1) Four cases were consolidated involving challenges to California's plans to reduce Medicaid reimbursement rates. The Secretary of Health and Human Services approved the plans, prompting a lawsuit claiming the plans violated federal law.
2) The district court granted an injunction against implementing the rates, finding the plaintiffs were likely to succeed on the merits of their claim that the plans violated federal law. The Secretary appealed.
3) The Ninth Circuit determined that the Secretary's approval of the plans was entitled to judicial deference under the Administrative Procedure Act. The court also found that the Secretary's decision that the plans complied with federal law was not arbitrary or capricious. The district court had failed to properly defer to the Secretary.
Parkview Health System, Inc. (Parkview) has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule with the Department of Health and Human Services (HHS) Office for Civil Rights (OCR). Parkview will pay $800,000 and adopt a corrective action plan to correct deficiencies in its HIPAA compliance program.
Presence Health Resolution Agreement with OCRdata brackets
This resolution agreement between the US Department of Health and Human Services (HHS) and Presence Health Network resolves HHS investigation number 14-176036 regarding Presence Health's violations of the HIPAA Breach Notification Rule. Presence Health failed to provide timely notification of a 2013 breach affecting 836 individuals to those individuals, media outlets, and HHS as required. The agreement requires Presence Health to pay $475,000 and comply with a corrective action plan, which involves revising policies and procedures around breach notification and applying sanctions to employees who fail to follow breach notification policies.
CMS uses both a national and local process to make coverage determinations for Medicare. The national coverage determination (NCD) process involves multiple opportunities for public comment and can result in coverage, coverage with restrictions, coverage with evidence development (CED), or non-coverage. Local coverage determinations (LCDs) are made by Medicare Administrative Contractors and can vary across jurisdictions. Engaging in both processes can help optimize coverage for new technologies.
1. Several courts have recently held that the Stark Law applies to Medicaid through the False Claims Act, even though the Stark Law provisions only expressly govern Medicare and CMS regulations have not implemented the Stark Law provisions for Medicaid.
2. The Stark Law was amended in 1993 to restrict federal Medicaid funding for designated health services referred by physicians with prohibited financial relationships, through a provision in the Medicaid statute. However, CMS has never finalized proposed regulations implementing this Medicaid provision.
3. In the absence of final regulations, most health care attorneys had advised clients that the Stark Law applied only to Medicare in practice. However, recent court decisions have now established that the government can use the False Claims Act to enforce the Stark Law in Medicaid through
This document discusses various approaches to tort reform that can help limit healthcare costs. It outlines how capping damages paid to plaintiffs has been found constitutional if optional withdrawal from the program or increased benefits are provided. Periodic payment plans that space out damages over time can also be constitutional. Tort reform can promote efficiency by encouraging physician retention and reducing frivolous malpractice claims through medical review panels. The document argues tort reform is overdue in Kentucky to allow the healthcare industry to serve communities more efficiently and at a higher standard.
Catholic Health Care Services Resolution Agreement and Corrective Action PlanAlex Slaney
Catholic Health Care Services of the Archdiocese of Philadelphia settlement, Resolution Agreement and Corrective Action Plan as a result of violating the HIPAA Security Rule for ePHI
The resolution agreement is between the Department of Health and Human Services (HHS) and Anchorage Community Mental Health Services (ACMHS) to resolve HHS's investigation into a data breach at ACMHS that affected over 2,700 individuals. Under the agreement, ACMHS agrees to pay HHS $150,000 and comply with a Corrective Action Plan to address security deficiencies. The agreement resolves alleged violations of HIPAA Privacy, Security, and Breach Notification rules but does not admit liability by ACMHS.
Oregon Health & Science University HIPAA Finesdata brackets
This resolution agreement is between the US Department of Health and Human Services (HHS) and Oregon Health & Science University (OHSU) to resolve HHS investigations of two data breaches at OHSU involving unsecured protected health information. OHSU agrees to pay HHS $2.7 million and comply with the terms of a corrective action plan, which requires OHSU to conduct a risk analysis, develop a risk management plan, implement encryption of mobile and network connected devices, and provide status updates to HHS. The agreement resolves alleged violations of HIPAA privacy and security rules related to the data breaches and ensures OHSU's ongoing compliance during a three year term.
Parkview Health System, Inc. (Parkview) has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule with the Department of Health and Human Services (HHS) Office for Civil Rights (OCR). Parkview will pay $800,000 and adopt a corrective action plan to correct deficiencies in its HIPAA compliance program.
Presence Health Resolution Agreement with OCRdata brackets
This resolution agreement between the US Department of Health and Human Services (HHS) and Presence Health Network resolves HHS investigation number 14-176036 regarding Presence Health's violations of the HIPAA Breach Notification Rule. Presence Health failed to provide timely notification of a 2013 breach affecting 836 individuals to those individuals, media outlets, and HHS as required. The agreement requires Presence Health to pay $475,000 and comply with a corrective action plan, which involves revising policies and procedures around breach notification and applying sanctions to employees who fail to follow breach notification policies.
CMS uses both a national and local process to make coverage determinations for Medicare. The national coverage determination (NCD) process involves multiple opportunities for public comment and can result in coverage, coverage with restrictions, coverage with evidence development (CED), or non-coverage. Local coverage determinations (LCDs) are made by Medicare Administrative Contractors and can vary across jurisdictions. Engaging in both processes can help optimize coverage for new technologies.
1. Several courts have recently held that the Stark Law applies to Medicaid through the False Claims Act, even though the Stark Law provisions only expressly govern Medicare and CMS regulations have not implemented the Stark Law provisions for Medicaid.
2. The Stark Law was amended in 1993 to restrict federal Medicaid funding for designated health services referred by physicians with prohibited financial relationships, through a provision in the Medicaid statute. However, CMS has never finalized proposed regulations implementing this Medicaid provision.
