Justia U.S. 9th Circuit Court of Appeals Opinion Summaries

Defendant appealed the district court's preliminary injunction precluding enforcement of California Welfare and Institutions Code 14105.191(f), which amended California's Medicaid Plan and set provider reimbursement rates for the 2009-2010 rate year, and for each year thereafter. Plaintiffs challenged the law under 42 U.S.C 1983 and the Supremacy Clause because the State did not obtain federal approval of its State Plan Amendment (SPA) prior to implementing the rate changes. The court vacated the preliminary injunction and held that plaintiffs have not shown that they have an unambiguously conferred right to bring a section 1983 claim.

Plaintiff, the personal representative of the Estate of Gaye S. Glaser, appealed the district court's affirmance of the Medicare Appeals Council's (MAC) ruling that Kaiser was not required to pay for Glaser's liver surgery. Plaintiff contended that by refusing to cover the procedure, Kaiser failed to comply with 42 C.F.R. 422.112(a)(3), which required Medicare Advantage plans to make their services available, accessible, and adequate, and 42 C.F.R. 422.112(a)(9) and 422.113(b)(iii), which required the plans to cover "urgently needed services." The court held that substantial evidence supported the MAC's decision and affirmed the judgment.

Plaintiffs, representing a putative class of purchasers of contact lens solutions, appealed the district court's order granting summary judgment for defendant. Plaintiffs brought suit alleging that defendant violated California's Unfair Competition Law (UCL), Cal. Bus. & Prof. Code 17200 et seq., and False Advertising Law (FAL), Cal. Bus. & Prof. Code 17500 et seq., by marketing Complete MoisturePlus as a product that cleaned and disinfected lenses. The district court ruled that plaintiffs lacked standing. Defendant argued that the ruling was not in error and that even if it was, the suit was properly dismissed because the class' claims were preempted by 21 U.S.C. 360k(a) of the Medical Devices Amendments of 1976 (MDA), 21 U.S.C. 360(c) et seq. The court held that the district court was incorrect to conclude that this class of plaintiffs lacked standing where they had demonstrated economic harm, but the court held that it could affirm the district court's summary judgment on any ground supported by the record. Therefore, the court held that the record demonstrated that the class' claims were preempted, so the court affirmed the grant of summary judgment.

The State of Arizona appealed the district court's order granting a preliminary injunction to prevent a state law from taking effect that would have terminated eligibility for healthcare benefits of state employees' same-sex partners. The district court found that plaintiffs demonstrated a likelihood of success on the merits because they showed that the law adversely affected a classification of employees on the basis of sexual orientation and did not further any of the state's claimed justifiable interests. The district court also found that plaintiffs had established a likelihood of irreparable harm in the event coverage for partners ceased. The court held that the district court's findings and conclusions were supported by the record and affirmed the judgment.

Plaintiff, 37-years-old, suffered from anorexia nervosa for more than twenty years. At issue was whether defendant was required to pay for her care at a residential treatment facility, either under the terms of her insurance plan or under California's Mental Health Parity Act (Parity Act), Cal. Health & Safety Code 1374.72. The court held that plaintiff's plan did not itself require that defendant pay for residential care for her anorexia nervosa. The court held, however, that the Parity Act provided that defendant "shall provide coverage for the diagnosis and medically necessary treatment" of "severe mental illnesses," including anorexia nervosa. Therefore, defendant was foreclosed from asserting that plaintiff's residential care was not medically necessary. Accordingly, the court held that defendant was obligated under the Parity Act to pay for plaintiff's residential care, subject to the same financial terms and conditions it imposed on coverage for physical illnesses.

Plaintiffs, a class of economically vulnerable Arizonians who receive public health care benefits through the state's Medicaid agency, sued the U.S. Secretary of Health and Human Services (Secretary) and the Director of Arizona's medicaid agency (director)(collectively, defendants), alleging that the heightened mandatory co-payments violated Medicaid Act, 42 U.S.C. 1396a, cost sharing restrictions, that the waiver exceeded the Secretary's authority, and that the notices they received about the change in their health coverage was statutorily and constitutionally inadequate. The court affirmed the district court's conclusion that Medicaid cost sharing restrictions did not apply to plaintiffs and that Arizona's cost sharing did not violate the human participants statute. The court reversed the district court insofar as it determined that the Secretary's approval of Arizona's cost sharing satisfied the requirements of 42 U.S.C. 1315. The court remanded this claim with directions to vacate the Secretary's decision and remanded to the Secretary for further consideration. Finally, the court remanded plaintiffs' notice claims for further consideration in light of intervening events.

This case arose when the Washington State Department of Health (Department) would not license Yakima Valley Memorial Hospital (Memorial) to perform certain procedures known as elective percutaneous coronary interventions (PCI) where, according to the Department, the community Memorial served did not need another PCI provider. The district court held that Memorial failed to state a claim of antitrust preemption, holding that the PCI regulations were a unilateral restraint on trade not barred by the Sherman Act, 15 U.S.C. 1-7. With regard to Memorial's claims under the dormant Commerce Clause, the district court found Memorial had standing because it alleged it would participate in an interstate market for PCI patients, doctors, and supplies. Nevertheless, the district court found that any burden on Memorial's interstate commercial activity was expressly authorized by Congress' approval of certificate of need regimes, making a dormant Commerce Clause violation impossible. The court agreed that Memorial failed to state a claim of antitrust preemption because the PCI regulations were a unilateral licensing requirement rather than an agreement in restraint of trade. The court also agreed that Memorial had standing under the dormant Commerce Clause, but reversed the district court's judgment on that claim because the Department failed to prove congressional authorization for the PCI regulations.

Steve Baldwin and the Pacific Justice Institute challenged the constitutionality of the so-called "individual mandate" provision in the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119, which would take effect in 2014. Baldwin objected to this provision but failed to allege that he did not have qualifying health insurance or that he would not have it in 2014. The Institute also objected but failed to allege that the "individual mandate" applied to it or that it had enough employees to be subject to the analogous "shared employer responsibility" provision. Therefore, neither Baldwin nor the Institute had shown injury in fact, or a genuine threat of prosecution, sufficient to give them standing or making their challenge justiciable. Accordingly, the court affirmed the district court's dismissal of the complaint.

In consolidated appeals, defendants appealed the denial of their motions for judgment on the pleadings where plaintiffs brought a diversity suit to enforce California Civil Code 2527 and 2528, which required defendants to supply the results of bi-annual studies of California's pharmacies' retail drug pricing for private uninsured customers to their clients, who were third-party payors such as insurance companies and self-insured employer groups. At issue was whether the court was bound by the Erie doctrine to follow the state appellate court decisions striking down section 2527 and if not, whether section 2527 violated the First Amendment or the California Constitution's free speech provision. The court held that the Erie doctrine did not require it to follow the state appellate court decisions and that section 2527 did not unconstitutionally compel speech under either the United States or California Constitutions. Accordingly, the court affirmed the judgment.

Appellant, a medicare provider, appealed its notice of program reimbursement for the fiscal year ending in 2001 to the Provider Reimbursement Review Board ("Board"), which dismissed the appeal because appellant missed its deadline to file a preliminary position paper. After the Board denied appellant's motion for reinstatement of its appeal, appellant filed the current action and subsequently appealed from the district court's order granting summary judgment for appellee. The court affirmed summary judgment and held that the Board's Instructions requiring dismissal of claims due to failure to timely submit preliminary position papers did not violate the Medicare Act, 42 U.S.C. 1395, and the Board's dismissal of appellant's claim was neither arbitrary or capricious.