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

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

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

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

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

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

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

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

In order to determine how much federal funding goes to each hospital for providing care, the Secretary of HHS makes certain “estimates” as required by the Affordable Care Act, 42 U.S.C. 1395ww(r). Tampa General filed suit arguing that the Secretary’s reliance on “obsolete” data rather than “the most recent data available” violated federal law. The district court dismissed the hospital’s claim for lack of subject matter jurisdiction, holding that section 1395ww(r)(3), which precludes judicial review of the Secretary’s “estimate” of a hospital’s amount of uncompensated care, bars review of the Secretary’s choice of data used in determining that estimate. The court agreed and held that the bar on judicial review of the Secretary's estimates precludes review of the underlying data and affirmed that section 1395ww(r)(3) bars Tampa General’s challenge. View "Florida Health Sciences v. Secretary of DHHS" on Justia Law

Petitioner seeks review of the Board's denial of his request to reopen the Board's 1999 benefits determination. The court concluded that the Railroad Retirement Act, 45 U.S.C. 231g, grants the court jurisdiction to review Board decisions denying requests to reopen initial benefits determinations. The court concluded, however, that the Board’s decision to deny petitioner's request to reopen was reasonable where it was reasonable for the Board to conclude that there were no errors in the allocation of petitioner's earnings that, if corrected, would have given him insured status at the time of the decision. Further, petitioner provided little to no explanation of how his initial decision contained a clerical error or an error that appears on the face of the evidence. Accordingly, the court denied the petition for review. View "Stovic v. RRRB" on Justia Law

Via Christi seeks an upward adjustment of the capital-asset depreciation reimbursement paid to its predecessor hospitals under a since curtailed Medicare regulation. Via Christi argues that it received St. Francis’s and St. Joseph’s assets at a lower value, i.e., more depreciated, than was reflected in the Secretary’s earlier depreciation reimbursements. As the hospitals’ successor-in-interest, Via Christi thus seeks additional reimbursements to cover the proportional Medicare share of the depreciation. The court concluded that the Secretary reasonably interpreted the bona fide sale requirement as limited to arm’s length transactions between economically self-interested parties. The Secretary concluded that St. Francis’s transfer of its assets to Via Christi was not an arm’s-length transaction in which each party sought to maximize its economic benefit. The court concluded that the Secretary's determination was supported by substantial evidence, and was not arbitrary, capricious or otherwise unlawful. In this case, Via Christi is not entitled to additional depreciation reimbursement in the absence of a qualifying transaction. View "Via Christi Hosp. Wichita v. Burwell" on Justia Law