3. In the absence of final regulations, most health care attorneys had advised clients that the Stark Law applied only to Medicare in practice. However, recent court decisions have now established that the government can use the False Claims Act to enforce the Stark Law in Medicaid through
This document discusses various approaches to tort reform that can help limit healthcare costs. It outlines how capping damages paid to plaintiffs has been found constitutional if optional withdrawal from the program or increased benefits are provided. Periodic payment plans that space out damages over time can also be constitutional. Tort reform can promote efficiency by encouraging physician retention and reducing frivolous malpractice claims through medical review panels. The document argues tort reform is overdue in Kentucky to allow the healthcare industry to serve communities more efficiently and at a higher standard.
Catholic Health Care Services Resolution Agreement and Corrective Action PlanAlex Slaney
Catholic Health Care Services of the Archdiocese of Philadelphia settlement, Resolution Agreement and Corrective Action Plan as a result of violating the HIPAA Security Rule for ePHI
The resolution agreement is between the Department of Health and Human Services (HHS) and Anchorage Community Mental Health Services (ACMHS) to resolve HHS's investigation into a data breach at ACMHS that affected over 2,700 individuals. Under the agreement, ACMHS agrees to pay HHS $150,000 and comply with a Corrective Action Plan to address security deficiencies. The agreement resolves alleged violations of HIPAA Privacy, Security, and Breach Notification rules but does not admit liability by ACMHS.
Oregon Health & Science University HIPAA Finesdata brackets
This resolution agreement is between the US Department of Health and Human Services (HHS) and Oregon Health & Science University (OHSU) to resolve HHS investigations of two data breaches at OHSU involving unsecured protected health information. OHSU agrees to pay HHS $2.7 million and comply with the terms of a corrective action plan, which requires OHSU to conduct a risk analysis, develop a risk management plan, implement encryption of mobile and network connected devices, and provide status updates to HHS. The agreement resolves alleged violations of HIPAA privacy and security rules related to the data breaches and ensures OHSU's ongoing compliance during a three year term.
Team D Community services agency presentation JoyceKessel
The Valley of the Sun YMCA was founded in 1892 in Arizona and provides various programs and services to help people of all ages and backgrounds learn, grow and thrive. It offers programs focused on youth development, healthy living and social responsibility. Services include diabetes prevention programs, senior fitness classes, military outreach and corporate wellness programs. Membership provides benefits like developing youth potential, promoting healthy lifestyles and delivering meaningful change to the community.
Este documento lista las expectativas para una nueva tienda de licuados, incluyendo mantener una buena higiene, ubicación cerca de un centro recreativo, realizar promociones y publicidad como exposiciones en escuelas, ofrecer muestras y descuentos a los clientes, y proveer entretenimiento en la tienda como música, juegos, wifi y televisión.
O documento descreve como associar computadores a um domínio no Active Directory, incluindo criar contas de computador manualmente ou automaticamente durante a associação. Explica que as contas de computador são armazenadas nos recipientes "Computers" ou "Domain Controllers" por padrão e como mover contas entre recipientes. Detalha os passos para associar um computador a um domínio usando o Painel de Controle ou propriedades do computador.
Rachel Malinsky is a Spanish language educator and missionary from Indianapolis, Indiana. She has over 15 years of experience teaching Spanish at the high school level and conducting mission work in Spain and Latin America. Malinsky is bilingual in Spanish and English and has led worship music, outreach programs, and Bible studies internationally. She holds a Bachelor's degree in Spanish Education and state teaching license.
Title: Stepping Stones to Year-Round Bicycling and Walking: Tackling Winter Maintenance
Track: Connect
Format: 90 minute moderated discussion
Abstract: This panel will explore the challenges of providing good pedestrian and bicycle access year-round in cold climate cities. The panel will address current best practices, agency perspectives on winter maintenance, and tough questions about who should be responsible for maintaining sidewalks and bikeways and to what level of service.
Presenters:
Presenter: Ciara Schlichting, AICP Toole Design Group
Co-Presenter: Becka Roolf Salt Lake City Transportation Division
Co-Presenter: Steve Sanders University of Minnesota
Este documento resume varios riesgos laborales comunes como el ruido, las vibraciones, la temperatura, la radiación, los explosivos, las sustancias inflamables, corrosivas e irritantes, así como los procesos infecciosos, tóxicos y alérgicos a los que pueden estar expuestos los trabajadores. Describe cada riesgo y explica brevemente cómo pueden afectar la salud de los empleados.
The Supreme Court of Kansas heard a case regarding the constitutionality of a Kansas statute that caps noneconomic damages in medical malpractice cases at $250,000. The Court upheld the statute as constitutional, finding that: (1) the statute and broader medical malpractice legislation further a valid public interest in promoting public welfare and healthcare availability; and (2) the legislature substituted an adequate statutory remedy for any modification of common law rights. The Court also rejected claims that the statute violated separation of powers, equal protection, or other constitutional provisions. While the cap limits damages awards, the Court found it did not prevent reasonable compensation or obstruct the right to a jury trial.
The document discusses Medicaid overpayments to providers. It summarizes the seminal Illinois Physicians Union v. Miller case that found in favor of using statistical sampling and extrapolation to determine Medicaid overpayments. The burden is always on the provider to prove their entitlement to Medicaid funds and demonstrate that any overpayment calculations are incorrect. Federal regulations require states to have procedures to safeguard against unnecessary payments and excess payments, allowing the use of statistical sampling to evaluate payments on a sample basis.
