Justia Government & Administrative Law Opinion Summaries

The Second Circuit affirmed the district court's grant of a permanent injunction enjoining the government from continuing to apply the requirement that government funds assisting plaintiffs' efforts to fight HIV/AIDS abroad could not be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.In Agency for Int'l Dev. v. Alliance for Open Soc. Int'l, Inc., 570 U.S. 205 (2013), the Supreme Court concluded that the requirement compelled speech in violation of the First Amendment. Applying the Supreme Court's reasoning in AOSI to this case, the court held that the speech of a recipient who rejects the government's message was unconstitutionally restricted when it has an affiliate who is forced to speak the government's contrasting message. The court rejected the remaining claims and held that the district court did not abuse its discretion. View "Alliance for Open Society International v. United States Agency for International Development" on Justia Law

Plaintiffs are four parents and their children residing throughout California and a California nonprofit corporation, A Voice for Choice, Inc. This case rose constitutional challenges to Senate Bill No. 277, which repealed the personal belief exemption to California’s immunization requirements for children attending public and private educational and child care facilities. Plaintiffs sued claiming Senate Bill No. 277 violated their rights under California’s Constitution to substantive due process, privacy, and a public education. The trial court sustained the defendants’ demurrer to plaintiffs’ complaint without leave to amend and plaintiffs appealed. On appeal, plaintiffs also raised an additional argument that Senate Bill No. 277 violated their constitutional right to free exercise of religion, although they did not allege a separate cause of action on that basis in their complaint. The Court of Appeal found "[p]laintiffs' arguments are strong on hyperbole and scant on authority." Finding no violation of plaintiffs' constitutional rights, the Court of Appeal affirmed the trial court. View "Love v. California Dept. of Education" on Justia Law

In 2006, the Washington legislature enacted legislation establishing a state health technology assessment program. Part of that legislation formed the Health Technology Clinical Committee ("HTCC") as an independent committee to judge selected medical technology and procedures by their safety, efficacy, cost-effectiveness, and health outcomes. In 2010, the HTCC began its review of a controversial procedure - femoroacetabular impingement (FAI) syndrome hip surgery. Michael Murray sustained a hip injury while at work in August 2009. L&I allowed his claim and provided medical treatment. Murray's physician, Dr. James Bruckner, asked the Washington Department of Labor and Industries ("L&I") to authorize surgery regarding Murray's hip condition, FAI syndrome. L&I denied payment for FAI surgery because the HTCC disallowed coverage for that procedure. Dr. Bruckner performed the surgery on Murray without authorization from L&I. The FAI surgery purportedly successfully rehabilitated Murray's hip injury. Murray appealed L&I's decision denying payment for the surgery to the Board of Industrial Insurance Appeals (Board or BIIA), which affirmed L&I. Murray appealed to the superior court, which affirmed the Board. Murray appealed to the Court of Appeals, which affirmed the superior court. Murray then petitioned the Washington Supreme Court, which reversed. The Supreme Court "harmonized" the HTCC legislation with the Industrial Insurance Act, and in doing so, determined that applying L&I's Medical Aid Rules, HTCC determinations were one of several sources of information L&I used to make medical coverage decisions. "While HTCC determinations are given considerable weight, the Medical Aid Rules do not afford such determinations preclusive effect. Under Medical Aid Rules, L&I, not the HTCC, remains responsible for medical treatment coverage decisions. Accordingly, such Department medical coverage decisions are then subject to review before the BIIA and in superior court, pursuant to chapter 51.52 RCW." Murray's reimbursement claim to L&I was remanded for further proceedings. View "Murray v. Dep't of Labor & Indus." on Justia Law

