Justia Government & Administrative Law Opinion Summaries

Kentucky and Arkansas residents sued the Secretary of Health and Human Services based on the approval under 42 U.S.C. 1315(a) of an “experimental, pilot, or demonstration projects which, in the judgment of the Secretary, is likely to assist in promoting the objectives” of Medicaid. The district court held that the Secretary failed to analyze whether the projects would promote the primary objective of Medicaid—to furnish medical assistance. Kentucky terminated its project and obtained voluntary dismissal.The D.C. Circuit affirmed with respect to the Arkansas Works program, which required beneficiaries aged 19-49 to “work or engage in specified educational, job training, or job search activities for at least 80 hours per month,” except beneficiaries who show they are medically frail or pregnant, caring for a dependent child under age six, participating in a substance treatment program, or are full-time students. Works proposed to eliminate retroactive coverage, to lower the income eligibility threshold from 133% to 100% of the federal poverty line, and eliminated using Medicaid funds to assist beneficiaries in paying the premiums for employer-provided health care coverage. Instead of analyzing whether the demonstration would promote the objective of providing coverage, the Secretary identified three alternative objectives. Congress has not conditioned the receipt of Medicaid benefits on fulfilling work requirements or taking steps to end receipt of governmental benefits View "Gresham v. Azar" on Justia Law

Central Mississippi Medical Center (CMMC) appealed a Chancery Court decision denying its appeal of a Division of Medicaid (DOM) hearing. The DOM had determined that CMMC owed it $1.226 million due to overpayment. The Mississippi Supreme Court recently decided a reimbursement dispute involving the DOM, Crossgates River Oaks Hosp. v. Miss. Div. of Medicaid, 240 So. 3d 385 (Miss. 2018). In Crossgates, the hospitals prevailed because the DOM had failed to adhere to the Medicare State Plan Agreement. Applying the same legal principles to this case, the Supreme Court ruled the DOM prevailed because the DOM adhered to the Plan. The chancellor found sufficient evidence to support the DOM’s decision, decreed that it was neither arbitrary nor capricious, and decreed that it did not exceed the DOM’s authority or violate any of CMMC’s statutory or constitutional rights. View "Central Mississippi Medical Center v. Mississippi Division of Medicaid" on Justia Law

Baystate filed suit against the Secretary, challenging his promulgation of a final rule calculating the wage index for hospital reimbursements in 2017. Baystate alleged that the Secretary failed to comply with the statutory requirement to calculate a wage index that reflected the actual wage levels in Massachusetts, relied on data that he knew to be false, and entirely failed to consider an important aspect of the problem.The DC Circuit affirmed the district court's grant of summary judgment for the Secretary, holding that the Secretary's interpretation of his authority under the Medicare statute was lawful and his action was not arbitrary and capricious. In this case, the Secretary provided a reasonable explanation for his decision to enforce the deadline and reject Nantucket's revised data; the decision to enforce the deadline against third-party hospitals was not arbitrary or capricious; and the Secretary's interpretation of his authority to enforce a deadline in calculating the wage index fell squarely within them. View "Baystate Franklin Medical Center v. Azar" on Justia Law

The DC Circuit denied a petition for review of the Commission's order finding that the company violated regulations promulgated by the Occupational Safety and Health Act (OSHA). In this case, the company had hired a construction contractor to remove steel beams from four shipping containers by crane. During unloading, the contractor crane operator touched an overhead power line with the crane, electrocuting three company employees and injuring others.The court held that the Commission adequately explained why it viewed the circumstances here as different from Sec'y of Labor v. Sasser Elec. & Mfg. Co., 11 O.S.H. Cas. (BNA) 2133, and more akin to Fabi Construction Co. v. Secretary of Labor, 508 F.3d 1077 (D.C. Cir. 2007). Unlike in Sasser, the Commission explained that this was the first time that the company had hired the contractor to perform crane work, so there was no history of safe crane practices in compliance with the Act upon which to base reasonable reliance. Furthermore, the Commission stated the potential duration of exposure to the violative condition was different. Therefore, the Commission's decision not to treat Sasser as dictating the outcome here was not arbitrary.The court also held that the Commission did not misapply the summary judgment standard, because there was no genuine dispute about the scope of the agreement between the company and the contractor, the foreseeability of the accident, and the "signaling" within OSHA regulation. View "Manua's, Inc. v. Scalia" on Justia Law

