Justia Government & Administrative Law Opinion Summaries

Samuel J.H. was committed to the care and custody of the County Human Services Department. After Samuel's initial placement in outpatient care, the Department transferred him to an inpatient facility because of his erratic and delusional behavior. Samuel petitioned for a review of his transfer and a transfer back to outpatient status, contending that he was entitled to a hearing within ten days of his transfer to the inpatient facility. The circuit court denied Samuel's petitions, concluding (1) a patient is entitled to a hearing within ten days of his transfer to a more restrictive placement only when the transfer is based on a violation of treatment conditions; and (2) Samuel's transfer to the inpatient facility was not based on a violation of his treatment conditions but rather on reasonable medical and clinical judgment. The Supreme Court affirmed, holding that Wis. Stat. 51-35(1)(e) does not require a hearing to be conducted within ten days of a transfer to a more restrictive placement when the transfer is based on reasonable medical and clinical judgment. View "Manitowoc County v. Samuel J. H." on Justia Law

In 2011 Wisconsin reduced subsidies for the Wisconsin Care Program, which funds grants for organizations administering programs for disabled persons who live in group homes. The plaintiffs are developmentally disabled and suffered the largest cuts. Persons who had received smaller payments bore smaller cuts. For some (frail elderly) per capita payments increased. Plaintiffs claim that making larger absolute cuts for persons whose care is most expensive violated the Rehabilitation Act and the Americans with Disabilities Act and that reduction in payments increases the risk that they will be moved from group homes to institutions. The district judge noted that states have waived sovereign immunity with respect to the Rehabilitation Act, as a condition to receiving federal funds. The Supreme Court has held that the portions of the ADA that are not designed to implement disabled persons’ constitutional rights cannot be used to override states’ sovereign immunity. The district court concluded that the relevant provisions of the ADA do not concern the Constitution and that other claims were premature because no plaintiff has been moved to an institution. The Seventh Circuit affirmed, noting that without information about care provided to other disabled persons, there is no useful theory of discrimination. View "Amundson v. WI Dep't of Health Servs." on Justia Law

States participating in Medicaid in a managed care environment are required to make, at least every fourth month, supplemental “wraparound” payments to federally-qualified health centers (FQHCs) equal to the difference between a rate set by statute multiplied by the number of Medicaid patient encounters, and the amount paid to FQHCs by managed care organizations (MCOs) for all Medicaid-covered patient encounters, 42 U.S.C.1396. Concerned that gaps in FQHC claim verification led to overpayments, the New Jersey Department of Human Services changed its calculation: instead of basing wraparound payments solely on the number of Medicaid encounters and total MCO receipts as self-reported by FQHCs, the state would rely on data reported by MCOs absent receipt of certain additional data from the FQHCs. Because MCOs report only encounters that they have approved and paid, prior MCO payment would be a prerequisite to wraparound reimbursement under the new system. An association of FQHCs sued, claiming that the change violated their due process rights as well as state and federal law, resulting in budget shortfalls. The district court granted the association summary judgment and a preliminary injunction. The Third Circuit affirmed the holding that the requirement that wraparound payments be contingent on prior MCO payment violated the Medicaid statute’s requirement that FQHCs receive timely full wraparound payment for all Medicaid-eligible claims. View "NJ Primary Care Assoc. v. NJ Dep't of Human Servs." on Justia Law

The Clinics filed suit challenging California Welfare and Institutions Code 14131.10, which eliminated certain Medi-Cal benefits that the state deemed optional, including adult dental, podiatry, optometry, and chiropractic services. The court reversed the district court's holding that the Clinics have a private right of action to challenge the Department's implementation of the state plan amendments (SPA) prior to obtaining approval; affirmed that the Clinics have a private right of action to bring a claim pursuant to 42 U.S.C. 1983 challenging the validity of section 14131.10; and reversed the district court's interpretation of the Medicaid Act, 42 U.S.C. 1396 et seq., holding that section 14131.10 impermissibly eliminated mandatory services from coverage. View "California Ass'n of Rural Health Clinics v. Douglas" on Justia Law

