In 2005, the Florida Pediatric Society, the Florida Association of Pediatric Dentists, and a number of parents and guardians on behalf of their individual children in the Medicaid program brought suit against the state of Florida alleging violations of the following:42 U.S.C. § 1396a(a)(8) and (a)(10) – requiring that children receive medical and dental services known as Early Periodic Screening Diagnosis and Treatment, with reasonable promptness (Reasonable Promptness);42 U.S.C. § 1396a(30)(A) – requiring that rates for reimbursing medical and dental providers be set, inter alia, so as to secure access to care for children that is equal to that of other children in the same geographical area (Equal Access); and42 U.S.C. § 1396a(a)(43) – requiring that the state conduct outreach programs to inform individuals determined to be eligible for Medicaid of the availability of services and to ensure that such patients requesting those services are able to receive them (Outreach).The plaintiffs contended, in essence, that the root cause of the violations of the Reasonable Promptness and Equal Access requirements were Medicaid provider reimbursement rates that were unreasonably low.

com or 713.646.1307.Who Decides When Medicaid Payment Rates Are Not Enough?By Robert M. WolinIn 2005, the Florida Pediatric Society, the Florida Association of Pediatric Dentists, and a number of parents and guardians on behalf of their individual children in the Medicaid program brought suit against the state of Florida alleging violations of the following: 42 U.S.C. § 1396a(a)(8) and (a)(10) – requiring that children receive medical and dental services known as Early Periodic Screening Diagnosis and Treatment, with reasonable promptness (Reasonable Promptness);42 U.S.C. § 1396a(30)(A) – requiring that rates for reimbursing medical and dental providers be set, inter alia, so as to secure access to care for children that is equal to that of other children in the same geographical area (Equal Access); and42 U.S.C. § 1396a(a)(43) – requiring that the state conduct outreach programs to inform individuals determined to be eligible for Medicaid of the availability of services and to ensure that such patients requesting those services are able to receive them (Outreach).The plaintiffs contended, in essence, that the root cause of the violations of the Reasonable Promptness and Equal Access requirements were Medicaid provider reimbursement rates that were unreasonably low.

The Plaintiffs consisted of patients covered by the Arizona Health Care Cost Containment System (“AHCCCS”), Arizona’s Medicaid agency, who were treated at the defendant hospitals. After AHCCCS negotiated payments to the hospitals on behalf of the patients, the hospitals placed a lien on the third-party tortfeasors who caused the patients’ injuries in order to “recover the remainder of their customary fees” beyond AHCCCS’ reimbursement.Plaintiffs filed the class action lawsuit against the hospitals alleging that 42 U.S.C. § 1396a(a)(25)(C) and 42 C.F.R. § 447.15 (federal Medicaid law and regulations), prohibited hospitals from balance billing patients, or in other words, collecting payments beyond reimbursement from AHCCCS. Hospitals previously operated in accordance with A.R.S. § 33-931(A), which provides that medical providers are “entitled to a lien for the care and treatment . . . of an injured person . . . for customary charges.”

20 Justice Kennedy’s apparent reluctance to join a sweeping rejection of a means of challenging a purported violation of the Medicaid entitlement may suggest a similar reticence to striking down a major piece of Spending Clause legislation this Term. *****************************************1 Social Security Act § 1902(a), 42 U.S.C. § 1396a(a).2 496 U.S. 498 (1990).3The federal civil rights statute, enacted in the aftermath of the Civil War, provides a cause of action for any individual who has been deprived of their rights, guaranteed by the Constitution or federal law, by the action of any state official acting under color of state law.

