Justia Government & Administrative Law Opinion Summaries

Respondents Northridge Environmental, LLC and Arch Insurance Company (carrier), appealed a decision of the New Hampshire Compensation Appeals Board (CAB) granting a request by petitioner John Nicholson for reimbursement for home health care services provided to him by his wife, Angela Nicholson. Petitioner was seriously injured on the job while working for Northridge. After a period of hospitalization, petitioner was discharged but prescribed medication and follow-up care, which included home health services. Following the petitioner’s release from the hospital, he had multiple open wounds that required daily cleaning, and he “needed 24/7 care, due to balance problems, short term memory loss, and inability to perform certain regular activities of daily living.” Although petitioner’s wife did not have any formal medical training, she provided the required care, including cleaning his wounds, bathing him, dressing him, aiding him in the use of the bathroom, helping him move around, and constantly supervising him. Petitioner sought reimbursement at a rate of $15 per hour, 16 hours per day, between the date of his release from the hospital, and June 4, 2012, the date of the Department of Labor (DOL) hearing. The DOL denied the request for reimbursement. On remand to the CAB, respondents argued that because petitioner’s wife did not fall within the definition of a “health care provider” as used in RSA 281-A:2, XII-b (2010), her services were not reimbursable. Petitioner conceded that his wife was not a “doctor, chiropractor, or rehabilitation provider” as listed in RSA 281-A:2, XII-b, but he still asserted that her services were, nonetheless, reimbursable. The CAB first concluded that petitioner was entitled to reimbursement for his wife’s services. Regarding the amount of reimbursement, the CAB observed that petitioner’s wife offered inexact dates, times, and durations of various treatments that she provided and also lacked written records of her care. Nonetheless, the CAB concluded that it was reasonable to reimburse the petitioner for 12 hours per day at $15 per hour for the period between August 25, 2010, and June 4, 2012. The parties filed motions for reconsideration, which were denied. Finding no reversible error in the CAB's decision, the Supreme Court affirmed. View "Appeal of Northridge Environmental, LLC" on Justia Law

The People filed a complaint charging defendants with causing, aiding, and abetting the illegal delivery of marijuana. The trial court granted an injunction barring defendants from further developing or marketing their marijuana delivery app. At issue on appeal is whether Proposition D, L.A. Mun. Code, 45.19.6, which City voters enacted in 2013 to regulate medical marijuana businesses, generally prohibits the delivery of marijuana by vehicles. The court concluded that the City established a likelihood of proving defendants’ app caused, aided, or abetted the violation of Proposition D because, outside of the narrow exception for designated primary caregivers, it prohibits the vehicular delivery of medical marijuana to qualified participants, identification card holders, or primary caregivers in the City. Further, defendants’ opposition to the City’s unfair competition allegations necessarily fails because the City has demonstrated a likelihood of success on its claim that defendants facilitated a violation of Proposition D. In this case, defendants made no showing at all concerning the balance of hardships, much less that the balance tipped sharply in their favor. Accordingly, the court affirmed the trial court's judgment. View "People v. Nestdrop, LLC" on Justia Law

The Hospital system filed suit seeking to obtain a writ of mandamus compelling HHS to adjudicate immediately its administrative appeals on claims for Medicare reimbursement. The parties agree that, as of February 2014, the Secretary had 480,000 appeals awaiting assignment to an ALJ, and the Secretary conceded in her brief that the number had by then climbed to more than 800,000 appeals, creating a ten-year backlog. The court concluded that the Medicare Act, 42 U.S.C. 1395 et seq., does not guarantee a healthcare provider a hearing before an ALJ within 90 days, as the Hospital System claims. Rather, it provides a comprehensive administrative process that a healthcare provider must exhaust before ultimately obtaining review in a United States district court. The court further concluded that the issuance of a judicial order now, however, directing the Secretary to hear the Hospital System’s claims in the middle of the administrative process, would unduly interfere with the process and, at a larger scale, the work of the political branches. Moreover, such intervention would invite other healthcare providers suffering similar delays to likewise seek a mandamus order, thereby effectively causing the judicial process to replace and distort the agency process. Accordingly, the court affirmed the district court's dismissal of the complaint. View "Cumberland Cnty. Hosp. v. Burwell" on Justia Law

Relator brought a qui tam action (False Claims Act, 31 U.S.C. 3730(b)), alleging KHN (network of hospitals, physicians, and healthcare facilities) falsely certified its compliance with the Health Information Technology for Economic and Clinical Health Act (HITECH), 123 Stat. 226 (2009), to receive “meaningful use” incentive payments. HITECH was designed to encourage the adoption of sophisticated electronic health record technology and creates incentive payments for “meaningful use” of certified technology, 42 U.S.C. 1395. To receive incentive payments, providers must meet meaningful-use objectives and accompanying compliance measures. Stage 1 of Act implementation required a security risk analysis in accordance with 45 C.F.R. 164.308(a)(1); implementation of need security updates; and correction of identified security deficiencies. During Stage 2, providers are required to address[] the encryption/security of data stored in Certified EHR Technology in accordance with 45 C.F.R. 164.312(a)(2)(iv) and 164.306(d)(3). To receive incentive payments, providers must attest to meeting these standards. The Sixth Circuit affirmed dismissal, finding that Relator failed to plausibly allege that KHN’s attestation of HITECH compliance was false and failed to plead a specific claim for payment; and that Relator’s claims were precluded by a prior Ohio state judgment in a case involving similar claims filed by Relator against KHN. View "United States v. Kettering Health Network" on Justia Law