This document summarizes a court case filed by the Coalition for Parity against the Secretaries of Health and Human Services, Labor, and Treasury regarding regulations issued to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The Coalition claims the regulations violated the notice and comment requirements of the Administrative Procedure Act. The court document provides background on the notice and comment procedures under the APA, an overview of the Mental Health Parity Act and the new regulations issued by the Departments. It also describes the regulatory process undertaken by the Departments to implement the new law through an interim final rule.
This document summarizes a court case filed by the Coalition for Parity against the Secretaries of Health and Human Services, Labor, and Treasury regarding regulations issued to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The Coalition claims the regulations violated the notice and comment requirements of the Administrative Procedure Act. The court document provides background on the notice and comment procedures under the APA, an overview of the Mental Health Parity Act and the new regulations issued by the Departments. It also describes the regulatory process undertaken by the Departments to implement the new law through an interim final rule.
This document is a summary of the Supreme Court case Pharmaceutical Research and Manufacturers of America v. Walsh, which addressed whether Maine's Rx Program was preempted by the federal Medicaid Act. The summary outlines the key aspects of Maine's Rx Program and the various opinions of the justices on whether the program was preempted or in violation of the Commerce Clause. In the end, the Court affirmed the First Circuit's ruling that petitioner did not demonstrate the program was likely preempted or unconstitutional.
This order declares a Georgia statute capping noneconomic damages in medical malpractice cases unconstitutional. The order discusses the facts of the case, in which a jury awarded damages to the plaintiffs that exceeded the statutory cap. The court considered motions to strike affidavits submitted by the plaintiffs and denied the motions. In a lengthy analysis, the court found that the statutory cap violates the right to a jury trial guaranteed by the Georgia constitution. The court examined the history and scope of the right to a jury trial and determined that the cap improperly infringes on this right. Therefore, the court declared the statutory cap unconstitutional.
The document summarizes obstacles to enforcing requirements of the Medicaid statute. It discusses how the Supreme Court initially permitted Medicaid enforcement lawsuits in Wilder v. Virginia Hospital Association but has since curtailed this pathway. While §1983 suits could previously challenge state reimbursement rates, Gonzaga v. Doe added new tests making it difficult to use this statute for enforcement. The document outlines failed attempts to use the Supremacy Clause as an alternative enforcement mechanism. As a result, the primary option left for addressing violations is complaining to CMS, though it has limited enforcement powers.
Child abuse & perjury before the california state legislature.compressedJOSEPH PREZIOSO
This document is a discrimination complaint letter sent to the California Department of Health Care Services. It alleges that the complainant's right to a fair hearing was violated by the Chief Administrative Law Judge. The letter provides context that the complainant submitted a state hearing request in March 2012 regarding their Medicaid application but has received no response or hearing date. The letter argues this violates several state and federal laws guaranteeing Medicaid applicants' due process rights to a timely hearing. It cites several cases and regulations regarding notice requirements and ensuring Medicaid programs are administered properly and in recipients' best interests.
The document summarizes several recent changes to Colorado law:
1) New rules for calculating filing deadlines take effect in 2012 and practitioners should check for updates. 2) The Jurisdiction and Venue Clarification Act of 2011 changes federal removal and venue rules. 3) The Colorado Supreme Court adopted a new public domain citation format for its opinions to make them more accessible.
Full text of the Supreme Court's 6-3 Obamacare rulingDaniel Roth
Chief Justice John Roberts: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.. IIf at all possible, we must interpret the act in a way that is consistent with the former, and avoids the latter.”
Scalia: "“We should start calling this law ‘SCOTUScare"
This document is a Supreme Court syllabus summarizing the case of King v. Burwell, Secretary of Health and Human Services. It provides background on the failed history of health insurance reform efforts in the 1990s and 2000s, and how provisions of the Affordable Care Act were based on reforms in Massachusetts that successfully reduced the uninsured rate. Specifically, it discusses the key issues in the case around whether the ACA's tax credits are available only in state-run exchanges or both state and federal exchanges. The Court ultimately ruled the tax credits are available in both types of exchanges based on reading the full context and structure of the law.
This document is a court opinion dismissing an ERISA claim brought by an employee health plan and employer against a hospital and medical college. The plan sought to recover alleged overpayments for medical treatment provided to a plan participant's child. The court found that the plan failed to establish an equitable lien against the defendants as required for relief under ERISA section 502(a)(3). The court allowed supplemental briefing on whether the plan has a viable federal common law unjust enrichment claim to establish jurisdiction.
CRM 123 – How to Brief a Case A case brief is a dissection.docxannettsparrow
CRM 123 – How to Brief a Case
A case brief is a dissection of a judicial opinion. It contains a written summary of the basic
components of that decision. Briefing a case helps you acquire the skills of case analysis and
legal reasoning. It also helps you understand it. Briefs help you remember cases for class
discussions and assignments. Learning law is a process of problem solving through legal
reasoning; case briefs, therefore, should not be memorized. Below are examples and
explanations of the components of a case brief.
1. Case Title and Citation
■ Buckhannon Board and Care Home, Inc. v. West Virginia Department of Health
and Human Services
(Plaintiff Nursing Home) v. (Defendant State Entity) 532 U.S. 598 (2001)
Case titles generally take on the names of the parties involved in the case. For example, in this
case Buckhannon Board and Care Home, Inc. v. West Virginia Department of Health and
Human Resources, Buckhannon Board is the party asking the Court to reverse a lower court’s
holding; W est Virginia Department of Health and Human Resources wants the Court to affirm
that holding.
A citation acts as the case’s “address.” There is a standard format for cases contained in the
United States Reports (abbreviated U.S. in case citations). Therefore, in this case, the citation is
532 U.S. 598. This means that this case is found on page 598 of the 532nd volume of the
United States Reports.
2. Procedural History
■ Procedural History
The Court of Appeals affirmed the District Court’s dismissal of the case and denial of
attorney’s fees. The Supreme Court affirmed. The procedural history (or posture) states how the
case got to the court that wrote the opinion that you are reading.
