Missionary Guadalupanas of the Holy Spirit Inc. v. Rouillard

251 Cal. Rptr. 3d 1, 38 Cal. App. 5th 421
CourtCalifornia Court of Appeal, 5th District
DecidedAugust 6, 2019
DocketC083232
StatusPublished
Cited by21 cases

This text of 251 Cal. Rptr. 3d 1 (Missionary Guadalupanas of the Holy Spirit Inc. v. Rouillard) is published on Counsel Stack Legal Research, covering California Court of Appeal, 5th District primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Missionary Guadalupanas of the Holy Spirit Inc. v. Rouillard, 251 Cal. Rptr. 3d 1, 38 Cal. App. 5th 421 (Cal. Ct. App. 2019).

Opinion

BLEASE, J.

*4*426This case presents the narrow issue of whether respondent Michelle Rouillard in her capacity as director of California's Department of Managed Health Care (Department) violated the Administrative Procedure Act (APA) ( Gov. Code, § 11340 et seq. ) when she sent letters to seven health care service plans directing them to comply with California law in their coverage of abortion services.1 Health care service plans are required by law to cover basic health care services "where medically necessary." ( Health & Saf. Code, §§ 1345, 1367, subd. (i) ; Cal. Code Regs., tit. 28, § 1300.67.) The issue tendered here and below is whether a "voluntary" abortion is a "medically necessary" procedure that health care service plans are required to cover. By setting up a false choice between "voluntary" abortions and "medically necessary" abortions, the petitioner attempts to limit coverage of most abortions by health care service plans in California.

The letters in question informed the seven health care service plans that the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act or Act) ( Health & Saf. Code, § 1340 et seq. ) requires that they cover basic health care services, and that the California Constitution prohibits health care service plans from discriminating against women who choose to terminate a pregnancy. The letters told the recipients that health care plans could not limit or exclude coverage for termination of pregnancies. Petitioner Missionary Guadalupanas of the Holy Spirit, Inc., claims that by sending out the letters interpreting "basic health care services" to include abortions, respondent ignored the APA rulemaking process. Petitioner's argument sets forth a false dichotomy between a "voluntary" service and a "medically necessary" health care service, which health care plans are required to cover under *427California Code of Regulations, title 28, section 1300.67.2 This false assumption led petitioner to the flawed conclusion that the Department's letters were for the purpose of clarifying an ambiguity in the statute, and that compliance with the rulemaking procedures of the APA was necessary.

Petitioner does not attempt a definition of "medically necessary." It cannot mean only lifesaving treatment. Many basic health care services are not lifesaving treatments. Nor can the term be limited to its definition in Welfare and Institutions Code section 14059.5, addressing Medi-Cal reimbursements. That law defines medically necessary treatment as "reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain." Particularly in the case of a woman's reproductive health, basic health care that is medically necessary includes labor and delivery services, even though such services may not be necessary *5to "protect life, prevent significant illness or significant disability, or to alleviate severe pain." We need not comprehensively define the term "medically necessary" for purposes of this case. However, in broad terms a "medically necessary" procedure must include a procedure that is a generally recognized treatment for a medical condition presented by the patient. While the Department may well be obligated to comply with the APA if it wants to narrow the broad definition, there is no need to comply with the APA in this case because an abortion procedure is both a recognized treatment for the medical condition of a patient's pregnancy, and a treatment every woman in California has the legal right to choose. ( Health & Saf. Code, § 123462.)

Whether an agency has adopted the only legally tenable interpretation of the law such that it is not required to comply with the APA, depends on whether the language of the law in question is ambiguous as applied to the circumstances presented. If the language is unambiguous, the agency need not comply with the APA. In this case, abortion services are unambiguously included in the statutory categories of "basic health care services" set forth in the statute. ( Health & Saf. Code, § 1345.) We also reject petitioner's argument that voluntary abortions are necessarily inconsistent with regulatory language that limits the scope of "basic health care services" to "medically necessary" services. ( Cal. Code Regs., tit. 28, § 1300.67.) We hold that an abortion is one of two medically necessary options for the treatment of a woman's pregnancy. A pregnant patient may elect medical services necessary to deliver a baby, or to terminate the pregnancy. Because California law guarantees every woman the right to choose whether to bear a child or obtain an abortion, the only legally tenable interpretation of the law is that abortions are basic health care services, which health care service *428plans are required to cover. Furthermore, the regulation's inclusion of "voluntary family planning services" in the list of "basic health care services" to be covered "where medically necessary" is inconsistent with an interpretation that excludes voluntary abortions from coverage. Accordingly, the application of the regulation to these facts is unambiguous, and the Department was not required to comply with the APA. Finally, we hold the trial court did not abuse its discretion when it denied petitioner's new trial motion.

We shall affirm the judgment.

FACTUAL AND PROCEDURAL BACKGROUND

The Department is in charge of executing California's laws relating to health care service plans (Plans) and ensuring that Plans provide access to quality health care services. ( Health & Saf. Code, § 1341.)3 Unless exempt, Plans cannot operate in the state without a license, which is issued by the Department. (§ 1349.)

The Legislature has not seen fit to detail each and every health care service a Plan is required to cover. Rather, Plans are required by statute to offer "basic health care services." ( § 1367, subd. (i).) "Basic health care services" are defined in the statute as:

"(1) Physician services, including consultation and referral.
"(2) Hospital inpatient services and ambulatory care services.
"(3) Diagnostic laboratory and diagnostic and therapeutic radiologic services.
"(4) Home health services.
"(5) Preventive health services.
*6"(6) Emergency health care services, including ambulance and ambulance transport services and out-of-area coverage. 'Basic health care services' includes ambulance and ambulance transport services provided through the '911' emergency response system.
"(7) Hospice care pursuant to Section 1368.2." ( § 1345, subd. (b).)

*429The Legislature has delegated to the Department the power to promulgate regulations setting forth the minimum scope of the "basic health care services" Plans are required to provide for licensure. ( § 1367, subd.

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Cite This Page — Counsel Stack

Bluebook (online)
251 Cal. Rptr. 3d 1, 38 Cal. App. 5th 421, Counsel Stack Legal Research, https://law.counselstack.com/opinion/missionary-guadalupanas-of-the-holy-spirit-inc-v-rouillard-calctapp5d-2019.