Justia Government & Administrative Law Opinion Summaries

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

Hospitals that are disadvantaged by their geographic location may reclassify to a different wage index area for certain Medicare reimbursement purposes by applying for redesignation to the Medicare Geographic Classification Review Board. Section 401 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, enacted 10 years after the Board was established, creates a separate mechanism by which qualifying hospitals located in urban areas “shall [be] treat[ed] . . . [as] rural” for the same reimbursement purposes. To avoid possible strategic maneuvering by hospitals, the U.S. Department of Health and Human Services issued a regulation providing that hospitals with Section 401 status cannot receive additional reclassification by the Board on the basis of that status, 42 C.F.R. 412.230(a)(5)(iii) (Reclassification Rule). Geisinger, a hospital located in an urban area, received rural designation under Section 401 but was unable to obtain further reclassification by the Board pursuant to the Reclassification Rule. Geisinger sued. The district court upheld the regulation. The Third Circuit reversed, finding that Section 401 is unambiguous: HHS shall treat Section 401 hospitals as rural for Board reclassification purposes, 42 U.S.C. 1395ww(d)(8)(E)(i) View "Geisinger Cmty. Med. Ctr. v. Sec'y United States Dep't of Health & Human Servs." on Justia Law

The appeals before the Tenth Circuit in this opinion concerned the regulations (as a part of the Affordable Care Act ("ACA")) that required group health plans to cover contraceptive services for women as a form of preventive care ("Mandate"). In response to religious concerns, the Departments implementing the ACA (Health and Human Services ("HHS"), Labor, and Treasury) adopted a regulation that exempted religious employers (churches and their integrated auxiliaries) from covering contraceptives. When religious non-profit organizations complained about their omission from this exemption, the Departments adopted a regulation that allowed them to opt out of providing, paying for, or facilitating contraceptive coverage. Under this regulation, a religious non-profit organization could opt out by delivering a form to their group health plan’s health insurance issuer or third-party administrator or by sending a notification to HHS. The Plaintiffs in the cases here were religious non-profit organizations. They argued that complying with the Mandate or the accommodation scheme imposed a substantial burden on their religious exercise. The Plaintiffs argued the Mandate and the accommodation scheme violated the Religious Freedom Restoration Act (“RFRA”) and the Religion and Speech Clauses of the First Amendment. While Tenth Circuit recognized the sincerity of Plaintiffs’ beliefs and arguments, it concluded the accommodation scheme relieved Plaintiffs of their obligations under the Mandate and did not substantially burden their religious exercise under RFRA or infringe upon their First Amendment rights. The Court affirmed the district court’s denial of a preliminary injunction to the plaintiffs in Little Sisters of the Poor Home for the Aged v. Sebelius, (6 F.Supp. 3d 1225 (D. Colo. 2013)), and reversed the district courts’ grants of a preliminary injunction to the plaintiffs in "Southern Nazarene University v. Sebelius," (No. CIV-13-1015-F, 2013 WL 6804265 (W.D. Okla. Dec. 23, 2013)), and "Reaching Souls International, Inc. v. Burwell," (No. CIV-13-1092-D, 2013 WL 6804259 (W.D. Okla. Dec. 20, 2013)). View "Little Sisters of the Poor v. Burwell" on Justia Law