3. Facts
■ Facts
Buckhannon Board and Care Home, Inc. (“Buckhannon”), which operates care homes
that provide assisted living to its residents, failed an inspection by the W est Virginia Office of the
State Fire Marshall because some of the residents were incapable of “self-preservation” as
defined under state law. On October 28, 1997, after receiving cease and desist orders requiring
the closure of its residential care facilities within 30 days, Plaintiff, on behalf of itself and other
similarly situated homes and residents brought suit in federal district court against the state of
West Virginia, two of its agencies, and 18 individuals. Plaintiff agreed to stay enforcement of the
cease-and-desist orders pending resolution of the case and the parties began discovery. The
district court granted W est Virginia’s motion to dismiss, finding that the 1998 legislation had
eliminated the allegedly offensive provisions and that there was no indication that the
Legislature would repeal the amendments. Buckhannon then moved for attorney’s fees as the
prevailing party.
This section includes a brief overview of the relevant facts of the case that (a) describe the
dispute at hand and (b) have bro.
The document summarizes the Anti-Kickback Statute, which prohibits offering or paying remuneration to induce patient referrals paid for by Medicare/Medicaid. It discusses how the statute is broadly interpreted to include any payment that could influence referrals. Exceptions include payments for services and certain investment returns. The Hanlester Network case established that physician ownership in healthcare providers can violate the statute if it induces referrals, even without an explicit agreement. Safe harbor regulations provide exemptions but strict compliance is required.
Catholic Health Care Services Resolution Agreement data brackets
This resolution agreement between HHS and CHCS resolves HHS's investigation into CHCS regarding compliance with HIPAA rules. CHCS will pay HHS $650,000 and comply with a corrective action plan to address deficiencies in its risk analysis, security measures, and policies and procedures related to protecting electronic protected health information. The corrective action plan requires CHCS to conduct annual risk analyses, develop and distribute policies to its workforce, report any failures to comply with policies, and provide documentation to HHS. This agreement resolves the issues related to a breach of electronic protected health information at CHCS and its affiliated skilled nursing facilities.
Team D Community services agency presentation JoyceKessel
The Valley of the Sun YMCA was founded in 1892 in Arizona and provides various programs and services to help people of all ages and backgrounds learn, grow and thrive. It offers programs focused on youth development, healthy living and social responsibility. Services include diabetes prevention programs, senior fitness classes, military outreach and corporate wellness programs. Membership provides benefits like developing youth potential, promoting healthy lifestyles and delivering meaningful change to the community.
Este documento lista las expectativas para una nueva tienda de licuados, incluyendo mantener una buena higiene, ubicación cerca de un centro recreativo, realizar promociones y publicidad como exposiciones en escuelas, ofrecer muestras y descuentos a los clientes, y proveer entretenimiento en la tienda como música, juegos, wifi y televisión.
O documento descreve como associar computadores a um domínio no Active Directory, incluindo criar contas de computador manualmente ou automaticamente durante a associação. Explica que as contas de computador são armazenadas nos recipientes "Computers" ou "Domain Controllers" por padrão e como mover contas entre recipientes. Detalha os passos para associar um computador a um domínio usando o Painel de Controle ou propriedades do computador.
Rachel Malinsky is a Spanish language educator and missionary from Indianapolis, Indiana. She has over 15 years of experience teaching Spanish at the high school level and conducting mission work in Spain and Latin America. Malinsky is bilingual in Spanish and English and has led worship music, outreach programs, and Bible studies internationally. She holds a Bachelor's degree in Spanish Education and state teaching license.
Title: Stepping Stones to Year-Round Bicycling and Walking: Tackling Winter Maintenance
Track: Connect
Format: 90 minute moderated discussion
Abstract: This panel will explore the challenges of providing good pedestrian and bicycle access year-round in cold climate cities. The panel will address current best practices, agency perspectives on winter maintenance, and tough questions about who should be responsible for maintaining sidewalks and bikeways and to what level of service.
Presenters:
Presenter: Ciara Schlichting, AICP Toole Design Group
Co-Presenter: Becka Roolf Salt Lake City Transportation Division
Co-Presenter: Steve Sanders University of Minnesota
Este documento resume varios riesgos laborales comunes como el ruido, las vibraciones, la temperatura, la radiación, los explosivos, las sustancias inflamables, corrosivas e irritantes, así como los procesos infecciosos, tóxicos y alérgicos a los que pueden estar expuestos los trabajadores. Describe cada riesgo y explica brevemente cómo pueden afectar la salud de los empleados.
The Supreme Court of Kansas heard a case regarding the constitutionality of a Kansas statute that caps noneconomic damages in medical malpractice cases at $250,000. The Court upheld the statute as constitutional, finding that: (1) the statute and broader medical malpractice legislation further a valid public interest in promoting public welfare and healthcare availability; and (2) the legislature substituted an adequate statutory remedy for any modification of common law rights. The Court also rejected claims that the statute violated separation of powers, equal protection, or other constitutional provisions. While the cap limits damages awards, the Court found it did not prevent reasonable compensation or obstruct the right to a jury trial.
The document discusses Medicaid overpayments to providers. It summarizes the seminal Illinois Physicians Union v. Miller case that found in favor of using statistical sampling and extrapolation to determine Medicaid overpayments. The burden is always on the provider to prove their entitlement to Medicaid funds and demonstrate that any overpayment calculations are incorrect. Federal regulations require states to have procedures to safeguard against unnecessary payments and excess payments, allowing the use of statistical sampling to evaluate payments on a sample basis.
