Federal court halts expanded religious exemption from ACA contraceptive mandate On January 7, 2019, the California Medical Association (CMA), along with other health care provider organizations, filed an amicus brief in support of the State of California in its challenge to federal rules that would expand a group health plan or health insurer's ability to claim a religious or moral objection to opt out of the Affordable Care Act’s (ACA) contraceptive coverage mandate. On January 13, 2019, one day before the effective date, the federal court granted the state’s motion for a preliminary injunction, blocking the rules from going into effect the plaintiff states. The U.S. Department of Health and Human Services, at the direction of the President “to address conscience-based objections to the preventative care mandate,” issued rules to broaden the scope of the religious and moral exemptions to encompass all entities and individuals with “sincerely held religious beliefs objecting to contraceptive or sterilization coverage” and made the accommodation process optional for eligible organizations, thus allowing for a full exemption from the mandate for those entities. California, along with Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, New York, North Carolina, Rhode Island, Vermont, Washington, the Commonwealth of Virginia, and the District of Columbia, sought a preliminary injunction in federal court to stop the rules from going into effect. The ACA requirement to provide FDA-approved contraception has been challenged by groups who allege that providing contraceptive coverage violates their religious beliefs. The contraceptive coverage mandate has been wrapped up in litigation for more than six years. CMA had previously filed a similar brief to enjoin the interim rules issued in October 2017, and this recent filing continues our advocacy in the line of cases involving the ACA’s contraceptive coverage mandate, including our amicus involvement in the Burwell v. Hobby Lobby and Zubik v. Burwell cases. CMA’s briefs have all stressed the importance of widespread access to contraception as an essential component of health care for women of child-bearing age. CMA strongly believes that medical decisions should be made by patients in consultation with their health care providers. CMA policy supports access, without copays, to all FDA approved contraception as a basic preventative health service. The overwhelming weight of the evidence establishes that access to the full range of FDA-approved prescription contraceptives is an essential component of effective health care for women and their families. January 22, 2019 General Access to Care, Amicus Briefs, Health Care Reform 0 0 Comment Read More »
U.S. Supreme Court hears arguments in challenge to California's Reproductive FACT Act A California law that requires specified facilities providing pregnancy-related services and counseling to disclose information about the availability of comprehensive reproductive health care services is currently being challenged before the United States Supreme Court. At issue in this case—NIFLA v. Becerra—are efforts by the State of California to ensure that patients receive accurate information about the availability and accessibility of free and low-cost comprehensive reproductive health services. Passed in 2015, the California’s Reproductive Freedom, Accountability, Comprehensive Care and Transparency (FACT) Act requires licensed health-care centers to notify patients of the availability of free or low-cost health care services, including contraception, prenatal care, and abortions, through state programs. The law additionally requires that unlicensed health care centers—for example facilities that provide primarily counseling services—to inform women that there are no licensed medical providers on staff. The issue before the U.S. Supreme Court is whether the disclosures required by the FACT Act violate the Free Speech Clause of the First Amendment. The California Medical Association (CMA) joined the American College of Obstetricians and Gynecologists, American Academy of Pediatrics – California, American Society for Reproductive Medicine and other health care provider organizations to file an amicus brief in support of California’s FACT Act. CMA's brief explained that requiring licensed facilities to inform women of the availability of comprehensive free or low-cost reproductive health care reduces delays in care that can pose significant risks to maternal and fetal health. “Women’s pregnancy-related health care services are highly time-sensitive, and unnecessary delay can pose significant risks to maternal and fetal health,” CMA’s brief said. Additionally, the brief argues that requiring unlicensed medical facilities to inform women that there are no licensed medical providers on staff allows women to make informed decisions about the pregnancy-related services that they receive and prevents such facilities from misleading women into believing that the services being offered are medically necessary or beneficial. CMA’s brief explains that “patients can neither fully consent nor make fully informed decisions about their health care if they are not meaningfully informed about the care they are receiving or the qualifications and expertise of the individual who will be providing the care.” Oral arguments in this case were heard in the U.S. Supreme Court on March 20, 2018, and a decision is expected by the end of June. April 5, 2018 General Amicus Briefs, Legal Advocacy, United States Supreme Court, Women's Health 0 0 Comment Read More »
