Hospital Ass'n of New York State, Inc. v. Toia

435 F. Supp. 819, 1977 U.S. Dist. LEXIS 14634
District Court, S.D. New York·Decided August 4, 1977·No. 76 Civ. 2027·Published·Cited by 14 cases

Opinion

LASKER, District Judge.

On March 16, 1977 the Court of Appeals remanded for this court’s consideration the question whether Congressional repeal of 42 U.S.C. § 1396a(g) (a provision requiring-states participating in the federal Medicaid program to waive their immunity to suit in federal courts with respect to certain claims made by hospital providers of services) as of its effective date subsequent to the entry of final judgment by this court against the State but before the appeal was decided affects the validity of that judgment, and if so whether the statute is constitutional. For reasons set forth below, it is concluded that both such questions must be answered in the affirmative and that therefore (1) the judgment of August 2nd, 1976 insofar as it grants monetary relief against the State of New York, must be vacated and (2) the State defendants’ motion to dismiss plain *822 tiffs’ claims for monetary relief against the State must be granted.

I.

In 1966 Congress enacted Title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq., commonly known as the Medicaid program. Under this program, administered by the states pursuant to the statute and to regulations promulgated by the federal Department of Health, Education and Welfare (HEW), providers of medical services are reimbursed by local, state and federal governments for services rendered to eligible patients. The statutory provision of the Medicaid Act at issue in this suit is 42 U.S.C. § 1396a(a)(13)(D) which requires that providers of inpatient hospital services be reimbursed by the states for the “reasonable cost” of providing such services, and that the “reasonable cost” must be determined in accordance with “methods and standards . . . approved by the Secretary [of HEW] and . . included in the [official state Medicaid plan].”

Since 1970 New York State has utilized a prospective methodology of reimbursing hospitals for inpatient services. Based on predicted costs for the forthcoming year rather than a retrospective formula, the prospective reimbursement methodology is part of the State Medicaid plan. Ordinarily, at the end of each calendar year the State publishes the reimbursement rates for each group of hospitals for the forthcoming year, on the basis of the “methods and standards” contained in the existing State plan.

At the end of 1975, however, New York issued “interim” rates consisting essentially of a “freeze” at the 1975 rates. On May 5, 1976, plaintiffs — a class consisting of all of the approximately 270 voluntary and public hospitals in New York State — sued the Secretary of HEW and various other State officials. They claimed that the “freeze” was illegal in two important respects: (1) it amounted to an amendment of the State plan which had not been, as required by 42 U.S.C. § 1396a(a)(13)(D) approved by the Secretary prior to implementation, and (2) the “freeze” deprived the hospitals of reimbursement for their “reasonable costs” of treating Medicaid patients to which the statute entitled them.

Two months after this suit commenced, the State promulgated a revised formula for determining the 1976 rates. The formula changed several important aspects of the reimbursement methodology: in particular, it lowered the ceiling on reimbursable costs for routine inpatient services from 110% to 100% of the average group costs, and for the first time imposed a ceiling (of 100% of average) on reimbursement for ancillary inpatient costs. 1 On July 16, 1976 plaintiffs amended their complaint and moved for a preliminary injunction against implementation of rates calculated according to the new formula. The amended complaint raised essentially the same objections to the revised methodology as had been raised in the original complaint against the freeze: namely, that the revised formula had not been approved by HEW and thus could not lawfully be implemented, and that reimbursement rates calculated according to the new formula would not reimburse plaintiffs their reasonable costs of providing services.

On July 20th and 28th, 1976 hearings were held on the motion for a preliminary injunction. At this time, the State argued that any grant of monetary relief against it was barred by the Eleventh Amendment. Plaintiffs argued, however, that New York’s “consent to suit,” executed on March 30, 1976 and incorporated in the State plan, removed any jurisdictional bar to such relief. Effective January 1, 1976, (42 U.S.C. § 1396a(g)) Congress had required states participating in the Medicaid program to consent to suit in federal court by hospitals claiming that the state was not in compliance with § 1396a(a)(13); states which failed to comply with this waiver provision were penalized 10% of the total federal Medicaid funds to which they would otherwise have been entitled, 42 U.S.C. § 1396b(1). Pursuant to the new law, but *823 under protest, New York had executed a consent to suit.

Defendants responded to plaintiffs’ argument by urging that the consent to suit was not voluntary, and had for all practical purposes been coerced by the new legislation, which imposed severe financial penalties on states which failed to waive their immunity. They urged that we find the waiver of immunity to be ineffective and the legislation requiring the waiver to be unconstitutional. After briefing and argument on this question, we held, on the authority of Employees of Department of Public Health & Welfare of Missouri v. Missouri Public Health Dept., 411 U.S. 279, 93 S.Ct. 1614, 36 L.Ed.2d 251 (1973), that Congress could constitutionally require such a waiver and that the State’s consent to suit was valid. We went on to find that § 1396a(a)(13) required prior Secretarial approval of the changes made in the reimbursement methodology, and that such approval had not been given. On August 2, 1976 final judgment on certain counts of the amended complaint was entered for the plaintiffs, and the defendants were permanently enjoined from implementing the challenged regulations until they were approved by HEW. Defendants were directed to recalculate the amounts owed members of the class under the previously approved methodology and to the extent that any hospitals had been underpaid by the State, to pay over the difference. A twelve day stay was granted.

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Hospital Ass'n of New York State, Inc. v. Toia, 435 F. Supp. 819, 1977 U.S. Dist. LEXIS 14634 (S.D.N.Y. 1977).

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