Justia Government & Administrative Law Opinion Summaries

In this case requiring the Supreme Court to determine the scope of the authority of the Wisconsin Department of Health Services (DHS) to recoup payments made to Medicaid service providers the Supreme Court held that DHS does not have the authority to enforce its recoupment policy.Plaintiffs, Kathleen Papa and Professional Homecare Providers, Inc. (collectively, PHP), challenged DHS's recoupment policy as it had been enforced against PHP nurses to recover payments made for services they provided to Medicaid patients. PHP claimed that DHS recoups payments nurses earned and received for their Medicaid services because the nurses' supporting records contained documentation shortcomings. The Supreme Court held (1) DHS may recoup Medicaid payments from service providers only in cases where DHS cannot verify certain facts; and (2) DHS's recoupment policy exceeds its authority. View "Papa v. Wisconsin Department of Health Services" on Justia Law

The Patient Protection and Affordable Care Act of 2010 (ACA) requires covered employers to provide women with “preventive care and screenings” without cost-sharing requirements and relies on Preventive Care Guidelines “supported by the Health Resources and Services Administration” (HRSA) to define “preventive care and screenings,” 42 U.S.C. 300gg–13(a)(4). Those Guidelines mandate that health plans cover all FDA-approved contraceptive methods. When the Federal Departments incorporated the Guidelines, they gave HRSA the discretion to exempt religious employers from providing contraceptive coverage. Later, the Departments promulgated a rule accommodating qualifying religious organizations, allowing them to opt out of coverage by self-certifying that they met certain criteria to their health insurance issuer, which would then exclude contraceptive coverage from the employer’s plan and provide participants with separate payments for contraceptive services without any cost-sharing requirements.In its 2014 “Hobby Lobby” decision, the Supreme Court held that the contraceptive mandate substantially burdened the free exercise of closely-held corporations with sincerely held religious objections. In a later decision, the Court remanded challenges to the self-certification accommodation so that the parties could develop an approach that would accommodate employers’ concerns while providing women full and equal coverage.The Departments then promulgated interim final rules. One significantly expanded the church exemption to include an employer that objects, based on its sincerely held religious beliefs, to coverage or payments for contraceptive services. Another created an exemption for employers with sincerely held moral objections to providing contraceptive coverage. The Third Circuit affirmed a preliminary nationwide injunction against the implementation of the rules.The Supreme Court reversed. The Departments had the authority under the ACA to promulgate the exemptions. Section 300gg–13(a)(4) states that group health plans must provide preventive care and screenings “as provided for” in comprehensive guidelines, granting HRSA sweeping authority to define that preventive care and to create exemptions from its Guidelines. Concerns that the exemptions thwart Congress’ intent by making it significantly harder for women to obtain seamless access to contraception without cost-sharing cannot justify supplanting that plain meaning. “It is clear ... that the contraceptive mandate is capable of violating the Religious Freedom Restoration Act.” The rules promulgating the exemptions are free from procedural defects. View "Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania" on Justia Law

The Supreme Court reversed the decision of the court of appeals affirming the order of the district court that non-homestead life estates should not be included in Marvin Schmalz's assets, holding that the term "individual" in Minn. Stat. 256B.056, subd. 4a applies only to the applicant for medical assistance.Esther Schmalz was living at a long-term-care facility when she submitted an application for medical assistance for long-term-care benefits. As part of the assessment of her husband Marvin's assets, Renville County Human Services (RCHS) included Marvin's portion of several non-homestead life estate interests that he and Esther owned. Esther appealed, arguing that the life estates should not be included in the total amount of assets that Marvin may retain. The human services judge concluded that RCHS properly denied Esther's application for medical assistance based on the inclusion of the life estate assets owned by Marvin. The Commissioner of Minnesota Department of Human Services adopted the human services judge's recommendation. The district court concluded that the non-homestead life estates should not be included in Marvin's assets, ruling that the term "individual" in section 256B.056, subd. 4a included Marvin. The Supreme Court reversed, holding that an "individual" in the statute refers to the medical assistance applicant and not a community spouse. View "In re Schmalz" on Justia Law

