Justia U.S. D.C. Circuit Court of Appeals Opinion Summaries

Plaintiff filed suit challenging the religious exemption in the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119, as an unconstitutional establishment of religion. Plaintiff also argued that the Administration’s decision to temporarily suspend enforcement of some of the Act’s requirements for a transitional period deprived him of the equal protection of the laws. The district court granted the government's motion to dismiss and held that plaintiff lacked standing to bring either claim. The court agreed with the district court that plaintiff lacks standing to assert his equal protection claim because nothing in the transitional policy requires him to buy insurance. In this case, plaintiff's inability to maintain his old plan was the independent choice of his insurer. The court concluded, however, that plaintiff did have standing to bring his Establishment Clause challenge. On the merits, the court concluded that the claim fails because the qualifications for exemption are not drawn on sectarian lines. Rather, they simply sort out which faiths have a proven track record of adequately meeting the statutory goals. Moreover, the exemption promotes the Establishment Clause’s concerns by ensuring that those without religious objections do not bear the financial risk and price of care for those who exempt themselves from the tax. As configured by this specific statutory framework, that is an objective, non-sectarian basis for cabining the exemption’s reach. View "Cutler v. HHS" on Justia Law

This case arose from the Secretary’s decision in 2005 to change the boundaries of the geographic areas used to compute regional wage indices. A group of hospitals challenged the Secretary's decision to include wage data from Southcoast campuses outside the Boston-Quincy area in calculating the index for that area for fiscal years 2006 and 2007. The court concluded that the Secretary's treatment of Southcoast hewed to the existing administrative treatment of such multi-campus hospital groups; there were substantial informational and operational obstacles to implementing a different computational method quickly in 2006 or retroactively; appellants admit that the temporary effect of Southcoast’s multi-campus data on the wage index was a “one-off” occurrence arising from “unusual circumstances” that apparently did not affect any other multi-campus hospital group’s treatment; and nothing in the Medicare Act, 42 U.S.C. 1395 et seq., or established principles of administrative review mandate that the Secretary individually tailor one hospital’s reporting treatment to fit appellants' preferred computational outcome. Accordingly, the court affirmed the judgment. View "Anna Jacques Hospital v. Burwell" on Justia Law

Grossmont and four other California hospitals sought reimbursement under the Medicare program for so-called “bad claims.” Payment was denied because the claims were submitted to Medicare without first being submitted to the State of California for a determination of any payment responsibility it may have for the claims. The court concluded that Grossmont has failed to preserve its challenge that the mandatory state determination policy violates the bad debt moratorium; Grossmont also failed to preserve its claim that the Secretary’s effort to limit the alternative documentation policy must be rejected because it is a change in policy that must be adopted in a notice and comment rule; and, as applied in this case, the Secretary’s state determination requirement was not arbitrary or capricious. The court need not decide whether the Secretary acts arbitrarily and capriciously if she refuses to allow claims as bad debt if a recalcitrant state refuses to issue state determinations of payment responsibility despite reasonably diligent efforts to obtain them. Finally, the Secretary's conclusion that the hold harmless provision, in Joint Signature Memorandum 370 (JSM 370), does not apply is supported by substantial evidence and is not arbitrary or capricious. Accordingly, the court affirmed the judgment. View "Grossmont Hosp. Corp. v. Burwell" on Justia Law

The Secretary issued regulations that effectively prohibit physicians who lease medical equipment to hospitals from referring their Medicare patients to these same hospitals for outpatient care involving that equipment. The association challenged the regulations as exceeding the Secretary's statutory authority and violating the Administrative Procedure Act (APA), 5 U.S.C. 500 et seq., and the Regulatory Flexibility Act (RFA), 5 U.S.C. 601-612. The district court granted summary judgment in favor of the Secretary. Although one majority agrees with the district court that the statute is ambiguous as to the regulation of leases that charge on a per-use basis, a different majority concludes that the Secretary’s explanation for prohibiting these leases is unreasonable; the court unanimously concludes that the Secretary’s interpretation of the statute to apply to the physician-groups performing the procedures is reasonable, and that the Secretary complied with the RFA; and therefore, the court affirmed in part, reversed in part, and remanded to the district court with instructions to remand the regulation relating to leases charging by use to the Secretary for further proceedings. View "Council for Urological Interests v. Burwell" on Justia Law

Plaintiffs, hospitals that participate in Medicare, filed suit against the Secretary, claiming that she violated the Administrative Procedure Act (APA), 5 U.S.C. 551 et seq., by engaging in arbitrary and capricious decision-making. This dispute arose from plaintiffs' belief that the Secretary set the monetary threshold for outlier payments too high in 2004, 2005, and 2006. The court affirmed the district court’s partial denial of the motion to supplement the administrative record and its rejection of the APA challenges to the 2005 and 2006 outlier thresholds. The district court erred, however, in concluding that the Secretary adequately explained the 2004 outlier threshold. Therefore, the court reversed the grant of summary judgment on this claim and remanded for further proceedings. View "District Hosp. Partners v. Burwell" on Justia Law

