated the district court's grant of equitable disgorgement to the States. View "Texas v. Rettig" on Justia Law

A man appealed superior court orders authorizing his hospitalization for evaluation, his 30-day commitment, and the involuntary administration of psychotropic medication. He argued the superior court’s failure to conduct a screening investigation was an error that required vacation of the evaluation order and the commitment and medication orders that followed it. He also specifically challenged the commitment order, claiming that the court erred by relying on facts not in evidence and by finding clear and convincing evidence that he was gravely disabled and that commitment was the least restrictive alternative. The Alaska Supreme Court concluded: (1) that failing to perform a screening investigation was error, but the error was harmless because the court made findings supported by clear and convincing evidence when ordering a 30-day commitment; (2) it was also harmless error to rely to any extent on facts not in evidence because there was sufficient evidence in the record to support a finding that the respondent was gravely disabled; (3) the superior court did not err when it found by clear and convincing evidence that the respondent was gravely disabled and that commitment was the least restrictive alternative, or when it granted the petition for involuntary hospitalization; and (4) the superior court did not err by finding that medication was in the respondent’s best interests and that there was no less intrusive alternative, or by granting the petition for its involuntary administration. View "In the Matter of the Necessity for the Hospitalization of Rabi R." on Justia Law

Hospitals and hospital associations filed suit challenging HHS's decision to reduce the reimbursement rates for 340B hospitals. The district court held that the rate cute exceeded HHS's statutory authority to adjust specified covered outpatient drugs (SCOD) rates.After determining that it had jurisdiction, the DC Circuit proceeded to the merits and held that HHS had statutory authority to impose its 28.5 percent cut to SCOD reimbursement rates for 340B hospitals. The court held that HHS reasonably interpreted 42 U.S.C. 1395l(t)(14)(A)(iii)(II)'s adjustment authority to enable reducing SCOD payments to 340B hospitals, so as to avoid reimbursing those hospitals at much higher levels than their actual costs to acquire the drugs. Applying Chevron deference, the court held that, at a minimum, the statute does not clearly preclude HHS from adjusting the SCOD rate in a focused manner to address problems with reimbursement rates applicable only to certain types of hospitals. View "American Hospital Ass'n v. Azar" on Justia Law

Tiffany O., a woman in her 60s, developed epilepsy early in childhood and suffered from regular seizures. She was also diagnosed with intellectual disability, and was described as "unable to engage in a meaningful conversation." In 2007, Tiffany's daughter Rachel petitioned for the appointment of a guardian for Tiffany. In March 2008, the superior court appointed the Office of Public Advocacy to serve as Tiffany’s public guardian. After a period of working well together, the relationship between Rachel and the public guardian soured. Rachel twice petitioned for review of the guardianship. In June 2011 Rachel was appointed as Tiffany’s guardian. The daughter relied on faith-based medicine to care for her mother, electing to, in one instance, pray over her mother after she became nonresponsive instead of calling emergency services. The superior court ultimately removed the daughter as guardian, finding that her behavior and “intractable belief system” caused her to deprive her mother of appropriate services and care. The Alaska Supreme Court found the superior court did not abuse its discretion when it removed the daughter as her mother’s guardian. The Court also concluded that removing the daughter as guardian did not violate the Alaska Constitution’s free exercise clause because the State possessed a compelling interest in preventing harm to the mother. View "In the Matter of the Protective Proceedings of Tiffany O." on Justia Law

In 1998, Pennsylvania and 45 other states entered into a settlement agreement with certain cigarette manufacturers, who agreed to disburse funding to the states to cover tobacco-related healthcare costs. Pennsylvania’s 2001 Tobacco Settlement Act established the "EE Program" to reimburse participating hospitals for “extraordinary expenses” incurred for treating uninsured patients according to a formula. The Department of Human Services (DHS) determines the eligibility of each hospital for EE Program payments. The Pennsylvania Auditor General reported that for Fiscal Years 2008-2012, some participating hospitals received disbursements for unqualified claims, and recommended that DHS claw back funds from overpaid hospitals and redistribute the money to hospitals that had been underpaid. DHS followed that recommendation for fiscal years prior to 2010 but discovered methodological discrepancies and discontinued the process for Fiscal Years 2010-2012.Plaintiffs, on behalf of all “underpaid” hospitals, sued an allegedly overpaid hospital, alleging conspiracy to defraud the EE Program in violation of RICO, 18 U.S.C. 1961–1964. The plaintiffs alleged that the defendants submitted fraudulent claims for reimbursement, in violation of the wire fraud statute, 18 U.S.C. 1343 (a RICO predicate offense). The Third Circuit reversed the dismissal of the claims, finding that the theory of liability adequately alleges proximate causation. No independent factors that accounted for the plaintiffs’ injury and no more immediate victim was better situated to sue. View "St. Lukes Health Network, Inc. v. Lancaster General Hospital" on Justia Law

