Justia Government & Administrative Law Opinion Summaries

Twenty California counties were plaintiffs in this petition for writ of mandate and complaint for declaratory and injunctive relief against defendants the State and its pertinent officials (DHCS and DMH). In their petition, the Counties alleged that a DHCS 2009 Memorandum and a DMH 2010 Letter were invalid. Under federal Medicaid law, the federal government did not pay for services to IMD patients between the ages of 21 and 65. In 1999, California added a state-only Medi-Cal benefit by enacting Welfare and Institutions Code section 14053.1. The section provided that the State would pay for "ancillary outpatient services" for IMD patients within the federal IMD exclusion. The specific focus of this appeal involved two Assembly Bills: No. 2877 (1999-2000 Reg. Sess.) and No. 430 (2000-2001 Reg. Sess.) that concerned subsequent sunsetting legislation regarding section 14053.1. Assembly Bill 2877 (enacted in 2000) sought to extend the original sunset provision an additional year, and Assembly Bill 430 (enacted in 2001) sought to eliminate the sunset provision altogether, thereby making section 14053.1 effective indefinitely. The counties argued the memorandum and letter were: (1) inconsistent with section 14053.1; and (2) they constituted underground regulations adopted in violation of the state Administrative Procedures Act (Gov. Code, 11340.5, subd. (a)). The Counties similarly sought a writ/injunction prohibiting the State from applying them against the Counties. The trial court denied the Counties' petition for writ of mandate and complaint for injunctive relief, and issued a declaratory judgment in favor of the State. The court concluded that the subsequent sunsetting amendments (Assem. Bills 2877 & 430) were void because they were enacted after the statute had already sunset by its own terms in 2000. Thus, in the absence of section 14053.1, the State did not promulgate an underground regulation by issuing the DHCS 2009 Memorandum and the DMH 2010 Letter and ancillary outpatient services for Medi-Cal eligible IMD patients within the federal IMD exclusion. The Court of Appeal concluded that section 14053.1 remained a valid law, and that 14053.1's presence in the California statutes was not the result of a legislative amendment to a repealed act. The Counties' petition for writ of mandate and complaint for declaratory and injunctive relief was granted: the DHCS 2009 Memorandum and the DMH 2010 Letter contravened section 14053.1 and were therefore invalid. The State was enjoined from applying them. The judgment of the trial court was reversed. View "Colusa County v. Douglas" on Justia Law

Townsend applied for social security disability benefits and supplemental security income in 2003, at age 44, claiming that she had become incapable of full‐time gainful employment in May 2002 when she had stopped working as a result of multiple physical and psychiatric ailments, including fibromyalgia. In 2012 an ALJ decided that she had become totally disabled in November 2008. By the time that decision was rendered she had died (of pulmonary diseases apparently unrelated to the ailments alleged to have made her totally disabled). Her father was substituted for her. The district court upheld the decision. The Seventh Circuit reversed and remanded, noting multiple errors in determining the onset of total disability. View "Williams v. Colvin" on Justia Law

The issues this case presented to the Supreme Court both arose from the Georgia Department of Community Health's ("DCH's") granting of an application for a Certificate of Need ("CON") to develop an outpatient ambulatory surgery service in East Cobb County to Kennestone Hospital, Inc. Kennestone's application was eventually approved by the DCH after the service was determined to be "part of a hospital" pursuant to Ga. Comp. R. & Regs. r. 111-2-2-.40 (1) (a). Northside Hospital, Inc. opposed the CON and sought administrative review of the DCH's initial decision. After the appeal was unsuccessful, Northside then filed a petition for judicial review with the superior court. The superior court reversed the DCH's decision to grant the CON on the basis that the "case-by-case" provision in Ga. Comp. R. & Regs. r. 111-2-2-.40 (1) (a) was unconstitutionally vague. The Court of Appeals upheld the superior court's determination. "The gist of the Rule is to afford a less stringent review for ambulatory surgery service proposals that are 'part of a hospital.' [. . .] the final sentence of the Rule cannot be read in isolation from the other language contained in it. Thus, contrary to Northside's contentions, the Rule is not unconstitutionally vague on its face, and the Court of Appeals was incorrect to conclude otherwise." View "Georgia Dept. of Community Health v. Northside Hospital, Inc." on Justia Law

