Justia Government & Administrative Law Opinion Summaries

Under Part A of the Ryan White Comprehensive AIDS Resources Emergency Act the U.S. Department of Health and Human Services (HHS) disburses funding to combat HIV/AIDS infection in metropolitan areas that are home to more than a specified number of individuals who have AIDS. When HHS determined that the Ponce metropolitan area no longer had enough AIDS cases to qualify for continued Part A funding, Ponce and several community health groups brought this lawsuit claiming that HHS had unfairly drawn the boundaries of Ponce’s metropolitan area too narrowly. The district court concluded that HHS acted arbitrarily and capriciously in defining the “metropolitan area” of Ponce and that HHS’s methodology for defining metropolitan areas in Puerto Rico was unfair and discriminatory. The First Circuit reversed, holding that Congress could reasonably be said to have told HHS to use the boundaries that it used in defining the Ponce metropolitan area. Remanded for entry of judgment in favor of Defendants dismissing the complaint with prejudice. View "Municipio Autonomo de Ponce v. U.S. Office of Mgmt." on Justia Law

The issue this case presented for the Pennsylvania Supreme Court’s review centered on review of a Commonwealth Court order Court interpreting a provision of a consent decree, negotiated by the Office of Attorney General of Pennsylvania ("OAG") and approved by the Commonwealth Court, between Appellant UPMC, a nonprofit health care corporation, and Appellee Highmark, a nonprofit medical insurance corporation, which established the obligations of both parties with respect to certain health care plans serving vulnerable populations. Specifically, the Court considered whether the Commonwealth Court erroneously interpreted this "vulnerable populations" provision as creating a contractual obligation for UPMC to treat all participants in Highmark’s "Medicare Advantage Plans" (for which Highmark and UPMC currently have provider contracts which UPMC has indicated it will terminate) as "in-network" for purposes of determining the rates it is permitted to charge these individuals for physician, hospital, and other medical services during the duration of the consent decree. After careful review, the Supreme Court affirmed the Commonwealth Court’s finding that the "vulnerable populations" clause of the consent decree required UPMC to "be in a contract" with Highmark for the duration of the consent decree, and, thus, that UPMC physicians, hospitals, and other services shall be treated as "in-network" for participants in Highmark Medicare Advantage plans which were subject to provider contracts between Highmark and UPMC set to be terminated by UPMC on December 31, 2015. The Court also affirmed the portion of the Commonwealth Court’s order requiring judicial approval for any further changes in business relationships between these parties which were governed by the consent decree, but quashed as not yet ripe for review the portion of the order which directed the OAG to file a request for supplemental relief to effectuate compliance with the consent decree. View "Pennsylvania v. UPMC" on Justia Law

A Hospital brought this lawsuit against a TennCare managed care organization (MCO), alleging that the MCO had not paid the Hospital all it was due for emergency services provided to the MCO’s TennCare enrollees. The MCO counterclaimed, seeking recovery of alleged overpayments made pursuant to the TennCare regulations. Thereafter, the MCO filed a motion for partial summary judgment, arguing that the Uniform Administrative Procedures Act (UAPA) required the Hospital to exhaust its administrative remedies by bringing its claims before TennCare prior to filing suit. The trial court agreed and dismissed the Hospital’s complaint and the MCO’s counterclaim for lack of subject matter jurisdiction. The Supreme Court reversed, holding (1) the UAPA requires exhaustion of administrative remedies in this matter to the extent that resolution of the parties’ claims would require the trial court to render a declaratory judgment concerning the validity or applicability of TennCare regulations; but (2) while the UAPA prohibits the trial court from rendering such declaratory relief absent exhaustion of administrative remedies, it does not address claims for damages. Remanded to the trial court with directions to hold the parties’ damage claims in abeyance pending resolution of administrative proceedings regarding the validity or applicability of the TennCare regulations at issue. View "Chattanooga-Hamilton County Hosp. Auth. v. UnitedHealthcare Plan of the River Valley, Inc." on Justia Law

The Supreme Court granted certiorari in this matter to determine whether a retiree of the City of Slidell, plaintiff Dean Born, could continue participating in the City of Slidell's health insurance plan following the City's adoption of Ordinance No. 3493, which required each city retiree to apply for Medicare coverage upon reaching the age of sixty-five. After review, the Supreme Court affirmed the Court of Appeal's finding that the City could not terminate plaintiff's desired plan coverage and require him to accept Medicare coverage, because plaintiff retired before the effective date of the Ordinance. View "Born v. City of Slidell" on Justia Law

Kevin A. appeals from an order granting the Public Conservator's petition to establish conservatorship for a one-year period. The court found him to be gravely disabled under the Lanterman-Petris-Short Act, Welf. & Inst. Code, 5000 et seq. In light of the recent California Supreme Court decisions in People v. Blackburn and People v. Tran, the court agreed with Kevin that the trial court erred in accepting a waiver of jury trial over his objection and request. Accordingly, the court reversed the order granting the petition. View "In re Kevin A." on Justia Law

