Justia Government & Administrative Law Opinion Summaries

Connor J. was living at a shelter for homeless youth, when his psychiatric condition allegedly began to deteriorate. A social worker filed a petition in superior court seeking authority to hospitalize Connor for evaluation. The petition noted Connor had a history of suicidal thoughts; that he had been diagnosed at various times with depression, anxiety, post-traumatic stress disorder, and oppositional defiant disorder; and that he had been treated for mental illness in the past at a hospital and several counseling centers. Connor was transported to Alaska Psychiatric Institute (API) for an evaluation. A few days later API filed a petition for 30-day commitment and a proceedings were initiated that lead to his commitment. The superior court issued a 30-day involuntary commitment order after finding that Connor was "gravely disabled" and there were no less restrictive alternatives to hospitalization. The respondent appealed, arguing that it was plain error to find he waived his statutory right to be present at the commitment hearing, that it was clear error to find there were no less restrictive alternatives, and that the commitment order should be amended to omit a finding that he posed a danger to others, a finding the superior court meant to reject. The Alaska Supreme Court concluded it was not plain error to find that the respondent waived his presence at the hearing. We further conclude that it was not clear error to find that there were no less restrictive alternatives to a 30-day hospital commitment. However, because there was no dispute that the “danger to others” finding should not have been included in the commitment order, the case was remanded for issuance of a corrected order. View "In Re Hospitalization of Connor J." on Justia Law

Hospitals challenged the method the Secretary used to calculate the volume-decrease adjustment (VDA) for certain fiscal years during the mid-2000s, as well as the Administrator's classification of certain costs as variable costs when calculating the adjustment.The Eighth Circuit affirmed the district court's decision to uphold the Secretary's actions and held that the Secretary's interpretation of the relevant regulations was a reasonable interpretation of the plain language of the Medicare statute. Given the lack of guidance in the statute and the substantial deference the court affords to the agency, the Secretary's decision reasonably complied with the mandate to provide full compensation. That the Secretary has prospectively adopted a new interpretation was not a sufficient reason to find the Secretary's prior interpretation arbitrary or capricious. The court also held that the Secretary's interpretation of the relevant regulations in these cases was clearly consistent with their text, and the costs at issue were reasonably classified as variable costs. View "Unity HealthCare v. Azar" on Justia Law

The Fifth Circuit affirmed the district court's grant of summary judgment to HHS in an action under the Administrative Procedure Act arising from a demonstration project deviating from the ordinary Medicare reimbursement rules. In this case Texas Tech could keep the additional fees it received for implementing the project only if its care management model achieved cost savings. When the government determined that Texas Tech failed to do so, it demanded return of about $8 million in fees.As a preliminary matter, the court held that the demonstration agreement was not a procurement contract and the HHS Departmental Appeals Board had jurisdiction over this case. On the merits, the court held that it need not resolve whether the Board erred in suggesting that the common law of contracts never informs grant disputes, because, even if it did, the Board made valid findings justifying the rejection of Texas Tech's various contract theories. The court rejected Texas Tech's contention that CMS breached the demonstration agreement by failing to provide an appropriately matched control group; by refusing to allow Texas Tech to access relevant Medicare claims data; and by engaging RTI to evaluate whether differences between the intervention and control groups may have accounted for the apparent lack of cost savings. Finally, the court held that, although the Board did not expressly address two common law contract doctrines -- mistake and impracticability -- it did make findings that doom those two defenses. View "Texas Tech Physicians Assoc. v. US Department of Health and Human Services." on Justia Law

