Various
other pending cases challenge State legislation requiring reductions in Medi-Cal reimbursements to Medi-Cal
providers. In
Independent Living
Center of Southern California, et al. v. Shewry, et al.
, health care advocates, Medi-Cal providers
and recipients challenge various reductions, payment holds and delays in cost-of-living adjustments in
the State Supplementary Program for the Aged, Blind and Disabled. The district court granted in part
a preliminary injunction, requiring the State, as of August 18, 2008, to pay the rates in effect prior
to the reduction. The district court thereafter issued a second preliminary injunction, restoring the
rates in effect prior to the reduction, as of November 2008, for two additional categories of services.
The State and plaintiffs appealed and the Ninth Circuit affirmed the preliminary injunctions and also
found that the district court erred in making the injunction effective as of August 18, 2008, and that
the injunction should apply to services rendered on or after July 1, 2008. The district court amended
the injunction to apply retroactively. The U.S. Supreme Court granted the State's petition for certiorari
in this matter and in other cases discussed below. On June 17, 2010, the district court stayed further
proceedings pending resolution of the petition for certiorari. On February 22, 2012, vacated the judgment
and remanded the matter to the Ninth Circuit for review. A final decision adverse to the State in this
matter could result in additional costs to the State General Fund of $192 million in retroactive reimbursements,
and possible additional costs for future Medi-Cal reimbursements.
In
California Pharmacists Association, et al. v. Maxwell Jolly, et al.
, various
Medi-Cal provider trade associations challenge reductions to Medi-Cal reimbursement rates. In a similar
matter,
Managed Pharmacy Care,
et al. v. Maxwell-Jolly, et al.
, Medi-Cal pharmacy providers challenge Medi-Cal reimbursement
rates reduction. In each matter, the district court granted a request for preliminary injunction and
the Ninth Circuit affirmed. The U.S. Supreme Court granted the state's petition for writ of certiorari
in these two matters, along with the
Independent Living Center
case, and issued its decision on February 22, 2012, as discussed above.
In
California Medical Association,
et al. v. Shewry, et al.
, professional associations representing Medi-Cal providers seek to enjoin
implementation of the Medi-Cal rate reductions planned to go into effect on July 1, 2008, alleging that
the legislation violates Medicaid requirements, State laws and regulations and the California Constitution.
The trial court denied plaintiffs' motion for a preliminary injunction, plaintiffs filed an appeal,
which was dismissed at their request. Plaintiffs have indicated that they will file an amended petition
seeking the retrospective relief the Ninth Circuit awarded in the
Independent Living
case, above, after final disposition of that case. A final
decision adverse to the State in this matter would result in costs to the State General Fund of $508.2
million.
In
California Pharmacists Association,
et al. v. David Maxwell-Jolly, et al.
, Medi-Cal pharmacy providers filed a suit challenging reimbursement
rates, including the Department of Health Care Services' use of reduced published average wholesale price
data to establish reimbursement rates. The district court granted a request for preliminary judgment
in part, and denied it in part, with respect to the Department of Health Care Services' reimbursement
rate methodology. Plaintiffs filed a motion seeking to modify the district court ruling, and both parties
filed notices of appeal to the Ninth Circuit. Proceedings in the Ninth Circuit and the district court
were stayed pending the outcome of
Independent
Living Center
. The Ninth Circuit has lifted the stay. At this time it is unknown what fiscal
impact this case would have on the State General Fund.
In
Centinela Freeman Emergency Medical Associates, et al. v. David Maxwell-Jolly, et
al.
, filed as a class action on behalf of emergency room physicians and emergency department groups,
plaintiffs claim that Medi-Cal rates for emergency room physicians are below the cost of providing care.
Plaintiffs seek damages and injunctive relief, based on alleged violations of the federal Medicaid requirements,
State law and the federal and State Constitutions. The trial court granted the petition of the plaintiffs
and ordered the Department of Health Care Services to conduct an annual review of reimbursement rates
for physicians and dentists. A final decision in this matter adverse to the State could result in costs
to the State General Fund of $250 million.
In
Sierra
Medical Services Alliance, et al. v. David Maxwell-Jolly
,
et al.
, emergency medical transportation companies challenge legislation,
which sets Medi-Cal reimbursement rates paid for medical transportation services. Plaintiffs seek damages
and injunctive relief. The case is stayed pending the outcome of
Independent Living Center
. At this time it is unknown what fiscal impact
this case would have on the State General Fund.
In California Association of Health Facilities v. David Maxwell-Jolly,
consolidated with Developmental Services Network, et al., v. David Maxwell-Jolly, plaintiffs (professional
associations representing Medi-Cal providers) challenge legislative action to maintain Medi-Cal reimbursement
rates for intermediate care facilities and freestanding pediatric sub-acute facilities as the rates for
Fiscal Year 2009-10, and each year thereafter, to not
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