Justia Health Law Opinion Summaries

Memorial Hospital at Gulfport and Singing River Health System (“Hospitals”) sought judicial review of a June 24, 2016 administrative decision which found the Division of Medicaid’s (“DOM’s”) 2014 Fiscal Year Methodology “correctly interprets statutes and regulations and is neither arbitrary or capricious.” The chancellor affirmed the decision of DOM. Finding no evidence in the record before it that DOM failed to comply with Sections 43-13-117 and 43-13-145 in allocating and distributing supplemental payments to Mississippi hospitals, the Mississippi Supreme Court affirmed. View "Memorial Hospital at Gulfport v. Dzielak" on Justia Law

From 1996-2011 Pennsylvania claimed the costs of a training program, the Pennsylvania Restraint Reduction Initiative, “to train long-term care facility staff in the use of alternative measures to physical and chemical restraints,” as administrative costs under its Medicaid program, 42 U.S.C. 1396b(a)(7) . The Centers for Medicare & Medicaid Services (CMS) reimbursed Pennsylvania for about $3 million. After an audit, CMS sought a return of the money on the ground that funds spent on training programs are not reimbursable as administrative costs under Medicaid. CMS relied heavily on a 1994 State Medicaid Director Letter. The Appeals Board, district court, and Third Circuit rejected the state’s arguments that the 1994 Letter was an invalid substantive rule, that the Letter’s text does not exclude the training costs from reimbursement, that the Letter imposed an ambiguous condition on a federal grant, that the Appeals Board abused its discretion in denying discovery, that the HHS Grants Administration Manual limits the disallowance period to three years, and that the district court should have taken judicial notice of the 2015 CMS Question and Answer document concerning training costs. The court noted CMS could have reimbursed Pennsylvania if Pennsylvania factored the amount into its rate-setting scheme instead of claiming it as administrative costs. View "Commonwealth of Pennsylvania Department of Human Services v. United States" on Justia Law

The Supreme Court held that Montana law does not preclude physical restraint of a seriously mentally ill individual during transportation from a courtroom to a hospital or mental health facility.The district court ordered J.J., who suffered from severe and chronic mental illness, involuntarily committed to Montana State Hospital (MSH). Thereafter, J.J. requested that he not be handcuffed in the sheriff’s vehicle on the way to MSH. The district court denied the request. The Supreme Court affirmed, holding that while Mont. Code Ann. 53-21-146 provides patients a statutory right to be free from physical restraint, nothing in the plain language of the statute leads to the conclusion that it applies to transportation. Further, Montana law enforcement officers owe the public a general duty to preserve the peace and protect the public from harm inflicted by third persons. Because J.J.’s potential for serious injury or harm was high and foreseeable, the district court did not abuse its discretion when it failed to grant J.J.’s request not to be handcuffed during transportation. View "In re J.J." on Justia Law

The Secretary appealed the district court's order enjoining him from enforcing a Medicaid policy set forth in a Frequently Asked Questions document (FAQ 33), which purported to clarify the methodology for calculating the maximum amount of financial assistance available to hospitals, like Children's Hospital, that serve a disproportionate number of low-income or special needs patients (DSHs).The Fourth Circuit held that the district court correctly determined that the policy set forth in FAQ 33 constituted a "legislative rule" and thus the Administrative Procedure Act mandated that the agency establish the FAQ 33 policy through notice-and-comment rulemaking. Therefore, the court affirmed the district court's judgment enjoining the Secretary from enforcing the policy set forth in FAQ 33 against Children's Hospital. The court declined to reach the substantive challenge and vacated the part of the district court's opinion addressing whether the policy conflicts with the language of 42 U.S.C. 1396r-4(g). View "Children's Hospital v. Azar" on Justia Law

The Supreme Court held that, in dismissing the Commonwealth’s petition to have Troy Lamar Giddens, Sr. civilly committed as a sexually violent predator, the trial court misapplied the relevant statute, Va. Code 37.2-905.1. Moreover, the evidence did not support dismissal.The trial court dismissed the Commonwealth’s petition, concluding that the burden was on the Commonwealth to prove that Giddens was eligible for the sexually violent predator program and that the Commonwealth failed to show that Giddens' score on Static-99, the test designed to assess the recidivism risk of adult male sexual offenders, was scored correctly. The Supreme Court reversed, holding that Giddens did not show gross negligence or willful misconduct, which was required for him to prevail under section 37.2-905.1. View "Commonwealth v. Giddens" on Justia Law