n statutes by merely posting a notice. Instead, the 2024 final rule states that posting a notice is a best practice towards achieving compliance. HHS provides sample language that it encourages entities to tailor to their circumstances and to the conscience protection statutes applicable to their operations:[Name of entity] complies with applicable Federal health care conscience protection statutes, including the Church Amendments, 42 U.S.C. 300a–7; the Coats-Snowe Amendment, section 245 of the Public Health Service Act, 42 U.S.C. 238n; the Weldon Amendment, e.g., Consolidated Appropriations Act, 2023, Public Law 117–328, div. H, title V General Provisions, section 507(d)(1) (Dec. 29, 2022); Sections 1303(b)(1)(A), (b)(4), and (c)(2)(A), and 1411(b)(5)(A), and 1553 of the ACA, 42 U.S.C. 18023(b)(1)(A), (b)(4), and (c)(2)(A), 18081(b)(5)(A), and 18113; certain Medicare and Medicaid provisions, 42 U.S.C. 1320a–1(h), 1320c–11, 1395i–5, 1395w–22(j)(3)(B), 1395x(e), 1395x(y)(1), 1395cc(f), 1396a(a), 1396a(w)(3), 1396u–2(b)(3)(B), 1397j–1(b), and 14406; the Helms, Biden, 1978, and 1985 Amendments, 22 U.S.C. 2151b(f), accord, e.g., Consolidated Appropriations Act, 2023, Public Law 117–328, div. K, title VII, section 7018 (Dec. 29, 2022); 22 U.S.C. 7631(d); 42 U.S.C. 280g–1(d), 290bb–36(f), 1396f, 1396s(c)(2)(B)(ii); 5106i(a)); and 29 U.S.C. 669(a)(5). More information to help entities determine which statutes are applicable to them is available at https://www.hhs.gov/conscience/conscience-protections/index.html. You may have rights as a provider, patient, or other individual under these Federal statutes, which prohibit coercion or other discrimination on the basis of conscience, whether based on religious beliefs or moral convictions, in certain circumstances. If you believe that [Name of entity] has violated any of these provisions, you may file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil

th advance directives generally, appointment of a health care surrogate is a matter of state law, and state law controls the order of priority for appointing a surrogate.Health Care Provider LiabilityStates typically have laws protecting health care providers against civil or criminal liability for good faith reliance on an advance health care directive, if the provider complies with applicable standards of care.[9] As you draft, review, or update policies and procedures on advance directives and health care decision making, you should consult applicable state legal requirements to ensure your organization’s policies and procedures are in alignment.Footnotes[1] Deborah Carr, Elizabeth A. Luth, Innovation in Aging, Vol. 1, Issue 1, Advance Care Planning: Contemporary Issues and Future Directions (The Gerontological Society of America, March 1, 2017).[2] Omnibus Budget Reconciliation Act of 1990, Pub. L. 101-508, 104 Stat. 1388, §§ 4206, 4751 (amending 42 U.S.C. §§ 1395cc (Medicare) and 1396a (Medicaid)).[3] 42 U.S.C. §§ 1395cc(f) and 1396a(w).[4] National Institutes of Health: National Institute on Aging, Advance Care Planning: Advance Directives for Healthcare (Oct. 31, 2022), https://www.nia.nih.gov/health/advance-care-planning-advance-directives-health-care.[5] See,e.g., Tenn. Code Ann. § 34-6-206.[6] See generally, Adrienne L. Jones, Abigail J. Moss and Lauren D. Harris-Kojetin, Ph.D., National Center for Health Statistics Data Brief No. 54, Use of Advance Directives in Long-term Care Populations (Centers for Disease Control and Prevention, National Center for Health Statistics, Jan. 2011), Products - Data Briefs - Number 54 - January 2011 (cdc.gov).[7] See, e.g., Tenn. Code Ann. § 68-11-224, Fla. Stat. § 401.45(3).[8] Uniform Health Care Decisions Act § 5(b) and (c) (Unif. Law Comm’n 1993).[9] See, e.g., Minn. Stat. Ann. § 145C.11, subd. 2, Tex. Health & Safety Code Ann. § 166.160(b), and 20 Pa. Cons. Stat. Ann. § 5431(a).

