Long Term Care Pharm. Alliance v. Ferguson

362 F.3d 50 (1st Cir. 2004) ; Clearinghouse Number: 55579

Description

Pharmacy Group Challenging Reimbursement Rate Reduction Has No Private Right of Action to Enforce Medicaid “Equal Access” Provision, First Circuit Rules

Abstract

Vacating a preliminary injunction from the district court, the First Circuit held that providers, in this case pharmacies supplying prescription drugs only to nursing home patients, had no private right of action to enforce the “equal access” provision of the Medicaid Act. Plaintiff sought to enjoin Massachusetts from implementing an emergency regulation that reduced the rate at which the state reimbursed pharmacies supplying prescription drugs to Medicaid patients. Plaintiff charged that the lack of a hearing before implementation violated a Medicaid Act provision (42 U.S.C. § 1396a(a)(13)(A)) requiring such a public hearing to set payment rates for nursing facility services. Plaintiff charged that the rate reduction violated the Act’s requirement (42 U.S.C. 1396a(a)(30)(A)) that rates for services generally be “sufficient to enlist enough providers to provide services similar to those generally available in the area.” That a public hearing had been held by the time the case reached the First Circuit did not render the case moot, the court said, because the state had not yet adopted a final rule. The First Circuit said that the Section (13)(A) protection procedures did not apply to plaintiff because the pharmacies were not providing “nursing facility services” within the scope of the provision’s intent and protection. The First Circuit found that Section (30)(A), the “equal access” provision, set forth only general objectives. Citing Gonzaga University v. Doe, 536 U.S. 273 (2002) (Clearinghouse No. 54643), the First Circuit saw in section (30)(A) no “rights-creating language” and no discrete class of beneficiaries. The statute gives enforcement authority to the secretary of health and human services, not providers, the First Circuit held.

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Attorney Information
Docket Date
2004-03-17 00:00:00+00:00

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