This document summarizes a court case filed by the Coalition for Parity against the Secretaries of Health and Human Services, Labor, and Treasury regarding regulations issued to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The Coalition claims the regulations violated the notice and comment requirements of the Administrative Procedure Act. The court document provides background on the notice and comment procedures under the APA, an overview of the Mental Health Parity Act and the new regulations issued by the Departments. It also describes the regulatory process undertaken by the Departments to implement the new law through an interim final rule.
This document summarizes a court case filed by the Coalition for Parity against the Secretaries of Health and Human Services, Labor, and Treasury regarding regulations issued to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The Coalition claims the regulations violated the notice and comment requirements of the Administrative Procedure Act. The court document provides background on the notice and comment procedures under the APA, an overview of the Mental Health Parity Act and the new regulations issued by the Departments. It also describes the regulatory process undertaken by the Departments to implement the new law through an interim final rule.
This document is a summary of the Supreme Court case Pharmaceutical Research and Manufacturers of America v. Walsh, which addressed whether Maine's Rx Program was preempted by the federal Medicaid Act. The summary outlines the key aspects of Maine's Rx Program and the various opinions of the justices on whether the program was preempted or in violation of the Commerce Clause. In the end, the Court affirmed the First Circuit's ruling that petitioner did not demonstrate the program was likely preempted or unconstitutional.
This order declares a Georgia statute capping noneconomic damages in medical malpractice cases unconstitutional. The order discusses the facts of the case, in which a jury awarded damages to the plaintiffs that exceeded the statutory cap. The court considered motions to strike affidavits submitted by the plaintiffs and denied the motions. In a lengthy analysis, the court found that the statutory cap violates the right to a jury trial guaranteed by the Georgia constitution. The court examined the history and scope of the right to a jury trial and determined that the cap improperly infringes on this right. Therefore, the court declared the statutory cap unconstitutional.
The document summarizes obstacles to enforcing requirements of the Medicaid statute. It discusses how the Supreme Court initially permitted Medicaid enforcement lawsuits in Wilder v. Virginia Hospital Association but has since curtailed this pathway. While §1983 suits could previously challenge state reimbursement rates, Gonzaga v. Doe added new tests making it difficult to use this statute for enforcement. The document outlines failed attempts to use the Supremacy Clause as an alternative enforcement mechanism. As a result, the primary option left for addressing violations is complaining to CMS, though it has limited enforcement powers.
Child abuse & perjury before the california state legislature.compressedJOSEPH PREZIOSO
This document is a discrimination complaint letter sent to the California Department of Health Care Services. It alleges that the complainant's right to a fair hearing was violated by the Chief Administrative Law Judge. The letter provides context that the complainant submitted a state hearing request in March 2012 regarding their Medicaid application but has received no response or hearing date. The letter argues this violates several state and federal laws guaranteeing Medicaid applicants' due process rights to a timely hearing. It cites several cases and regulations regarding notice requirements and ensuring Medicaid programs are administered properly and in recipients' best interests.
The document summarizes several recent changes to Colorado law:
1) New rules for calculating filing deadlines take effect in 2012 and practitioners should check for updates. 2) The Jurisdiction and Venue Clarification Act of 2011 changes federal removal and venue rules. 3) The Colorado Supreme Court adopted a new public domain citation format for its opinions to make them more accessible.
Full text of the Supreme Court's 6-3 Obamacare rulingDaniel Roth
Chief Justice John Roberts: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.. IIf at all possible, we must interpret the act in a way that is consistent with the former, and avoids the latter.”
Scalia: "“We should start calling this law ‘SCOTUScare"
This document is a Supreme Court syllabus summarizing the case of King v. Burwell, Secretary of Health and Human Services. It provides background on the failed history of health insurance reform efforts in the 1990s and 2000s, and how provisions of the Affordable Care Act were based on reforms in Massachusetts that successfully reduced the uninsured rate. Specifically, it discusses the key issues in the case around whether the ACA's tax credits are available only in state-run exchanges or both state and federal exchanges. The Court ultimately ruled the tax credits are available in both types of exchanges based on reading the full context and structure of the law.
This document is a court opinion dismissing an ERISA claim brought by an employee health plan and employer against a hospital and medical college. The plan sought to recover alleged overpayments for medical treatment provided to a plan participant's child. The court found that the plan failed to establish an equitable lien against the defendants as required for relief under ERISA section 502(a)(3). The court allowed supplemental briefing on whether the plan has a viable federal common law unjust enrichment claim to establish jurisdiction.
CRM 123 – How to Brief a Case A case brief is a dissection.docxannettsparrow
CRM 123 – How to Brief a Case
A case brief is a dissection of a judicial opinion. It contains a written summary of the basic
components of that decision. Briefing a case helps you acquire the skills of case analysis and
legal reasoning. It also helps you understand it. Briefs help you remember cases for class
discussions and assignments. Learning law is a process of problem solving through legal
reasoning; case briefs, therefore, should not be memorized. Below are examples and
explanations of the components of a case brief.
1. Case Title and Citation
■ Buckhannon Board and Care Home, Inc. v. West Virginia Department of Health
and Human Services
(Plaintiff Nursing Home) v. (Defendant State Entity) 532 U.S. 598 (2001)
Case titles generally take on the names of the parties involved in the case. For example, in this
case Buckhannon Board and Care Home, Inc. v. West Virginia Department of Health and
Human Resources, Buckhannon Board is the party asking the Court to reverse a lower court’s
holding; W est Virginia Department of Health and Human Resources wants the Court to affirm
that holding.
A citation acts as the case’s “address.” There is a standard format for cases contained in the
United States Reports (abbreviated U.S. in case citations). Therefore, in this case, the citation is
532 U.S. 598. This means that this case is found on page 598 of the 532nd volume of the
United States Reports.
2. Procedural History
■ Procedural History
The Court of Appeals affirmed the District Court’s dismissal of the case and denial of
attorney’s fees. The Supreme Court affirmed. The procedural history (or posture) states how the
case got to the court that wrote the opinion that you are reading.