The Supreme Court reversed the judgment of the district court upholding the decision of the Department of Health for Medicaid, holding that the Department did not act in accordance with law when it denied Lucile Anderson’s application to have her sons’ payment of her attorney fees treated as a return of assets.The Department found Anderson eligible for nursing home benefits but suspended her eligibility as a penalty for her transfer of assets at below fair market value. Anderson’s sons paid the attorney fees and costs Anderson incurred in her unsuccessful appeal, and Anderson applied to have that payment treated as a return of assets, which would shorten the penalty period. The Department denied the application. The district court affirmed the Department’s decision. The Supreme Court reversed, holding that the Department erred in denying Anderson’s application because the Department’s Medicaid rules did not, as a matter of law, preclude the payment of Anderson’s attorney fees from being treated as a return of assets. View "Anderson v. State ex rel. Department of Health" on Justia Law

In 2015, the California Governor issued a proclamation convening a special session of the Legislature for certain specified purposes, including to “[i]mprove the efficiency and efficacy of the health care system, reduce the cost of providing health care services, and improve the health of Californians.” Pertinent to this appeal, the Legislature enacted the End of Life Option act, which legalized physician-assisted suicide for the terminally ill. During a special session, the Legislature passed the Act. Plaintiffs were five individual physicians along with a professional organization that promoted ethical standards in the medical profession (collectively the Ahn parties), who asserted causes of action for violations of due process, of equal protection, and of California constitutional limitations on the power of the Legislature to act in special session. In February 2018, the Ahn parties filed a motion for judgment on the pleadings. After hearing argument, the trial court ruled that it would grant the motion, without leave to amend. On May 24, 2018, the trial court entered judgment in favor of the Ahn parties, and enjoined enforcement of the Act. Days later, three nonparties5 (collectively the Fairchild parties) filed an ex parte application to vacate the judgment, which was denied. The State filed a petition for writ of mandate to the Court of Appeal along with a request for an immediate stay. The Court granted a temporary stay, during which the Fairchild parties filed an appeal of the judgment, contending that, as a result of the denial of their ex parte application to vacate the judgment, they had standing to appeal and, in that appeal, to challenge the judgment on the merits. The Ahn parties disputed this. The issue this case presented for the Court of Appeal’s review was not whether the Fairchild parties are parties to the appeal, but only whether they were parties to this writ proceeding. Admittedly, the State’s writ petition did not name the Fairchild parties, nor did the Fairchild parties formally move to intervene. “However, a person can become a party to an action, even if not named in the complaint, by appearing and participating without any objection by the other parties. We see no reason why this principle should not also apply to a writ proceeding. This is not to say that they are necessarily proper parties.” The Court ultimately concluded the Ahn parties lacked standing on any of the theories they asserted in this appeal. The Court was unclear whether, on remand, they would be able to amend their complaint so as to allege standing, whether the trial court will grant them leave to do so, or whether they will be able to prove up their amended allegations. “It is possible (though by no means certain) that we will see this case again; if so, however, at least we will be sure that the constitutional issue is properly presented.” The Court issued a writ of mandate to direct the superior court to vacate its order granting the motion for judgment on the pleadings and to vacate the judgment. View "California v. Superior Court (Ahn)" on Justia Law

The Tennessee Hospital Association and three hospitals sued, challenging efforts by the Centers for Medicare and Medicaid Services (CMS) to direct states to recoup certain reimbursements made under the Medicaid program. The hospitals serve a disproportionate share of Medicaid-eligible patients and are thereby entitled to supplemental payments under the Medicaid Act, (DSH payments), 42 U.S.C. 1396a(a)(13)(A)(iv); 1396r-4(b). The Act limits the amount of DSH payments each hospital can receive in a given year. CMS contends that the hospitals miscalculated their DSH payment-adjustments for fiscal year 2012 and received extra payments. Plaintiffs argued, and the district court agreed, that CMS’s approach to calculating DSH payment adjustments is inconsistent with the Act and the regulations that CMS implemented in 2008. The Sixth Circuit affirmed, agreeing that CMS’s policy is inconsistent with its 2008 rule and cannot be enforced unless it is promulgated pursuant to notice-and-comment rulemaking. The court disagreed with the district court’s conclusion that CMS’s policy exceeds the agency’s authority under the Medicaid Act. CMS’s payment-deduction policy is a reasonable interpretation of an ambiguous section of the Act but is not a valid interpretative rule. CMS attempted to exercise its delegated discretion to “determine[]” the “costs incurred” in serving Medicaid-eligible patients—precisely the sort of agency action that requires notice-and-comment rulemaking. View "Tennessee Hospital Association v. Azar" on Justia Law