Hospital at center of "existential threat" to medical staff self-governance files for bankruptcy The Tulare hospital embroiled in a bitter legal battle over the self-governance rights of its medical staff has filed for Chapter 9 bankruptcy. The filing came just two days before closing arguments were scheduled in the case, Tulare Regional Medical Center Medical Staff v. Tulare Regional Medical Center, et al. Although the hospital is in bankruptcy, the California Medical Association (CMA) will continue to seek a legal remedy in this matter. If the medical staff is unable to resolve the case out of court, the trial court could resume the case and render a judgment after the hospital emerges from bankruptcy. In 2016, lay hospital administrators at Tulare Regional Medical Center (TRMC) terminated the entire medical staff and its duly elected officers. The hospital then adopted new medical staff bylaws in secret and without input from physicians at the hospital. The hospital dictated leadership and standards of medical care, seized control of the disciplinary process without legal or factual justifications, and prohibited the terminated medical staff from voting on medical staff matters or holding leadership positions. CMA has been actively and aggressively supporting the medical staff in this case since the illegal actions of the hospital board in January 2016. CMA believes that, if left to stand, the hospital’s actions will create a dangerous precedent that could have much broader implications for the fundamental rights of medical staffs and physicians’ ability to care for patients in hospitals. “Every once in a while, you get a really important case that’s a flashpoint,” said Long Do, CMA legal counsel and director of litigation in an interview with the American Medical Association (AMA). “This case serves as an existential threat to independent hospital medical staffs.” CMA filed pre- and post-trial amicus briefs and has organized fundraising for the case. Recognizing the far-reaching implications of this case, the AMA Litigation Center and state medical societies have also provided legal and financial support to the physician plaintiffs. “This case epitomizes why protecting medical staff independence and self-governance is a matter of great public importance,” Do wrote in CMA’s post-trial brief. “The record abundantly demonstrates that the hospital has committed serious violations of the medical staff’s rights to independence and self-governance and that such illegal conduct is causing real harm to patients.” It cannot be understated how grave the consequences could be on patient care and safety if the hospital’s illegal actions are left to stand. Medical staff self-governance would become meaningless if a hospital can pick for itself a replacement medical staff and eschew the large body of laws and regulations that require a truly independent medical staff that is self-governing and democratic. This case was recently featured in a New York Times op-ed, which provides a good look at why this local conflict could have a dangerous effect on patient care in U.S. hospitals. If interested in contributing to CMA’s Legal Defense Fund, which is used to litigate cases of critical importance to physicians, please download the contribution form or contact Sarah Wolley directly at swolley@cmanet.org. The Legal Defense Fund of the California Medical Association is a collection of monies voluntarily contributed by the CMA membership for appropriate litigation costs. These funds shall be administered by the Executive Committee of the CMA Board of Trustees. The purpose of this fund shall be to provide monetary support in cases, generally brought by our members, which seek to protect or establish important legal rights of physicians. CMA will consider providing assistance only in those cases which reflect those principles and policies that CMA has established and that impact our members in their practice of medicine. Contributions to the California Medical Association Legal Defense Fund are not tax deductible as charitable contributions for federal income tax purposes. However, the contribution may be tax deductible as a business expense for federal income tax purpose. Contribution to this fund is not a political contribution. October 19, 2017 CMA, General Amicus Briefs, Hospital Medical Staff, Legal Advocacy, Medical Staff, Medical Staff Self-Governance 0 0 Comment Read More »
