Bloom v. Azar

• Citation: 976 F.3d 157
• Decision Date: 23 September 2020
• Docket Number: August Term, 2019,Docket No. 18-2390-cv
• Parties: Jonathan A. BLOOM, Plaintiff-Appellant, v. Alex AZAR, Secretary, United States Department of Health and Human Services, Defendant-Appellee.
• Court: United States Courts of Appeals. United States Court of Appeals (2nd Circuit)

976 F.3d 157

Jonathan A. BLOOM, Plaintiff-Appellant,

v.Alex AZAR, Secretary, United States Department of Health and Human Services, Defendant-Appellee.^*

Docket No. 18-2390-cv

August Term, 2019

United States Court of Appeals, Second Circuit.

Argued: October 7, 2019

Decided: September 23, 2020

James Pistorino (Debra M. Parrish, on the brief), Parrish Law Offices, Pittsburgh, PA, (Craig S. Nolan, Alexandrea L. Nelson, on the brief), Sheehey Furlong & Behm P.C., Burlington, VT, for Plaintiff-Appellant Jonathan A. Bloom.

Melissa A.D. Ranaldo, Assistant United States Attorney (Gregory L. Waples, Assistant United States Attorney, on the brief), for Christina E. Nolan, United States Attorney for the District of Vermont, Burlington, VT, for Defendant-Appellee Alex Azar, Secretary, United States Department of Health and Human Services.

Before: LIVINGSTON, Chief Judge, LEVAL and LOHIER, Circuit Judges.

LOHIER, Circuit Judge:

Jonathan A. Bloom is a Medicare beneficiary who uses a Continuous Glucose Monitoring device (CGM) to manage his Type I diabetes. Since 2011 Bloom has regularly sought Medicare coverage to offset the costs associated with his CGM. Three times between 2015 and 2017, the Medicare Appeals Council rejected Bloom's requests for coverage. Bloom challenged the Appeals Council's adverse decisions in federal court, but the United States District Court for the District of Vermont (Crawford, C.J. ) dismissed Bloom's suit in part. It concluded that two of the three challenged decisions failed to meet the $1,500 amount-in-controversy threshold for federal court jurisdiction under the Medicare Act. It also held that the Medicare Act did not permit Bloom to cure the jurisdictional deficiency by "aggregat[ing]" the three separate amounts at issue in each decision. 42 U.S.C. § 1395ff(b)(1)(E)(ii). The question before us is whether the District Court erred in refusing to let Bloom aggregate his claims to satisfy the Act's amount-in-controversy requirement. For the reasons below, we VACATE the District Court's judgment and REMAND for proceedings consistent with this opinion.

BACKGROUND

I

Jonathan Bloom has been suffering from Type I diabetes for several decades. Bloom's diabetes is currently "brittle"—that is, particularly acute—which means that his blood-glucose levels fluctuate "rapidly" every day, sometimes even "unpredictably." Appellant's App'x 179. And unlike the many diabetics who can tell when their blood sugar is too low, Bloom suffers from "hypoglycemic unawareness," a condition that makes it is "impossible" for him "to detect when he is experiencing [ ] unexpected[ly] low" blood sugar. Id. As a result, Bloom has fallen unconscious into a diabetic coma on three separate occasions, two of which were "life threatening." Special App'x 4.

Since 2006 Bloom has attempted to better manage his diabetes by using a CGM—essentially a tiny sensor that he inserts just under his skin to actively monitor his blood-glucose levels. The CGM evaluates Bloom's blood sugar every five minutes, and "warn[s] him of drops in glucose that would lead to [further bouts of] unconsciousness." Supp. App'x 87. The device "has markedly improved [Bloom's] ... quality of life and overall safety." Special App'x 4.

Bloom sought Medicare coverage for his CGM at least thirteen separate times. On three occasions, the Appeals Council denied Bloom's requests for coverage. First, in a decision dated November 13, 2015 (the M-15-1505 decision), the Appeals Council denied Bloom coverage for a thirty-day supply of disposable CGM sensors valued at $473. Second, in a decision dated February 24, 2016 (the M-15-4332 decision), the Appeals Council denied Bloom's claim for coverage of a CGM transmitter and two sets of disposable CGM sensors, which cost a total of $1,976. Finally, in a decision dated January 27, 2017 (the M-16-10554 decision), the Appeals Council denied Bloom coverage for a ninety-day supply of disposable CGM sensors, totaling $1,419. With respect to each denial, the Appeals Council concluded that Bloom's CGM was "precautionary" in nature and thus failed to serve a "primary medical purpose." Appellant's App'x 73 (M-15-4332 decision), 185 (M-15-1505 decision), 270 (M-16-10554 decision).