3. Facts
■ Facts
Buckhannon Board and Care Home, Inc. (“Buckhannon”), which operates care homes
that provide assisted living to its residents, failed an inspection by the W est Virginia Office of the
State Fire Marshall because some of the residents were incapable of “self-preservation” as
defined under state law. On October 28, 1997, after receiving cease and desist orders requiring
the closure of its residential care facilities within 30 days, Plaintiff, on behalf of itself and other
similarly situated homes and residents brought suit in federal district court against the state of
West Virginia, two of its agencies, and 18 individuals. Plaintiff agreed to stay enforcement of the
cease-and-desist orders pending resolution of the case and the parties began discovery. The
district court granted W est Virginia’s motion to dismiss, finding that the 1998 legislation had
eliminated the allegedly offensive provisions and that there was no indication that the
Legislature would repeal the amendments. Buckhannon then moved for attorney’s fees as the
prevailing party.
This section includes a brief overview of the relevant facts of the case that (a) describe the
dispute at hand and (b) have bro.
The document summarizes the Anti-Kickback Statute, which prohibits offering or paying remuneration to induce patient referrals paid for by Medicare/Medicaid. It discusses how the statute is broadly interpreted to include any payment that could influence referrals. Exceptions include payments for services and certain investment returns. The Hanlester Network case established that physician ownership in healthcare providers can violate the statute if it induces referrals, even without an explicit agreement. Safe harbor regulations provide exemptions but strict compliance is required.
Catholic Health Care Services Resolution Agreement data brackets
This resolution agreement between HHS and CHCS resolves HHS's investigation into CHCS regarding compliance with HIPAA rules. CHCS will pay HHS $650,000 and comply with a corrective action plan to address deficiencies in its risk analysis, security measures, and policies and procedures related to protecting electronic protected health information. The corrective action plan requires CHCS to conduct annual risk analyses, develop and distribute policies to its workforce, report any failures to comply with policies, and provide documentation to HHS. This agreement resolves the issues related to a breach of electronic protected health information at CHCS and its affiliated skilled nursing facilities.
Chapter 3 Due Process, Equal Protection, and Civil Rights Those .docxchristinemaritza
Chapter 3 Due Process, Equal Protection, and Civil Rights
Those who deny freedom to others deserve it not for themselves.
Abraham Lincoln
CHAPTER OBJECTIVES
After studying this chapter you should better understand:
· • The standards applied for determining whether a procedure satisfies the constitutional due process requirements
· • The manner in which the restrictions on federal government action in the Bill of Rights have been incorporated into the due process guaranty that applies to state actions
· • The U.S. Supreme Court’s approach to determining whether classifications violate the constitutional equal protection requirements
· • The classifications to which “strict scrutiny” is applied in the equal protection analysis
· • The basic remedies available for civil rights violations
At the heart of the rule of law lie the ideals that everyone should be treated fairly and equally before the law. Toward this end the U.S. Constitution protects individual rights by constraining government. But fairness and equality cannot be reduced to prohibitions. To reach more broadly the Constitution also includes fundamental guaranties. Many important court decisions and legislative acts addressing individual rights have been based on the two most fundamental general guaranties: the Due Process Clause and the Equal Protection Clause.
A Due Process Clause was part of the Fifth Amendment in the original Bill of Rights and it was aimed at the federal government. It provides that no person shall be “deprived of life, liberty, or property, without due process.” The original Bill of Rights did not mention equal protection of the laws in a general sense. The Fourteenth Amendment, added after the Civil War and aimed at former slave states, included the same due process provisions as the Fifth Amendment. The Fourteenth Amendment also included the Equal Protection Clause. It provides that no state shall “deny to any person within its jurisdiction the equal protection of the laws.” Although nothing in the text said that equal protection applied to the federal government as well as to the states, the U.S. Supreme Court eventually held that it did. In 1954 in Bolling v. Sharpe the Court said that “the concepts of equal protection and due process, both stemming from our American ideal of fairness, are not mutually exclusive. The ‘equal protection of the laws’ is a more explicit safeguard of prohibited unfairness than ‘due process of law,’ and, therefore, we do not imply that the two are always interchangeable phrases. But, as this Court has recognized, discrimination may be so unjustifiable as to be violative of due process.”1 Consequently due process and equal protection apply to both federal and state laws.
The Due Process and Equal Protection Clauses address government action. They require that laws and legal procedures be fair. As discussed in the final section of this chapter, other constitutional provisions or laws may directly address unfair or discriminato ...
The document discusses agency rules and regulations. It explains that rules are established by agencies to implement enabling statutes and solve problems of public concern. There are different types of rulemaking procedures, including informal which allows public comments, and formal which involves evidentiary hearings. Rules implement legislative goals and are directed towards the future, while decisions resolve specific disputes. The requirements for federal and state rulemaking are outlined.
This document is a memorandum and order from a federal district court judge denying motions to dismiss an amended complaint filed by the Federal Trade Commission. The FTC's amended complaint alleges that various defendants, including new defendants Guaranteed Trust Life Insurance Co. and some of its subsidiaries and executives, engaged in a common scheme to deceptively market medical discount plans through false claims that they were equivalent to major medical insurance. The court found that the amended complaint contained sufficient factual allegations against all defendants to survive a motion to dismiss.
This document discusses procedural fairness in the context of administrative law. It covers several key topics:
1) Sources of procedural fairness obligations, including the Charter, Canadian Bill of Rights, common law, and statutes.
2) Key Supreme Court of Canada cases that have shaped the modern understanding of procedural fairness, including Nicholson, Baker, and Knight.
3) Factors considered in determining whether and to what extent procedural fairness applies in a given case, such as the nature of the decision, statutory context, and importance to individuals affected.