State's high court rules health plans cannot negligently delegate payment responsibility The California Supreme Court today ruled that health plans cannot absolve themselves of the responsibility to pay claims for emergency care by noncontracted providers by negligently delegating that responsibility to a risk-bearing organization that it knows—or should have known—to be financially insolvent. "Today's ruling is a huge victory for physicians," said Francisco Silva, Senior Vice President and General Counsel for the California Medical Association (CMA). "California's high court is unequivocally telling health plans they cannot get away with this morally blameworthy behavior. They cannot irresponsibly delegate risk and leave physicians unpaid for services provided in good faith to their enrollees." CMA filed an amicus brief in this case, Centinela Freeman Emergency Medical Assocs. v. Health Net et al., on behalf of a broad coalition of out-of-network health care providers who were left unpaid for emergency medical care when La Vida Independent Practice Association (IPA) went bankrupt in 2010. The IPA, a risk-bearing organization (RBO) that provided health care coverage to hundreds of thousands of patients in Southern California, was contracted by HealthNet and six other health plans to pay insurance claims to providers. Existing law insulates health plans from payment responsibility for medical claims once they enter into a delegation arrangement with an RBO. Notwithstanding such law, the providers in Centinela sought reimbursement from the health plans on the theory that they negligently delegated to La Vida, because they continued to send patients to the IPA when they knew or should have known of its financial distress and impending insolvency. CMA's amicus briefs urged a fair and just interpretation of provisions within the Knox-Keene Act that permit health plans to delegate payment responsibility to risk-bearing organizations. CMA recognizes the viability of the delegation model and accepts that, generally, health plans are absolved of liability after they delegate to an RBO. When health plans delegate negligently, however, CMA believes they must be held accountable for their own misconduct—and the California Supreme Court agrees. "We conclude that a health care service plan may be liable to noncontracting emergency service providers for negligently delegating its financial responsibility to an IPA or other contracting medical provider group that it knew or should have known would not be able to pay for emergency service and care provided to the health plan's enrollees," the court wrote in its ruling. "We further conclude that…a health care service plan may be liable to noncontracting emergency service providers for negligently continuing or renewing a delegation contract with an IPA when it knows or should know that there can be no reasonable expectation that its delegate will be able to reimburse noncontracting emergency service providers for their covered claims." “Imposing a duty on plans to act reasonably in choosing an IPA or other RBO will promote a healthy functioning of the managed health care model endorsed by the Knox-Keene Act. Indeed, a requirement that health care service plans reasonably select financially solvent delegates will more likely result in timely processing and ultimate payment of covered emergency service claims, which will in turn support the continuing availability and provision of such emergency services.” Contact: CMA Center for Legal Affairs, (800) 786-4262 or legalinfo@cmanet.org. November 21, 2016 Managed Care Amicus Briefs, California Supreme Court, Health Net, Legal Advocacy 0 0 Comment Read More »
CMA files amicus brief in support of hospital medical staff self-governance The California Medical Association (CMA) has filed an amicus brief in support of the medical staff at Tulare Regional Medical Center in its lawsuit against the hospital alleging violations of state laws when the hospital terminated the entire medical staff and its duly elected officers. The hospital has recognized a replacement medical staff formed by a group of seven physicians led by the vice chairman of the hospital board. This group presented itself as a newly formed medical staff after it selected new bylaws and named officers to the medical executive committee. None of the other physicians at the hospital were aware of such actions or voted on the new bylaws and officers. The physicians were told that they would have provisional membership in the replacement medical staff, without any right to hold office or vote on medical staff matters. CMA's amicus brief explains that the replacement medical staff has no legal basis and that the hospital has committed serious violations of the self-governing rights of the original medical staff and its physician members. The brief asserts that