Justia Health Law Opinion Summaries

Yale New Haven Hospital (“YNHH”) receives federal funds under the Medicare Act. As part of the statutory formula for determining appropriate funding, the Medicare Act directs the Secretary of Health and Human Services (the “Secretary”) to “estimate” the “amount of uncompensated care” that each hospital will provide to indigent patients in a given federal fiscal year (“FFY”). Here, YNHH contended that the Secretary failed to conduct adequate notice-and-comment rulemaking before choosing to use only YNHH’s historical data – and not that of a hospital that had recently merged into YNHH – to estimate YNHH’s amount of uncompensated care for FFY 2014. The Secretary moved to dismiss for lack of subject-matter jurisdiction under 42 U.S.C Section 1395ww(r)(3), which prohibits “judicial review” of “[a]ny estimate of the Secretary.” The district court denied the Secretary’s motion, reasoning that section 1395ww(r)(3) applies only to substantive challenges to estimates, but not to procedural challenges like YNHH’s. The district court subsequently granted summary judgment in favor of YNHH.   The Secretary appealed, disputing (1) the district court’s ruling that it had jurisdiction to consider YNHH’s procedural challenge, and alternatively (2) the district court’s merits ruling that the Secretary’s estimate was procedurally unlawful.   The Second Circuit reversed the district court’s denial of the Secretary’s motion to dismiss YNHH’s procedural challenge for lack of subject-matter jurisdiction; vacated, for lack of subject-matter jurisdiction, the district court’s grant of summary judgment for YNHH on its procedural challenge; REMAND the case to the district court with instructions to dismiss the remainder of YNHH’s action for lack of subject-matter jurisdiction; and dismissed YNHH’s cross-appeal disputing the district court’s chosen remedy. View "Yale New Haven Hosp. v. Becerra" on Justia Law

Plaintiffs brought various claims against Rockland County ("Rockland County Defendants") officials including a violation of the Free Exercise Clause of the First Amendment, based on orders which excluded children who were not vaccinated against measles from attending school and an emergency declaration which barred unvaccinated children, other than those with medical exemptions, from places of public assembly. The district court granted summary judgment for Rockland County Defendants.The Second Circuit reversed, finding that Plainitffs' claim raises numerous disputes—including whether there is evidence of religious animus, to whom the emergency declaration applied, and what the County’s purpose was in enacting the declaration—that prevent Defendants from prevailing on summary judgment. View "M.A. v. Rockland County Department of Health" on Justia Law

Class members are Medicare Part A beneficiaries who are formally admitted to a hospital as "inpatients" before their subsequent reclassification as outpatients receiving "observation services." Plaintiffs filed suit alleging that the Secretary violated their due process rights by declining to provide them with an administrative review process for the reclassification decision. The district court entered an injunction ordering the creation of such a process.The Second Circuit affirmed, concluding that the named plaintiff had standing by demonstrating that they suffered a financial injury as a result of being reclassified as receiving observations services; the failure of the Secretary to provide an appeals process for the reclassification decision implicates the same set of concerns—namely, a loss of Part A coverage—for both the named plaintiffs and the absent class members; and the litigation incentives are sufficiently aligned so that the named plaintiffs can properly assert claims on behalf of those class members who will be hospitalized in the future. The court also concluded that the district court properly certified the plaintiff class and that the class satisfies the commonality and typicality requirements. Furthermore, the plaintiff class was properly certified under Federal Rule of Civil Procedure 23(b)(2).The court concluded that the district court did not clearly err by finding that plaintiffs' due process rights are violated by the current administrative procedures available to Medicare beneficiaries. In this case, plaintiffs have demonstrated that the Secretary violates their due process rights when utilization review committees reclassify them from inpatients to those receiving observation services without providing a mechanism to appeal that decision. View "Barrows v. Becerra" on Justia Law

The Second Circuit affirmed the district court's dismissal of plaintiff's claims for damages for violation of section 18(2)(e) of the New York Public Health Law, which provides that health care providers may impose only a "reasonable charge," not to exceed "seventy-five cents per page," for copies of medical records. In its answer to a certified question of law from the Second Circuit, the New York Court of Appeals concluded that no private right of action lies for violations of section 18(2)(e). Accordingly, dismissal was proper. View "Ortiz v. Ciox Health LLC" on Justia Law

Teachers and school administrators challenge the denial of motions to preliminarily enjoin the enforcement of an order issued by the New York City Commissioner of Health and Mental Hygiene mandating that individuals who work in New York City schools be vaccinated against the COVID-19 virus.The Second Circuit concluded that the Vaccine Mandate does not violate the First Amendment on its face. However, the court concluded that plaintiffs have established their entitlement to preliminary relief on the narrow ground that the procedures employed to assess their religious accommodation claims were likely constitutionally infirm as applied to them. The court explained that the Accommodation Standards as applied here were neither neutral nor generally applicable to plaintiffs, and thus the court applied a strict scrutiny analysis at this stage of the proceeding. The court concluded that these procedures cannot survive strict scrutiny because denying religious accommodations based on the criteria outlined in the Accommodation Standards, such as whether an applicant can produce a letter from a religious official, is not narrowly tailored to serve the government's interest in preventing the spread of COVID-19. Accordingly, the court vacated the district court's orders denying preliminary relief and concurred with and continued the interim relief granted by the motions panel as to these fifteen individual plaintiffs. The court remanded for further proceedings. View "Kane v. De Blasio" on Justia Law