Petitioner Andrew Panaggio appealed a decision of the New Hampshire Compensation Appeals Board (board). Petitioner suffered a work-related injury to his lower back in 1991; a permanent impairment award was approved in 1996 and in 1997, he received a lump sum settlement. Petitioner continued to suffer ongoing pain as a result of his injury and has experienced negative side effects from taking prescribed opiates. In 2016, the New Hampshire Department of Health and Human Services determined that Panaggio qualified as a patient in the therapeutic cannabis program, and issued him a New Hampshire cannabis registry identification card. Panaggio purchased medical marijuana and submitted his receipt to the workers’ compensation insurance carrier for reimbursement. The respondent-carrier, CNA Insurance Company, denied payment on the ground that “medical marijuana is not reasonable/necessary or causally related” to his injury. The board denied his request for reimbursement from the respondent.On appeal, Panaggio argued the board erred in its interpretation of RSA 126-X:3, III, and when it based its decision in part on the fact that possession of marijuana is illegal under federal law. The New Hampshire Supreme Court reversed in part and remanded for further proceedings. Specifically, the Court determined that because the board found that Panaggio’s use of medical marijuana was reasonable, medically necessary, and causally related to his work injury, the board erred when it determined the insurance carrier was prohibited from reimbursing Panaggio for the costs of purchasing medical marijuana. The Court determined that because the board’s order failed to sufficiently articulate the law that supported the board’s legal conclusion and failed to provide an adequate explanation of its reasoning regarding federal law, it was impossible for the Court to discern the grounds for the board’s decision sufficient for it to conduct meaningful review. Accordingly, the case was remanded to the board for a determination of these issues in the first instance. View "Appeal of Panaggio" on Justia Law

In 2016, St. Luke’s Health System, Ltd. accepted an indigent patient suffering from meningitis, seizures, and brain lesions. The patient was ready for transfer to another medical facility by February 18, 2016, but was refused by multiple care providers because they did not want to admit an indigent patient without a payor source. St. Luke’s finally contracted with Life Care, another medical facility, to take the patient on the condition that St. Luke’s would guarantee payment for a thirty day period. The patient was transferred to Life Care on March 9, 2016. St. Luke’s applied for medical indigency benefits covering the period of time from the patient’s initial hospitalization until she was transferred to the Life Care facility. Gem County initially approved the application for benefits through February 3, 2016. St. Luke’s appealed that determination, and after a hearing, the Board approved medical indigency benefits from January 26, 2016, until February 18, 2016. The Board entered a written determination titled “Amended Determination of Approval for County Assistance” which set forth the various bills that were approved for payment, but did not in any way reflect the denial of benefits or the reasoning of the Board. St. Luke’s then sought judicial review of the Amended Determination before the district court, which affirmed the Board’s decision. St. Luke’s appealed. The Idaho Supreme Court vacated the Board’s Amended Determination because it did not reflect the partial denial of benefits and because there were no findings of fact or conclusions of law setting forth the basis for the Board’s denial. View "St. Lukes v. Bd of Commissioners of Gem Co" on Justia Law

The Court of Appeals held that N.Y. Mental Hyg. Law 33.13, which protects the confidentiality of the clinical records of patients and clients as maintained by facilities licensed or operated by the Office of Mental Health or the Office for People with Developmental Disabilities, does not require automatic sealing of the entire court record of all proceedings involving insanity acquittees who have dangerous mental disorders within the meaning of N.Y. Crim. Proc. Law (CPL) 330.20.Defendant, an insanity acquittee, was found to have a dangerous mental disorder as defined by CPL 330.20(1)(c) and was committed to the custody of the Commissioner for the Office for People with Developmental Disabilities. Supreme Court denied Defendant’s motion to seal the entire court record in his case, finding that the documents related to the legal proceedings rather than Defendant’s treatment. The Appellate Division modified. The Court of Appeals affirmed, holding that the legislature provided no automatic sealing requirement of an entire court record in either CPL 330.20 or the Mental Hygiene Law for an insanity acquittee, and Defendant cited no authority for such an obligation. View "In re James Q." on Justia Law