the hospital has effectively unseated duly elected medical staff officers in favor of unelected individuals that support the hospital to serve in their stead, unilaterally imposed new medical staff bylaws and blocked the proper use of medical staff funds. Nothing in state law permits a hospital to dissolve an entire medical staff in such manner, CMA notes. CMA emphasizes in its brief that these violations can undermine physician independence and patient care. The laws establishing medical staff independence and self-governance are designed to insulate medical decision-making from interference by hospital administrators or other lay individuals who are motivated by concerns not related to patient welfare. The replacement medical staff, which does not conform to these laws, is already showing signs of undue influence and control by the hospital. Under the bylaws for the replacement medical staff, privileging and other conditions of membership are connected to patient admissions at the hospital. The hospital board also gets control over who serves as medical staff officers, and there are general conditions requiring physicians to uphold the welfare of the hospital. CMA has a long history of fighting for legislation and regulations that establish the right of self-governance for medical staffs. It is also the only statewide advocacy group dedicated to protecting the professional interests of medical staffs to ensure quality care in California’s hospitals. CMA is concerned that the hospital’s actions will create a dangerous precedent if left to stand. Medical staff self-governance would become meaningless if a hospital can pick for itself a replacement medical staff and eschew the large body of laws and regulations that require a truly independent medical staff that is self-governing and democratic. The Tulare County Superior Court declined to grant a temporary restraining order as requested by the medical staff, claiming there was not enough evidence at the early stages of the case to impose such extraordinary relief. The case next proceeds to discovery and fact finding. Read the brief here. March 31, 2016 CMA Hospital Medical Staff, Legal Advocacy, Self-Governance, Amicus Briefs 0 0 Comment Read More »
CMA files amicus brief in case that could weaken physician protections from silent PPOs The California Medical Association (CMA) and nine other physician organizations filed an amicus brief asking the Supreme Court of California to review an appeals ruling that would have significant, widespread negative impact on the health care industry, undermining a California law designed to protect physicians from "silent PPOs." Robust managed health care provider networks and reasonable reimbursement for medical services are vital to ensuring adequate accessibility and the highest quality of medical care. A historical and ongoing threat to these goals is the silent PPO problem, whereby health plans unilaterally and stealthily conscript their network providers into servicing third parties at discounted in-network rates without affording the providers any benefits in return. To combat this problem, the California legislature in 2003 passed a CMA-sponsored bill (AB 175) to prevent the improper use of a health provider's contract in the event that a plan rents the provider network to a third party, such as a union trust fund, self-insured employer or another plan, for their use in obtaining discounted rates. The resulting statute (Health and Safety Code section 1375.7) requires that "when a contracting agent sells, leases or transfers a health provider's contract to a payor, the rights and obligations of the providers shall be governed by the underlying contract between the health care provider and the contracting agent." In this case, a union’s benefits trust – the United Food and Commercial Workers and Employers Benefits Trust (UEBT) – contracted with Blue Shield of California to access the insurer's provider network – which included Sutter Health – at in-network rates. The underlying contract between Blue Shield and Sutter Health included an arbitration agreement, which would be enforceable against UEBT pursuant to Health and Safety Code section 1375.7. In 2014, UEBT filed a suit against Sutter Health alleging that the health system overcharged millions of workers for health care. Sutter requested binding arbitration, as stipulated in its contract with Blue Shield. The trial court in this case ruled – and the appeals court agreed – that Sutter couldn’t compel UEBT to arbitrate its claims of antitrust and unfair competition because the union was not a party to the “provider contract" between Blue Shield and Sutter. The court also ruled that section 1375.7 did not apply because Blue Shield did not technically “sell, lease or transfer” Sutter’s provider contract to UEBT, even though the union trust clearly made arrangements to take advantage of Sutter’s services and discounted rates. CMA’s amicus brief