jersey fifty cents of every dollar spent in new jersey on medicaid is funded by state taxpayers and the other fifty cents of every dollar is funded by the federal government subject to strict compliance with federal rules appellants have a responsibility to state tax payers and to the federal government to ensure that every dollar spent is accounted for and justified and this is responsibility extends one hundred million dollars worth of supplemental payments they're paid every year to federally qualified health centers the district court's decision for it's the state's efforts to apply program integrity rules to the f me that they're not really fantastic thing the two rather they are raising the two to say that payment should not be the rox debility i think it's two issues your honor i think they are contesting asking for those two pieces of information on the grounds they say not that it's prohibited by federal law but that it is not consistent we say that this supplemental payment is what the statute describes it as a supplement it is a supplement to the n c o payment and we believe both the fourth circuit and the first circuit have accurately described the payments that the equation services of a single provider to different locations those are those the meet the definition of medicaid coverage kalar right and there's not a hole in your argument a hole in my argument yes no i don't i don't believe so your honor because the medicaid the h m o's are responsible for making the medicaid payment to the f two eight says the state has paid them the state has paid the n c o has to be responsible  verify and reconcile only those claims reasonably and as you yes your honor the district court decision prevents the state from collecting the information and it prevents the state from from from conditioning supplemental payment on them and if you agree with me that that really is the issue judge design or order that the parties reason together  to resolve this you just have those discussions those there have been discussions in process and have been more focused on post payment auditing review and the sharing of information but your honor we believe the record shows that repeatedly the state has said t a bunch of money that they have to pay but is there anything preventing the state left with the district court decision aside from is a really preventing the state from asking the agent with whom he has a contract to provide it with information as to the supplemental payment instead that said let's use the encounter data in the interim us let's use the h m o data to generate the supplemental payment which did result in a higher a higher amount and that is what led to the plaintiffs coming into encounter i guess is what yes and they're fairly accurate but it could change right it can change but it depends what what the what the plaintiffs are asking for here is that if they don't get paid from the h t m l and they might they want you to pay regardless of whether it's a medicaid eligible encounter well you know they with what they would say your honor is we only want you we only want pain and for medicaid eligible  counter but we decide we the provider decides and that is not the way that it works in medicaid the state should decide what is eligible or not eligible and then in the case of managed care the managed care company decides just going to be too costly to get to that kind of news now the state wants it the state gets it the memory other providers that the state needs the information and the and it needs to be able to say use the n c o data and that's what you that's what led to you you know mary you say you are not responsible at the p p s rate if the n c o has failed to make a prior payment for any reason right yes because our responsibility is to make number one to to oversee the n c o the pay and ceo's to make sure that the m c a those are complying with their contract and then to supplement the n c o payment including a zero dollars payment be a medicaid covered service it might not be a medicaid and that's a wire biter and that's why i have some difficulty with you friends across the aisle basically the payment information is useful and relevant whether or not i proxy is whether or whether or not it is the proxy it is relevant information in some of those things you talk to some of the things you just articulate it is that it is relevant information it is required by the federal government and plan which is the document rightly in the federal government the state government is a that's was federally approved that's federally approved the state regulations are not federally i think of what's the most expeditious way for you to get this information so that you c make that the decision that you have to make so that primary care gets paid well you're hired that but the state the most expeditious place the way that the state tried to do it which is to ask the f q agencies for the information and then they use that information to process that assume i would assume i don't know so much of this is new to me but i assume they have the information because when they submit a claim to an h m o the agent who says no zero and here's the reason that the way it state's collection of the entry of data field a man and a per se or do you just object to the policy of making wraparound payments contingent on prior and see  those painted fields in order to make a determination as to whether or not to pay and so it's not your objection is not to giving them the information the objection is to having state the state has not operationalized what it's going to do with that information it's coming up on them as a single state agency under the medicaid act they're the ones that have to design a system to make supplemental payments in accordance with federal law but this started in two thousand and four i see the trying to work this out it's the process really started them trying to work together in two thousand four this is two thousand and thirteen and would you agree that you're really not that far apart i'm not sure your honor i know exactly the record sites that you're referring to about the parties trying to work together but they also show that the state has been on notice since two thousand and four that there are significant discrepancies between n c o data and what the s q a sees