The Fifth Circuit affirmed HHS's decision that extrapolating the Medicare underpayment rate to all claims paid over the relevant time period resulted in a repayment demand of more than $12 million. The court held that the district court correctly rejected Palm Valley's due process claim; Palm Valley failed to exhaust its challenge to the "homebound" standard and thus the court could not consider the issue; substantial evidence supported HHS's determination that many beneficiaries were not homebound; and there was no error in the extrapolation methodology. View "Palm Valley Health Care, Inc. v. Azar" on Justia Law

Marques Davis was an inmate at the Hutchinson Correctional Facility (“HCF”) from June 2016 until his death in April 2017. During the course of his confinement, Davis suffered from constant neurological symptoms, the cause of which went untreated by HCF medical personnel. When he eventually died from Granulomatous Meningoencephalitis, Davis’s estate (“the Estate”) brought federal and state law claims against Corizon Health, Inc. and numerous health care professionals who interacted with Davis during his incarceration. One such medical professional, Dr. Sohaib Mohiuddin, filed a qualified-immunity-based motion to dismiss the Estate’s 42 U.S.C. 1983 claim. The district court denied the motion, concluding the complaint set out a clearly established violation of Davis’s right to be free from deliberate indifference to the need for serious medical care. Mohiuddin appealed, arguing the district court erred in determining the complaint’s conclusory and collective allegations stated a valid Eighth Amendment claim as to him. Upon de novo review, the Tenth Circuit concluded the complaint did not state a valid deliberate indifference claim as to Mohiuddin. Thus, it reversed the denial of Mohiuddin’s motion to dismiss and remanded the matter to the district court for further proceedings. View "Walker v. Corizon Health" on Justia Law

The Court of Appeal affirmed the trial court's grant of summary judgment for defendant, a managed care health plan that provides health coverage to low-income individuals under Medi-Cal.The court held that the legislative history of Welfare and Institutions Code section 14105.28, along with the statement of legislative intent within the statute itself, indicate that the Legislature intended the APR-DRG (All Patient Refined Diagnosis Related Group) rates to apply to out-of-network inpatient poststabilization services under Medi-Cal. Consistent with the legislature's intent, the court interpreted the phrase "managed care inpatient days" to refer to services provided pursuant to a managed care contract, that is, in-network services. View "Dignity Health v. Local Initiative Health Care Authority of Los Angeles County" on Justia Law

Among its reforms, the Patient Protection and Affordable Care Act (“ACA”) required private health insurers to provide coverage for individuals regardless of their gender or health status, including preexisting conditions. Congress anticipated these reforms might hamper the ability of insurers to predict health care costs and to price health insurance premiums as more individuals sought health insurance. To spread the risk of enrolling people who might need more health care than others, Congress established a risk adjustment program for the individual and small group health insurance markets. Congress tasked the Department of Health and Human Services (“HHS”) with designing and implementing this risk adjustment program with the states. HHS developed a formula to calculate how much each insurer would be charged or paid in each state. The formula relied on the “statewide average premium” to calculate charges and payments. Plaintiff-Appellee New Mexico Health Connections (“NMHC”), an insurer that was required to pay charges under the program, sued the HHS Defendants-Appellants under the Administrative Procedure Act (“APA”), alleging that HHS’s use of the statewide average premium to calculate charges and payments in New Mexico from 2014 through 2018 was arbitrary and capricious. The district court granted summary judgment to NMHC, holding that HHS violated the APA by failing to explain why the agency chose to use the statewide average premium in its program. It remanded to the agency and vacated the 2014, 2015, 2016, 2017, and 2018 rules that implemented the program. After the district court denied HHS’s motion to alter or amend judgment under Federal Rule of Civil Procedure 59(e), HHS appealed. The Tenth Circuit Court of Appeals: (1) determined NMHC’s claims regarding the 2017 and 2018 rules were moot, so the matter was remanded to the district court to vacate its judgment on those claims and dismiss them as moot; (2) reversed the district court’s grant of summary judgment to NMHC as to the 2014, 2015, and 2016 rules because it determined HHS acted reasonably in explaining why it used the statewide average premium in the formula. Because the Court reversed the district court on its summary judgment ruling in favor of NMHC, it did not address the denial of HHS’s Rule 59(e) motion. View "New Mexico Health Connections v. HHS" on Justia Law