The Patient Protection and Affordable Care Act (42 U.S.C 18001) includes “guaranteed issue” and “community rating” requirements, which bar insurers from denying coverage or charging higher premiums based on health; requires individuals to maintain health insurance coverage or make a payment to the IRS, unless the cost of buying insurance would exceed eight percent of that individual’s income; and seeks to make insurance more affordable by giving refundable tax credits to individuals with household incomes between 100 per cent and 400 percent of the federal poverty line. The Act requires creation of an “Exchange” in each state— a marketplace to compare and purchase insurance plans; the federal government will establish “such Exchange” if the state does not. The Act provides that tax credits “shall be allowed” for any “applicable taxpayer,” only if the taxpayer has enrolled in an insurance plan through “an Exchange established by the State under [42 U.S.C. 18031],” An IRS regulation interprets that language as making credits available regardless of whether the exchange is established by a state or the federal government. Plaintiffs live in Virginia, which has a federal exchange. They argued Virginia’s Exchange does not qualify as “an Exchange established by the State,” so they should not receive any tax credits. That would make the cost of buying insurance more than eight percent of their income, exempting them from the coverage requirement. The district court dismissed their suit. The Fourth Circuit and Supreme Court affirmed. Tax credits are available to individuals in states that have a federal exchange. Given that the text is ambiguous, the Court looked to the broader structure of the Act and concluded that plaintiffs’ interpretation would destabilize the individual insurance market in any state with a federal exchange. It is implausible that Congress meant the Act to operate in that manner. Congress made the guaranteed issue and community rating requirements applicable in every state, but those requirements only work when combined with the coverage requirement and tax credits. View "King v. Burwell" on Justia Law

In 2010, the Colorado Governor, under guidance from the state's medical and nursing boards, decided that Colorado would opt-out of a federal regulation requiring certified registered nurse anesthetists (CRNAs) administer anesthesia under a physician's supervision. Under the regulation, hospitals, ambulatory surgical centers and critical access hospitals received Medicare reimbursement if CRNAs worked under a physician's supervision. Petitioners the Colorado Medical Society and the Colorado Society of Anesthesiologists, filed suit against the Governor, claiming that Colorado law did not permit CRNAs to administer anesthesia without supervision. In ruling on the Governor's motion to dismiss, the trial court found that petitioners failed to state a valid claim and granted relief. The appellate court agreed with the trial court's conclusion. The Supreme Court agreed with the result, but held that the Governor's decision to opt-out of the federal regulation was revieweable by a court only for a gross abuse of discretion. Because petitioners did not allege that such a gross abuse occurred here, the court of appeals' decision to affirm dismissal of the case was affirmed. View "Colorado Medical Society v. Hickenlooper" on Justia Law

Consolidated direct appeals to the Pennsylvania Supreme Court centered on appellees' efforts to resurrect a defunct state-run health insurance program. Appellees were recipients of state-subsidized, low-cost health insurance via the "adultBasic" program, which was previously administered by the Department of Insurance and made available to certain qualifying adults in Pennsylvania. The program received the bulk of its funding from the proceeds of a 1998 multi-state master settlement agreement between forty-seven states and several major U.S. tobacco product manufacturers. The allocation and distribution of funds received annually by the Commonwealth under this settlement was initially administered outside of the Fiscal Code, via the Tobacco Settlement Act (TSA). As relevant here, for purposes of fiscal years 2010-2011 and 2011-2012, the General Assembly used modifications to the Fiscal Code to override the TSA’s requirements for tobacco settlement monies. One effect of the amendments was to divert tobacco settlement funds more generally to other fiscal priorities of the Commonwealth. In March 2011, Appellees Cheryl Sears and seventy-four other former recipients of adultBasic filed an original-jurisdiction petition for review at the Commonwealth Court, styled as a class action. As amended, the petition contended, inter alia, that the redirection of tobacco settlement monies under Acts 46 and 26 violated the TSA’s requirements for appropriation and allocation of tobacco settlement funds. The petition also asserted that these enactments offended various provisions of the Pennsylvania Constitution governing legislative processes, including the general requirement that no bill shall be passed containing more than a single subject. Appellees sought declaratory, mandamus, and injunctive relief retroactively reestablishing the adultBasic program and reimbursing the program over two hundred million dollars. Appellee Eric Weisblatt commenced a separate action, also styled as a class action, proffering materially similar allegations and claims for relief, in the relevant respects, only naming executive-branch officials and agencies as defendants. Appellees in both proceedings moved for a preliminary injunction to preclude the Treasury from disbursing the tobacco settlement monies which were due to be received that month as appropriated per Act 46. Relief was denied by the court, however, upon its finding that the harm asserted by Appellees was neither immediate nor irreparable. Several weeks after the Commonwealth Court’s issuance of its opinion in Sears, the court issued a divided decision in "Weisblatt." During the pendency of the appeals, additional omnibus amendments to the Fiscal Code were enacted into law, which, inter alia, effectuated a repeal of the allocation formula provided in the TSA; the result formally displaced adultBasic funding within the terms of the TSA itself. In light of these amendments, Appellees renewed their request for relief from the supersedeas, which was again denied. Upon review of both sides' arguments appealing the Commonwealth Court's decision, the Supreme Court held that Appellees lacked standing to pursue the relief requested in their petitions for review. View "Sears v. Wolf" on Justia Law