Heather W. appealed an order reappointing the Public Guardian as her conservator under the Lanterman-Petris-Short Act (LPS Act), Welf. & Inst. Code, 5000 et seq. The court concluded that the trial court erred by not advising Heather W. of her right to a jury trial and not obtaining her on-the-record personal waiver of that right without a finding that she lacked the capacity to make a jury waiver. The court further concluded that a remand is required for the trial court to determine whether Heather W. "lacked the capacity to make a knowing and voluntary waiver at the time of counsel's waiver." The court rejected Heather W.'s claims that the trial court's comments show it shifted the burden of proof, relied on statements by the Public Guardian's counsel instead of evidence, and did not apply the gravely disabled standard. The court reviewed the parties' remaining contentions and concluded that they will not change the result the court has reached. Accordingly, the court reversed the order and remanded for further proceedings. View "San Luis Obispo Cnty. Public Guardian v. Heather W." on Justia Law

In these consolidated appeals, plaintiff challenged the regulations implementing the contraceptive mandate of the Affordable Care Act, 42 U.S.C. 300gg-13(a), arguing that the regulations’ accommodation for nonprofit organizations with a religious objection to providing contraceptive coverage violates the Religious Freedom Restoration Act (RFRA), 42 U.S.C. 2000bb, et seq. The court concluded that the regulations do not substantially burden plaintiffs' religious exercise and, alternatively, because (1) the government has compelling interests to justify the accommodation, and (2) the accommodation is the least restrictive means of furthering those interests. The court rejected EWTN’s challenges under the Establishment and Free Exercise Clauses because the accommodation is a neutral, generally applicable law that does not discriminate based on religious denomination. The court also rejected EWTN’s challenge under the Free Speech Clause because any speech restrictions that may flow from the accommodation are justified by a compelling governmental interest and are thus constitutional. View "Eternal Word Television Network v. Secretary" on Justia Law

Plaintiffs seek a writ of mandamus compelling the Secretary to act within Congress's prescribed specific time frames, 42 U.S.C. 1395ff, for the Secretary to reach decisions on various stages of administrative appeals of Medicare reimbursement claim denials. The district court concluded that mandamus relief was unwarranted. The court concluded that the statute imposes a clear duty on the Secretary to comply with the statutory deadlines, that the statute gives the Association a corresponding right to demand that compliance, and that escalation—the only proposed alternative remedy—is inadequate in the circumstances of this case. Because the Association has demonstrated that the threshold requirements for mandamus jurisdiction are met, and because the Secretary’s other jurisdictional arguments fail, the court reversed the district court’s dismissal for lack of jurisdiction. On remand, the district court should determine whether “compelling equitable grounds” now exist to issue a writ of mandamus. View "American Hospital Ass'n v. Burwell" on Justia Law

In 2000, the Secretary of Health and Human Services issued a regulation, known as the “reclassification rule,” 42 C.F.R. 412.230(a)(5)(iii), which provided that a hospital that has been reclassified from urban to rural under the Medicare Act, 42 U.S.C. 1395ww(d)(8)(E), may not thereafter receive an additional reclassification by the Medicare Geographic Classification Review Board (MGCRB) for reclassification as urban under subsection (d)(10). Lawrence filed suit seeking a preliminary injunction to enjoin defendants from applying the Secretary's reclassification rule to Lawrence's MGCRB application. The district court denied the motion. However, the court found the statutory language to be plain and unambiguous, and at odds with the Secretary’s reclassification rule, 42 C.F.R. 412.230(a)(5)(iii). Therefore, the court declared the regulation invalid and reversed the judgment of the district court, remanding for a determination of the appropriate remedy. View "Lawrence + Memorial Hosp. v. Burwell" on Justia Law

Plaintiff Leslie Taylor asked the Colorado Medicaid program to combine the benefits she received through two assistance programs to help her get to medical appointments. If approved, this combination would allow the agency to pay attendants for time driving Taylor to and from her appointments. The agency refused, and the plaintiffs in this case alleged that the refusal constituted discrimination against Taylor based on her disability. The Tenth Circuit concluded that this refusal did not constitute discriminate against Taylor based on her disability. View "Taylor v. Colorado Dept of Health Care" on Justia Law

THI is a subsidiary of THI of New Hampshire, LLC, itself a subsidiary of a parent company that owns nursing home operators throughout the country. In approximately 2003, THI purchased and began operating a nursing home, Pleasant Valley Nursing Center (Pleasant Valley), in Derry. In 2012, THI had an opportunity to expand when Exeter Healthcare, Inc. closed its nursing home in Exeter and offered to sell its 109 licensed nursing beds. THI and Exeter Healthcare entered into a purchase and sale agreement for the beds in 2013, and THI made deposit payments to Exeter Healthcare in accordance with the agreement. The following month, THI requested that the Board grant approval for the transfer of the beds from Exeter Healthcare to THI. Because the Pleasant Valley building would not accommodate all of the beds to be transferred, THI also requested permission to apply for a Certificate of Need (CON) to construct a new building to house the beds in a different location. THI selected a site in Londonderry for the new building, which it planned to operate under the name Traditions at Londonderry. In its application, THI explained that the transfer would occur in the same nursing home region in Rockingham County, such that the number of beds in the region would not increase. THI also informed the Board that its contract conditioned its obligation to buy the beds from Exeter Healthcare upon the Board’s approval of the CON for Traditions at Londonderry. In this appeal of the Health Services Planning and Review Board's (Board) order, THI argued that the Board incorrectly interpreted RSA 151-C:4, III(a) as preventing the Board from granting a certificate of need (CON) to THI for the construction of the Pleasant Valley nursing home. Although the Board found that THI’s proposed facility would satisfy regulatory requirements for services offered, quality of care, and financial feasibility, among other criteria, the Board nevertheless denied THI’s application because the Pleasant Valley facility was not an “existing facility.” Finding no error, the Supreme Court affirmed the Board's decision. View "Appeal of THI of New Hampshire at Derry, LLC " on Justia Law