The Pennsylvania Office of the Attorney General (OAG), on behalf of the Commonwealth, filed suit against more than two dozen nursing homes and their parent companies (collectively, “Appellees”), alleging violations of the Unfair Trade Practices and Consumer Protection Law, (“UTPCPL”), and unjust enrichment. After consideration of Appellees’ preliminary objections, the Commonwealth Court dismissed the claims and this appealed followed. After its review, the Pennsylvania Supreme Court found the dismissal of the UTPCPL claims was improper, but the dismissal of the unjust enrichment claim was proper because the claim was filed prematurely. Accordingly, the Court reversed the Commonwealth Court’s order and remanded for further proceedings. View "Commonwealth, AG Shapiro v. GGNSC LLC, et al" on Justia Law

At issue in this appeal before the Pennsylvania Supreme Court was the "breadth of gubernatorial power" concerning home health care services, and whether Pennsylvania Governor Thomas Wolf's executive order (2015-05) was an impermissible exercise of his authority. The Order focused on the in-home personal (non-medical) services provided by direct care workers (“DCW”) to elderly and disabled residents who receive benefits in the form of DCW services in their home rather than institutional settings (“participants”), pursuant to the Attendant Care Services Act (“Act 150”). After careful consideration of the Order, the Supreme Court concluded Governor Wolf did not exceed his constitutional powers. Thus, the Court vacated the Commonwealth Court’s order, and remanded for additional proceedings. View "Markham, et al v. Wolf" on Justia Law

The Eighth Circuit affirmed the district court's partial grant of summary judgment for Children's Hospitals and decision to vacate a Medicaid policy, Frequently Asked Question 33, which explained how to calculate a hospital's uncompensated medical care costs. The court held that by imposing new reporting requirements for private insurance payments, Question 33 expanded the footprint of 42 C.F.R. 447.299 and thus constituted a substantive change in the regulation. The court explained that section 447.299 has specific language explicitly stating what payments must be deducted from each hospital's "total cost of care," and the Secretary's own definition of "uncompensated care costs" did not include private insurance payments. The court declined to read substantive changes into the regulation under the guise of interpretation. Furthermore, the court joined the First and Fourth Circuits in concluding that Question 33 was a legislative rule that was not adopted in accordance with the procedure required by law and thus must be set aside, notwithstanding the Secretary's policy arguments to the contrary. View "Children's Health Care v. Centers for Medicare and Medicaid Services" on Justia Law

Hospitals challenged the methodology that the Department used to calculate the "outlier payment" component of their Medicare reimbursements for 2008, 2009, 2010, and 2011. At issue was whether the Department's decision to continue with its methodology after the 2007 fiscal year was arbitrary in light of accumulating data about the methodology's generally sub-par performance. The DC Circuit held in Banner Health v. Price, 867 F.3d 1323 (D.C. Cir. 2017) (per curiam), that the Department's decision to wait a bit longer before reevaluating its complex predictive model was reasonable, because the Department had, at best, only limited additional data for 2008 and 2009 and because the 2009 data suggested that hospitals were paid more than expected.In this appeal, the court held that Banner Health foreclosed the hospitals' challenges to the Department's failure to publish a proposed draft rule during the 2003 rulemaking process and the Department's failure to account for the possibility of reconciliation claw-backs in setting the 2008, 2009, 2010, and 2011 thresholds. Finally, the court held that, while the hospitals' frustration with the Department's frequently off-target calculations was understandable, the methodology had not sunk to the level of arbitrary or capricious agency action. View "Billings Clinic v. Azar" on Justia Law