§Why CasetextPricing

Post Acute Medical at Hammond, Llc v. Burwell

Cross MOTION for Summary Judgment

55 Cited authorities

  1. Motor Vehicle Manufacturers Assoc. of the United States, Inc. v. State Farm Mutual Auto. Ins. Co.

    463 U.S. 29 (1983)   Cited 6,633 times   50 Legal Analyses
    Holding that " `settled course of behavior embodies the agency's informed judgment that, by pursuing that course, it will carry out the policies [of applicable statutes or regulations]'"

  2. Auer v. Robbins

    519 U.S. 452 (1997)   Cited 2,337 times   88 Legal Analyses
    Holding that a federal agency's interpretation of a regulation is controlling where it is not "plainly erroneous or inconsistent with the regulation"

  3. Vermont Yankee Nuclear Power Corp. v. Natural Resources Defense Council, Inc.

    435 U.S. 519 (1978)   Cited 1,757 times   5 Legal Analyses
    Holding that where rulemaking fulfills basic APA standards for notice and procedure, a court will not impose additional process

  4. Sebelius v. Auburn Reg'l Med. Ctr.

    568 U.S. 145 (2013)   Cited 493 times   11 Legal Analyses
    Holding that "the presumption in favor of equitable tolling does not apply" to a nonjurisdictional agency appeal deadline given the statutory history and administrative context

  5. Encino Motorcars, LLC v. Navarro

    136 S. Ct. 2117 (2016)   Cited 371 times   18 Legal Analyses
    Holding that agency needed to provide "a more reasoned explanation for its decision to depart from its existing ... policy" in light of serious and ongoing industry reliance on prior policy when negotiating compensation packages

  6. Good Samaritan Hosp. v. Shalala

    508 U.S. 402 (1993)   Cited 355 times
    Holding that "the consistency of an agency's position is a factor in assessing the weight that position is due" and that "agency interpretation of a relevant provision which conflicts with the agency's earlier interpretation is entitled to considerably less deference than a consistently held agency view."

  7. Marshall County Health Care Auth. v. Shalala

    988 F.2d 1221 (D.C. Cir. 1993)   Cited 404 times
    Holding that in agency review context there was no real distinction between questions presented in Rule 12(b) motion to dismiss and motion for summary judgment

  8. County of Los Angeles v. Shalala

    192 F.3d 1005 (D.C. Cir. 1999)   Cited 271 times   1 Legal Analyses
    Holding that it was error for the district court to fashion a remedy for the agency to follow after declaring agency action unlawful

  9. Allina Health Servs. v. Sebelius

    746 F.3d 1102 (D.C. Cir. 2014)   Cited 106 times   10 Legal Analyses
    Holding that an announcement that the agency would “clarify” an existing policy did not suggest that the agency was “open to reconsidering existing policy”

  10. Methodist Hosp. of Sacramento v. Shalala

    38 F.3d 1225 (D.C. Cir. 1994)   Cited 132 times
    Holding that when the Department used the most reliable data available at the time, it was not required to recalculate reimbursements based on subsequently corrected data

  11. Rule 56 - Summary Judgment

    Fed. R. Civ. P. 56   Cited 328,736 times   158 Legal Analyses
    Holding a party may move for summary judgment on any part of any claim or defense in the lawsuit

  12. Section 706 - Scope of review

    5 U.S.C. § 706   Cited 20,440 times   184 Legal Analyses
    Granting courts jurisdiction to "compel agency action unlawfully held or unreasonably delayed"

  13. Section 553 - Rule making

    5 U.S.C. § 553   Cited 4,090 times   145 Legal Analyses
    Exempting "interpretative rules," among other things, from the notice-and-comment requirement

  14. Section 1395x - Definitions

    42 U.S.C. § 1395x   Cited 1,161 times   40 Legal Analyses
    Stating that the regulations "may provide for using different methods in different circumstances"