The Secretary issued regulations that effectively prohibit physicians who lease medical equipment to hospitals from referring their Medicare patients to these same hospitals for outpatient care involving that equipment. The association challenged the regulations as exceeding the Secretary's statutory authority and violating the Administrative Procedure Act (APA), 5 U.S.C. 500 et seq., and the Regulatory Flexibility Act (RFA), 5 U.S.C. 601-612. The district court granted summary judgment in favor of the Secretary. Although one majority agrees with the district court that the statute is ambiguous as to the regulation of leases that charge on a per-use basis, a different majority concludes that the Secretary’s explanation for prohibiting these leases is unreasonable; the court unanimously concludes that the Secretary’s interpretation of the statute to apply to the physician-groups performing the procedures is reasonable, and that the Secretary complied with the RFA; and therefore, the court affirmed in part, reversed in part, and remanded to the district court with instructions to remand the regulation relating to leases charging by use to the Secretary for further proceedings. View "Council for Urological Interests v. Burwell" on Justia Law

Keith Westphal and Joyce Osborn Wilson filed suit against David Northcutt III, DMD, Bobby R. Wells, DMD, Stephen R. Stricklin, DMD, Thomas T. Willis, DMD, Sam J. Citrano, Jr., DMD, William Chesser, DMD, and Sandra Kay Alexander, RDH, in their official capacities as members of the Alabama Board of Dental Examiners. Westphal and Wilson sought a judgment declaring unconstitutional the portion of the Alabama Dental Practice Act, (Sec. 34-9-1 et seq., Ala. Code 1975) that made it unlawful for anyone other than a duly licensed dentist to perform teeth-whitening services, and sought a permanent injunction forbidding future enforcement of the prohibition in the Act on teeth-whitening services performed by non-dentists. The parties submitted cross-motions for a summary judgment, and the Jefferson Circuit Court entered a summary judgment in favor of the Dental Board. Westphal and Wilson appealed. But finding no reversible error, the Supreme Court affirmed. View "Westphal v. Northcutt III" on Justia Law

Plaintiff’s minor daughter, Brayden, who suffers from Coffin-Lowry Syndrome, had been receiving home and community-based waiver services for approximately twelve years when the Nebraska Department of Health and Human Services (DHHS) determined that she no longer qualified for waiver services and terminated the services. Plaintiff filed this action on behalf of Brayden, contending that DHHS used the wrong criteria to evaluate Brayden’s eligibility and erred in finding that she did not qualify for waiver services. The district court affirmed the termination of those services. The Supreme Court reversed, holding (1) DHHS’ creation and use of exhibit 4, the assessment document used to evaluate children with disabilities, to evaluate Brayden was arbitrary and produced an unreasonable result; and (2) DHHS should have found that Brayden qualified for waiver services. View "Merie B. v. State" on Justia Law

Plaintiffs, hospitals that participate in Medicare, filed suit against the Secretary, claiming that she violated the Administrative Procedure Act (APA), 5 U.S.C. 551 et seq., by engaging in arbitrary and capricious decision-making. This dispute arose from plaintiffs' belief that the Secretary set the monetary threshold for outlier payments too high in 2004, 2005, and 2006. The court affirmed the district court’s partial denial of the motion to supplement the administrative record and its rejection of the APA challenges to the 2005 and 2006 outlier thresholds. The district court erred, however, in concluding that the Secretary adequately explained the 2004 outlier threshold. Therefore, the court reversed the grant of summary judgment on this claim and remanded for further proceedings. View "District Hosp. Partners v. Burwell" on Justia Law