4) Examples of specific procedural protections, such as the right to a hearing, right to provide oral submissions, and right to respond to allegations.
First HIPAA enforcement action for lack of timely breach notification settles...David Sweigert
First HIPAA enforcement action for lack of timely breach notification settles for $475,000
The U.S. Department of Health and Human Services, Office for Civil Rights (OCR), has announced the first Health Insurance Portability and Accountability Act (HIPAA) settlement based on the untimely reporting of a breach of unsecured protected health information (PHI). Presence Health has agreed to settle potential violations of the HIPAA Breach Notification Rule by paying $475,000 and implementing a corrective action plan. Presence Health is one of the largest health care networks serving Illinois and consists of approximately 150 locations, including 11 hospitals and 27 long-term care and senior living facilities. Presence also has multiple physicians’ offices and health care centers in its system and offers home care, hospice care, and behavioral health services. With this settlement amount, OCR balanced the need to emphasize the importance of timely breach reporting with the desire not to disincentive breach reporting altogether.
On January 31, 2014, OCR received a breach notification report from Presence indicating that on October 22, 2013, Presence discovered that paper-based operating room schedules, which contained the PHI of 836 individuals, were missing from the Presence Surgery Center at the Presence St. Joseph Medical Center in Joliet, Illinois. The information consisted of the affected individuals’ names, dates of birth, medical record numbers, dates of procedures, types of procedures, surgeon names, and types of anesthesia. OCR’s investigation revealed that Presence Health failed to notify, without unreasonable delay and within 60 days of discovering the breach, each of the 836 individuals affected by the breach, prominent media outlets (as required for breaches affecting 500 or more individuals), and OCR.
Similar to A Summary of Managed Pharmacy Care v. Sebelius (20)
First HIPAA enforcement action for lack of timely breach notification settles...
A Summary of Managed Pharmacy Care v. Sebelius
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WILLIAMS & JENSEN, PLLC
MEMORANDUM
From: Jessica Hoppe
Date: December 20, 2012
Re: Managed Pharmacy Care v. Sebelius
Background
Four cases gave rise to consolidated appeals involving Kathleen Sebelius, Secretary of the
Department of Health and Human Services (“Secretary”) and Toby Douglas, the Director of the
California Department of Health Care Services (“Director” or “DCHS”). DHCS prepared two State
Plan Amendments (“SPAs” or “Plans”) seeking to reduce reimbursement rates to providers of
certain Medi-Cal services. In preparing these Plans, DHCS collected data and reviewed the impact
such a reduction would have on access to services. Along with the SPAs, DHCS also submitted an
82-page monitoring plan which identified 23 different measures DHCS will regularly review to
ensure that the reduction in reimbursement rates will not negatively affect beneficiary access. These
SPAs, along with the 82-page plan, were submitted to CMS for approval, as required by statute.
The Secretary approved the SPAs, which gave rise to the underlying lawsuit in this appeal.
The four groups of Plaintiffs filed suit against the Secretary and the Director in the U.S. District
Court for the Central District of California, asking for a preliminary injunction to prevent the
reimbursement rates from taking effect. The Plaintiffs claimed that the SPAs violate §30(A), and
that the Supremacy Clause provides a private right of action to challenge the reimbursement rates as
violating §30(A). Specifically, the Plaintiffs relied on the same district court’s opinion in Orthopedic
Hospital, which required a state seeking to reduce reimbursement rates to consider cost data prior to
submitting the SPAs to CMS, and disagreed with DHCS’s research methodology with respect to the
potential impact of the reductions on beneficiary access.
The United States District Court for the Central District of California, Christina A. Snyder, J.
granted preliminary injunctions in favor of various providers and beneficiaries of Medi–Cal,
California's Medicaid program, prohibiting program director from implementing reimbursement rate
reductions authorized by the California legislature and approved by the Secretary of Department of
Health and Human Services (HHS), and staying Secretary's approval. The Secretary and Director
appealed, and plaintiffs cross-appealed the court's modification of its orders to allow the rate
reductions as to Medi–Cal services provided before the injunctions took effect.
Courts have reasoned that state participation in Medicaid is not required, but those who do
“must comply both with statutory requirement imposed by the Medicaid Act and with regulations
promulgated by the Secretary of HHS.” 1
Every state must have plan, and according to federal code,
all state plans must “provide such methods and procedures relating to the utilization of, and the
payment for, care and services available under the plan … as may be necessary to safeguard against
unnecessary utilization of such care and services and to assure that payments are consistent with
efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and
services are available under the plan at last to the extent that such care and services are available to
1 Alaska Dep’t of Health and Soc. Servs. V. Ctrs. For Medicare & Medicaid Servs., 424 F.3d 931, 935 (9th Cir. 2005).
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the general population in the geographic area.”2
Congress delegated to the Secretary the authority to
approve, or deny, these plans.
Preliminary Injunction
In order to succeed on a motion for preliminary injunction, the Plaintiffs must show that
“he is likely to succeed on the [underlying] merits, that he is likely to suffer irreparable harm in the
absence of such preliminary relief, that the balance of equities tips in his favor, and that an
injunction is in the public interest.”3
It is an extraordinary remedy, and one that courts are only
supposed to impose when there truly is no other way to preserve the status quo before a full hearing
on the merits can be held. The district court in this case found that the Plaintiffs were able to
demonstrate to the court that they were likely to succeed on the merits of their underlying claims,
namely that the SPAs violated §30(A), and thus granted the injunction.
