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

Articles Posted in Public Benefits
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Saunders worked as a bus attendant for the Washington, D.C., school system, helping students with special needs and those in wheelchairs on and off the bus. On January 7, 2014, she slipped and fell on ice at work, suffering a hip contusion and back pain. Saunders never returned to work but filed a disability claim with the Social Security Administration six months after her fall. She obtained multiple opinions from Dr. Williams, her generalist, and Dr. Liberman, her neurologist. Saunders received disability benefits from the Washington, D.C., workers’ compensation board.After Saunders’s federal disability claims were denied an ALJ held a hearing and concluded that she was not disabled. The ALJ gave “some” weight to certain medical opinions but “no weight” to others, including Dr. Lieberman’s opinion that Saunders was permanently disabled. The ALJ placed considerable weight on the vocational expert’s testimony and found that someone with Saunders’s functional capacity could perform her past work as generally performed in the national economy. The district court affirmed. The D.C. Circuit remanded. The ALJ erroneously failed to consider certain medical opinions, particularly those of Saunders’s treating physician. View "Saunders v. Kijakazi" on Justia Law

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When Medicare overpays hospitals, it offsets that mistake by reducing future payments. By 2013, Medicare was out $11 billion because of new diagnostic codes and bookkeeping that did not keep up. Congress required that the Secretary of Health and Human Services recoup that amount by the end of fiscal year 2017 by reducing the base rate (standardized amount) paid for inpatient care and directed the Secretary to adjust the base rate by 0.5% each year through 2023, 129 Stat. 87, 163 (2015). Subsequently, while reviewing the 2017 budget, the Secretary realized that a -3.2% adjustment would leave the agency short of its $11 billion goal and announced a -3.9% adjustment. Congress then told the Secretary to increase the base rate by 0.4588% (not 0.5%) in 2018, 130 Stat. 1033, 1320 (2016). In 2017, the Secretary adjusted the base rate -3.9%. The agency met its goal. In 2018, the Secretary adjusted the base rate -3.4412%.Medicare providers sued, arguing that the Secretary should have reversed that expedient at the end of 2017 rather than carry it over into 2018, costing the hospitals $840 million in lost payments. The D.C. Circuit affirmed the dismissal of the suit. While the hospitals felt a “significant financial impact” from the -0.7% adjustment, Section 7(b)(5) bars judicial review of adjustments made under the Act. View "Fresno Community Hospital and Medical Center v. Cochran" on Justia Law

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Plaintiff filed suit alleging that DCPS failed to provide her son with a free appropriate public education (FAPE) based on his 2017 individualized education program (IEP). The DC Circuit affirmed the district court's dismissal of the claim as moot, holding that the case presents a fact-specific challenge to particular provisions in an inoperative IEP. Furthermore, the parties agreed to a subsequent IEP and plaintiff does not seek retrospective relief. The court also held that an exception to mootness does not apply where the voluntary cessation doctrine is inapplicable and plaintiff's claim fails to meet the capable of repetition prong because the challenge focuses on a fact-specific inquiry rather than a recurring legal question. View "J. T. v. District of Columbia" on Justia Law

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The Department of Health and Human Services disallowed roughly $30 million in Medicaid reimbursements for payments Virginia made to two state hospitals. HHS determined that Virginia had materially altered its payment methodology without notifying HHS or obtaining approval and that the new methodology resulted in payments that overstepped applicable federal limits. Virginia had allocated disproportionate share hospitals (DSH) payments for the two hospitals to fiscal years other than “the actual year in which [related] DSH costs were incurred” by those hospitals for purposes of complying with the annual statewide DSH allotment and hospital-specific limit. The district court and D.C. affirmed. A comparison between Virginia’s previous operation of its plan—as manifested in the state’s prior representations about the plan’s operation—and its later operation of the same plan shows that there was a “[m]aterial change” in “the State’s operation of the Medicaid program,” so that the state was required to amend its plan and present the amendment for approval, 42 C.F.R. 430.12(c)(1)(ii). View "Department of Medical Assistant Services of the Commonwealth of Virginia v. United States Department of Health and Human Services" on Justia Law

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Kentucky and Arkansas residents sued the Secretary of Health and Human Services based on the approval under 42 U.S.C. 1315(a) of an “experimental, pilot, or demonstration projects which, in the judgment of the Secretary, is likely to assist in promoting the objectives” of Medicaid. The district court held that the Secretary failed to analyze whether the projects would promote the primary objective of Medicaid—to furnish medical assistance. Kentucky terminated its project and obtained voluntary dismissal.The D.C. Circuit affirmed with respect to the Arkansas Works program, which required beneficiaries aged 19-49 to “work or engage in specified educational, job training, or job search activities for at least 80 hours per month,” except beneficiaries who show they are medically frail or pregnant, caring for a dependent child under age six, participating in a substance treatment program, or are full-time students. Works proposed to eliminate retroactive coverage, to lower the income eligibility threshold from 133% to 100% of the federal poverty line, and eliminated using Medicaid funds to assist beneficiaries in paying the premiums for employer-provided health care coverage. Instead of analyzing whether the demonstration would promote the objective of providing coverage, the Secretary identified three alternative objectives. Congress has not conditioned the receipt of Medicaid benefits on fulfilling work requirements or taking steps to end receipt of governmental benefits View "Gresham v. Azar" on Justia Law