Ector Manuel Savala-Quintero sustained injuries when he jumped through the fourth-story window of room in the Wabaunsee County jail where he had been placed by sheriff officials during an investigation. The University of Kansas Hospital Authority sued the Board of Wabaunsee County Commissioners for reimbursement of the medical expenses incurred in its treatment of Savala-Quintero. The district court granted summary judgment in favor of the County. The Court of Appeals reversed. The Supreme Court reversed the Court of Appeals, holding that the County was not obligated to pay the medical expenses of Savala-Quintero because, although Savala-Quintero was temporarily detained at the county jail, he was not a prisoner committed to or held in the jail at the time he was injured. View "Univ. of Kan. Hosp. Auth. v. Bd. of Comm'rs " on Justia Law

The plaintiffs in this case were David and Barbara Green, their three children, and the businesses they collectively owned and operated: Hobby Lobby Stores, Inc. and Mardel, Inc. As owners and operators of both Hobby Lobby and Mardel, the Greens organized their businesses with express religious principles in mind. As was particularly relevant to this case, one aspect of the Greens’ religious principles was a belief that human life begins when sperm fertilizes an egg. In addition, the Greens believed it was immoral for them to facilitate any act that caused the death of a human embryo. Plaintiffs brought an action to challenge portions of the Patient Protection and Affordable Care Act (ACA) whereby employment-based group health plans covered by the Employee Retirement Income Security Act (ERISA) were required provide certain types of health services for women that implicated contraceptive methods, sterilization procedures, and patient education and counseling (without cost-sharing by plan participants or beneficiaries) - all "abortifacients" that went against plaintiffs' religious beliefs. Plaintiffs filed suit to challenge the contraceptive-coverage requirement of the ACA under the Religious Freedom Restoration Act (RFRA), the Free Exercise Clause of the First Amendment, and the Administrative Procedure Act. Plaintiffs simultaneously moved for a preliminary injunction on the basis of their RFRA and Free Exercise claims. The district court denied that motion. Plaintiffs appealed the denial of the injunction. After review by the Tenth Circuit Court of Appeals, the Court held that Hobby Lobby and Mardel were entitled to bring claims under RFRA, established a likelihood of success that their rights under statute were substantially burdened by the contraceptive-coverage requirement, and established an irreparable harm. However, the case was remanded back to the district court for further proceedings on two remaining factors governing the grant or denial of a preliminary injunction. View "Hobby Lobby Stores, et al v. Sebelius, et al" on Justia Law

The South Carolina Supreme Court answered certified two questions from the U.S. District Court for the District of South Carolina. The case concerned supplemental health insurance policies, which differ from ordinary health insurance policies in both purpose and operation. The questions were: (1) whether the definition of "actual charges" contained within S.C. Code Ann. 38-71-242 be applied to insurance contracts executed prior to the statute's effective date; and (2) whether the South Carolina Department of Insurance could mandate the application of "actual charges" to policies already inexistence on the statute's effective dates by prohibiting an insurance company from paying claims absent the application of that definition. The South Carolina Supreme Court answered both questions "no." View "Kirven v. Central States" on Justia Law

In 2011, the Bullitt County Board of Health enacted a Regulation that prohibited tobacco smoke in all enclosed public places, among other places, and placed additional restrictions regarding tobacco use on smoking-regulated businesses and regulated places. Appellants filed a petition for declaration of rights against the Board, arguing that the Board had exceeded its authority by enacting a substantive law without proper enabling legislation. The trial court agreed with Appellants and held that the Regulation was invalid. The court of appeals reversed, determining that the Regulation was valid and a proper exercise of the Board’s statutory authority. The Supreme Court reversed, holding that the Board exceeded its statutory authority in adopting the Resolution, and therefore, the Resolution was invalid and unenforceable. View "Bullitt Fiscal Court v. Bullitt County Bd. of Health" on Justia Law

