Grier v. Goetz
| Decision Date | 15 November 2005 |
| Docket Number | No. 3:79-3107.,3:79-3107. |
| Citation | 402 F.Supp.2d 876 |
| Parties | Gaynell GRIER, et al., individually and on behalf of others similarly situated, Plaintiffs, and Sanford Bloch, Mark Levine, Tim Jones, and William Duncan, and Mary Kathryn Duncan, by their next friend, Robert Duncan, Plaintiffs-Intervenors, v. M.D. GOETZ, Jr., Commissioner, Tennessee Department of Finance and Administration, et al., Defendants, and Tennessee Association of Health Maintenance Organizations, et al., Defendants-Intervenors. |
| Court | U.S. District Court — Middle District of Tennessee |
Dorothy M. Siemon, Franco Allocco Munoz, A.A.R.P. Foundation Litigation, Washington, DC, Erin E. Oshiro, Welfare Law Center, New York, NY, Everette L. Doffermyre, Doffermyre, Shields, Canfield, Knowles & Devine, Atlanta, GA, George Gordon Bonnyman, Jr., Tennessee Justice Center, Inc., Nashville, TN, for Pearl Bailey, Cluster Daniels, Plaintiffs.
George Gordon Bonnyman, Jr., Tennessee Justice Center, Inc., Nashville, TN, Michele M. Johnson, Lisa J. D'Souza, Ralph I. Knowles, Jr., Doffermyre, Shields, Canfield, Knowles & Devine, Atlanta, GA, Russell James Overby, Tennessee Justice Center, Inc., Nashville, TN, for Gaynell Grier, Dorothy Cantrell, Carolyn Fitts, Nannie Breeden.
George Edward Barrett, Edmund L. Carey, Jr., Gerald E. Martin, Barrett, Johnston & Parsley, Nashville, TN, for Nashville Cares a Tennessee not-for-profit corporation, Sanford Bloch, Mark Levine.
Charles J. Cooper, Cooper & Kirk, Charles A. Miller, Covington & Burling, Washington, DC, Derek L. Shaffer, Kathryn L. Wheelbarger, Cooper & Kirk, Washington, DC, Linda A. Ross, Tennessee Attorney General's Office, Michael L. Roden, Office of the United States Attorney, Nashville, TN, Nicole J. Moss, Ronald G. Harris, Steven B. Carter, Sue A. Sheldon, Nicholas G. Aemisegger, Jr. for Public Health, Tennessee Department of, Human Services, Tennessee Department of, Department of Health and Human Services, Health Care Financing Administrator, C. Warren Neel, Defendants.
Bobby D. Green, Ashland City, Pro se.
Lois Vaughan, Interlachen, FL, Pro se.
Gary C. Shockley, Baker, Donelson, Bearman, Caldwell & Berkowitz, PC, Nashville, TN, Margaret Mary Huff, Nashville, TN, John S. Hicks, Lewis R. Donelson, Baker, Donelson, Bearman, Caldwell & Berkowitz, PC, Nashville, TN, William Matthew Barrick, William Beesley Hubbard, Hubbard, Berry, Doughty, Harris & Barrick, PLLC, Nashville, TN, John M. Murdock, Epstein, Becker & Green, Washington, DC, Blakeley D Matthews, Cornelius & Collins, LLP, Nashville, for Tennessee Association of Health Maintenance Organizations, Inc., Memphis Managed Care Corporation doing business as TLC Family Care Health Plan, John Deere Health Plan, Inc., Tennessee Coordinated Care Network doing business as Access Medplus, Volunteer State Health Plan, Inc. doing business as BlueCare, Vanderbilt Health Plans, Inc., Preferred Health Partnership of Tennessee, Inc. doing business as PHP TennCare, Tennessee Pharmacists Association, Tim Jones, Intervenor Plaintiffs.
Lea C. Owen, Baker, Donelson, Bearman, Caldwell & Berkowitz, PC, Nashville, TN, for The Regional Medical Center at Memphis, Chattanooga-Hamilton County Hospital Authority, The, Nashville General Hospital at MeHarry, Methodist Healthcare, THA An association of Hospitals and Health Systems, Hospital Alliance of Tennessee, Babtist Memorial Health Care Corporation, Wellmont Health System, Amisub (SFH), Inc., UT Medical Group, Inc.
This case is pending before the Court on Defendants' Motion to Modify and/or Clarify the Consent Decree (Doc. Nos.1086, 1087), and the responses thereto (Doc. Nos.1106, 1111, 1141, 1148, 1236). A hearing was held between June 29, 2005 and July 19, 2005, and on July 28, 2005. Due to the time-sensitive nature of this matter, the Court issued four Orders between July 28, 2005 and August 9, 2005 (Doc. Nos.1246, 1248, 1256, 1261) adjudicating Defendants' Motion to Modify and/or Clarify the Consent Decree. The Court hereby explains the reasons underlying its previously issued Orders.