argues that the appeals court misguidedly and narrowly focused on the statute's terms of "sells, leases or transfers." The court ruled that because UEBT merely "accessed" the network, the union is not bound by the arbitration agreement contained in the underlying contract. "The Court of Appeal myopically reads AB 175 out of context and without regard to the statutory scheme enacted by the Legislature to address silent PPO problems rampant in the late 1990s and early 2000s," CMA and the other physician organizations wrote in the brief. "It would be implausible that the legislature intended for third party payors to be able to avoid their obligations to providers on technical grounds, based on the specific manner in which they access provider discounts." The brief argues that the appeals court's interpretation of the statute is too narrow, out of context and to the detriment of providers, while giving a windfall to third-party payors and health plans. "The opinion severely limits the protections of section 1375.7 to the point that it no longer can guarantee that providers continue to receive the advantages and benefits of joining a health plan network when their services are accessed by third-party payors," the brief said. "In short, the Court of Appeal's opinion eviscerates the primary statutory remedy against silent PPOs and could threaten provider network adequacy and patient access to care." The other physician groups signing on to this amicus brief include the American College of Emergency Physicians (California Chapter); California Academy of Family Physicians; California Orthopaedic Association; California Psychiatric Association; California Radiological Society; California Society of Pathologists; Latino Physicians of California; Medical Oncology Association of Southern California, Inc.; and the Osteopathic Physicians and Surgeons of California. The Supreme Court is expected to rule on Sutter’s petition for review in early February. To read the brief, click here. Contact: CMA's legal information line, (800) 786-4262 or legalinfo@cmanet.org. January 15, 2016 Managed Care Legal Advocacy, Payor Contracting, Provider Networks, Silent PPOs, Amicus Briefs 0 0 Comment Read More »
CMA tells California Supreme Court it must protect patient data in CURES The California Medical Association (CMA) has filed an amicus brief with the California Supreme Court asking that it give meaningful privacy protection to patient data contained in the Controlled Substance Utilization Review and Evaluation System (CURES) database. CMA was joined on the brief by the American Medical Association, California Psychiatric Association, California Dental Association and the American Dental Association. This case, Lewis v. Superior Court (Medical Board), examines the constitutionality of the Medical Board of California's practice of routinely data mining the confidential prescription records of California patients. In response to a patient complaint—a complaint that had nothing to do with Dr. Lewis's prescribing practices—the medical board investigator accessed from CURES the prescribing records of every single one of Dr. Lewis's patients during a three-year period. In addition, it obtained three years of confidential prescription records for all medications, including non-controlled substances, dispensed to Dr. Lewis's patients from the corporate headquarters of CVS Pharmacy. The information obtained identified patients by name and included details about medications prescribed to them. The medical board did not obtain any patient authorizations, warrants or issue subpoenas prior to accessing this patient data. CMA’s amicus brief underscores the importance of confidentiality of medical information as an indispensable component of quality medical care. It explains the importance of recognizing that patients have a privacy interest in their medical information maintained in CURES, despite the government’s arguments that patients have a diminished expectation of privacy in their prescription data. The brief shows how prescription records can reveal sensitive information about an individual’s medical condition and argues that the medical board’s routine, unfettered and indiscriminate access to prescription data from CURES circumvents existing laws protecting the confidentiality of medical records. The brief also addresses the heightened importance of protecting patient privacy rights in the digital age where technology has facilitated the government’s ability to store and mine large amounts of data. The ACLU of California and the Electronic Frontier Foundation also filed amicus briefs in this case in support of Dr. Lewis. The California Supreme Court will likely schedule oral arguments in this case in 2016. Click here to read CMA's brief. Contact: CMA's Center for Legal Affairs, (800) 786-4262 or legalinfo@cmanet.org. November 9, 2015 General CMA Legal Case List, CURES, Amicus Briefs, California Supreme Court 0 0 Comment Read More »
