Pinnacle Nursing Home v. Axelrod
| Decision Date | 25 March 1991 |
| Docket Number | 1193,1091,D,Nos. 1090,1192,s. 1090 |
| Citation | 928 F.2d 1306 |
| Court | U.S. Court of Appeals — Second Circuit |
| Parties | , Medicare&Medicaid Gu 39,194 PINNACLE NURSING HOME; Lakeshore Nursing Home; Fenton Park Nursing Home; Sylcox Nursing Home and Health Related Facility; Nortonian Nursing Home; Elcor Nursing Home; Elcor's Marriott Manor; Waterview Hills Nursing Center, Inc.; Walnut Mountain Care Center; Ridge View Manor Nursing Home; Manor Oak Skilled Nursing Facility, Buffalo; Manor Oak Skilled Nursing Facility, Jamestown; Manor Oak Skilled Nursing Facility, Warsaw; Fenton Park Health Related Facility, doing business as Greenhurst Health Care Center; Oneonta-Richmond, Inc., doing business as Oneonta Nursing Home; Vestal-Johnson, Inc., doing business as Vestal Johnson Nursing Home; Crest Manor Nursing Home; Doanes Nursing Home; Blossom Health Care Center; Pontiac Nursing Home; Brae Loch Manor Health Care Facility; Nor Loch Manor Health Care Facility; Grand Island Manor Nursing Home; Hornell Nursing Home and Health Related Facility; Hurlbut Nursing Homes; Penfield Nursing Home; Conesus Lake Nursing Home; Elm Manor Nursing Home; Wedgewood Nursing Home; Westgate Nursing Home; Woodside Manor Nursing Home, Inc.; Newark Manor Nursing Home; Avon Nursing Home; Valley View Manor Nursing Home, Appellees/Cross-Appellants, v. David AXELROD, M.D., as Commissioner of Health of the State of New York; Cesar Perales, as Commissioner of Social Services of the State of New York; Dall Forsythe, as Director of the Budget of the State of New York, Appellants/Cross-Appellees. ockets 90-6295, 90-6297, 90-6307, 90-6313. |
Thomas G. Smith, Rochester, N.Y. (Ross P. Lanzafame, Carol O'Keefe, and Harter, Secrest & Emery, Rochester, N.Y., on the brief) for appellees/cross-appellants Pinnacle Nursing Home, et al.
Michael A. Rosenbloom, Rochester, N.Y., for appellee/cross-appellant Valley View Manor Nursing Home.
Clifford A. Royael, Albany, N.Y. for appellants/cross-appellees.
Before FEINBERG, TIMBERS, and MINER, Circuit Judges.
Appellants David Axelrod, M.D., Commissioner of Health of the State of New York; Cesar Perales, Commissioner of Social Services of the State of New York; and Dall Forsythe, Director of the Budget of the State of New York (collectively the state) appeal from a final amended judgment entered October 9, 1990 in the Western District of New York, Michael A. Telesca, Chief Judge, declaring null and void on procedural grounds the 1987 adjustment to the Medicaid reimbursement methodology utilized by the state (1987 Adjustment); dismissing a substantive challenge to the 1987 Adjustment; and not reaching a constitutional challenge to the 1987 Adjustment. The federal defendant, Secretary of the United States Department of Health and Human Services (Secretary), does not join in this appeal. Plaintiffs, various residential health care facilities or nursing homes (collectively nursing homes) located throughout New York State, cross-appeal from that judgment. This appeal also brings up for review the non-final decision and order entered by the court on August 15, 1989. Pinnacle Nursing Home v. Axelrod, 719 F.Supp. 1173 (W.D.N.Y.1989).
On appeal, the state contends that the 1987 Adjustment comports with the procedural requirements of the Medicaid Act. On cross-appeal, the nursing homes contend that the 1987 Adjustment constitutes a substantive violation of the Medicaid Act and a constitutional violation of their right to equal protection.
For the reasons which follow, we affirm that part of the district court's order and final judgment which held that the 1987 Adjustment fails to satisfy the procedural requirements of the Medicaid Act. We vacate the district court's dismissal of the nursing homes' substantive and constitutional claims. We remand the case with instructions to reinstate those claims and to proceed in accordance with this opinion.
We summarize only those facts and prior proceedings believed necessary to an understanding of the issues raised on appeal. At the outset, we also summarize briefly the relevant aspects of the Medicaid scheme.
