Pressley Ridge Schools v. Shimer

134 F.3d 1218, 1998 U.S. App. LEXIS 1055, 1998 WL 25695
Court of Appeals for the Fourth Circuit·Decided January 27, 1998·No. 97-1049·Published·Cited by 5 cases

Opinion

Dismissed by published opinion. Judge DIANA GRIBBON MOTZ wrote the .opinion, in which Judge MURNAGHAN and ■Senior Judge BUTZNER joined.

DIANA GRIBBON MOTZ, Circuit Judge:

Two West Virginia officials attempt to appeal the district court’s judgment holding that the State violated Medicaid regulations and the Due Process and Equal Protection clauses of the United States Constitution in handling various Medicaid claims submitted by a Medicaid provider. Subsequent to the district court’s decision, the parties entered into a written settlement agreement, which at their request the district court entered as a consent^order. Pursuant to the settlement agreement, the parties purported to permit the State to appeal two issues. However, because the settlement agreement renders this case moot, we must dismiss the appeal.

I.

Pressley Ridge Schools, Inc. (Pressley Ridge), a nonprofit corporation providing behavioral health care services to children, entered into an agreement with the Bureau for Medical Services (the Bureau), the state agency responsible for implementing, overseeing and regulating the Medicaid program in West Virginia, authorizing Pressley Ridge to participate as a Medicaid provider. Press-ley Ridge thus became eligible to receive reimbursement through the Bureau for behavioral health services rendered to Medicaid-eligible clients in West Virginia. As a Medicaid provider, Pressley Ridge agreed to make all of its records and documents available and to participate in evaluations and audits authorized by the State Department of Health and Human Resources (the Department) to ensure that Pressley Ridge’s services and program complied with the applicable Medicaid regulations. The Department, in turn, agreed to provide an appeal process permitting Pressley Ridge to challenge any adverse decisions by the Department.

*1220 In August 1995, the Bureau informed Pressley Ridge that all Medicaid reimbursements to it would be suspended indefinitely. The Bureau conducted an on-site review of Pressley Ridge for all Medicaid services billed from January 1 through June 20,1995, and disallowed reimbursement to Pressley Ridge for those services due to lack of “quantified baseline data” in Pressley Ridge’s behavior management plans. The Bureau also instituted a prepayment review for Medicaid claims made by Pressley Ridge for services delivered after October 31,1995.

Pressley Ridge then brought this action in which it sought various forms of injunctive relief. Specifically, Pressley Ridge asked the district court to order the State to reimburse Pressley Ridge for behavior management services it had already provided to Medicaid-eligible clients and to prohibit the State from adopting the prepayment review procedure without notice or hearing. After a four day bench trial, the district court granted Press-ley Ridge the requested injunctive relief. The court reasoned that the Bureau’s requirement of “quantified baseline data” did not accord with the requirements set forth in the Bureau’s Medicaid Provider Manual and, therefore, violated federal regulations requiring the Bureau to provide for notice and comment of “any significant proposed change in its methods and standards for setting payment rates for services.” 42 C.F.R. § 447.205. In addition, the court ruled that the State’s institution of prepayment review of Pressley Ridge’s behavior management services, without notice or hearing, violated state and federal regulations. Finally, the court held that these regulatory violations denied Pressley Ridge its constitutional Due Process and Equal Protection rights.

The State noted an appeal. While the appeal was pending, but before the ease had been briefed or argued, the parties entered into a written settlement agreement. The agreement settled “all disputed claims” between the parties with regard to the adequacy of the services provided by Pressley Ridge for the periods in question, and determined how Pressley Ridge would be compensated for past and future behavior management services provided to Medicaid-eligible clients in West Virginia. The agreement purported to permit the State to maintain an appeal as to whether the Bureau must submit its requirement of “quantitative baseline data” to “notice and comment” before it was utilized, and whether the Bureau must provide an administrative review hearing upon adopting prepayment review. The settlement agreement stated, however, that “[rjegardless of the outcome of any appeal, the financial impact of this agreement shall remain intact.”

II.

On appeal, the State attempts to challenge the district court’s holding that it violated Pressley Ridge’s rights by retroactively applying quantitative baseline data to behavior management plans submitted by Pressley Ridge and by refusing to grant Pressley Ridge an administrative hearing to appeal the State’s decision to impose prepayment review. Because the parties have entered into a settlement, however, no live dispute between them currently exists. Accordingly, we lack jurisdiction to consider this case.

Article III of the United States Constitution limits the jurisdiction of the federal courts to “actual, ongoing controversies.” Honig v. Doe, 484 U.S. 305, 317, 108 S.Ct. 592, 601, 98 L.Ed.2d 686 (1988); see U.S. Const. art. III, § 2, cl. 1. “To qualify as a case fit for federal-court adjudication, an actual controversy must be extant at all stages of review, not merely at the time a complaint is filed.” Arizonans for Official English v. Arizona, — U.S.-,-, 117 S.Ct. 1055, 1068, 137 L.Ed.2d 170 (1997) (citation and internal quotation omitted). Thus, a federal court has no “power to render advisory opinions [or] ... decide questions that cannot affect the rights of litigants in the case before them.” Honig, 484 U.S. at 317, 108 S.Ct. at 600-01; see also Preiser v. Newkirk, 422 U.S. 395, 401, 95 S.Ct. 2330, 2334, 45 L.Ed.2d 272 (1975).

At oral argument, the State cited two cases assertedly supporting its contention that, despite the settlement agreement, the issues raised in this appeal are not moot. See Havens Realty Corp. v. Coleman, 455 U.S. 363, 369, 102 S.Ct. 1114, 1119, 71 L.Ed.2d 214 (1982); Reeves Bros., Inc. v. United States *1221 Envtl. Protection Agency, 956 F.Supp. 665, 675 (W.D.Va.1995). Both cases are clearly distinguishable from the one at hand. In Havens, although the parties had entered into a settlement agreement, “one of the parties continue[d] to seek damages” and the agreement simply set forth a means to liquidate those damages. 455 U.S. at 371, 102 S.Ct. at 1120. The Supreme Court concluded that “[g]iven respondents’ continued active pursuit of monetary relief, this case remains ‘definite and concrete, touching the legal relations of parties having adverse legal interests.’ ” Id. (quoting Aetna Life Ins. Co. v. Haworth,

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Pressley Ridge Schools v. Shimer, 134 F.3d 1218, 1998 U.S. App. LEXIS 1055, 1998 WL 25695 (4th Cir. 1998).

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