This case involved a petition for injunctive and declaratory relief brought by plaintiffs Harbor Homes, Inc. and Gary Dube, Thomas Taylor, Cynthia Washington, and Arthur Furber against defendants the New Hampshire Department of Health and Human Services (DHHS), the Commissioner of DHHS, the Associate Commissioner of DHHS, and the Administrator of the Bureau of Behavioral Health seeking, in part, to enjoin DHHS from denying the individual plaintiffs the right to obtain Medicaid-funded services from their chosen provider, Harbor Homes. The individual plaintiffs received Medicaid-funded rehabilitative services from Harbor Homes. Since 1991, Harbor Homes participated in New Hampshire's Medicaid program pursuant to a Medicaid Provider Enrollment Agreement. On June 23, 2008, Harbor Homes entered into an interagency agreement (IAA) with a community mental health program, Community Council of Nashua, NH, now known as Greater Nashua Mental Health Center (GNMHC), which authorized Harbor Homes to provide certain Medicaid-funded rehabilitative services to GNMHC patients. In February 2011, Harbor Homes learned that GNMHC did not intend to renew its IAA and that the Medicaid reimbursable services provided by Harbor Homes would be transitioned to GNMHC. This was done pursuant to Administrative Rule He-M 426.04(a)(2), which meant that Harbor Homes would no longer have an IAA with a community mental health provider, and it would no longer be permitted to provide Medicaid funded mental health services to approximately one hundred and forty of its clients, including the individual plaintiffs in this case. Plaintiffs filed a petition for injunctive and declaratory relief, seeking a court order enjoining DHHS from "terminating or limiting Harbor Homes' status as a qualified Medicaid provider" and to direct the State to allow the individual plaintiffs to obtain community mental health services from Harbor Homes, the provider of their choice. Following two hearings, the court denied the plaintiffs' request for a preliminary injunction. Thereafter, all parties moved for partial summary judgment on the plaintiffs' claim that DHHS's reliance upon the IAA requirement as a reason to terminate Harbor Homes' status as a qualified Medicaid provider was improper because the requirement was invalid both on its face and as applied in this case. Plaintiffs appealed rulings of the Superior Court that denied their summary judgment motions and granting the defendants' cross-motions for summary judgment on two counts in the plaintiffs' petition. Upon review of the matter, the Supreme Court reversed the Superior Court's ruling that New Hampshire Administrative Rules, He-M 426.04(a)(2) did not violate the federal Medicaid Act. The case was remanded for further proceedings. View "Dube v. New Hampshire Dept. of Health & Human Svcs." on Justia Law

This case was among a number of civil actions brought by state attorneys general against pharmaceutical companies challenging the propriety of prescription drug pricing, as it impacted third-party reimbursement for brand-name drug purchases subsidized by government social welfare programs. The Commonwealth focused its claims upon alleged overpayments tied to the use of an industry benchmark figure (average wholesale price, or "AWP") in government reimbursement formulas. While many issues of concern were raised about the Commonwealth’s approach to this litigation and the judgment it has obtained, the Pennsylvania Supreme Court overturned the monetary component of that judgment grounded on the Commonwealth’s failure to offer a rational accounting for the billion dollars in rebate monies which Commonwealth agencies received from the drug manufacturers it sued. View "Pennsylvania v. TAP Pharmaceutical Products, Inc." on Justia Law

Mountain Regional Services, Inc. (MRSI), which provides services to individuals who receive medical benefits administered by the Wyoming Department of Health, filed a petition seeking judicial review of a “Provider Bulletin” issued by the Department concerning these benefits. The district court dismissed the petition for lack of ripeness and because MRSI failed to exhaust its administrative remedies before seeking judicial review. The Supreme Court affirmed, holding (1) the district court correctly concluded that the matter was not ripe for judicial review, and (2) therefore, it was unnecessary to consider the issue of exhaustion of administrative remedies. View "Mountain Reg'l Servs., Inc. v. State ex rel., Dep't of Health" on Justia Law