In Re Consolidated Hospital Surcharge Appeals of GILLETTE CHILDREN’S SPECIALTY HEALTHCARE, St. Luke’s Hospital, North Memorial Health Care, HealthEast Care System, Park Nicollet Health Services, Fairview Health Services, and Children’s Hospitals and Clinics of Minnesota

883 N.W.2d 778, 2016 Minn. LEXIS 520, 2016 WL 4379919
CourtSupreme Court of Minnesota
DecidedAugust 17, 2016
DocketA14-1462
StatusPublished
Cited by11 cases

This text of 883 N.W.2d 778 (In Re Consolidated Hospital Surcharge Appeals of GILLETTE CHILDREN’S SPECIALTY HEALTHCARE, St. Luke’s Hospital, North Memorial Health Care, HealthEast Care System, Park Nicollet Health Services, Fairview Health Services, and Children’s Hospitals and Clinics of Minnesota) is published on Counsel Stack Legal Research, covering Supreme Court of Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In Re Consolidated Hospital Surcharge Appeals of GILLETTE CHILDREN’S SPECIALTY HEALTHCARE, St. Luke’s Hospital, North Memorial Health Care, HealthEast Care System, Park Nicollet Health Services, Fairview Health Services, and Children’s Hospitals and Clinics of Minnesota, 883 N.W.2d 778, 2016 Minn. LEXIS 520, 2016 WL 4379919 (Mich. 2016).

Opinion

OPINION

ANDERSON, Justice.

Respondent Minnesota Department of Human. Services (DHS) assessed surcharges against seven hospital and hospital systems (collectively, the Hospitals) under MinmStat. § 256.9657, subd. 2 (2014). 1 The Hospitals dispute the authority of DHS to assess the surcharges, contending that the surcharge is preempted by federal law with respect to-revenues they receive from insurance carriers participating in both the Federal Employee Health Benefits Program and the TRICARE program. The Commissioner of DHS denied the Hospitals’ claim and the court of appeals affirmed, concluding that the surcharge is not preempted. Because federal law does not preempt the surcharge, we affirm.

’ I.

Under Minnesota law, the Hospitals are subject to a 1.56% surcharge on their net patient revenue, - excluding revenue received from Medicare patients. Minn.Stat. § 256.9657, subd. 2. The amount of each hospital’s surcharge liability is calculated by DHS and is based on information reported to DHS by each hospital at the end of the fiscal year.' DHS then invoices each hospital for its surcharge liability on a monthly basis. 2

A hospital may appeal the amount of the surcharge assessed by DHS within 30 days *781 of receiving notice of the amount due. Minn.Stat. § 256.9657, subd. 6 (2014). Because DHS provides notice of each monthly charge, a hospital must perfect an appeal for every monthly assessment that it finds objectionable. Minn. R. 9510.2040, subp. 6 (2015). In this case, the parties have stipulated that the Hospitals all perfected appeals of their surcharge assessments for various months between August 2010 and February 2013.

Each of the appeals asserted the same basic legal theory. The Hospitals claim that federal law preempts the surcharge to the extent that it requires them to pay a surcharge on revenues obtained from insurance carriers that participate in the Federal Employee Health Benefits Act (FEHBA) or the TRICARE program. Both FEHBA and TRICARE are programs through which the federal government provides its employees and uniformed members of the armed services with health insurance benefits.

FEHBA authorizes the federal government to provide health insurance to employees- of the federal government, as well as their families and dependents. See generally 5 U.S.C. §§ 8901-14 (2012). The program is managed by the Office of Personnel Management (OPM). Rather than providing health insurance directly, FEH-BA authorizes OPM to enter into contracts with group health insurance carriers. 5 U.S.C. § 8902(a), Premiums are paid by the employing federal agency, and the federal employee and are kept in a fund, known as the FEHBA Fund, in the U.S. Treasury. 5 U.S.C. § 8906. OPM administers the FEHBA Fund and manages disbursements from the fund to FEHBA carriers. Id.

Carriers fall into two different categories: community-rated and experience-rated. Premiums paid to community-rated carriers by the FEHBA Fund are based on a. capitation rate 'that charges -a set amount -for each individual insured by the carrier. 48 C.F.R. § 1602.170-2. Premiums due to community-rated carriers are paid -on a monthly basis, regardless of actual costs incurred by the carrier. 48 C.F.R. § 1632.170(a).

-Premiums'paid to experience-rated carriers, on the other- hand, are based on historical data of the actual expenses incurred by the carrier. 48 C.F.R. § 1602.170-7. The premiums due to experience-rated plans are held in the FEHBA Fund under a Letter of Credit (LOC). , 48 C.F.R. § 1632.170(b). The premiums are paid to the carrier from the FEHBA Fund on a “checks-presented basis.” 48 C.F.R. § 1632.170(b)(2). - In other words, an experience-rated carrier must reimburse the provider, usually based on a pre-negotiat-ed rate, and then seek reimbursement for their expenditures from the FEHBA Fund based on the amount the carrier paid to the provider.

TRICARE, the other federal program at issue, provides health insurance to uniformed members of the United States Armed Services and their dependents. 10 U.S.C. § 1072(7) (2012); 32 C.F.R. § 199.17. TRICARE’s authorizing statute directs the Secretary of Defense to enter into contracts with group health insurance carriers.. 10 U.S.C. § 1074(c)(2)(B) (2012). During the relevant period, TRICARE entered into contracts with regional contractors to administer the TRICARE program.

The TRICARE regional contractor for the West Region,, to which Minnesota belongs, entered into contracts with some, but not all, of the Hospitals. If a hospital has a contract with the TRICARE regional contractor, the hospital is reimbursed for care provided to TRICARE patients at a negotiated rate,' which cannot excéed TRICARE’s maximum-allowable rate- and usually represents either a percentage of *782 the maximum:allowable rate or a percentage of the actual charges billed by the hospital. If a hospital does not have a contract with the TRICARE regional contractor, the hospital is usually reimbursed for care provided to TRICARE patients at the maximum-allowable rate.

Both FEHBA and TRICARE’s authorizing statutes contain provisions preempting certain state laws. FEHBA’s preemption provision provides:

No tax, fee, or other monetary payment may be imposed, directly or indirectly, on a carrier or an underwriting or plan administration subcontractor of an approved health benefits plan by any State ... or by any political subdivision or other governmental authority thereof, with respect to any payment made from the Fund.

5 U.S.C. § 8909(f)(1). FEHBA contains an exception for state or local taxes, fees, or monetary payments “on the net income or profit accruing to or realized by such carrier ... from business conducted under this chapter, if that tax, fee, or payment is applicable to a broad range of business activity.” 5 U.S.C. § 8909(f)(2).

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883 N.W.2d 778, 2016 Minn. LEXIS 520, 2016 WL 4379919, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-consolidated-hospital-surcharge-appeals-of-gillette-childrens-minn-2016.