Greater Cleveland Hospital Ass'n Group Appeal v. Schweiker

599 F. Supp. 1000
CourtDistrict Court, N.D. Ohio
DecidedMarch 27, 1984
DocketNo. C81-1757
StatusPublished
Cited by1 cases

This text of 599 F. Supp. 1000 (Greater Cleveland Hospital Ass'n Group Appeal v. Schweiker) is published on Counsel Stack Legal Research, covering District Court, N.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Greater Cleveland Hospital Ass'n Group Appeal v. Schweiker, 599 F. Supp. 1000 (N.D. Ohio 1984).

Opinion

MEMORANDUM OF OPINION AND ORDER

KRENZLER, District Judge.

This is an action for judicial review of the Secretary of Health and Human Services’ final decision denying plaintiffs’ claims for reimbursement under the Medicare program (Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq.).

Both parties have filed summary judgment motions which are pending before the Court. At issue is the validity of the Medicare regulation which disallows reimbursement for beside telephones provided to Medicare beneficiaries on the theory that such items are non-reimbursable personal comfort items. 42 C.F.R. § 405.310(j).

Plaintiffs are 22 hospitals located in the Northern District of Ohio who, by virtue of 42 U.S.C. § 1395cc, are “providers of service” under contract with the Department of Health and Human Services. Pursuant to 42 U.S.C. § 1395x(u), “providers of services” are primarily hospitals, skilled nurs[1002]*1002ing facilities, or home health agencies which elect to, and are accepted to, participate in the Medicare program. Through the providers, eligible beneficiaries of the program are able to obtain health care services. The providers are then reimbursed by the government through “fiscal intermediaries”, usually private organizations under contract with the Secretary. 42 U.S.C. § 1395h. In this case, the fiscal intermediary is the Blue Cross Association/Blue Cross of Northeast Ohio.1

Title 42, section 1395y(a)(6) of the United States Code specifically excludes from coverage items or services that constitute “personal comfort items”. The Secretary has promulgated a regulation, 42 C.F.R. § 405.310, which provides that telephones are excludable personal comfort items. In pertinent part, 42 C.F.R. § 405.310 reads as follows:

Notwithstanding any other provision of this Part 405, no payment may be made for any expenses incurred for the following items or services:
******
(j) Personal comfort items and services (for example a television set, or telephone service, etc.)____

Based upon this regulation, the intermediary in the instant case disallowed plaintiffs’ claims for the cost of making bedside telephones available to their inpatients.

Plaintiffs timely appealed these determinations of the intermediary to the Provider Reimbursement Review Board (“PRRB”), 42 U.S.C. § 1395oo(a); 42 C.F.R. § 405.-1835. The appeals were consolidated in a group appeal and, after a hearing held on November 20, 1980, the PRRB upheld the intermediary’s disallowance of costs. The providers then requested review by the Health Care Financing Administration (“HCFA”). 42 U.S.C. § 1395oo (f)(1). On July 9, 1981, the Deputy Administrator of HCFA affirmed the PRRB’s decision.

On August 25, 1981, plaintiffs filed their complaint in this Court pursuant to 42 U.S.C. § 1395oo (f).

The parties present two issues for this Court’s review. The first is whether the Court has jurisdiction to review the validity of the patient-telephone regulation. The second is the validity of the regulation.

The Secretary contends that 42 U.S.C. § 1395oo(g) prohibits the Court from exercising jurisdiction over the instant action. That section provides as follows:

(1) The finding of a fiscal intermediary that no payment may be made under this subchapter for any expenses incurred for items or services furnished to an individual because such items or services are listed in section 1395y of this title shall not be reviewed by the Board, or by any court pursuant to an action brought under subsection (f) of this section.

42 U.S.C. § 1395oo(g)(l). Defendant contends that since the patient-telephone regulation is promulgated pursuant to the statutory command of 42 U.S.C. § 1395y excluding from reimbursement personal comfort items, the above section precludes judicial review of the instant action.

The majority of the courts that have addressed this issue have held that 42 U.S.C. § 1395oo (g) does not preclude judicial review of the patient-telephone regulation. Memorial Hospital v. Heckler, 706 F.2d 1130 (11th Cir.1983); St. Mary of Nazareth Hospital Center v. Department of Health and Human Services, 698 F.2d 1337 (7th Cir.1983); Arlington Hospital v. Schweiker, 547 F.Supp. 670 (E.D.Va.1982).2

[1003]*1003In Memorial Hospital v. Heckler, supra, 706 F.2d 1130, the Court reasoned as follows:

In essence, the issue here does not involve just an intermediary finding that no payment may be made. Rather, it concerns the validity of the regulation itself. The intermediary merely followed the Secretary’s regulation ____ To expand the non-reviewability of intermediary decisions to include policy decisions of the Secretary would not merely insulate from judicial scrutiny the finding of an intermediary. It would give the Secretary virtually unbridled discretion to prevent reimbursement through regulations. Such a result would run contrary to the presumption favoring judicial review [citations omitted]____

Id. at 1133. See also, St. Mary of Nazareth v. Dept. of HHS, supra, 698 F.2d at 1346: (“[W]e are faced only with a challenge to the Secretary’s interpretation contained in his regulations of the term ‘personal comfort item.’ Contrary to the Secretary’s position, section 1395oo (g) does not restrict this court’s jurisdiction to review the Secretary’s interpretation of what a personal comfort item consists of.”)

Defendant cites Highland District Hospital v. Secretary of Health and Human Services,

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GREATER CLEVELAND HOSP. ASS'N v. Schweiker
599 F. Supp. 1000 (N.D. Ohio, 1984)

Cite This Page — Counsel Stack

Bluebook (online)
599 F. Supp. 1000, Counsel Stack Legal Research, https://law.counselstack.com/opinion/greater-cleveland-hospital-assn-group-appeal-v-schweiker-ohnd-1984.