New York’s “Prevention of COVID-19 transmission” Rule, issued in August 2021, directs hospitals, nursing homes, hospices, adult care facilities, and other healthcare entities to “continuously require” certain employees to be fully vaccinated against COVID-19. It establishes a medical exemption to the requirement, but—consistent with New York’s prior vaccination requirements for healthcare workers—does not include an exemption based on religious belief. The Rule permits, but does not require, employers to make other accommodations for individuals who choose not to be vaccinated based on their sincere religious beliefs.The plaintiffs, primarily healthcare workers, challenged the Rule, claiming that being vaccinated would violate their religious beliefs because the vaccines were developed or produced using cell lines derived from cells obtained from voluntarily aborted fetuses. One district court enjoined the Rule insofar as it prevented healthcare workers from being eligible for a religious exemption; the other denied relief.The Second Circuit rejected the Plaintiffs’ claims. With respect to the Free Exercise claim, they have not established that they are likely to prove that the Rule is not a neutral law of general applicability or that it does not satisfy rational basis review. Nor have they demonstrated a likelihood of success on their Supremacy Clause claim; they have not shown that it would likely be impossible for employers to comply with both the Rule and Title VII. The Plaintiffs are not likely to succeed on their claim that the Rule contravenes the Fourteenth Amendment. View "We The Patriots USA, Inc. v. Hochul" on Justia Law

Bellin brought a putative class action under 42 U.S.C. 1983, alleging that managed long-term care plans (MLTCs) that contract with New York State violate Medicaid beneficiaries’ due process rights by denying them the right to appeal an MLTC’s initial determination of the personal care services hours the MLTC will provide the beneficiary if they choose to enroll with the MLTC. Bellin also alleged that beneficiaries are entitled to this appeal right, and to notice of the right, under federal statutory and constitutional law. Bellin brought her claims against ElderServe, an MLTC that she alleges denied her these rights, and Zucker, in his official capacity as Commissioner of the New York State Department of Health, for his alleged failure to enforce these asserted rights.The Second Circuit affirmed the dismissal of Bellin’s federal law claims on the grounds that the relevant federal statutes do not provide Medicaid beneficiaries a right to appeal initial personal care services hours determinations. The court vacated the dismissal of Bellin’s Fourteenth Amendment due process claims; Bellin plausibly alleged a constitutionally protected property interest in the determination of her personal care services hours. View "Bellin v. Zucker" on Justia Law

Connecticut Governor Ned Lamont and the state's Commissioner of the Department of Emergency Services and Public Protection James Rovella appeal from the district court's order granting a preliminary injunction ordering that the Governor repeal, in light of the COVID-19 pandemic, a provision to suspend collection of fingerprints in connection with applications for authorization to obtain firearms. The injunction also ordered that the Governor repeal that provision of the executive order and that the DESPP Commissioner resume fingerprinting services at that agency.The Second Circuit vacated the preliminary injunction and concluded that: (1) with respect to the individual plaintiffs, the preliminary injunction motion became moot in the district court; and (2) CCDL lacked organizational standing. Because the motion was moot and CCDL lacked standing, the district court had no jurisdiction to issue the preliminary injunction. View "Connecticut Citizens Defense League, Inc. v. Lamont" on Justia Law

Plaintiffs, a group of nursing homes that participate in both the Medicare and Medicaid programs, challenge the legality of DHS's Final Rule permitting survey teams conducting certain inspections of nursing homes not to include a registered nurse. The district court dismissed plaintiffs' claims, brought under the Medicare and Medicaid Acts, for lack of subject-matter jurisdiction based on claim-channeling and jurisdiction-stripping provisions governing claims arising under the Medicare Act.The Second Circuit reversed, concluding that the district court has jurisdiction under 28 U.S.C. 1331 over plaintiffs' claim arising under the Medicaid Act, which does not incorporate the same claim-channeling and jurisdiction-stripping provisions as the Medicare Act. The court explained that the Medicare Act's review provisions do not preclude plaintiffs from challenging the Final Rule in federal court because their challenge is independently rooted in the Medicaid Act. Furthermore, plaintiffs' Medicaid Act claim is not inextricably intertwined with a Medicare Act claim for benefits or compliance determination, and the government's policy rationale does not support claim channeling and jurisdiction stripping in this case. Accordingly, the court remanded for further proceedings. View "Avon Nursing & Rehabilitation v. Becerra" on Justia Law

Defendants appealed the district court's judgment certifying a plaintiff class and enjoining state defendants from conducting Medicaid fair hearings in a manner that does not result in final determinations of Medicaid eligibility within 90 days of hearing requests. At issue is the phrase "final administrative action" in the context of a federal Medicaid regulation that requires a state agency to take such action within a specified time limit following a Medicaid applicant's request for a fair hearing. 42 C.F.R. 431.244(f).The Second Circuit held that the federal regulatory requirement of "final administrative action" within 90 days requires the state to determine Medicaid eligibility within that time. However, the court explained that such determinations may be made in hearing decisions or on remand to local agencies. Therefore, the regulation mandates that states meet the applicable deadline, but it does not limit states as to the administrative level at which that deadline is met. The court affirmed in part and remanded for further proceedings. View "Lisnitzer v. Zucker" on Justia Law