On March 6, 2020, in response to the COVID-19 pandemic, Pennsylvania Governor Tom Wolf issued a Proclamation of Disaster Emergency (“Proclamation”) pursuant to 35 Pa.C.S. 7301(c), a provision of the Emergency Management Services Code. This Proclamation activated many emergency resources. Days later, the Governor issued an order closing businesses that were not considered life-sustaining. Four Pennsylvania businesses and one individual challenged the Governor's Order, alleging that it violated the Emergency Management Services Code and various constitutional provisions. On April 13, 2020, in an exercise of its King’s Bench jurisdiction, the Pennsylvania Supreme Court ruled that the Governor’s order complied with both the statute and Commonwealth Constitution. On June 3, 2020, the Governor renewed the Proclamation for an additional ninety days. June 9, 2020, the Pennsylvania House of Representatives adopted a concurrent resolution to order the Governor to terminate the disaster emergency. The matter reached a loggerhead and went again before the Supreme Court. The Court issued an opinion stating "we find it necessary to make clear what this Court is, and is not, deciding in this case. We express no opinion as to whether the Governor’s response to the COVID-19 pandemic constitutes wise or sound policy. Similarly, we do not opine as to whether the General Assembly, in seeking to limit or terminate the Governor’s exercise of emergency authority, presents a superior approach for advancing the welfare of our Commonwealth’s residents." Instead, the Court decided here a narrow legal question: whether the Pennsylvania Constitution and the Emergency Services Management Code permitted the General Assembly to terminate the Governor’s Proclamation of Disaster Emergency by passing a concurrent resolution, without presenting that resolution to the Governor for his approval or veto. To this, the Supreme Court responded "no": "because the General Assembly intended that H.R. 836 terminate the Governor’s declaration of disaster emergency without the necessity of presenting that resolution to the Governor for his approval or veto, we hold, pursuant to our power under the Declaratory Judgments Act, that H.R. 836 is a legal nullity." View "Wolf v. Scarnati" on Justia Law

The Supreme Court affirmed the judgment of the circuit court declaring section 11.800 of House Bill No. 2011 (HB2011) invalid, holding that there was a direct conflict between the language of Mo. Rev. Stat. 208.153.2 and 208.152.1(6), (12) requiring the MO HealthNet Division of the Missouri Department of Social Services to pay its authorized providers for covered physicians' services and family planning provided to Medicaid-eligible individuals and the language of section 11.800 prohibiting MO HealthNet from doing so.Planned Parenthood of the St. Louis Region and Reproductive Health Services of Planned Parenthood (Planned Parenthood) was an authorized provider of physicians' services and family planning because it had an agreement with MO HealthNet to do so. MO HealthNet informed Planned Parenthood that it could not reimburse Planned Parenthood for those services during the fiscal year 2019 due to section 11.800, which stated that "No funds shall be expended to any abortion facility...." The circuit court concluded that section 11.800 of HB2011 violated Mo. Const. Art. III, 23 because it amended substantive law. The Supreme Court affirmed, holding (1) section 11.800 was invalid because article III, section 23 prohibits using an appropriation bill to amend a substantive statute; and (2) the circuit court properly severed that provision from the remainder of HB2011. View "Planned Parenthood of St. Louis Region v. Department of Social Services, Division of Medical Services" on Justia Law

The Supreme Court held that equitable tolling can lessen the otherwise strict time limit on the availability of writs of administrative mandate under Cal. Gov't Code 11523.The State Department of Public Health (the Department) imposed a fine on Saint Francis Memorial Hospital when it learned that doctors left a surgical sponge in a patient during a surgery. The Department later denied Saint Francis's request for reconsideration. Eleven days after the Department denied reconsideration but forty-one days after being served with the Department's final decision Saint Francis filed a petition for a writ of administrative mandate.The Department demurred on the ground that the petition was untimely under section 11523. The superior court sustained the Department's demurrer, reasoning that Saint Francis's petition was time-barred and that Saint Francis's mistake about the availability of reconsideration was not a sufficient basis to excuse a late filing. The court of appeal affirmed. The Supreme Court vacated the court of appeal's judgment, holding (1) equitable tolling may apply to petitions filed under section 11523; and (2) because the court of appeal didn't address equitable tolling's third element, the case is remanded for further proceedings. View "Saint Francis Memorial Hospital v. State Department of Public Health" on Justia Law

In section 901 of the Family Smoking Prevention and Tobacco Control Act (TCA), Congress authorized the Secretary of Health and Human Services to determine which other products should be governed by the TCA's regulatory scheme. Plaintiffs filed suit against the FDA, its Commissioner, and the Secretary, asserting that Congress's delegation to the Secretary was unconstitutional.The Fifth Circuit affirmed the district court's dismissal of the complaint, holding that section 901's delegation to the Secretary does not violate the nondelegation doctrine. The court held that Congress undeniably delineated its general policy in the TCA; Congress plainly limited the authority that it delegated; and the relevant caselaw supports these conclusions. View "Big Time Vapes, Inc. v. FDA" on Justia Law