The DEA bars hospitals from hiring, as an employee with “access to controlled substances,” any doctor who “for cause” has surrendered his registration to handle those substances. The DEA enforced this regulation against Doctors McDonald and Woods, who had voluntarily surrendered their registrations while in addiction treatment. They later regained full registrations. The doctors sued to enjoin the DEA from enforcing the regulation against them in the future, arguing that it no longer applied to them once their registrations were restored. The parties settled. Their agreement provides that “[t]he DEA no longer interprets 21 C.F.R. 1301.76(a) as requiring . . . potential employers of doctors with unrestricted DEA registrations to seek waivers.” The Sixth Circuit denied the government’s motion to keep the agreement under seal, noting “a strong presumption in favor of openness as to court records.” The government did not identify information too sensitive to remain public. Public interest is particularly strong where the information pertains to an agency’s interpretation of a regulation. Other doctors would no doubt be interested. View "Woods v. United States Drug Enforcement Administration" on Justia Law

This case was one in a longstanding dispute between major health services providers operating in Western Pennsylvania: UPE, a/k/a Highmark Health and Highmark, Inc. (collectively, Highmark) and UPMC (University of Pittsburgh Medical Center). Highmark and UPMC separately entered into Consent Decrees with the Commonwealth's Office of Attorney General (OAG). In this case, an issue arose concerning the obligations imposed by the Consent Decrees relative to UMPC's attempt to terminate ten hospital Medicare Acute Care Provider Agreements it had with Highmark. Pertinent here, UPMC's Consent Decree required it to treat Highmark's Medicare Advantage Plan consumers as in-network through the end date of the Consent Decree. UPMC allowed Provider Agreements with Highmark to renew annually in satisfaction of its in-network obligation. UPMC informed Highmark in accordance with the notice provisions, it would terminate the Provider Agreements on December 31, 2018, but would nonetheless continue to comply with all terms and obligations of those agreements through June 30, 2019, pursuant to the Decree runout provision. Highmark filed for an injunction and to hold UPMC in contempt. The Commonwealth granted OAG's petition to enforce, rejecting UPMC's contention that the six-month runout provision of the Provider Agreements satisfied its obligation to remain in "contract" with Highmark. The Pennsylvania Supreme Court reversed, finding the runout provision of the Provider Agreement satisfied UPMC's obligation to contract for in-network access to its facilities for Highmark's MA Plan subscribers through June 30, 2019. View "Pennsylvania v. UPMC, et al" on Justia Law

The Supreme Court affirmed the order of the district court approving S.D.’s waiver of her rights and ordering S.D.’s involuntary commitment, holding that the district court did not violate S.D.’s statutory and due process rights when it committed her without holding a hearing.The State filed a petition against S.D., alleging that she suffered from a mental disorder and required involuntary commitment. S.D. and her attorney signed a “waiver of hearing on petition,” and S.D. expressly waived all her procedural rights listed in Mont. Code Ann. 53-21-115 to -118 except the right to receive treatment. The district court issued an order committing S.D. to the Montana State Hospital. S.D. appealed, arguing that the district court erred when it committed her upon her signed waiver without a hearing or trial. The Supreme Court affirmed, holding that both S.D.’s waiver and the district court’s order committing her were sufficient to find an intentional and knowing waiver pursuant to section 53-21-119(1), and it was not necessary for the court to set a hearing to inquire further into S.D.’s waiver of rights. View "In re S.D." on Justia Law

This case involved the "340B Program," which allowed certain hospitals to purchase outpatient drugs from manufacturers at or below specified prices. Plaintiffs filed suit challenging a regulation that sets the Outpatient Prospective Payment System (OPPS) reimbursement drugs purchased through the 340B Progam for 2018. The district court held that plaintiffs failed to present claims for reimbursement to the Secretary, as required to obtain judicial review of claims under Medicare, and thus dismissed the complaint for lack of subject matter jurisdiction.The DC Circuit held that plaintiffs neither presented their claim nor obtained any administrative decision at all, much less the "final decision" required under 42 U.S.C. 405(g). In this case, when plaintiffs filed this action, neither the hospital plaintiffs, nor any members of the hospital-association plaintiffs, had challenged the new reimbursement regulation in the context of a specific administrative claim for payment. They could not have done so because the new regulation had not yet even become effective. Therefore, plaintiffs failed to satisfy the presentment requirement of section 405(g), and the district court properly dismissed this case for lack of subject matter jurisdiction. View "American Hospital Ass'n v. Azar" on Justia Law

Petitioners sought a writ of mandate directing the superior court to vacate its order denying their motion for summary judgment and issue an order granting the motion. The Court of Appeal issued a stay pending this court's resolution of the petition and an order to show cause why a writ of mandate should not issue. In this case, real party in interest's complaint alleged that petitioners' breakfast cereals were required by California's Proposition 65 to display cancer and reproductive harm warnings because they contain acrylamide. The court held that the Proposition 65 claim was preempted by federal law and granted the petition. The court directed the superior court to vacate its order denying petitioners' motion and enter a new and different order granting the motion. View "Post Foods, LLC v. Superior Court" on Justia Law