Transitional Hospitals Corp. of Louisiana, Inc. v. Shalala
United States Court of Appeals for the District of Columbia Circuit
222 F.3d 1019 (2000)
- Written by Haley Gintis, JD
Facts
In 1983, Congress implemented the Medicare Prospective Payment System (PPS), under which healthcare facilities received a flat reimbursement rate for treating Medicare patients. However, long-term-care hospitals, defined as facilities with an average inpatient stay of 25 days or greater, can receive reimbursement through the reasonable-cost system, under which reimbursement rates were calculated based on the average cost of the service performed. Congress tasked the Department of Health and Human Services (HHS) Secretary Donna Shalala (defendant) with determining how to decide whether the facility met the statutory definition. HHS promulgated regulations requiring facilities to collect inpatient-stay data for six months before receiving long-term-care status. In 1992, Transitional Hospitals Corporation of Louisiana (THC) (plaintiff) applied for long-term-care status. HHS denied the request, explaining that the statute allowed exemption only for a facility that has an average inpatient stay of 25 days or greater, and therefore HHS had instituted the mandatory data-collection period. THC completed the data collection and then received long-term-care-hospital status. However, HHS refused to reimburse THC for the six-month data-collection period using the reasonable-cost system, as was consistent with the HHS regulation. THC requested a hearing by the Provider Reimbursement Review Board (board). The board concluded it did not have authority to hold HHS regulations invalid. THC filed suit in district court. The district court agreed with THC that the PPS statute required HHS to exempt long-term-care facilities from the PPS reimbursement scheme from the time the facility first participates in Medicare. HHS appealed.
Rule of Law
Issue
Holding and Reasoning (Garland, J.)
What to do next…
Here's why 832,000 law students have relied on our case briefs:
- Written by law professors and practitioners, not other law students. 46,400 briefs, keyed to 994 casebooks. Top-notch customer support.
- The right amount of information, includes the facts, issues, rule of law, holding and reasoning, and any concurrences and dissents.
- Access in your classes, works on your mobile and tablet. Massive library of related video lessons and high quality multiple-choice questions.
- Easy to use, uniform format for every case brief. Written in plain English, not in legalese. Our briefs summarize and simplify; they don’t just repeat the court’s language.