had in their records wou ld you agree that the payment eight nine payment information if it's not even if it's not this fozzy to is is useful relevant  to condensing those claims in this field it could be useful but it should not be dispositive that's what i'm saying by the fact of the problem is that we have in the record we have a couple of declarations that discuss the issue of this this bundle paying it so when the n c o they make it can be a global fee a bundle fee whatever you want to call it for a series of visits they pay once their communities are entitled to a supplemental payment for each component of that bundling and the state has not designed a system that that will make an appropriate appropriate supplemental payment isn't that really what is at issue here finding a way by which the state can verify and reconcile claims reasonably and does the state is already has been on notice and they've conceded that this is an issue this is a gap in their system this isn't this really the understood it correctly that you know we don't make a payment that you're in town to there is a review process it's a really review process not that but see that there won't be there is no review for when an h t m l has has denied a bundled claim like try to protect their interests but there is no process that was contemplated that in that night feel to the letter that they sent out in september of two thousand and eleven so if there's a real a real process you'd be satisfied  well if the result why not design a system from the get go if you know that this is a problem if you've been trying to work with the health centers as judge perry said since two thousand and four why would you design a system that a little that does not address such ordinary documentation but the information that they're going to get from the health centers when they put down zero because it was a bundle claim that it was there is no night though they'll be there the state has not come up with problem i mean this is you know five percent of the claims will be caught in a zero it can be as much as ten percent ok we had one one a declaration in the record from camp here saying as many as much as ten percent  been what what has the state been doing for the last ten years before they made this change in policy that was perfectly perfectly acceptable i think you know health center smith i mean i always think of accountability and it seems to me that that's what they're are at stake and always saying is that the state needs to devise a system the govt goes ahead and needs payment to protect the health centers when the judge design no order that defendants and then a plan of action to the honor there's been a preliminary plan that the state has submitted in december of two thousand and twelve and now they are they're working on a revised thirteenth that will kind of interesting isn't it what i've been saying from the beginning if you have this if you can work together on this we have not worked together your honor it well if you didn't have you plan and come to some sort of agreement those and all this stuff the way it could but it hasn't worked out that way we've had an opportunity to comment on some some aspects of what the state has presented but we've really been presented with a accompli well i think we might ask around about that when she gets back up i have one question that's been bothering me and the state didn't raise it which somewhat surprise do you have a private right of action to enforce the medicaid actually wireman that the states of the change to its plan to the federal government i mean is this really  state does have procedures to appeal denials of supplemental wraparound payments and i gather from your argument that those appellate procedures are not sufficient to satisfy your concerns not no your honor and under process would allow a grouping of common common claims but it's good that you know that the point is that that there is there they have acknowledged that there that these payments are not getting made and they should be made to the house and ours but yet they haven't devised a system that accomplishes that we're right back to the way we started out the system that's all we need just a system to resolve those disputed claims or to validate the ones that were denied and i hear today that there has been a plan proposed in december to twelve and it's been submitted and there are amending it a new bill agree with it but it sounds like that now addressing all of these issues and i don't know if if everybody wants us to do with opinion here there are a lot of issues a lot of issues can go either way well if you're honest keep in mind that there is an overarching statutory scheme to how this is supposed to work and have and and that's that's honor first i'd just like to get the bundled payment issue out of the way page fifteen of our reply brief we quote the instructions from the state to the centers that make a distinction between a zero dollar payment and a bundle situation same right as every other provider to appeal within the h m o to try to get that result and if they still believe that they have been done after that appeal that they have been denied the payment for a valid medicaid claim they can file a claim for  about that much money but then you have to go back again and back again and it's not cost effective yes but the question your honor that the district court held in that the plaintiffs are asking you to hold is that federal law prohibits prohibits the state from saying we're only making supplemental payments supplement to the n c o payment there is nothing in federal law that excuses the f u e disease from having to go through the appeal process is not that there are reasonable differences between the parties there can be different and forth and it's it's not cost effective so what's the what's the sort of the first step your honor is for the state to be able to get this information right now it is only able to get that information after it has what happens what happens if you get once recognizes that it has a responsibility to make sure that the f three cs are paid for the valid services that they provide by the tomorrows and that they receive supplemental payments but the state also has a responsibility to the taxpayers to make sure that it's only think what it is if