Justia Government & Administrative Law Opinion Summaries
Articles Posted in Health Law
Lawrence + Memorial Hosp. v. Burwell
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
Taylor v. Colorado Dept of Health Care
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
Appeal of THI of New Hampshire at Derry, LLC
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
Municipio Autonomo de Ponce v. U.S. Office of Mgmt.
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
Pennsylvania v. UPMC
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
Chattanooga-Hamilton County Hosp. Auth. v. UnitedHealthcare Plan of the River Valley, Inc.
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
Born v. City of Slidell
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
In re Kevin A.
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
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Government & Administrative Law, Health Law
Freedom of Info. Officer, Dep’t of Mental Health & Addiction Servs. v. Freedom of Info. Comm’n
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
St. Alphonsus RMC v. Gooding County
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
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Government & Administrative Law, Health Law