Michigan Ass'n of Homes & Services for the Aging, Inc. v. Shalala

931 F. Supp. 1338, 1996 U.S. Dist. LEXIS 8624, 1996 WL 354344
CourtDistrict Court, E.D. Michigan
DecidedMay 20, 1996
DocketNo. 95-75278
StatusPublished
Cited by1 cases

This text of 931 F. Supp. 1338 (Michigan Ass'n of Homes & Services for the Aging, Inc. v. Shalala) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Michigan Ass'n of Homes & Services for the Aging, Inc. v. Shalala, 931 F. Supp. 1338, 1996 U.S. Dist. LEXIS 8624, 1996 WL 354344 (E.D. Mich. 1996).

Opinion

MEMORANDUM OPINION AND ORDER GRANTING DEFENDANTS’ MOTION TO DISMISS AND DENYING PLAINTIFF’S MOTION FOR A PRELIMINARY INJUNCTION

EDMUNDS, District Judge.

Plaintiff Michigan Association of Homes and Services for the Aging, Inc. (“MA-SHA”)’s First Amended Complaint seeks in-junctive and declaratory relief and raises constitutional and statutory challenges to federal regulations governing a nursing facility’s ability to participate in the Medicare and Medicaid programs. This matter comes before the court on Plaintiffs motion for a preliminary injunction and Defendants’ motion to dismiss pursuant to Fed.R.Civ.P. 12(b)(1) and 12(b)(6) arguing this court lacks subject matter jurisdiction over Plaintiffs claims and further arguing that Plaintiff has failed to state claims upon which relief can be granted.1

This court concludes that it lacks subject matter jurisdiction over Plaintiffs claims. Plaintiffs claims arise under the Medicare Act, therefore, the jurisdictional limits of 42 U.S.C. §§ 405(g) and (h) apply. The Supreme Court has held that claims for declaratory and injunctive relief, even those asserting constitutional and statutory challenges, arise under the Medicare Act. See Weinberger v. Salfi, 422 U.S. 749, 95 S.Ct. 2457, 45 L.Ed.2d 522 (1975); Heckler v. Ringer, 466 U.S. 602, 104 S.Ct. 2013, 80 L.Ed.2d 622 (1984). Thus, 42 U.S.C. § 405(h), which is incorporated into the Medicare Act through 42 U.S.C. § 1395ii, precludes jurisdiction under 28 U.S.C. §§ 1331 and 1346 — the jurisdictional basis asserted in Plaintiffs complaint.

[1340]*1340Judicial review of Plaintiffs claims is not foreclosed; it is merely delayed. Section 1395cc(h)(l) of the Medicare Act provides for judicial review. Plaintiffs members, however, must first satisfy the nonwaivable requirement of 42 U.S.C. § 405(g), which is incorporated into the Medicare Act via § 1395cc(h)(l), by presenting their claims to the Secretary. Plaintiffs members have not done this. Accordingly, this court lacks subject matter jurisdiction over Plaintiffs claims. Defendants’ motion to dismiss is GRANTED and Plaintiffs motion for a preliminary injunction is DENIED.

1. Background

Plaintiff MASHA is an association representing 90 not-for-profit nursing homes in Michigan that participate in the Medicare and Medicaid programs.2 To participate in Medicare and Medicaid, a nursing home must comply with health and safety standards established by statute, 42 U.S.C. §§ 1395i— 3(a)-(d) (Medicare) and 42 U.S.C. §§ 1396r(a)-(d) (Medicaid), and the implementing regulations set forth in 42 C.F.R. part 483, subpart B.

Defendant Shalala, Secretary of Health and Human Services (“the Secretary”), is responsible for monitoring nursing homes that participate in Medicare and Medicaid, is responsible for enforcing participation requirements, is authorized to promulgate regulations in furtherance of her duties, 2 U.S.C. § 1302, and has delegated that authority to the Health Care Financing Administration (“HCFA”). Defendant Tirone, who is sued in his official capacity, is Director of the Office of Survey and Certification in the Health Standards and Quality Bureau of the HCFA.

The federal and state governments monitor and enforce compliance with the participation requirements through the survey, certification, and enforcement process. The regulations, 42 C.F.R. § 483.1(b), provide a single-set of requirements that “serve as the basis for survey activities for the purpose of determining whether a [nursing] facility meets the requirements for participation in Medicare and Medicaid.” Facilities found to be out of compliance with the requirements may be subject to sanctions including the denial of payment for Medicare and Medicaid patients, the imposition of civil money penalties of up to $10,000 per day, or the termination of the facility’s participation in Medicare and Medicaid, 42 U.S.C. § 1395i — 3(h); 42 U.S.C. § 1396r(h). If a facility is found to have provided “substandard quality of care,” the State is required by statute to notify the appropriate state licensing authority for nursing home administrators and the attending physicians of the affected residents, 42 U.S.C. §§ 1395i-3(g)(5)(C), 1396r(g)(5)(C), and the facility may not operate an approved nursing aide training and competency evaluation program for two years, §§ 1395i— 3(f)(2)(B)(iii), 1396r(f)(2)(B)(iii).

On August 28, 1992, HCFA published a proposed rule implementing these statutory provisions. On November 10, 1994, after considering comments, HCFA published the final regulations. July 1, 1995 was established as the effective date of the new regulations. Minor corrections to the final regulations were published on August 30, 1995. These new regulations were promulgated in an effort to implement comprehensive reforms to the nursing facility survey, certification and enforcement process authorized by Congress in the Omnibus Budget Reconciliation Act of 1987 (“OBRA 87”). The Act and the regulations were intended to establish an enforcement process that would encourage [1341]*1341compliance with the Act’s certification requirements.

Plaintiffs lawsuit is a challenge to several aspects of the new regulations. In addition to injunctive relief, Plaintiff seeks a judgment declaring that: (1) the factors set forth in 42 C.F.R. § 488.404

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Cite This Page — Counsel Stack

Bluebook (online)
931 F. Supp. 1338, 1996 U.S. Dist. LEXIS 8624, 1996 WL 354344, Counsel Stack Legal Research, https://law.counselstack.com/opinion/michigan-assn-of-homes-services-for-the-aging-inc-v-shalala-mied-1996.