Community Health Care Ass'n of New York v. Mahon

106 F. Supp. 2d 523, 2000 U.S. Dist. LEXIS 10604, 2000 WL 1048454
CourtDistrict Court, S.D. New York
DecidedJuly 25, 2000
Docket98 Civ 4539(BDP)
StatusPublished
Cited by7 cases

This text of 106 F. Supp. 2d 523 (Community Health Care Ass'n of New York v. Mahon) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Community Health Care Ass'n of New York v. Mahon, 106 F. Supp. 2d 523, 2000 U.S. Dist. LEXIS 10604, 2000 WL 1048454 (S.D.N.Y. 2000).

Opinion

MEMORANDUM DECISION AND ORDER

BARRINGTON D. PARKER, Jr., District Judge.

Plaintiffs commenced this action pursuant to 42 U.S.C. § 1983, and the Administrative Procedure Act, 5 U.S.C. § 500, et seq., seeking a declaratory judgment that local, state and federal officials violated the cost reimbursement provision of the federal Medicaid program. See 42 U.S.C. § 1396(b)(m)(2), et seq. This Court, inter alia, previously dismissed this action against Barbara DeBuono, former Commissioner of the New York State Department of Health sued in her official capacity, on Eleventh Amendment grounds. Subsequently, the remaining defendant, Kevin P. Mahon, Commissioner of West-chester County’s Department of Social Services (the “County”) filed a third-party complaint against the state defendant. Before this Court is the state defendant’s motion to dismiss Mahon’s third-party complaint, again on Eleventh Amendment grounds. In addition, the County moves to dismiss the entire lawsuit without prejudice on grounds that the state defendant is an indispensable party. See Fed.R.Civ.P. 19(b). Lastly, plaintiffs move for partial summary judgment pursuant to Fed. R.Civ.P. 56.

For the reasons stated below, the state’s motion to dismiss the third-party complaint is granted, the County’s Rule 19 motion is denied and plaintiffs’ motion for partial summary judgment is granted.

FACTUAL & PROCEDURAL BACKGROUND 1

I. 42 U.S.C § 1396b(m)(2)(A)(ix) — Reasonable Cost Reimbursement.

Plaintiffs are six New York state outpatient medical facilities designated by the federal government as federally qualified health centers (“FQHCs”); three New York State Medicaid managed care plans affiliated with FQHCs and licensed as Prepaid Health Services Plans (“PHSPs”) to serve Medicaid recipients and beneficiaries of other government health insurance pro *526 grams, and an association of FQHCs in New York state. 2 The original defendants included Barbara DeBuono, sued in her official capacity as Commissioner of the New York State Department of Health (the “State”), and the County. By Memorandum Decision and Order dated September 27, 1999, this Court, inter alia, dismissed this action against the State based upon Eleventh Amendment immunity. 3

This case concerns a provision of the Medicaid law that was in effect from 1990 until October 1, 1997. Since 1989 Congress has required state Medicaid programs to pay FQHCs a fee-for-service medicaid rate which covers 100% of their “reasonable costs” for treating Medicaid recipients. In 1990, Congress extended the mandate to state Medicaid managed care programs under 42 U.S.C. § 1396b(m)(2)(A)(ix), the provision of federal Medicaid law at issue here. 4 Under this law, in order for the federal government to pay its share of Medicaid expenses, plaintiffs allege states were required to include in their contracts with managed care plans provisions allowing the plans to elect reasonable cost reimbursement to FQHCs and requiring the states to reimburse the plans for the extra costs of paying reasonable cost reimbursement. The FQHC reasonable cost reimbursement provisions were amended by the Balanced Budget Act of 1997. See Balanced Budget Act of 1997 § 4712(b), Pub.L. 105-33. Under the Balanced Budget Act, states are now required to pay reasonable cost reimbursement directly to FQHCs who render services to Medicaid managed care patients, as opposed to reimbursing the plans themselves. See 42 U.S.C. §§ 1396a(A)(13)(C)(i) and 1396b(m)(2)(A)(ix). Plaintiffs do not allege that the County defendant violated the new reasonable cost provision.

Effective January 1, 1996, the Westches-ter County Department of Social Services (“WCDSS”) operated a mandatory Medicaid managed care program, pursuant to a waiver from the federal Health Care Financing Administration (“HCFA”). In May of 1994, WCDSS issued its own proposal for developing the Medicaid Managed Care Program, and made modifications to the State’s managed care model. In April of 1995, the County issued a request for proposal (“RFP”) to managed care health plans regarding contracts to provide medical services under the West-chester County Managed Care Plan. The RFP included a provision which did not guarantee a reasonable cost-based reimbursement of services provided by FQHCs. On May 18, 1995, HCFA’s regional administrator upheld the provision and ruled that Westchester County had *527 not violated federal law. Westchester County’s subsequent contracts with Medicaid managed care plans, including plaintiffs, did not include a reasonable cost reimbursement election provision. Instead the contracts stated:

There will be no guaranteed cost-based reimbursement of services provided by FQHCs or look-alikes for individuals enrolled in a PHSP which contracts on an at risk basis for the services provided to managed care enrollees.

Affidavit of Georganne Chapin, Exh. 7.

On October 22, 1999 plaintiffs served an amended complaint and stipulated to withdraw this action against the State without prejudice to any appeal or any other rights of plaintiffs with respect to this Court’s September 27, 1999 Decision and Order. Specifically, plaintiffs allege in then-amended complaint that in a managed care Medicaid contract between the County and plaintiff Westchester Prepaid Health Services Plan, Inc. (“HealthSource”), 5 the County did not include the medicaid provision which permitted plaintiff Peekskill Area Health Center (“Peekskill”) and other FQHCs to elect the reasonable cost reimbursement compensation methodology. In an affidavit in support of plaintiffs’ motion for summary judgment, Georganne Chapin (“Chapin”), President and Chief Executive Officer of HealthSource, states that from 1988 to the present, Health-Source paid enhanced rates to Peekskill and other FQHCs which were higher than the rates HealthSource paid to comparable providers but were not high enough to guarantee full reasonable cost reimbursement to the FQHCs. Plaintiffs assert,

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Bluebook (online)
106 F. Supp. 2d 523, 2000 U.S. Dist. LEXIS 10604, 2000 WL 1048454, Counsel Stack Legal Research, https://law.counselstack.com/opinion/community-health-care-assn-of-new-york-v-mahon-nysd-2000.