In the 1980s, the owners bought the Cottonwood seasonal campground in Cedar Grove, Indiana. Each of 50-80 campsites has a water spigot and sewer hookup for recreational vehicles. The property also has two restrooms with working toilets, sinks, and showers. In 1998, the Environmental Protection Agency (EPA) issued an Administrative Order under the Safe Drinking Water Act, 42 U.S.C. 300g-3(b), (g), finding that Cottonwood operated as a public water system and was required to sample its water system, and to notify any individuals who use the property of its past failure to monitor the water system. The owners tested the water only sporadically over the following years. They denied that the water system constituted a public water system under SDWA because the water spigots are marked as “Non-Potable,” so users would know that water is not provided for human consumption. The district court entered summary judgment, finding violation of SDWA. The Seventh Circuit dismissed an appeal, finding that the owners had not raised any of their appellate arguments in the district court. View "United States v. Ritz" on Justia Law

Plaintiffs, several nursing homes approved by the Iowa Department of Human Services (DHS) as Medicaid providers, submitted annual reports disclosing their income and expenses to DHS. DHS used the reports to calculate the Medicaid per diem reimbursement rates for the nursing homes. Some of the facilities' expenses were disallowed by DHS, and DHS reduced reimbursement rates accordingly. The facilities appealed the adjustments. The director of human services upheld the action. The district court affirmed. The court of appeals reversed, concluding that the DHS rules did not support its decision that the disputed costs were not allowable. The Supreme Court affirmed, holding that DHS's exclusion of the facilities' lab, x-ray, and prescription drug costs from the nursing homes' reports was based on an incorrect interpretation of its rules. View "Sunrise Ret. Cmty. v. Iowa Dep't of Human Servs." on Justia Law

The State Health Planning & Development Agency (SHPDA) granted Rainbow Dialysis (Rainbow) a conditional certificate of need to establish two dialysis facilities in Maui. Liberty Dialysis-Hawaii (Liberty), another Maui dialysis provider, sought reconsideration of SHPDA's decision. A five-member reconsideration committee unanimously approved Rainbow's certificate of need. Liberty appealed, arguing that the SHPDA administrator and another committee member should have been disqualified from participating in the reconsideration decision. The circuit court affirmed, holding that the SHPDA administrator should have been disqualified but his participation was harmless. The Supreme Court affirmed, holding that neither the administrator nor the other committee member was disqualified from participating in the reconsideration decision. View "Liberty Dialysis-Hawaii, LLC v. Rainbow Dialysis, LLC" on Justia Law

Millard petitioned for review of the Commission's affirmance of citations issued to Millard for committing violations of emergency response, training, record-keeping, and other requirements after more than 30,000 pounds of anhydrous ammonia escaped from one of Millard's refrigerated storage facilities. The court concluded that Millard's challenges to the two process safety management violations, Millard's contention that OSHA was estopped from asserting that the company violated agency regulations, and Millard's ten remaining challenges either lacked merit or merited neither reversal nor further discussion. Accordingly, the court denied the petition for review. View "Millard Refrigerated Services v. Secretary of Labor" on Justia Law

The Iowa Board of Nursing and Iowa Department of Public Health (collectively, Defendants) enacted rules allowing advanced registered nurse practitioners (ARNPs) to supervise radiologic technologists using fluoroscopy machines. Several physician associates brought this action against Defendants to invalidate the rules. Two nursing associations intervened to defend the rules. The district court invalidated the rules, concluding that Defendants exceeded their authority in promulgating the rules. The Supreme Court reversed, holding (1) the Board's application of law to fact was not irrational, illogical, or wholly unjustifiable; (2) the rules fell within the authority of the Board and Department; and (3) the other challenges to the rules failed. Remanded. View "Iowa Med. Soc'y v. Iowa Bd. of Nursing" on Justia Law

Plaintiffs appealed the Secretary's denial of their claims for Medicare coverage for dental services. Plaintiffs contended that this denial was premised on the Secretary's unreasonable interpretation of the Medicare Act, Pub. L. No. 89-97, 79 Stat. 286, which contravened the intent of Congress and violated plaintiffs' right to equal protection under the Fifth Amendment. The court concluded that, although the statutory provision for exclusion of dental services was ambiguous in the sense that plausible divergent constructions could be urged, the Secretary's interpretation of the statute was reasonable. The court also concluded that the Secretary's statutory interpretation warranted Chevron deference and the Secretary's statutory interpretation was reasonable. Accordingly, the court affirmed the judgment. View "Fournier v. Sebelius" on Justia Law