A 2014 statute and 2013 regulation re-defined which abortions qualified as “medically necessary” for the purposes of Medicaid funding. The statute defined medically necessary abortions as those that “must be performed to avoid a threat of serious risk to the life or physical health of a woman from continuation of the woman’s pregnancy” as a result of a number of listed medical conditions; the regulation was similarly restrictive. Planned Parenthood of the Great Northwest challenged both the statute and regulation as unconstitutional, and the superior court held that both measures violated the equal protection clause of the Alaska Constitution. The court reasoned that these measures imposed a “high-risk, high- hazard” standard on abortion funding unique among Medicaid services, and held that our 2001 decision striking down an earlier abortion funding restriction on equal protection grounds compelled the same result. The State appealed, arguing that the statute and regulation should be interpreted more leniently and therefore do not violate the Alaska Constitution’s equal protection clause. The Alaska Supreme Court affirmed the superior court’s decision: the statute’s and the regulation’s facially different treatment of pregnant women based upon their exercise of reproductive choice required the Court to apply strict scrutiny, and the proposed justifications for the funding restrictions "did not withstand such exacting examination." View "Alaska v. Planned Parenthood of the Great Northwest" on Justia Law

Provider Plaintiffs and Individual Plaintiffs filed suit seeking a preliminary injunction against the OIG's decision to terminate the Medicaid provider agreements to Planned Parenthood affiliates throughout the state. The district court held that the Individual Plaintiffs possessed a private right of action under the "qualified-provider" provision of the Medicaid Act and issued a preliminary injunction.The Fifth Circuit held that the district court erred in evaluating the evidence de novo, rather than under the arbitrary and capricious standard, and in applying the reasoning in Planned Parenthood Gulf Coast v. Gee, 862 F.3d 445 (5th Cir. 2017), to its determination of a "qualified" provider in this context. Therefore, the district court erred legally and plaintiffs were unlikely to show a likelihood of success on the merits of their claim. Accordingly, the court vacated the preliminary injunction and remanded for the district court to limit its review to the agency record under an arbitrary-and-capricious standard. View "Planned Parenthood of Greater Texas Family Planning and Preventative Health Services v. Smith" on Justia Law

Two separate appeals from involuntary commitment orders, brought by two appellants, one of whom also appealed a related involuntary medication order were consolidated for the Alaska Supreme Court's review. The challenged orders expired while the respective appeals were pending; the issue each case presented centered on whether the Supreme Court should revisit its mootness jurisprudence in involuntary commitment and involuntary medication appeals. The Court held that all appeals of involuntary admissions for treatment and involuntary medication were categorically exempt from the mootness doctrine. After reviewing each case on its merits and finding no error in the orders appealed, the Court affirmed in each case. View "In Re Hospitalization of Naomi B." on Justia Law

Ashlee Oldham and Robert Prunckun (collectively, “Recipients”) were the only two Delaware Medicaid recipients housed at Judge Rotenberg Center (“JRC”), a facility in Massachusetts and the only facility in the United States known to use electric shock therapy as part of their comprehensive behavioral treatment plans. These services were covered by Medicaid with the knowledge and approval of Delaware’s Department of Health and Social Services (“DHSS”). in 2012, the Center for Medicare and Medicaid Services (“CMS”) advised the Massachusetts state agency responsible for Medicaid administration that continued use of electric shock therapy would place that state’s waiver program in jeopardy of losing federal funding. Following CMS’s letter to Massachusetts, Delaware took measures to avoid placing its own Home and Community Based Services (“HCBS”) waiver program at risk. DHSS finally terminated JRC as a qualified provider after JRC refused to cease using electric shock therapy. Although the procedural history was complex, the gist of Appellants’ challenge on appeal to the Delaware Supreme Court was that they were denied due process because Delaware’s administrative hearing officer bifurcated proceedings to address what she concluded was a threshold issue, namely, whether electric shock therapy was a covered Medicaid service under the Medicaid HCBS Waiver program. Instead, Recipients contended they should have been allowed to introduce evidence that electric shock therapy was medically necessary, and that by removing shock services, DHSS threatened Recipients’ ability to remain in a community-based setting (a conclusion they desired to prove through evidence and expert testimony). The Supreme Court determined the hearing officer's determination that electric shock therapy was not a covered service under federal and state law was supported by substantial evidence and free from legal error, and affirmed the district court. View "Prunckun v. Delaware Dept. of Health & Social Services" on Justia Law