Court rules against constitutional attack on MICRA On June 9, the California Court of Appeal based in San Francisco issued its precedential opinion in Chan v. Curran, fully upholding various provisions of California's landmark Medical Injury Compensation Reform Act (MICRA) against constitutional attacks by California’s trial attorneys. The California Medical Association (CMA), together with a broad coalition of health care providers, including the American Medical Association, the California Hospital Association and the California Dental Association, had filed an amicus brief last year supporting the constitutionality of the non-economic damages cap of MICRA. This appeal was the latest in a protracted line of cases challenging MICRA's constitutionality since the Legislature enacted the statute in 1975. The California Supreme Court on numerous occasions has previously upheld the constitutionality of MICRA's cost saving provisions, including MICRA's $250,000 cap on non-economic damages. Numerous intermediate courts of appeal have also upheld MICRA. Despite Supreme Court and court of appeal precedents, the plaintiff appealed, arguing that the MICRA cap on non-economic damages violated her constitutional rights to equal protection, due process and trial by jury. In this published opinion, the Court of Appeal characterized all of Chan’s arguments as “ultimately grounded on the assertion she is entitled to seek non-economic damages sufficient to cover attorney fees.” This was a novel twist that the trial lawyers came up with – to argue that the MICRA cap essentially deprived injured plaintiffs of their day in court because few attorneys would take on contingency cases subject to the $250,000 cap on noneconomic damages. To this, the court responded in its opinion, “[n]o California court has ever endorsed such a proposition, and, as we discuss, it is contrary to many well-established legal principles.” The court went on to reject each and every one of Chan’s constitutional arguments. It observed that California courts have consistently rejected constitutional attacks on MICRA because they are contrary to well-established legal principles for determining the constitutionality of economic and social welfare legislation under the extremely deferential rational basis test. The court discussed previous California Supreme Court cases upholding section 3333.2 and other MICRA provisions against similar constitutional challenges. The court also rejected Chan’s argument that MICRA’s constitutionality should be reexamined due to “changed circumstances” in today’s medical malpractice insurance climate; the court held that she failed to demonstrate that the circumstances leading to MICRA’s enactment no longer exist. The court acknowledged that MICRA may inhibit medical malpractice plaintiffs from finding counsel willing to accept cases on a contingency basis, but concluded that that result did not offend due process. Finally, the court held that the Supreme Court and other Courts of Appeal had previously considered and properly rejected Chan’s argument that MICRA infringed on the right to a jury trial. In conclusion, the Court of Appeal determined that “the legitimate debate over the wisdom of MICRA’s noneconomic damages cap remains a matter for the Legislature and state electorate.” Last November, California voters overwhelmingly rejected Proposition 46, by a two to one margin, which would have raised the MICRA cap on non-economic damages. Read the brief here. Contact: CMA legal information line, (800) 786-4262(800) 786-4262 FREE FREE or legalinfo@cmanet.org. Call Send SMS Call from mobile Add to Skype You'll need Skype CreditFree via Skype June 26, 2015 General Legal Advocacy, MICRA, Amicus Briefs 0 0 Comment Read More »
CMA files amicus brief in health care provider whistleblower case Last week, the California Medical Association (CMA) filed an amicus curiae brief in the California Supreme Court to urge a broad interpretation of the hospital whistleblower statute (Health and Safety Code section 1278.5). In Shaw v. Superior Court, defendant Los Angles Kindred Hospital terminated the plaintiff for complaining that the hospital was employing unlicensed and uncertified healthcare professionals. Following the termination, the plaintiff sued Kindred, arguing that health care providers who are categorized as whistleblowers are protected from retaliation by California Health & Safety Code section 1278.5. Last year, in Fahlen v. Sutter Central Valley Hospital (2014) 58 Cal. 4th 655, the California Supreme Court sided with an amicus brief filed by CMA that this whistleblower statute entitles physicians to sue directly in court when hospitals retaliate by terminating their medical staff privileges. The Court rejected the hospital industry’s argument that physicians in such situations must instead challenge the adverse peer review decision through a writ petition, which is less advantageous for the