Plaintiffs, the Department of Mental Health and Addiction Services and its Freedom of Information Officer, received a request under the Freedom of Information Act from Ron Robillard for records concerning Amy Archer Gillian, who was convicted of second degree murder for the arsenic poisoning of a resident of her nursing home. Plaintiffs disclosed some, but not all, of the requested records. The Freedom of Information Commission determined that Gilligan’s medical and dental records were not exempt from disclosure. The trial court sustained Plaintiffs’ appeal as to those records. The Supreme Court reversed, holding (1) Plaintiffs had standing to appeal the decision of the Commission; and (2) the documents at issue were medical records related to the diagnosis and treatment of a patient and were, therefore, psychiatric records exempt from disclosure pursuant to Conn. Gen. Stat. 52-146e. View "Freedom of Info. Officer, Dep’t of Mental Health & Addiction Servs. v. Freedom of Info. Comm’n" on Justia Law

Gooding County appealed the district court’s decision reversing the Gooding County Board of Commissioners’s (BOCC) decision affirming the denial of a third-party medical indigency application. In 2013, Saint Alphonsus Regional Medical Center (Hospital) submitted a third-party medical indigency application to the Department of Health and Welfare on behalf of a patient who had been hospitalized at its facility since July 27, 2013. The County Clerk denied the application on the basis that it was untimely filed, and the BOCC affirmed. The Hospital appealed that decision to the Gooding County district court, which reversed the decision and remanded for further proceedings. Gooding County then appealed to this Court. On appeal, Gooding County argued that the district court erred when it held that the date of admission is excluded when calculating an application’s deadline under Idaho Code section 31-3505(3). Finding no reversible error, the Supreme Court affirmed. View "St. Alphonsus RMC v. Gooding County" on Justia Law

This case arose from the Secretary’s decision in 2005 to change the boundaries of the geographic areas used to compute regional wage indices. A group of hospitals challenged the Secretary's decision to include wage data from Southcoast campuses outside the Boston-Quincy area in calculating the index for that area for fiscal years 2006 and 2007. The court concluded that the Secretary's treatment of Southcoast hewed to the existing administrative treatment of such multi-campus hospital groups; there were substantial informational and operational obstacles to implementing a different computational method quickly in 2006 or retroactively; appellants admit that the temporary effect of Southcoast’s multi-campus data on the wage index was a “one-off” occurrence arising from “unusual circumstances” that apparently did not affect any other multi-campus hospital group’s treatment; and nothing in the Medicare Act, 42 U.S.C. 1395 et seq., or established principles of administrative review mandate that the Secretary individually tailor one hospital’s reporting treatment to fit appellants' preferred computational outcome. Accordingly, the court affirmed the judgment. View "Anna Jacques Hospital v. Burwell" on Justia Law

Grossmont and four other California hospitals sought reimbursement under the Medicare program for so-called “bad claims.” Payment was denied because the claims were submitted to Medicare without first being submitted to the State of California for a determination of any payment responsibility it may have for the claims. The court concluded that Grossmont has failed to preserve its challenge that the mandatory state determination policy violates the bad debt moratorium; Grossmont also failed to preserve its claim that the Secretary’s effort to limit the alternative documentation policy must be rejected because it is a change in policy that must be adopted in a notice and comment rule; and, as applied in this case, the Secretary’s state determination requirement was not arbitrary or capricious. The court need not decide whether the Secretary acts arbitrarily and capriciously if she refuses to allow claims as bad debt if a recalcitrant state refuses to issue state determinations of payment responsibility despite reasonably diligent efforts to obtain them. Finally, the Secretary's conclusion that the hold harmless provision, in Joint Signature Memorandum 370 (JSM 370), does not apply is supported by substantial evidence and is not arbitrary or capricious. Accordingly, the court affirmed the judgment. View "Grossmont Hosp. Corp. v. Burwell" on Justia Law

Under Neb. Rev. Stat. 71-1207, a mental health board “shall” hold a hearing within seven days after the subject is taken into emergency protective custody. Appellant was convicted of sexual assault on a child. Before Appellant finished his sentence, the Mental Health Board of the Fourth Judicial District (Board) issued a warrant directing that Appellant remain in custody under the Sex Offender Commitment Act (SOCA) until a commitment hearing. The hearing was held approximately five weeks later. The Board determined that Appellant was a dangerous sex offender and placed him in the custody of the Department of Health and Human Services for inpatient treatment. Appellant petitioned for a writ of habeas corpus alleging that the Board’s failure to hold a hearing within seven days violated the SOCA and his right to due process. The district court dismissed Appellant’s habeas petition, concluding that the seven-day time limit in section 71-1207 is directory, not mandatory. The Supreme Court affirmed, holding that the seven-day time limit for holding a hearing under the statute is directory, and therefore, the untimeliness of the commitment hearing in this case did not deprive the Board of jurisdiction. View "D.I. v. Gibson" on Justia Law