(MCL 500.3107c(1)(a))Like Medicare, Medicaid has a complicated relationship with Michigan’s auto No-Fault insurance law in terms of who covers what, what triggers coverage and whether car accident victims would have to pay to reimburse for the money spent on their medical bills.That relationship is about to get even more complicated with the passage of Michigan’s new auto No-Fault law. It’s important that car accident victims know what their legal rights are and how Medicaid cover auto accident injuries under the new Michigan No-Fault law.Has Medicaid covered auto accident injuries in Michigan previously?Historically, Medicaid was not supposed to cover auto accident injuries in Michigan. Like Medicare, Medicaid is a “secondary payer” under federal law, meaning that it would not pay for a car accident victim’s medical care and treatment if a third-party such as No-Fault auto insurance has the “legal liability” to pay. (42 U.S.C. 1396a(a)(25)(A); 42 CFR § 433.138(a))However, in the rare, unintended circumstance that Medicaid did end up covering auto accident injuries – even though No-Fault insurance coverage was available – Medicaid would always seek reimbursement from the car accident victim. (42 U.S.C. 1396a(a)(25)(B); 42 CFR § 433.139)Typically, reimbursement involved Medicaid’s assertion of a lien on a car accident victim’s third-party tort recovery for pain and suffering compensation.

Second, I want to thank both David Roth and Ivana Greco for their contributions to this Update, which is a lengthy one. We will cover the Court's recent decisions in: Rodriguez v. United States (13-9972), holding that, absent reasonable suspicion, a traffic stop may not be extended for the purpose of conducting a dog sniff; United States v. Wong (13-1074 and 13-7075), holding that the Federal Tort Claims Act's limitations periods are subject to equitable tolling; Oneok, Inc. v. Learjet, Inc. (13-271), on the scope of preemption under the Natural Gas Act; and Armstrong v. Exceptional Child Center, Inc. (14-15), holding that health care providers cannot bring suit under the Supremacy Clause to enjoin state laws that conflict with 42 U.S.C. § 1396a(a)(30)(A). When is a sniff not up to snuff (as far as the Fourth Amendment is concerned)?

Although the court denied AHF’s claims that the Medi-Cal 340B Carve-In Law resulted in discrimination violating the Equal Protection Clause of the 14th Amendment to the U.S. Constitution, the court found that the law was in conflict with, and preempted by, federal Medicaid regulations that required CMS approval through an amendment to California’s Medicaid State Plan. In addition, the Court found that the State of California did not comply with 42 U.S.C. Section 1396a(30)(A), which required the State to consider the following before enacting the Med-Cal 340B Carve-In Law: (i) factors of efficiency, economy, and quality of care and Medi-Cal beneficiary access to health care services; and (ii) the costs that 340B Covered Entities incur in dispensing drugs to Medi-Cal beneficiaries. Ober|Kaler’s Comments Although the court ruled in favor of AHF, the court’s decision suggests that the Med-Cal 340B Carve-In Law would have been enforceable if implemented in a manner compliant with Medicaid law.

at states must cover all “FQHC services”—a defined term in the law—regardless of whether they are included in the state Medicaid plan. Because the definition of “FQHC services” extends to services provided by dentists, podiatrists, optometrists, and chiropractors, the court held that Arizona could not categorically exclude such services, although it remanded for further consideration of whether Arizona could impose limitations on them.Fam. Health Ctrs. Of Sw. Fla. v. Marstiller, 2023 U.S. Dist. LEXIS 33226* (Feb. 28, 2023)In Family Health Centers of Southwest Florida, an FQHC successfully challenged the Florida State Medicaid Secretary in federal court after the State rejected the plaintiff’s request to increase its reimbursement rate to account for its growing workforce. The central issue hinged on the interpretation of Medicaid’s requirement to adjust FQHC reimbursement rate for “any increase or decrease in the scope of such services furnished by the [FQHC] during that fiscal year.” 42 U.S.C. § 1396a(bb)(3). Although Florida provided that the rate may be adjusted based on “[a]n increase or decrease in the scope of service(s),” it defined this condition as “the addition of a new service not previously provided by the FQHC” or “the elimination of an existing service provided by the FQHC.”The plaintiff argued that Florida’s definition was too narrow, citing the Centers for Medicare & Medicaid Services’ (CMS) broader interpretation of a change in the “scope of services” as “a change in the type, intensity, duration and/or amount of services.” The court agreed with plaintiff and held that Florida’s interpretation was inconsistent with an “unambiguously clear” federal law. The court’s order granting plaintiff’s motion for summary judgment is under appeal. Cmty. Health Ctr. All. For Patient Access v. Baass, 2023 U.S. Dist. LEXIS 122599* (July 14, 2023)In Community Health Center Alliance for Patient Access, a coalition of FQHCs and their association contested the implementation of California’s M