The Medicare program provides federally funded healthcare to the elderly and the disabled. See Title XVIII of the Social Security Act, 42 U.S.C. 1395. Under a “complex statutory and regulatory regime” called Medicare Part A, the Government reimburses participating hospitals for care that they provide to inpatient Medicare beneficiaries. Most hospitals are reimbursed for inpatient hospital services pursuant to a standardized rate, but the Social Security Act also provides a method for calculating reimbursement rates for certain rural hospitals that qualify as “sole community hospital[s]” (SCHs) or that qualify as “medicare-dependent small rural hospital[s]” (MDHs). SCHs and MDHs receive reimbursement based on either the standard rate or a hospital-specific rate derived from its actual costs of treatment in one of the base years specified in the statute, whichever is higher. MDHs and SCHs challenged revisions to the rules covering their Medicare reimbursements for inpatient hospital services, arguing that the Medicare statute forbids the Secretary from modifying the hospitals’ reimbursements with budget neutrality adjustments from years prior to the base year. The district court rejected the claims. The D.C. Circuit affirmed, finding that the revisions were neither arbitrary nor manifestly contrary to the statute. View "Adirondack Med. Ctr. v. Burwell" on Justia Law

At issue in these consolidated cases is whether a regulatory accommodation for religious nonprofit organizations that permit them to opt out of the contraceptive coverage requirement under the Patient Protection and Affordable Care Act (ACA), 42 U.S.C. 300gg-13(a)(4), itself imposes an unjustified substantial burden on plaintiffs' religious exercise in violation of the Religious Freedom Restoration Act (RFRA), 42 U.S.C. 2000bb. The court concluded that the challenged regulations do not impose a substantial burden on plaintiffs' religious exercise under RFRA. All plaintiffs must do to opt out is express what they believe and seek what they want via a letter or two-page form. Religious nonprofits that opt out are excused from playing any role in the provision of contraceptive services, and they remain free to condemn contraception in the clearest terms. The ACA shifts to health insurers and administrators the obligation to pay for and provide contraceptive coverage for insured persons who would otherwise lose it as a result of the religious accommodation. Because the regulatory opt-out mechanism is the least restrictive means to serve compelling governmental interests, it is fully consistent with plaintiffs' rights under RFRA. The court also found no merit in plaintiffs' additional claims. The court rejected all of plaintiffs' challenges to the regulations and affirmed the district court's opinion in Priests for Life in its entirety. As for the RCAW decision, the court vacated the district court's grant of summary judgment for Thomas Aquinas and its holding as to the unconstitutionality of the non-interference provision and affirmed the remainder of the decision. View "Priests For Life v. HHS" on Justia Law

Section 5000A of the Patient Protection and Affordable Care Act, 26 U.S.C. 5000A, mandates that as of January 2014, non-exempt individuals maintain minimum health care coverage or, with limited exceptions, pay a penalty. Plaintiff filed suit alleging that the mandate violated the Commerce Clause and the Origination Clause of the Constitution. The court concluded that plaintiff's contention that the mandate obligating him to buy government-approved health insurance violates the Commerce Clause fails under the Supreme Court's interpretation of the mandate in National Federation of Independent Business v. Sebelius; plaintiff's contention that the mandate's shared responsibility payment was enacted in violation of the Origination Clause fails under Supreme Court precedent interpreting the Clause; and, therefore, the court affirmed the district court's dismissal of his complaint. View "Sissel v. HHS, et al." on Justia Law

Appellants challenged the IRS's interpretation of 26 U.S.C. 36B, enacted as part of the Patient Protection and Affordable Care Act, under the Administrative Procedure Act (APA), 5 U.S.C. 706(2)(A). The district court held that the ACA's text, structure, purpose, and legislative history make "clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated Exchanges." The district court held that even if the ACA were ambiguous, the IRS's regulation would represent a permissible construction entitled to Chevron deference. The court concluded, however, that the ACA unambiguously restricts the section 36B subsidy to insurance purchased on Exchanges "established by the State." Accordingly, the court reversed the judgment of the district court and vacated the IRS's regulation. View "Halbig v. Burwell" on Justia Law

Petitioners, a group of hospitals that serve a significant number of elderly, very low-income patients, filed suit challenging the Secretary's issuance of a rule concerning the "disproportionate share percentage" calculation of supplemental payments for low-income Medicare patients. When the Secretary published reimbursement calculations for FY 2007, petitioners learned that their payments would decrease by tens of millions of dollars per year. The rule change had an enormous financial consequence on hospitals. The court held that the Secretary did not provide adequate notice and opportunity to comment before promulgating its 2004 rule, and so affirmed the portion of the district court's opinion vacating the rule. The court reversed only the portion of the district court's opinion directing the Secretary to recalculate the hospitals' reimbursements using the alternate methodology. View "Allina Health Services, et al. v. Sebelius" on Justia Law