This case was filed in 1979 as a class action under 42 U.S.C. § 1983 on behalf of present and future Medicaid recipients, and alleged that Tennessee's Medicaid program violated the requirements of the Medicaid Act, 42 U.S.C. §§ 1396, et seq., and the Due Process Clause of the Fourteenth Amendment. Specifically, the original Plaintiffs asserted that Tennessee's Medicaid program failed to provide them with adequate notice and procedural protection upon denial of their claims. These issues were resolved in 1986 through a consent decree. A second consent decree also dealing with notice and hearing requirements was entered in 1992.
In January 1994, Tennessee converted its traditional Medicaid fee-for-service program to a managed care model known as TennCare. TennCare, which expanded the scope of eligibility beyond Tennessee's previous Medicaid program, is a special demonstration project authorized by the United States Secretary of Health and Human Services (the "Secretary") pursuant to the waiver authority conferred by section 1115 of the Social Security Act, 42 U.S.C. § 1315. Instead of directly purchasing medical services for eligible individuals, TennCare contracts with private managed care contractors ("MCCs")1 to provide healthcare to TennCare recipients. From TennCare's inception, the MCCs were required by their contracts to comply with the rules developed by Defendants (or the "State") to implement the federal notice and hearing requirements of 42 C.F.R. § 431, Subpart E.
In 1995, Plaintiffs moved to modify the second consent decree alleging that the TennCare program was being administered in a manner inconsistent with the decree, as well as federal law. This Court agreed and held that the State's TennCare notice and hearing procedures violated the Medicaid Act and the Due Process Clause of the Fourteenth Amendment. See Daniels v. Wadley, 926 F.Supp. 1305 (M.D.Tenn.1996). Consistent with the Court's ruling, the parties negotiated, and this Court entered, an agreed order establishing policies and procedures through which the federal Medicaid due process requirements would be implemented in the context of the new managed care program ("1996 Agreed Order").
In 1999, Plaintiffs filed another motion alleging that the State failed to comply with the 1996 Agreed Order. A settlement conference followed and culminated in this Court's approval and entry of the October 26, 1999 Revised Consent Decree Governing TennCare Appeals. Shortly thereafter, six TennCare managed care organizations and their trade association, the Tennessee Association of Health Maintenance Organizations, as well as trade associations representing hospitals and pharmacists, successfully moved to intervene in order to challenge this latest decree. Subsequently, on July 31, 2000, the Court entered a Revised Consent Decree to clarify terms and correct technical errors, which became effective immediately ("2000 Consent Decree").
The intervenors challenged the 2000 Consent Decree in an appeal to the Sixth Circuit. Although the Sixth Circuit remanded the case for a fairness hearing in order to determine whether the 2000 Consent Decree was adequate, reasonable and fair to the intervenors, the Sixth Circuit rejected the intervenors other challenges to the 2000 Consent Decree. See Tenn. Ass'n of Health Maint. Orgs. ("TAHMO") v. Grier, 262 F.3d 559 (6th Cir.2001). After a fairness hearing was held in late 2002, the State filed a motion to modify the 2000 Consent Decree. On February 14, 2003, the Court approved the 2000 Consent Decree in its entirety, but held the State's motion to modify in abeyance while a Magistrate Judge oversaw discovery and negotiations for possible modifications to the 2000 Consent Decree.
In March 2003, Governor Philip N. Bredesen's administration entered negotiations to modify the 2000 Consent Decree, and to discuss three other class actions involving different aspects of TennCare's administration. In August 2003, after six months of negotiations, the parties to the four class actions entered into a global settlement. On October 1, 2003, following a fairness hearing, the Court approved and entered the Revised Consent Decree (Modified) ("2003 Consent Decree," "Consent Decree" or "Decree").
On June 15, 2005, the State filed its present motion to modify and/or clarify the 2003 Consent Decree. The State's motion contains twenty separate requests for modification and/or clarification of the 2003 Consent Decree, a number of which contain several distinct subparts. Altogether, the motion contains thirty-four separate requests for modification and/or clarification relating primarily to prescription drugs, benefit limits, and the TennCare appeals process. For the reasons discussed below, the Court has granted in part and denied in part the State's Motion to Modify and/or Clarify the 2003 Consent Decree. (See Doc. Nos. 1256, 1261.)
A consent decree is an agreement between the parties that is enforceable and subject to the rules applicable to other judgments. Rufo v. Inmates of Suffolk County Jail, 502 U.S. 367, 378, 112 S.Ct. 748, 116 L.Ed.2d 867 (1992). Accordingly, consent decrees are subject to modification pursuant to Federal Rule of Civil Procedure 60(b), which provides in relevant part:
On motion and upon such terms as are just, the court may relieve a party ... from a final judgment, order, or proceeding for the following reasons: ... (5) ... it is no longer equitable that the judgment should have prospective application; or (6) any other reason justifying relief from the operation of the judgment....
The Supreme Court has noted that because consent decrees often remain in place for extended periods of time, a...
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