The Secretary and the Director appealed the preliminary injunction, which is a “final
decision” for purposes of appeal. The Court of Appeals reviewed the district court’s opinion using
the “abuse of discretion” standard, which essentially looks to make sure that the district court
correctly identified and applied the appropriate legal rule, and that the decision was supported by
facts in the record. It is not the job of the appeals court to decide whether or not they agree with
the decision, but rather whether the decision could logically follow an application of the law to the
facts. In this case, the Ninth Circuit reviewed the facts and the appropriate law and found that the
lower court did not afford the Secretary’s decision the appropriate deference as required by the
Administrative Procedure Act (APA).
Application of the Administrative Procedure Act
This case also involves the application of the Administrative Procedure Act (APA), which
comes into play when Congress delegates the authority to engage in rulemaking and the execution of
laws to an administrative agency. The Court must review an agency’s statutory interpretation to
determine whether or not 1) it should be afforded Chevron deference; 2) it was a permissible
interpretation of the statute, and 3) whether the agency’s decision was “arbitrary and capricious.”
In this case, Congress delegated to the Secretary the authority and responsibility to approve
state Medicaid plans. As required by federal law, these plans, among other things, must “assure that
payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist
enough providers…”4
Thus, any plan that the Secretary approves must fall within the parameters as
outlined by Congress in their statutory directives. Because not every detail of rulemaking and
execution can be prescribed proscriptively, Congress allows the agencies a certain amount of
deference and discretion in how they choose to manage their authority. Under the APA, and as
interpreted over the years through common law, Courts give deference to an agencies interpretation
or implementation of a statute it administers if Congress has not directly spoken to the “precise
question at issue, and if the agency’s action is “permissible” under the statute.5
Furthermore, courts
defer to agencies’ decision when it appears that Congress intended that the agency have the
authority to make rules carrying the force of law, and when the agency was promulgating rules in the
2 42 U.S.C. § 1396a(a)(30)(A) (2012).
3 Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7, 24, 20 (2008).
4 42 U.S.C. § 1396a(a)(30)(A).
5 Chevron U.S.A., Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837 (1984).
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exercise of that law.6
This is known as the “Chevron/Mead” deference. When an administrative
agency, such as the Department of Health and Human Services, acts pursuant to congressionally-
delegated authority, the courts are to give deference to their actions.
In reviewing the lower court’s decision, the Ninth Circuit Court of Appeals (the court
issuing this opinion) found that the Secretary’s approval of the SPAs was entitled to Chevron
deference for various reasons. Most notably, when the Secretary disapproves a proposed plan
amendment, a State has the opportunity to petition for reconsideration and be heard at a formal
hearing. The Court saw this factor as dispositive that Congress intended the agency’s determination
to carry the force of law. Other factors that suggest that Congress intended deference to an agency
decision include, “the interstitial nature of the legal question, the related expertise of the agency, the
importance of the question to the administration of the statute, the complexity of that
administration, and the careful consideration the agency has given the question over a long period of
time.”7
In recognizing that Medicaid administration is a complex task, and that Congress gave the
Secretary the explicit authority to determine whether a State’s Medicaid plan complies with federal
law, the Court thus concluded that Chevron deference applies to SPA approvals.
After deciding that the Secretary’s approval of the SPAs should be afforded judicial
deference, the Court then addressed the issue of whether the interpretation was based on a
“permissible” reading of the statute. The Court determined that although §30(A) required a
substantive result, Congress did not specifically instruct the Secretary as to how these goals must be
achieved, and as such that decision is left to the agency. Thus, because the statute is silent as to any
particular methodology, the Court holds that “the Secretary must be free to consider, for each state,
the most appropriate way for that State to demonstrate compliance with §30(A).”8
Additionally, the
Court noted that other circuits have agreed that §30(A) does not require any particular methodology
for satisfying its substantive requirements as to modifications of state plans. The Ninth Circuit’s
finding that the district court’s failure to defer to the Secretary’s decision that the SPAs comply with
30(A) was thus an “abuse of discretion.”
Finally, the Court must determine whether or not the agency’s decision was “arbitrary and
capricious,” which requires an examination into whether or not the agency’s decision may be
reasonably discerned by the record. In looking at DHCS’s analysis of beneficiary access, as well as
their 82-page comprehensive plan, the Court determined that it was not “arbitrary or capricious for
the agency to consider California’s monitoring plan.” Furthermore, the Court found that “the
hundreds of pages of analysis submitted by DHCS support the Secretary’s conclusion that the SPAs
comply with §30(A) and are unlikely to affect beneficiary access in a detrimental way.”9
Supremacy Clause and Takings Clause Claims
The Court declined to rule on the Supremacy Clause claims, as similar cases are currently in
mediation. Furthermore, the Court held that even if there were a cause of action under the
Supremacy Clause, the “Plaintiffs are unlikely to succeed on the merits on any Supremacy Clause
claim against the Director … for the same reason they are unlikely to prevail on their APA claims
against the secretary.”10
The Court also dismissed the Plaintiff’s “Takings Claim” because
6 United States v. Mead Corp., 533 U.S. 218 (2001).
7 Barnhart v. Walton, 535 U.S. 212, 222 (2002).
8 Managed Pharmacy Care v. Sebelius, 12-55067, 2012 WL 6204214, 30 (9th Cir. Dec. 13, 2012).
9 Id. at 38.
10 Id. at 40.
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participation in Medicaid is voluntary, and providers to not have a property interest in a particular
reimbursement rate.
Conclusion
To summarize, the Ninth Circuit Court of Appeals held: 1) the Secretary's approval of
California's requested reimbursement rates, including her permissible view that prior to reducing
rates states need not follow any specific procedural steps, such as considering providers' costs, was
entitled to deference under Chevron; 2) the Secretary reasonably determined that state's amended
reimbursement rates complied with Medicaid Act; and 3) Medicaid service providers did not, for
purposes of Takings Clause, have a property interest in a particular reimbursement rate. The Court
reversed and remanded, and the injunctions were vacated.