physician. The principal question in Shaw v. Superior Court is whether plaintiffs who file whistleblower retaliation lawsuits are entitled to a jury trial. If not, such lawsuits would have to be tried before a judge sitting as a fact-finder and ultimate decision maker. Conventional wisdom holds that jury trials are preferable over bench trials for plaintiffs. In other words, physicians who suffer whistleblower retaliation by hospitals are likely to prefer a jury trial. CMA’s amicus brief supports entitlement to a jury trial under section 1278.5. Resolution of the question depends on a statutory interpretation of Health and Safety Code section 1278.5, particularly the types of remedies that are afforded to aggrieved whistleblowers. A broad view of the available remedies supports a finding that section 1278.5 includes the right to a jury trial. In its deliberations, the Supreme Court will focus on 2007 legislation that amended section 1278.5 to extend whistleblower protections to medical staff physicians while also expanding the available remedies for whistleblowers. As the sponsor of that legislation, CMA is in a unique position to explain to the Court the intent and purpose behind the amendments as well as the overall legislative history of section 1278.5. Oral arguments in Shaw v. Superior Court are expected this summer and a decision will come 90 days later. Click here to read CMA's brief. April 29, 2015 General Legal Advocacy, Amicus Briefs 0 0 Comment Read More »
CMA files brief in Medicaid case to be heard by the U.S. Supreme Court The California Medical Association (CMA) has filed an amicus brief in a Medicaid reimbursement case (Armstrong v. Exceptional Child Center) that will go before the U.S. Supreme Court this year to determine whether Medicaid providers have a cause of action under the Supremacy Clause of the U.S. Constitution to challenge a state’s compliance with Medicaid laws in setting reimbursement rates. CMA established good precedent in the Ninth Circuit appellate district on this specific question in our Medi-Cal rate cut litigation, but the Supreme Court’s ruling in the Armstrong case could overturn that precedent. The Medicaid Act's equal access provision requires that states must reimburse providers at a level high enough to attract enough providers to participate so that enrollees have the same access to care that private pay enrollees have in the same geographic area. The ability of providers to sue under the “supremacy clause” has been tested in many states that have tried to reduce Medicaid reimbursements in response to budget constraints. There is no federal guidance on how reimbursement rates should be determined. The Supreme Court in this case will examine a decision made by the U.S. Court of Appeals for the Ninth Circuit that allowed Idaho Medicaid providers to sue state Medicaid administrators even though the federal statute does not contain the private right to sue. In the Idaho case, five nursing homes sued the state Department of Health and Welfare for failure to provide the reimbursement levels required under the federal Medicaid Equal Access Requirement. Although Idaho in 2005 created, and the Centers for Medicare and Medicaid Services (CMS) approved, a funding formula that would have increased reimbursement for care provided to developmentally disabled adults, the state never implemented it and continued to pay at the old rate. The state stipulated that it was, in fact, unable to meet the federally mandated standards, as the Idaho Legislature had failed to allocate the necessary funding. After reviewing the facts of the case, the trial court granted summary judgment for the nursing homes and against the state. It found that the inaction of the Idaho Legislature had violated the Supremacy Clause and ordered Idaho Medicaid administrators it to increase reimbursement for providers. The State of Idaho, however, contends that the U.S. Constitution does not allow private parties to enforce federal Medicaid funding laws against states. Idaho officials say it's up to the federal agencies that oversee Medicaid to decide whether a state is in compliance with reimbursement rules. Twenty-seven states, including Idaho, have filed briefs arguing that CMS is the ultimate determiner of rate adequacy. CMA involvement in support of the respondents in Armstrong is critical to uphold and to protect the precedential decisions of the Ninth Circuit and to extend the good law recognized in those cases to the entire country. CMA, along with American Medical Association, the American Dental Association, American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the American Academy of Family Physicians and the College of Emergency Physicians have all filed briefs in this case. Click here to read the brief. Contact: CMA legal information line, (800) 786-4262 or legalinfo@cmanet.org. January 22, 2015 Medi-Cal Medicaid, Amicus Briefs, Legal Advocacy, Medi-Cal 0 0 Comment Read More »
