Belen Consolidated Schools v. Otten

259 F. Supp. 2d 1203, 2003 U.S. Dist. LEXIS 7115, 2003 WL 1957473
CourtDistrict Court, D. New Mexico
DecidedApril 21, 2003
DocketCIV-02-1131MV/WWDACE
StatusPublished

This text of 259 F. Supp. 2d 1203 (Belen Consolidated Schools v. Otten) is published on Counsel Stack Legal Research, covering District Court, D. New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Belen Consolidated Schools v. Otten, 259 F. Supp. 2d 1203, 2003 U.S. Dist. LEXIS 7115, 2003 WL 1957473 (D.N.M. 2003).

Opinion

MEMORANDUM OPINION AND ORDER

VAZQUEZ, District Judge.

THIS MATTER comes before the Court on Defendants’ Motion to Dismiss Complaint for Injunctive Relief, filed September 26, 2002 [Doc. No. 16]. The Court, having considered the motion, briefs, relevant law and being otherwise fully informed, finds that Defendants’ motion is well-taken, and, accordingly, will be GRANTED.

BACKGROUND

The Medicaid in the Schools (“MITS”) Program, which provides Medicaid-reimbursable health care services to Medicaid-eligible children in the schools, began in 1994 under the administration of the New Mexico Human Services Department (“HSD”). As the single state Medicaid agency, HSD has the authority to enter into interagency agreements with local public agencies, including school districts, to assist in the administration of its medical assistance programs. The school districts are under contract with HSD to assist in administering a portion of the Medicaid program in the schools. There are two contracts between HSD and the school districts, both of which must be in *1205 place to allow the school districts to operate an MITS Program in their schools: (1) the Joint Powers Agreement (“JPA”) and (2) the Provider Participation Agreement (“PPA”). The JPA is the legal mechanism by which the school district is required to contribute the state’s share for the particular medical assistance program in which it is involved, thus enabling HSD to obtain the federal matching funds for that program. The JPA also allows the school district to perform administrative activities for the single state Medicaid agency (HSD), and to be paid by Medicaid for those services. The JPA provides by its own terms that it may be terminated by any party without cause, with proper notice. The PPA, which is required for all Medicaid providers, may be terminated by HSD with proper notice.

On August 15, 2002, HSD announced its decision to terminate the administrative claiming portion of the MITS Program, effectively eliminating the ability of the school districts to claim reimbursement for their administrative costs in providing direct medical services. HSD further announced that it had already taken the first step in eliminating administrative claiming by terminating the individual JPAs between the school districts and HSD. HSD then submitted new JPAs to each school district, reflecting the termination of administrative claiming under the MITS Program. On August 23, 2002, HSD announced its final decision that any school district that did not execute and return HSD’s version of the JPA would suffer revocation of its Medicaid provider number, terminating the school district’s right to participate in the MITS Program.

According to Defendants, in 2000, HSD conducted an extensive review of the administrative claims submitted by the MITS school districts. In its claims review, HSD identified numerous improper administrative claiming practices in the school districts’ 2000 fiscal year administrative claims and denied payment of those claims. HSD and the school districts have since engaged in two years of litigation concerning the school districts’ 2000 and 2001 administrative claims and related issues. It was in this context, Defendants contend, that HSD decided in late June 2002 to eliminate the optional administrative claiming portion of the MITS program and to focus HSD’s limited Medicaid resources on medical services that directly impact school children by adding nursing services and certain behavioral health services to the MITS program. HSD also decided to eliminate the 5% administrative fee the school districts had been required to pay HSD.

Defendants contend that, in order to eliminate administrative claiming and the 5% administrative fee from the MITS program, HSD was obligated to terminate the existing JPAs and enter into new agreements. Although the existing JPAs allow for a 30-day notice of termination, HSD gave the MITS school districts 92 days notice. On June 28, 2002, HSD provided notice of termination of the JPAs, effective September 30, 2002, by letter from Robert Maruca to all MITS school districts. Enclosed with the letter was a new JPA which reflected the elimination of administrative claiming and the 5% administrative fee. The MITS districts were asked to sign the new JPAs and return them by August 31, 2002. Many of the plaintiffs submitted alternative language for the new JPAs. HSD incorporated some of those changes, and issued a revised JPA on August 30, 2002.

Plaintiffs did not sign or return the revised JPAs. According to Defendants, if Plaintiffs did not sign and return the revised JPA before the expiration of the then current JPA, on September 30, 2002, their Medicaid providers status would be in jeopardy, as under federal regulations *1206 and policies the school districts cannot participate as MITS providers without a valid interagency agreement in place. If there were no JPAs in place, the PPAs, required of all Medicaid providers, would have to be canceled. On August 30, 2002, Plaintiffs were given notice of the cancellation of the PPAs in the event the revised JPAs were not in effect by October 1, 2002.

Plaintiffs commenced the instant action on September 6, 2002, filing a Complaint for Injunctive Relief, a Motion for Preliminary Injunction, and a Motion for Eviden-tiary Hearing on Plaintiffs’ Motion for Preliminary Injunction. On that same date, Plaintiffs filed a Motion for a Temporary Restraining Order (“TRO”) and Preliminary Injunction in the First Judicial District Court in Santa Fe (“State Case”). In the State Case, Judge James A. Hall denied the motion for a TRO.

On September 16, 2002, Defendants filed a Response to Plaintiffs Motion for Preliminary Injunction and Request for Stay of Proceedings. In their Motion, Defendants requested that this Court stay the federal court proceedings until the State Case had been heard, as it was set for hearing on September 17, 2002. Judge Hall held a hearing on the preliminary injunction filed in the State Case on September 17, 2002, and ruled from the bench, denying the preliminary injunction.

On September 26, 2002, Plaintiffs filed a motion in this Court for a TRO, seeking to enjoin Defendants from terminating the administrative portion of the MITS Program and revoking the Medicaid provider numbers of the school districts until this Court held a hearing on Plaintiffs’ September 6, 2002 Motion for a Preliminary Injunction. On September 30, 2002, the Court held an evidentiary hearing on Plaintiffs’ motion for a TRO. Following the hearing, on October 2, 2002, the Court entered a Memorandum Opinion and Order denying the motion.

Also on September 26, 2002, Defendants filed the instant motion to dismiss. Plaintiffs filed their response in opposition on October 22, 2002. Defendants set forth three arguments in support of their motion to dismiss: (1) Plaintiffs fail to sate a claim upon which relief can be granted because the statutory scheme upon which they rely does not indicate Congressional intent to create an individual right of enforcement under 42 U.S.C. § 1983; (2) Plaintiffs lack standing under prudential standing requirements; and (3) principles of comity and the Bwrford

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Bluebook (online)
259 F. Supp. 2d 1203, 2003 U.S. Dist. LEXIS 7115, 2003 WL 1957473, Counsel Stack Legal Research, https://law.counselstack.com/opinion/belen-consolidated-schools-v-otten-nmd-2003.