  15. Section 1395oo - Provider Reimbursement Review Board

    42 U.S.C. § 1395oo   Cited 672 times   11 Legal Analyses
    Granting jurisdiction to the district court over this type of appeal

  16. Section 1395ww - Payments to hospitals for inpatient hospital services

    42 U.S.C. § 1395ww   Cited 608 times   35 Legal Analyses
    Providing for a wage-index adjustment

  17. Section 1395hh - Regulations

    42 U.S.C. § 1395hh   Cited 261 times   36 Legal Analyses
    Granting broad rulemaking authority

  18. Section 412.62 - Federal rates for inpatient operating costs for fiscal year 1984

    42 C.F.R. § 412.62   Cited 11 times
    Stating that “[t]he term rural area means any area outside an urban area”

  19. Section 412.523 - Methodology for calculating the Federal prospective payment rates

    42 C.F.R. § 412.523   Cited 4 times

    (a)Data used. To calculate the initial prospective payment rates for inpatient hospital services furnished by long-term care hospitals, CMS uses- (1) The best Medicare data available; and (2) A rate of increase factor to adjust for the most recent estimate of increases in the prices of an appropriate market basket of goods and services included in covered inpatient long-term care hospital services. (b)Determining the average costs per discharge for FY 2003. CMS determines the average inpatient operating

  20. Section 412.503 - Definitions

    42 C.F.R. § 412.503   Cited 2 times

    As used in this subpart- CMS stands for the Centers for Medicare & Medicaid Services. Discharge. A Medicare patient in a long-term care hospital is considered discharged when- (1) For purposes of the long-term care hospital qualification calculation, as described in § 412.23(e)(3) , the patient is formally released; (2) For purposes of payment, as described in § 412.521(b) , the patient stops receiving Medicare-covered long-term care services; or (3) The patient dies in the long-term care facility

  21. Section 412.517 - Revision of LTC-DRG group classifications and weighting factors

    42 C.F.R. § 412.517   Cited 1 times

    (a) CMS adjusts the classifications and weighting factors annually to reflect changes in- (1) Treatment patterns; (2) Technology; (3) Number of discharges; and (4) Other factors affecting the relative use of hospital resources. (b) Beginning in FY 2008, the annual changes to the LTC-DRG classifications and recalibration of the weighting factors described in paragraph (a) of this section are made in a budget neutral manner such that estimated aggregate LTCH PPS payments are not affected. (c) Beginning

  22. Section 412.513 - Patient classification system

    42 C.F.R. § 412.513   Cited 1 times

    (a)Classification methodology. CMS classifies specific inpatient hospital discharges from long-term care hospitals by long-term care diagnosis-related groups (LTC-DRGs) to ensure that each hospital discharge is appropriately assigned based on essential data abstracted from the inpatient bill for that discharge. (b)Assignment of discharges to LTC-DRGs. (1) The classification of a particular discharge is based, as appropriate, on the patient's age, sex, principal diagnosis (that is, the diagnosis established

  23. Section 412.522 - Application of site neutral payment rate

    42 C.F.R. § 412.522   Cited 1 times   1 Legal Analyses

    (a)General. For discharges in cost reporting periods beginning on or after October 1, 2015- (1) Except as provided for in paragraph (b) of this section, all discharges are paid based on the site neutral payment rate as determined under the provisions of paragraph (c) of this section. (2) Discharges that meet the criteria for exclusion from site neutral payment rate specified in paragraph (b) of this section are paid based on the standard Federal prospective payment rate established under § 412.523

  24. Section 412.535 - Publication of the Federal prospective payment rates

    42 C.F.R. § 412.535

    Except as specified in paragraph (b), CMS publishes information pertaining to the long-term care hospital prospective payment system effective for each annual update in the FEDERAL REGISTER. (a) For the period beginning on or after July 1, 2003 and ending on June 30, 2008, information on the unadjusted Federal payment rates and a description of the methodology and data used to calculate the payment rates are published on or before May 1 prior to the start of each long-term care hospital prospective