The Medicaid Program (the Act) was established pursuant to title XIX of the Social Security Act, 42 U.S.C. Sec. 1396 et seq. (1988). It establishes a joint federal and state cost-sharing system to provide necessary medical services to indigent persons who otherwise would be unable to afford such care. Participation in this system is optional. Once a state does decide to participate, however, it must abide by certain requirements imposed by the Act and regulations promulgated thereunder. To qualify for federal reimbursement, a state must submit to the Secretary for approval a plan for medical assistance. 42 U.S.C. Sec. 1396a(b). This plan "is a comprehensive written statement submitted by the agency describing the nature and scope of its Medicaid program and giving assurance that it will be administered in conformity with the specific requirements of title XIX, the regulations in ... Chapter IV [of the Code of Federal Regulations], and other applicable official issuances of the Department." 42 C.F.R. Sec. 430.10 (1987). Upon approval of a state plan by the Secretary, the state is entitled to receive reimbursement from the federal government for a percentage of the funds it pays to residential health care facilities which provide medical assistance to Medicaid recipients. 42 U.S.C. Sec. 1396b(a). The remainder of the costs under the Medicaid Program are borne by state and local governments.
The Boren Amendment was enacted with two specific purposes in mind: (1) to provide the states with greater flexibility in developing methods of reimbursing skilled nursing facilities, intermediate care facilities, and inpatient hospital services; and (2) to increase the economy and efficiency of all plans. S.Rep. No. 139, 97th Cong., 1st Sess. 478, reprinted in 1981 U.S.Code Cong. & Admin.News 396, 744; see also Colorado Health Care Ass'n v. Colorado Dep't of Social Servs., 842 F.2d 1158, 1165 (10 Cir.1988). "The flexibility given the States[, however, was] not intended to encourage arbitrary reductions in payment that would adversely affect the quality of care." S.Rep. No. 139, supra, at 744.
The regulations promulgated under the Act require that a state make findings "[w]henever the Medicaid agency makes a change in its methods and standards, but not less often than annually...." 42 C.F.R. Sec. 447.253(b). Pursuant to that regulation, a state must find that "[t]he Medicaid agency pays for inpatient hospital services and long-term care facility services through the use of rates that are reasonable and adequate to meet the costs that must be incurred by efficiently and economically operated providers...." 42 C.F.R. Sec. 447.253(b)(1)(i).
Since New York elected to participate in the Medicaid Program, it was required to abide by the Boren Amendment and the regulations promulgated thereunder. Harris v. McRae, 448 U.S. 297, 301, 100 S.Ct. 2671, 2680, 65 L.Ed.2d 784 (1980); AMISUB (PSL), Inc. v. Colorado Dep't of Social Servs., 879 F.2d 789, 794 (10 Cir.1989), cert. denied, --- U.S. ----, 110 S.Ct. 3212, 110 L.Ed.2d 660 (1990). Article 28 of the New York Public Health Law charges the New York State Department of Health (DOH) with the responsibility for setting Medicaid reimbursement...
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...provide necessary medical services to indigent persons who otherwise would be unable to afford such care. See Pinnacle Nursing Home v. Axelrod, 928 F.2d 1306, 1309 (2d Cir.1991); 42 U.S.C. § 1396 et seq. Participation in the program is optional, but once a state does elect to participate, i......
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...Policy & Planning, 60 F.3d 262, 266 (7th Cir.1995)(reviewing approved state plan amendment with deference); Pinnacle Nursing Home v. Axelrod, 928 F.2d 1306, 1313 (2d Cir.1991)(same). Accordingly, we conclude that incontinence supplies are described in the medical assistance category of "hom......
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Krug v. County of Rennselaer, 1:04-CV-0640 (TJM/DRH).
...faith intent to injure. Accordingly, all equal protection claims asserted by Robert Krug are dismissed. See Pinnacle Nursing Home v. Axelrod, 928 F.2d 1306, 1317 (2d Cir.1991) ("The breadth of coverage under the equal protection clauses of the federal and [New York State] constitutions is e......
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Standards of Review and Federal Court Remedies
...social security law as well. Deference, however, even at its highest levels, is not a “rubber stamp.” Pinnacle Nursing Home v. Axelrod, 928 F.2d 1306, 1314 (2d Cir. 1991). Flack points to the universality of this idea in all areas of court review of administrative decisions: It is elementar......
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Standards of Review and Federal Court Remedies
...social security law as well. Deference, however, even at its highest levels, is not a “rubber stamp.” Pinnacle Nursing Home v. Axelrod, 928 F.2d 1306, 1314 (2d Cir. 1991). Flack points to the universality of this idea in all areas of court review of administrative decisions: It is elementar......