Justia Government & Administrative Law Opinion Summaries

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

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