Healthcare insurers filed suit challenging an emergency regulation promulgated in 2017 by New York's Superintendent of the Department of Financial Services that would have significantly reduced the amount of risk adjustment funding to which plaintiffs were entitled in 2017 under the Patient Protection and Affordable Care Act (ACA) and subsequent years using HHS's federal methodology.The Second Circuit held that New York's emergency regulation was preempted by the ACA and HHS's regulations. The court held that New York's regulation interferes with, indeed reverses, some of the central "criteria and methods" that HHS, acting within its statutory authority, established for implementing a risk adjustment program and methodology. Accordingly, the court reversed the portion of the district court's judgment that dismissed plaintiffs' preemption claim and remanded with instructions to grant summary judgment in plaintiffs' favor on that claim. The court also vacated the district court's dismissal of plaintiffs' takings and exaction claims, remanding for further proceedings. View "UnitedHealthcare of New York, Inc. v. Lacewell" on Justia Law

The ACAP and others challenged the Departments' Short-Term Limited Duration Insurance (STLDI) Rule defining STLDI as coverage with an initial contract term of less than one year and a maximum duration of three years counting renewals. The Departments also expanded disclosure requirements.The DC Circuit affirmed the district court's grant of summary judgment to the Departments and agreed with the district court that the STLDI Rule was a reasonable interpretation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Patient Protection and Affordable Care Act (ACA), and that the change from the 2016 Rule to the current STLDI Rule was not arbitrary and capricious. View "Association for Community Affiliated Plans v. Department of the Treasury" on Justia Law

In these consolidated actions, a group of hospitals challenged HHS's rate reduction for off-campus provider-based departments (PBDs) falls outside of the agency's statutory authority. The district court agreed and set aside the regulation.Applying Chevron deference, the DC Circuit reversed and held that HHS's regulation rests on a reasonable interpretation of its statutory authority to adopt volume-control methods. In this case, Congress did not unambiguously forbid the agency from doing so and the agency reasonably read 42 U.S.C. 1395l(t)(2)(F) to allow a service specific, non-budget-neutral reimbursement cut in the circumstances the court considered here. View "American Hospital Assoc. v. Azar" on Justia Law

The Fifth Circuit reversed the Commission's decision affirming the application of OSHA's commercial diving safety regulations to the dives its staff members perform to feed animals housed at the Aquarium and to clean the facility's tanks. A majority of the Commission panel affirmed the ALJ's determination that feeding and cleaning dives did not fall within the "scientific diving" exemption to the commercial standard.The court held that the ALJ did not err in crediting the compliance officer's testimony about the Commercial Diving Operations (CDO) standard as lay opinion testimony; even if the compliance officer testified to some matters that fell outside the realm of lay opinion testimony, the admission of the testimony was harmless; and the Aquarium's witnesses were properly treated as lay witnesses. Under a plain reading of the entire definition of "scientific diving," as well as the regulation guidelines and regulatory history, the court held that the activities performed during the feeding and cleaning dives fall within the plain text of the exemption. In this case, the Aquarium has shown that feeding and cleaning dives are a necessary component of its scientific research. View "Houston Aquarium, Inc. v. Occupational Safety and Health Review Commission" on Justia Law

The Fifth Circuit denied a petition for review of the Commission's determination that Sanderson violated various regulations of the Department of Labor's Occupational Safety and Health Administration (OSHA).The court held that the ALJ's determination that the compressor cutouts and the emergency stops are subject to the mechanical integrity program was not an abuse of discretion or otherwise contrary to law; the ALJ's determination that Sanderson failed to rebut the presumption of exposure to a hazard was not an abuse of discretion or otherwise contrary to law; and the Secretary bore his burden with respect to all elements of a violation regarding Items 5a and 5b. View "Sanderson Farms, Inc. v. Occupational Safety and Health Review Commission" on Justia Law