Justia Government & Administrative Law Opinion Summaries

A Vermont statute requires all "health insurers" to file with the State reports containing claims data and other "information relating to health care." Liberty Mutual sought a declaration that the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., preempted the Vermont statute and regulation. The district court granted summary judgment in favor of Vermont. The court held that the reporting requirements of the Vermont statute and regulation have a "connection with" ERISA plans and were therefore preempted as applied. The court's holding was supported by the principle that "reporting" is a core ERISA function shielded from potentially inconsistent and burdensome state regulation. Accordingly, the court reversed and remanded with instructions to enter judgment for Liberty Mutual. View "Liberty Mutual Ins. Co. v. Donegan" on Justia Law

Gentry has psoriasis, a chronic autoimmune condition causing patches of raised skin covered with flaky buildup of dead skin cells that crack and bleed and can interfere with sleeping, walking, sitting, standing, and using one’s hands. She also has psoriatic arthritis, an inflammatory disease that causes fatigue, stiffness and swelling in and around the joints, tenderness, pain and swelling in the tendons, swollen fingers and toes, and reduced range of motion. There is no cure for either condition. Gentry suffered severe injuries to her ankle, arm and wrist, and hip in a 1994 car accident and developed avascular necrosis and post-traumatic arthritis. She requires a brace on her leg to walk, has a limp and waddling gait, and has frequent pain in her leg and foot, back, neck, and hands. She also has deformities in her foot, ankylosing spondylitis cervical radiculopathy, cervical stenosis, lumbar spondylosis, possible sacroilitis or facet arthropathy in the low back, degenerative joint disease in the low back, chronic lumbar strain, possible herniated disc carpal tunnel syndrome, and lumbosacral/thoracic radiculopathy, among other things. In 2004, Gentry (age 29) applied for disability benefits under the Social Security Act, 42. U.S.C.401. She had worked 10 years as a pizza maker and delivery driver. She had most recently worked as a receptionist, but was discharged because her psoriasis bled on the paperwork. After Gentry’s application was denied, the case was remanded twice. The district court affirmed the denial of benefits. The Sixth Circuit reversed the denial as not supported by substantial evidence. View "Gentry v. Comm'r of Soc. Sec." on Justia Law

Defendant Micah Smith was charged with unauthorized participation in a medical assistance program. The State maintained Smith was excluded from participating in medical assistance programs through the administrative process by the Louisiana Department of Health and Hospitals (DHH) for various allegations of fraud and misconduct. After that exclusion, Smith continued to serve as the billing agent for Medicaid providers, despite his exclusion. Smith filed a motion to quash in which he challenged La. R.S. 14:126.3.1(A)(4) as overbroad because it "prohibit[ed] a substantial amount of free speech and actions which would be protected under the First Amendment." He filed a second motion to quash, challenging La. R.S. 14:126.3.1(A)(3) as "so sweeping in its proscription that it denie[d] a wide range of protected benefits to which a majority of Americans are entitled." The district court denied Smith's first motion by granted the second. The State appealed. After review of the district court record and the applicable law, the Supreme Court reversed the district court's declaration that La. R.S. 14:126.3.1(A)(3) was unconstitutional, and remanded the case for further proceedings. View "Louisiana v. Smith" on Justia Law

In 2007, the Secretary revamped Medicare's Inpatient Prospective Payment System, updating the diagnostic weighting used to calculate reimbursements for hospitals treating the program's beneficiaries. Plaintiffs sought review of the Secretary's decision regarding a downward prospective adjustment for hospital-specific rate payments. The district court concluded that the statutory scheme was ambiguous and deferred to the Secretary's reasonable interpretation of the adjustment provisions. Applying Chevron deference, the court agreed with the district court's conclusion that the statutory scheme was ambiguous and unclear. Accordingly, the court affirmed the judgment of the district court. View "Adirondack Medical Center, et al. v. Sebelius" on Justia Law

The City appealed the district court's grant of plaintiffs' motion for a preliminary injunction enjoining Local Law 17. Local Law 17, inter alia, requires pregnancy services centers to make certain disclosures regarding the services that the centers provide. The court concluded that the law was not impermissibly vague; plaintiffs failed to demonstrate a likelihood of success on the merits with respect to one of the challenged disclosures, which requires pregnancy services centers to disclose if they have a licensed medical provider on staff; plaintiffs have demonstrated a likelihood of success on the merits with respect to other provisions challenged by plaintiffs that require other forms of disclosure and impermissibly compel speech; and because the provisions are severable, the court severed the enjoined provisions from the rest of Local Law 17. Accordingly, the court affirmed in part, vacated in part, and remanded for further proceedings. View "The Evergreen Association, Inc v. City of New York" on Justia Law