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The Hospitals challenged HHS's implementation of a Medicare outlier-payment program in the late 1990s and early 2000s. The Hospitals contend that HHS violated the Administrative Procedure Act (APA), 5 U.S.C. 551 et seq., by failing to identify and appropriately respond to flaws in its methodology that enabled certain "turbo-charging" hospitals to manipulate the system and receive excessive payments at the expense of non-turbo-charging hospitals, including the Hospitals. The DC Circuit held that District Hospital Partners, L.P. v. Burwell, 786 F.3d 46 (D.C. Cir. 2015), controlled to the extent that the Hospitals repeated challenges decided in that case. In regard to the remaining challenges, the court affirmed the district court's denials of the Hospitals' motions to supplement the record and to amend their complaint, and its decision that HHS acted reasonably in a manner consistent with the Medicare Act in fiscal years (FYs) 1997 through 2003, and 2007. However, because HHS inadequately explained aspects of the calculations for FYs 2004 through 2006, the court reversed summary judgment in that regard and remanded for further proceedings. View "Banner Health v. Price" on Justia Law

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Healthcare Providers sought a mandamus order to force the HHS Secretary to clear the administrative appeals backlog and adhere to the Medicare statute's timeframe to complete the process. The district court subsequently determined that mandamus was appropriate and adopted Healthcare Provider's proposed timetable when the Secretary refused to engage with the premise of setting a timetable at all and proposed no alternative targets. The DC Circuit held that, notwithstanding the district court's earnest efforts to make do with what the parties presented, the failure to seriously test the Secretary's assertion of impossibility and to make a concomitant finding of possibility was an abuse of discretion. Accordingly, the court vacated the mandamus order and the order denying reconsideration, and remanded to the district court to evaluate the merits of the Secretary's claim that unlawful compliance would be impossible. View "American Hospital Assoc. v. Price" on Justia Law

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Texas Neighborhood Services received Head Start grant money to provide childcare services to low-income families in Texas. The Department subsequently required Neighborhood Services to repay $1.3 million in federal funds it awarded to staff in the form of performance bonuses. The Department argued that the payments were unreasonable and inadequately documented and the Appeals Board agreed. The DC Circuit affirmed the district court's rejection of Neighborhood Services' challenge under the Administrative Procedures Act. In this case, Neighborhood Services failed to produce documentation sufficient to show that it was awarding performances in accordance with the Office of Management and Budget's Circular A-122, which explains when and how the government will reimburse federal grantees, including organizations receiving Head Start money, for different types of expenses. View "Texas Neighborhood Services v. HHS" on Justia Law

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Under the Department of Housing and Urban Development’s (HUD) Housing Choice Voucher Program, 42 U.S.C. 1437f, housing agencies use HUD funds to issue housing subsidy vouchers based on family size. The Montgomery County, Maryland Housing determined, based on a medical form, that Angelene has a disability and requires a live-in aide. HUD regulations mandate that any approved live-in aide must be counted in determining family size. The Commission issued Angelene a two-bedroom voucher. Angelene’s sister was Angelene’s live-in aide. Angelene decided to move to the District of Columbia. Program vouchers are portable. Angelene obtained a two-bedroom voucher from the D.C. Housing Authority. The sisters moved into a two-bedroom District apartment. Within weeks, they received a letter revoking Angelene’s right to a live-in aide and her legal entitlement to a two-bedroom voucher. They sued, citing the Americans with Disabilities Act, 42 U.S.C. 12132, Rehabilitation Act, 29 U.S.C. 794, and Fair Housing Act, 42 U.S.C. 3604(f)(1). The court denied motions for a temporary restraining order and to seal their complaint, medical records, and “nondispositive materials.” While the case was pending, the Authority sent another letter reaffirming that Angelene’s request for a live-in aide was denied, but stating that the decision did not reverse the two-bedroom voucher. The court dismissed, finding no allegation of injury-in-fact. The D.C. Circuit reversed with respect to the motion to seal and the dismissal. At the pleadings stage, plaintiff’s allegation that the government denied or revoked a benefit suffices to show injury-in-fact. Angelene’s loss of a statutory entitlement traces directly to the Authority’s letter and would be redressed by a court order to approve her aide request. View "Hardaway v. District of Columbia Housing Authority" on Justia Law

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In 42 U.S.C. 433, Congress authorized the President to enter into social security coordination agreements - known as totalization agreements - with other countries. This case involves a totalization agreement between the United States and France. At issue is whether or not two French taxes enacted into law after that totalization agreement was adopted amend or supplement the French social security laws covered by the agreement, and thus fall within the agreement’s ambit. The court concluded that the trial court committed legal error in declaring the status of those French laws not by analyzing the text of the totalization agreement or the understanding of the parties, but by resorting to American dictionaries. The court reversed and remanded because insufficient consideration was given to the text and the official views of the United States and French governments. View "Eshel v. Commissioner" on Justia Law