General’s clinicians perform services in long-term care facilities. General bills Medicare under 42 U.S.C. 1395. A Centers for Medicare and Medicaid Services (CMS) contractor, AdvanceMed, initiated audits in 2002 after the CMS fraud unit received complaints about General’s billing practices. In 2004 AdvanceMed initiated an audit of General’s physicians without providing any notice to General. AdvanceMed sent records requests to physicians at 12 General facilities, covering 382 claims involving 278 patients in 2002-2004. General was not notified of these requests. AdvanceMed did not request any records from General. AdvanceMed determined that 35 of the 382 claims were allowed as billed; 33 claims were allowed at different levels than billed. The remaining 314 claims were denied: 3 did not meet policy guidelines, 73 had no documentation to support the services, and 238 were medically unnecessary.General learned of this audit when it received a letter in 2007, indicating that General had been overpaid by $16,778.80; the overpayment was extrapolated to a universe of 41,818 claims. The total amount of overpayment demanded was $1,836,646.56. The Appeals Council determined and the Sixth Circuit affirmed that no remedy should be granted because the lack of notice was inconsequential and did not prevent General from ably and thoroughly arguing the principal issues resulting from the audit, the validity of the sampling methodology, and the coverage of the reviewed claims. The addition of more medical records would not have materially impacted its findings. View "General Medicine, P.C. v. Azar" on Justia Law

Objector, a conservatee subject to conservatorship under the Lanterman-Petris-Short Act, contested the petition to reappoint a public guardian as his conservator. On appeal, objector contends the trial court violated Welfare and Institutions Code section 5350, subdivision (d)(2), and denied him due process by failing to commence the jury trial within 10 days of his demand for trial.The Court of Appeal was deeply troubled by the significant delay of over four months in holding a trial on objector's petition, especially given the lack of any justification by the court for most of the delay. The court emphasized the statutory obligation of trial courts to hold a jury trial within 10 days, with only a limited exception for a 15-day continuance if requested by the proposed conservatee. However, the court held that the trial court's failure to commence trial within 10 days of the jury trial demand did not support dismissal of the petition. Rather, the time limit in section 5350, subdivision (d)(2), is directory, not mandatory, because the Legislature has not expressly provided for dismissal of the conservatorship petition if a trial is not held within 10 days. Furthermore, objector was not prejudiced and denied due process. Accordingly, the court affirmed the judgment. View "Conservatorship of Jose B." on Justia Law

At issue before the Pennsylvania Supreme Court was a challenge to a local judicial district’s policy prohibiting the use of medical marijuana by individuals under court supervision, such as probationers. Relevant here, the applicable statutory authority, the Pennsylvania Medical Marijuana Act, contained an immunity provision protecting patients from government sanctions. In September 2019, the 52nd Judicial District -- comprised of the Lebanon County Court of Common Pleas (the “District”) -- announced a “Medical Marijuana Policy” under the issuing authority of the president judge. The Policy prohibited “the active use of medical marijuana, regardless of whether the defendant has a medical marijuana card, while the defendant is under supervision by the Lebanon County Probation Services Department.” Petitioners were individuals under the supervision of the Lebanon County probation agency who filed suit in the Commonwealth Court's original jurisdiction to challenge the validity of the Policy in light of the MMA's immunity provision. Separately, Petitioners filed an application for special relief in the nature of a preliminary injunction. Soon thereafter, the Commonwealth Court proceeded, sua sponte, to transfer the case to this Court, concluding that it lacked jurisdiction to grant the requested relief. The District then filed its response in this Court opposing preliminary injunctive relief. It claimed, among other things, that Petitioners were unlikely to prevail on the merits, arguing, inter alia, that the General Assembly didn’t intend the MMA to override the courts’ ability to supervise probationers and parolees. After review, the Pennsylvania Supreme Court granted Petitioners' request for declaratory and injunctive relief. The Policy was deemed to be contrary to the immunity accorded by the MMA, and as such, should not be enforced. "[N]othing impedes a revocation hearing or other lawful form of redress, where there is reasonable cause to believe that a probationer or other person under court supervision has possessed or used marijuana in a manner that has not been made lawful by the enactment." View "Gass et al. v. 52nd Judicial District" on Justia Law