New Hampshire Hospital Association et al. v. Alex M. Azar,1 Secretary, U.S. Department of Health and Human Services et al.

2019 DNH 057
District Court, D. New Hampshire·Decided March 28, 2019·No. 15-cv-460-LM·Published

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE

New Hampshire Hospital Association et al.

v. Civil No. 15-cv-460-LM Opinion No. 2019 DNH 057

Alex M. Azar,1 Secretary, U.S. Department of Health and Human Services et al.

O R D E R

In November 2015, several New Hampshire hospitals2 and the New Hampshire Hospital Association (“NHHA”), a non-profit trade association, brought this suit against the Secretary of Health and Human Services (the “Secretary”), the Centers for Medicare and Medicaid Services (“CMS”), and the Administrator of CMS. Plaintiffs alleged that defendants set forth certain “policy clarifications” regarding the method of calculating supplemental Medicaid payments to certain hospitals. They alleged these policy clarifications were issued in responses to frequently asked questions posted on medicaid.gov, and that both the

1 Alex M. Azar became Secretary of the U.S. Department of Health and Human Services on January 29, 2018, replacing Thomas Price. See Fed. R. Civ. P. 25(d).

2 Plaintiff hospitals are Mary Hitchcock Memorial Hospital, LRGHealthcare, Speare Memorial Hospital, and Valley Regional Hospital, Inc.

policies themselves and the manner in which they were promulgated contradicted the plain language of the Medicaid Act and violated the Administrative Procedure Act (“APA”).

On March 2, 2017, the court granted in part plaintiffs’

motion for summary judgment, holding that defendants’ enforcement of the policy clarifications set forth in the responses to the frequently asked questions violated the APA. N.H. Hosp. Ass’n v. Burwell, No. 15-cv-460-LM, 2017 WL 822094, at *8-14 (D.N.H. Mar. 2, 2017) (“March 2 Order”). The court permanently enjoined defendants from enforcing the policies in the responses to the frequently asked questions. Id. at *12 n.16. Defendants appealed the March 2 Order, and the First Circuit Court of Appeals affirmed.3 N.H. Hosp. Ass’n v. Azar, 887 F.3d 62 (1st Cir. 2018).

After the appeal concluded, NHHA moved for an award of attorneys’ fees (doc. no. 64), arguing that it is entitled to recover such fees under the Equal Access to Justice Act (“EAJA”

3 After the court issued the March 2 Order, defendants published a final rule regarding the calculation of the supplemental payments. See Medicaid Program: Disproportionate Share Hospital Payments—Treatment of Third Party Payers in Calculating Uncompensated Care Costs, 82 Fed. Reg. 16114–02, 16117 (Apr. 3, 2017) (“2017 Rule”). The 2017 Rule expressly included within its text the policies that had been set forth in the responses to the frequently asked questions. That rule has since been vacated. See Children’s Hosp. Ass’n of Texas v. Azar, 300 F. Supp. 3d 190 (D.D.C. 2018).

or “Act”), 28 U.S.C. § 2412.4 Defendants objected, arguing that NHHA is not entitled to attorneys’ fees under the EAJA and, if it is, that those fees must be substantially reduced.

While NHHA’s motion was pending, defendants moved for “modification or, in the alternative, clarification of March 2017 permanent injunction” (doc. no. 69). In that motion, defendants argued that the First Circuit’s decision affirming the March 2 Order was “based on reasoning that differed from the reasoning of this Court’s decision.” Doc. no. 69 at 8. Defendants requested that the court modify or clarify its permanent injunction to be in conformance with the First Circuit’s decision.

Plaintiffs objected to defendants’ motion. In addition, NHHA filed a supplement to its motion for attorneys’ fees (doc. no. 77), in which it seeks additional fees incurred in responding to defendants’ motion to modify or clarify the injunction and in preparing the motion for fees. In response to the supplement, defendants reiterate their arguments that NHHA is not entitled to fees under the EAJA or, in the alternative, that the court should significantly reduce those fees.

The court addresses defendants’ motion first before turning to NHHA’s request for attorneys’ fees.

4 For reasons discussed further below, NHHA only, and not the plaintiff hospitals, moved for an award of attorneys’ fees.

I. Motion to Clarify or Modify Injunction A. Background Because the court has set forth the background of this case in other orders, it assumes a general level of familiarity with the facts and provides only a brief summary. Because Medicaid payments received from the government often do not cover the full costs of an indigent patient’s care, the Medicaid Act, 42 U.S.C. §§ 1396 et seq., authorizes the payment of additional funds to hospitals that serve a high number of such patients. Those payments to the hospitals are limited to each hospital’s “costs incurred” in providing services to the indigent patients.5 The phrase “costs incurred” includes two specific sources of payment that must be offset against the total cost of care, neither of which is relevant to this case. Costs incurred may further be defined “as determined by the Secretary” of the United States Department of Health and Human Services.

States are required to provide to the Secretary an annual report and audit on their DSH program. In 2008, the Secretary promulgated a final rule implementing the statutory reporting and auditing requirement (“2008 Rule”). The 2008 Rule did not

These payments are often referred to as “disproportionate-

5

share hospital” or “DSH” payments.

elaborate on the meaning of the phrase “costs incurred” as it is contained in the Medicaid Act.

In 2010, the Secretary announced, in the form of answers to “Frequently Asked Questions” posted on medicaid.gov (“FAQs 33 and 34”), that the payments to be offset against total costs in calculating “costs incurred” also included reimbursements from Medicare and private insurance. Plaintiffs brought this suit, alleging that the policies set forth in the responses to FAQs 33 and 34 conflicted with the plain language of the Medicaid Act and were promulgated in violation of the APA.

In its order granting in part plaintiffs’ motion for summary judgment, the court held that defendants’ actions in promulgating and enforcing the policies set forth in the responses to FAQs 33 and 34 violated the APA. The court permanently enjoined defendants from enforcing those policies and stated that defendants “shall follow the policies and procedures in effect before defendants issued FAQs 33 and 34, until and unless those policies and procedures are replaced by an enforceable and properly promulgated regulation.” Burwell, 2017 WL 822094 at *16. The First Circuit affirmed the court’s decision.

B. Discussion In their motion to modify or clarify the court’s permanent injunction, defendants note that the First Circuit agreed with this court’s holding in the March 2 Order that the policies set forth in the responses to FAQs 33 and 34 “represented a substantive policy decision that could not be adopted without notice and comment” under the APA. Azar, 887 F.3d at 66. They argue, however, that the First Circuit’s decision relied on different reasoning than the March 2 Order, and that this alternate reasoning requires modification or clarification of the court’s permanent injunction.

Specifically, defendants point to this court’s directive in the March 2 Order that they must “follow the policies and procedures in effect before defendants issued FAQs 33 and 34, until and unless those policies and procedures are replaced by an enforceable and properly promulgated regulation.” Burwell, 2017 WL 822094 at *16 (emphasis added). According to defendants, the court must modify or clarify that portion of its injunction because that statement suggests that CMS had a specific policy of not including Medicare or private insurance payments in the costs-incurred calculation. Defendants argue that the First Circuit’s order, in contrast, made it clear that “CMS did not have any lawfully adopted policy governing the proper treatment of third-party payments.” Doc. no. 69 at 12.

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New Hampshire Hospital Association et al. v. Alex M. Azar,1 Secretary, U.S. Department of Health and Human Services et al., 2019 DNH 057 (D.N.H. 2019).

2019 DNH 057 (New Hampshire Hospital Association et al. v. Alex M. Azar,1 Secretary, U.S. Department of Health and Human Services et al.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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