II

In 2016 Bloom filed this lawsuit against the agency responsible for overseeing the Appeals Council, the Department of Health and Human Services (HHS), to challenge the three decisions denying coverage. See generally 42 U.S.C. §§ 1395ff(b)(1)(A), 1395ii, 405(g), 405(h). Bloom and HHS each eventually moved for judgment based on the pleadings and the administrative records. As relevant here, the District Court granted HHS's motion in part, concluding that it lacked jurisdiction to review the M-15-1505 and M-16-10554 decisions because the dollar amounts at issue in each of those decisions fell below the amount-in-controversy requirement upon which the Medicare Act conditions judicial review. The District Court also concluded that Bloom could not "aggregate[ ]" the amounts at issue in each decision to satisfy the amount-in-controversy threshold and cure the jurisdictional deficiency. Id. § 1395ff(b)(1)(E)(ii).

This appeal followed.

DISCUSSION

I

At issue in this appeal are the Appeals Council's M-15-1505 and M-16-10554 decisions denying Bloom's claims. There is no dispute that these decisions present common questions of law and fact. Bloom argues that the District Court had jurisdiction under 42 U.S.C. § 1395ff(b)(1)(E)(i) to review his challenges to those decisions because the aggregated amount of those claims indisputably exceeded $1,500. On de novo review, we agree. See United States v. Williams, 733 F.3d 448, 452 (2d Cir. 2013).

A

We begin with the language of the Medicare Act, which contains two provisions that are directly relevant to our resolution of this appeal.

The first provision states that "[a] hearing ... shall not be available to an individual ... if the amount in controversy is less than $100, and judicial review shall not be available to the individual if the amount in controversy is less than $1,000." 42 U.S.C. § 1395ff(b)(1)(E)(i). The $1,000 amount in controversy is annually adjusted for inflation and was set at $1,500 in 2016, the year in which Bloom sought judicial review. See Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2016, 80 Fed. Reg. 57,827, 57,828 (Sept. 25, 2015) ; see also 42 U.S.C. § 1395ff(b)(1)(E)(iii).

The second provision at issue in this appeal directs that "[i]n determining the amount in controversy, the Secretary [of HHS], under regulations, shall allow two or more appeals to be aggregated if the appeals involve" "the delivery of similar or related services to the same individual by one or more providers of services or suppliers." 42 U.S.C. § 1395ff(b)(1)(E)(ii). Medicare beneficiaries may thus aggregate their claims for benefits, but only upon satisfying the following conditions: the claimant's unaggregated claims must (1) involve "related services" (here, the CGM sensors and transmitters) that (2) are rendered "to the same individual" (Bloom) (3) by "one or more providers." Id.

So long as each Medicare claim before the district court satisfies these conditions, the text of § 1395ff(b)(1)(E) permits plaintiffs to aggregate the amount of their claims against HHS to meet the amount-in-controversy requirement for judicial review. The statutory text directs the Secretary to make regulations that allow two or more appeals to be aggregated (under stated conditions) in determining the amount in controversy without suggesting that those regulations should apply only to agency review and not to judicial review. The statute thus expresses congressional intent that, as to both agency and judicial review, aggregation is permitted when the claims conform to the conditions specified. This reading of the text reflects a basic reality: federal courts have long permitted the aggregation of a single plaintiff's claims against a single defendant to satisfy the jurisdictional amount in controversy in other contexts. Take, for example, "[t]he traditional judicial interpretation" of the diversity jurisdiction statute's amount-in-controversy requirement, which "has been from the beginning that ... [a]ggregation has been permitted ... in cases in which a single plaintiff seeks to aggregate two or more of his own claims against a single defendant." Snyder v. Harris, 394 U.S. 332, 335, 89 S.Ct. 1053, 22 L.Ed.2d 319 (1969). The same was true for the federal question statute, which until 1980 carried its own amount-in-controversy requirement. See Hunter v. United Van Lines, 746 F.2d 635, 650 (9th Cir. 1984) (collecting authorities); Hales v. Winn-Dixie Stores, Inc., 500 F.2d 836, 846 n.11 (4th Cir. 1974) ("The general rule is that in an action involving a single plaintiff and a single defendant, when the basis of jurisdiction is diversity of citizenship or when each of the claims sought to be joined involves a federal question, a party may aggregate all the claims he has against an opposing party in order to satisfy the requisite jurisdictional amount."); see also 14AA Charles A. Wright & Arthur R. Miller, Federal Practice and Procedure § 3704 (4th ed. 2020). There is no textual basis to conclude that the Medicare Act, which by its terms mandates regulations that allow aggregation of claims by a single plaintiff against a single defendant involving "related services," prevents the aggregation of all claims against HHS in the district court over which the court would independently have jurisdiction but for the jurisdictional amount requirement.

The District Court, relying on the fact that § 1395ff(b)(1)(E)(ii) is directed to "the Secretary [of HHS]," interpreted that provision as applying only to appeals before the agency. The court concluded that § 1395ff(b)(1)(E) "is silent about aggregation of claims at the district court level." The lack of any mention of aggregation at the judicial review stage, the...