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Dartmouth-Hitchcock v Toumpas 03-02-12 Order

Dartmouth-Hitchcock v Toumpas 03-02-12 Order

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Published by Grant Bosse
Order of Judge Stephen McAuliffe in Dartmouth-Hitchcock v Toumpas.
Order of Judge Stephen McAuliffe in Dartmouth-Hitchcock v Toumpas.

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Published by: Grant Bosse on Mar 05, 2012
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08/23/2012

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UNITEDSTATESDISTRICTCOURTDISTRICTOFNEWHAMPSHIREDartmouth-HitchcockClinic,etal.,Plaintiffs
v.
CaseNo.11-cv-358-SMOpinionNo.2012DNH032NicholasToumpas,Commissioner,N.H.Dept.ofHealthandHumanServices,Defendant
o
RD
ER
AnumberofNewHampshirehospitalsandtwoindividualsseekanorderprospectivelyenjoiningtheState'sCommissionerofHealthandHumanServicesfromenforcingsignificantlyreducedreimbursementratesformedicalcareprovidedundertheState'sMedicaidProgram.Thehospitalandhealthcaresystemplaintiffsare"providers"ofmedicalcare,andtheindividualplaintiffsare"beneficiaries"undertheprogram.Plaintiffscomplainthat,inseveralrespects,theCommissionerignoredhisclearobligationsunderfederallaw,bothprocedurallyandsubstantively.First,theysay,hefailedtoprovidethemwithnoticeandanopportunitytocommentbeforethereducedratesbecamefinal.Second,theyclaimhefailedtoprovidenoticeandanopportunitytocommentbeforetheDepartmentofHealthandHumanServices("DHHS")employedrate-settingmethodsandstandardsthatweremateriallydifferentfromthoseestablishedintheState'sfederally-approvedMedicaid
 
plan.Finally,plaintiffsassertthatthereducedratescannotanddonotsatisfysubstantive(andpreemptive)federalrequirements(i.e.,thatMedicaidreimbursementratesbesetatalevelsufficienttobothassurequalityofcareandenlistenoughproviderstodelivermedicalservicestoMedicaidbeneficiariestothesameextentsuchcareisavailabletothegeneralpopulation)(30)(A)").See42U.S.C.
§
1396a(a)(30)(A)("SectionAttheriskofoversimplifyingthecomplaint,itgenerallyallegesthatNewHampshire'sLegislatureandGovernoreffectivelydictatedsubstantialreductionsinMedicaidreimbursementrates(aswellasotherMedicaidfunding)solelytoaccommodatestatebudgetarypreferences-thatis,tosavetheStatemoney.And,sayplaintiffs,theyactedinamannercompletelydivorcedfromthefederallyrequiredrate-settingprocessthattheStateagreedtofollowwhenitvoluntarilyenlistedintheMedicaidprogram.TheCommissioner'sfailuretocomplywithmandatorynoticerequirements,andhisfailuretosetreimbursementratesinalawfulmanner,plaintiffsargue,renderthosereducedratesinvalidandunenforceable.Accordingly,sayplaintiffs,theyareentitledtoequitableinjunctivereliefasnecessarytoobtaintheCommissioner'scompliancewithfederallaw.
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v'
TheCommissioneropposesthemotionforinjunctivereliefonanumberofgrounds.Healsomovestodismissplaintiffs'substantiveclaims(CountsI-IV)ongroundsthattheMedicaidActdoesnotincludeaprivaterightofactionentitlingeithermedicalserviceprovidersorbeneficiariestoenforcetheAct'ssubstantiveprovisions.EnforcementoftheMedicaidAct'ssubstantiveprovisions,saystheCommissioner,isamatterthatCongresshascommittedtothesounddiscretionofthefederalsecretaryofHealthandHumanServices,notprivatelitigants.Moreover,theCommissionerargues,plaintiffs'assertionofadirectclaimundertheSupremacyClauseoftheUnitedStatesConstitutionislittlemorethanatransparentefforttoend-runCongressionalintent,byputtingadifferentlabelonwhatisreallyanefforttoenforceprivaterightsundertheMedicaidAct.Withrespecttoplaintiffs'proceduralclaims,theCommissionerdeniesthatDHHSemployedrate-settingmethodsorstandardsdifferentfromthosedescribedintheState'sMedicaidplan(andsodeniesthatanypublicnoticewasrequired),andhedeniesthathewasobligatedtoobtainfederalapprovalofachangeinrate-settingmethodologybeforereducingthereimbursementrates.Moreover,hecontendsthat,totheextentanynoticeandopportunityforpubliccommentwererequired,the
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