This case involved Cobb Hospital, Inc.'s and Kennestone Hospital, Inc.'s (collectively, “Wellstar”) challenge to the decision by the Georgia Department of Community Health (“DCH”) to grant Emory University Hospital Smyrna (“Emory”) a new certificate of need (“CON”) to renovate a hospital that Emory had recently acquired. After DCH made an initial decision granting the CON, Wellstar appealed to the CON Appeal Panel. The panel’s hearing officer affirmed the decision, ruling that as a matter of law he could not consider Wellstar’s arguments regarding the validity of Emory’s existing CON, and that he would not allow Wellstar to present evidence related to those arguments. Wellstar then appealed the hearing officer’s decision to the DCH Commissioner, allegedly arguing among other things that the decision violated Wellstar’s constitutional right to due process. The Commissioner affirmed the hearing officer’s decision without ruling on the constitutional claim. In Division 2 of its opinion in this case, the Georgia Supreme Court determined the Court of Appeals erred by holding that the constitutional due process claim enumerated by Wellstar was not preserved for appellate review because it was not ruled on during the administrative proceeding that led to the filing of this case in the trial court. The Supreme Court thus granted Wellstar’s petition for a writ of certiorari to address that issue, reversed the Court of Appeals’s opinion, and remanded for that court to reconsider Wellstar’s constitutional claim. View "Cobb Hospital v. Department of Community Health et al." on Justia Law

Mandamus petitions before the Alabama Supreme Court presented a question of whether the Cherokee Circuit Court and the Etowah Circuit Court (collectively, "the trial courts") could properly exercise personal jurisdiction over the petitioners, out-of-state companies (collectively, the defendants) in actions filed against them by the Water Works and Sewer Board of the Town of Centre ("Centre Water") and the Water Works and Sewer Board of the City of Gadsden ("Gadsden Water"). Centre Water and Gadsden Water alleged the defendants discharged toxic chemicals into industrial wastewater from their plants in Georgia, which subsequently contaminated Centre Water's and Gadsden Water's downstream water sources in Alabama. After moving unsuccessfully in the trial courts to have the actions against them dismissed, the defendants filed petitions for writs of mandamus seeking orders from the Alabama Supreme Court directing the trial courts to dismiss the actions against them based on a lack of personal jurisdiction. The Supreme Court consolidated all the petitions for the purpose of issuing one opinion. Because Indian Summer, Kaleen, and Milliken made a prima facie showing that the trial courts lacked specific personal jurisdiction and Centre Water and Gadsden Water failed to produce any evidence to contradict that showing, the trial courts should have granted their motions to dismiss. Indian Summer, Kaleen, and Milliken have, therefore, demonstrated a clear legal right to the relief sought –- dismissal of Gadsden Water's and Centre Water's complaints against them –- and the petitions for a writ of mandamus in case nos. 1170887, 1171197, and 1171199 were granted. The Supreme Court concluded the trial courts could exercise specific personal jurisdiction over the remaining defendants, and that the remaining defendants did not demonstrated a clear legal right to relief at this stage. View "Ex parte Kaleen Rugs, Inc." on Justia Law