Grier v. Goetz

421 F. Supp. 2d 1061, 2006 U.S. Dist. LEXIS 11233, 2006 WL 572314
CourtDistrict Court, M.D. Tennessee
DecidedMarch 7, 2006
Docket3:79-3107
StatusPublished
Cited by4 cases

This text of 421 F. Supp. 2d 1061 (Grier v. Goetz) is published on Counsel Stack Legal Research, covering District Court, M.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Grier v. Goetz, 421 F. Supp. 2d 1061, 2006 U.S. Dist. LEXIS 11233, 2006 WL 572314 (M.D. Tenn. 2006).

Opinion

MEMORANDUM ORDER

JOHN T. NIXON, Senior District Judge.

Pending before the Court is Plaintiffs’ Application For Recovery Of Attorney’s Fees And Expenses As A Prevailing Party (Doc. No. 1310), to which Defendants have responded in opposition (Doc. No. 1320). 1 *1063 Plaintiffs request attorney’s fees and expenses for two separate phases of this ongoing litigation: (1) Plaintiffs’ monitoring of the State’s implementation and enforcement of the 2003 Consent Decree, and (2) Plaintiffs’ opposition to Defendants’ Motion to Modify and/or Clarify the Consent Decree.

1. BACKGROUND

On October 1, 2003, this Court approved the Revised Consent Decree (Modified) (the “2003 Consent Decree”) that embodied the Plaintiffs’ and Defendants’ settlement agreement reached after lengthy negotiations earlier that year. (Doc. No. 908.) 2 The 2003 Consent Decree gave Plaintiffs broad authority to monitor Defendants’ implementation and enforcement of the Decree. (Id. § D.) As a result, Plaintiffs’ counsel met regularly over a period of many months with the State to monitor and assist with implementation. (See Doc. No. 1310, Att. A, Manny Martins Dep. at 98-99, 102.) These monitoring activities related to the appeals and pharmacy provisions of the 2003 Consent Decree. (Id. at 100-02.) The State, in recognition of Plaintiffs’ right to conduct monitoring activities, worked eollegially with Plaintiffs’ counsel to further implementation and enforcement of the 2003 Consent Decree. (Id. at 103-05.)

In the meantime, on February 17, 2004, Governor Bredesen announced his plan to restructure TennCare. Seven months later, on September 27, 2004, Defendants filed with the Court the State’s Proposed Amendment to the TennCare Demonstration Project, an application that had been submitted to the federal Centers for Medicare and Medicaid Services (“CMS”) seeking permission to change the TennCare program in ways that were acknowledged to require modification of the 2003 Consent Decree. (Doc. 939 at 15.) Subsequently, the State proposed to eliminate non-Medicaid eligibility categories and disenroll 430,-000 adults and children from the program. In response, Plaintiffs counsel unilaterally moved for temporary modification of the 2003 Consent Decree. (Doc. No. 963.) Defendants rejected this temporary modification. (Doc. No. 972.) Eight months after that, on June 6, 2005, Defendants filed a notice with the Court stating that CMS had partially approved the State’s request for a TennCare waiver amendment. (Doc. No. 1076.) On June 15, 2005, Defendants moved to modify and/or clarify the 2003 Consent Decree to implement the changes approved by CMS. (Doc. No. 1086.) The motion contained twenty requests for modification and/or clarification of the 2003 Consent Decree, a number of which contained several subparts for a total of thirty-four requests. On June 27, 2005, Plaintiffs responded primarily in opposition to Defendants’ motion to modify, but also noted requests to which they did not object. (Doc. No. 1111.)

*1064 After a three week trial, the Court issued orders on July 28, July 29, August 3, and August 9, 2005 granting in part and denying in part Defendants’ motion. (Doc. Nos. 1246, 1248, 1256, 1261.) The Court issued its memorandum opinion on November 15, 2005 explaining the reasons underlying its previous orders. (Doc. No. 1282.) Out of Defendants’ thirty-four requests for modification, the Court granted five without limitation. (See Doc. No. 1256 at 8, 12, 14-15 (granting Defendants’ requests (e), (f), (g), (m), and (s)).) Out of these five, Plaintiffs did not object to requests (e), (f) and (s). (Doc. No. 1240 at 79, 93.) For the remaining twenty-nine requests — the vast majority — ’the Court either granted the requests with several limitations or denied them in their entirety. (See Doc. No. 1256.) Nevertheless, Defendants claim that the “Court’s order granted substantially all of the modifications that the State requested.... Simply put, the State prevailed ... and plaintiffs lost.” (Doc. No. 1320 at 8.) Much to the Court’s displeasure, it is not that simple. A brief summary of the Court’s previous rulings demonstrates that neither party is a clear winner or loser in this ease.

• (a) The State requested authorization to implement all the reforms approved by CMS, including, but not limited to, those approved in CMS’ letters of March 24, 2005 and June 8, 2005. The Court granted this request in part, by permitting the State to implement the reforms already approved by CMS, subject to the Court’s ruling on the compatibility of the reforms with the 2003 Consent Decree and federal law. Further, the Court denied the request in part by prohibiting implementation of future CMS-approved reforms that are inconsistent with the 2003 Consent Decree, as revised. This is the very ruling that Plaintiffs requested. (Doc. Nos. 1111 at 2, 1240 at 74.)
• (b) The State requested authorization to “require prior authorization by the TennCare Bureau as a condition of coverage for any drug or drug class so designated by the State.... ” Plaintiffs agreed that the State could already require such prior authorization under the 2003 Consent Decree. (Doc. No. 1111 at 2.) In granting this request, the Court simply reaffirmed the plain language of the 2003 Consent Decree. (Doc. No. 1282 at 42-43.) The State also requested authorization to deny reimbursement for drugs lacking the prior authorization. Over Plaintiffs’s objection, the Court partially granted this request, but limited the situations in which the State could categorically deny reimbursement.
• (c) This request, which sought the implementation of a five-prescription-per-month limit, was heavily contested. In opposing this request, Plaintiffs strongly advocated the use of a “soft,” as opposed to a “hard,” limit. While ultimately granting this request in its entirety, the Court did so with the expectation that the State would move quickly to implement a “soft” limit rather than the “hard” limit proposed in the request. (Doc. No. 1256 at 4.) Indeed, this Court specifically requested the State’s oral assurance during closing argument that a “soft” limit would be implemented. (Doc. No. 1247, Tr. at 10-11; Doc. No. 1282 at 55; see also Doc. No. 1150, Tr. at 203-05.) In addition, the Court continues to expect the State to “submit with its proposed revisions to the 2003 Consent Decree, evidence that it has sought approval from CMS to imple *1065 ment a ‘soft’ five-prescription-per-month limit.” (Doc. No. 1282 at 62.) .
(d) This request dealt with five different aspects of the appeals process in the context of a denial of prior authorization. The Court granted most of the requests, but imposed certain limitations. (Doc. No. 1256 at 4-8.) Defendants now claim this as a significant victory, but ignore the fact that Plaintiffs did not object to many aspects of the State’s request. (See Doc. No.

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Bluebook (online)
421 F. Supp. 2d 1061, 2006 U.S. Dist. LEXIS 11233, 2006 WL 572314, Counsel Stack Legal Research, https://law.counselstack.com/opinion/grier-v-goetz-tnmd-2006.