Tanisha Bates was indicted for arson. The circuit court found Bates not guilty by reason of insanity. Subsequently, the circuit court concluded that Bates was in need of inpatient hospitalization and committed her to the custody of the Commissioner of Mental Health, Mental Retardation and Substance Abuse Services. The Supreme Court affirmed, holding that the circuit court did not err when it determined that the particular circumstances warranted Bates’ commitment to inpatient hospitalization rather than to conditional release because it correctly applied the standards articulated in Va. Code Ann. 19.2-182.3 and 19.2-182.7 to the present case. View "Bates v. Commonwealth" on Justia Law

The former miner sued in 1992 and an administrative law judge determined that he was not medically qualified for benefits under the Black Lung Benefits Act, 30 U.S.C. 901 and indicated that Arkansas Coals was not the “responsible operator” required to pay benefits. About 17 years later, the miner filed a second claim. After finding that his medical condition had worsened and that he was now disabled, an ALJ awarded benefits and determined that Arkansas Coals was the responsible operator. The Benefits Review Board and the Sixth Circuit affirmed, rejecting the company’s finality, waiver, and collateral estoppel arguments; the miner was entitled to bring a second claim under 20 C.F.R. 725.309(d)(4) and the determination that Arkansas Coals was the responsible operator was not “necessary” to the resolution of the initial claim. Substantial evidence supports the determination that Arkansas Coals is the responsible operator. View "Arkansas Coals, Inc. v. Lawson" on Justia Law

Maynes, a miner who developed pneumoconiosis after working in Consolidated’s coal mine for 25 years, received benefits under the Black Lung Benefits Act, 30 U.S.C. 901-944, from 1997 until he died of respiratory failure in 2003. His widow sought survivors’ benefits. The then-current version of the BLBA conditioned her eligibility for benefits on proof that pneumoconiosis either caused or hastened her husband’s death. Her 2003 claim was denied. The Benefits Review Board and Sixth Circuit affirmed. In 2010, Congress passed the Affordable Care Act, which amended the law so that survivors are automatically entitled to benefits if the miner received BLBA benefits during his lifetime. Congress specified that the changes would apply to claims filed after January 2005, but did not address whether persons whose claims had been denied under the previous eligibility framework, could receive benefits by filing a subsequent claim. The issue was answered in the affirmative by the Benefits Review Board and affirmed by the Third and Fourth Circuits. Although the Department of Labor, an administrative law judge, and the Benefits Review Board agreed Maynes was entitled to benefits, they disagreed about the appropriate commencement date for benefits. The Sixth Circuit rejected Consolidated’s appeal, upholding the 2009 commencement date. View "Consolidation Coal Co. v. Maynes" on Justia Law

ATRA petitioned for review, challenging revisions made by OSHA to the wording of a paragraph (a)(2) of OSHA's hazard communication (HazCom) standard, 29 C.F.R. 1910.1200. HazCom establishes labeling requirements for chemicals used in the workplace. The changes reflect the agency's view that HazCom preempts state legislative and regulatory requirements, but not state tort claims. The court rejected ATRA's arguments under the Occupational Safety and Health Act (OSH Act), 29 U.S.C. 651-678, concluding that OSHA has no authority to speak with the force of law on preemption and the agency never meant for the disputed paragraph to have the effect of a legislative rule. Because Paragraph (a)(2) is merely interpretive, it is not subject to notice and comment rulemaking and was not subject to judicial review. Accordingly, ATRA's challenge was unripe for review. Accordingly, the court denied the petition for review. View "American Tort Reform Assoc. v. OSHA, et al." on Justia Law

Ramage, born in 1933, worked for Island Creek for 28 years, five years underground and 23 years on the surface. In 2007 he sought black lung benefits. While the claim was pending, Congress revived a statutory rebuttable presumption that a coal miner who worked in an underground coal mine for 15 years and suffers from a total respiratory or pulmonary disability is presumed to be totally disabled due to pneumoconiosis, 30 U.S.C. 921(c)(4), applicable to pending claims filed after January 1, 2005. The ALJ noted that x-rays did not show pneumoconiosis, that Ramage could not complete a pulmonary function test due to a tracheostomy, and that arterial blood-gas studies were qualifying under the federal standards. The ALJ summarized the medical opinions of five doctors, including one who emphasized that it was impossible to distinguish between the damage due to coal dust as opposed to the damage due to smoking. The ALJ awarded benefits and the Benefits Review Board affirmed. The Sixth Circuit denied a petition for review, holding that the ALJ’s determinations were reasoned and reasonable and that the legislative provisions creating the presumption are self-executing.View "Island Creek KY Mining v. Ramage" on Justia Law