The following press release from the National Health Law Program describes the Supreme Court’s cruel and abusive ruling today to prevent providers of treatment services from being advocates for the children they are treating. According to the Court, treatment providers are not allowed to challenge State Medicaid Agencies and their contracted Managed Care Organizations when they misbehave and impose excessive restrictions, limitations and other impediments to access to EPSDT treatment funding.
This ruling affirms that the only avenue available to providers of EPSDT (Medicaid) funded services like Behavioral Health Rehabilitation Services (BHRS, still mistakenly called “wraparound services” in Pennsylvania), when children are prevented from accessing them due to the maintenance of low payment rates (payment rates in Pennsylvania haven’t been raised in 23 years) and excessively restrictive service delivery requirements set by Managed Care Organizations (both of which effectively drive providers of BHRS from the field) is the Office for Civil Rights. A ruling on the Civil Rights complaints filed in December of 2012 is expected relatively soon and will hopefully provide more justice than the Supreme Court could muster….
WASHINGTON–Today, the National Health Law Program (NHeLP) released the following statement reacting to the ruling by the U.S. Supreme Court in Armstrong v. Exceptional Child. The Court ruled that the Supremacy Clause of the Constitution does not confer a private right of action for health care providers to sue for an injunction to enforce § 30(A) of the Medicaid Act, a provision that requires states to ensure Medicaid-participating providers are adequately paid.
“Today’s decision ignores hundreds of Supreme Court cases, dating from the early 1800s, which have recognized the ability of private parties to bring Supremacy Clause suits in federal court to stop state officials from implementing state laws that violate a federal law or the Constitution,” said Jane Perkins, NHeLP legal director.
“The ruling immediately affects Medicaid providers, but it will be interesting to see whether this Court will find a way to limit the ruling to Medicaid and similar programs for low-income Americans, while continuing to allow banks, railroads, airlines and telecommunications companies to bring Supremacy Clause actions.”
In Armstrong, Medicaid providers sued Idaho to enjoin state policies (provider reimbursement rates) that they argued are inconsistent with the federal Medicaid statute. The Ninth Circuit affirmed a lower court ruling that the Supremacy Clause gave providers a private right of action to sue to enforce the federal Medicaid law. Today, the Supreme Court reversed the Ninth Circuit in a 5-4 decision. Justice Breyer voted with the majority and Justice Kennedy voted with the dissent. “The Medicaid Act contains provisions that set forth protections and obligations,” said Elizabeth G. Taylor, NHeLP executive director. “The ability to enforce those provisions in court has been a critical hallmark. Today, the Supreme Court has shamefully interfered.”
NHeLP filed an extensive amicus brief, joined by 19 of the nation’s leading consumer organizations, defending the ability of health care providers to enforce Medicaid law when states do not comply.