Source: http://www.law.cornell.edu/supct/html/historics/USSC_CR_0457_0991_ZO.html
Timestamp: 2013-05-26 08:39:51
Document Index: 318675795

Matched Legal Cases: ['§ 365', '§ 1396', '§ 1396', '§ 1396', '§ 414', '§ 416', '§ 421', '§ 456', '§ 416', '§ 456', '§ 731']

1. N.Y.Soc.Serv.Law § 365-a.2(b) (McKinney Supp.1982). Title XIX requires, as a condition to the receipt of federal funds, that participating States provide financial assistance to eligible persons in need of "skilled nursing facility services." 42 U.S.C. §§ 1396a(a)(13)(B), 1396d(a)(4)(A) (1976 ed. and Supp. IV). Federal assistance is also available to States that choose to reimburse the cost of "intermediate care facility services." § 1396d(a)(15). See §§ 1396d(c), (f). New York regulations refer to facilities that provide the latter type of care as HRF's. 10 NYCRR § 414.1(a) (1981).
2. Compare 10 NYCRR §§ 416.1-416.2 with §§ 421.1-421.2 (1978). The parties have stipulated that Medicaid reimbursement rates for HRF's are generally lower than those for SNF's. See App. 169, ¶ 12.
3. Congress has provided that federal funds supplied to assist in reimbursing nursing home costs will be reduced unless the participating State provides for the periodic review of patient care
4. These committees must be composed of private physicians who are not directly responsible for the patient whose care is being reviewed. 42 CFR §§ 456.306, 456.406 (1981). Under New York law, the committee members may not be employed by the SNF or HRF, and may not have a financial interest in any residential care facility. 10 NYCRR §§ 416.9(b)(2), 421.13(b)(2) (1980).
5. If the committee determines that a discharge or transfer is called for, it must afford the patient's attending physician an opportunity to present his views, although the committee's decision ultimately is final. 42 CFR §§ 456.336(f), (h), 456.436(f), (i) (1981). See 10 NYCRR §§ 731.11, 741.14 (1980).
6. The class was defined to include patients
7. The complaint also alleged that URC transfers to lower levels of care and corresponding reductions in Medicaid benefits were arbitrary, and were caused by improperly constituted URC's that acted without adequate written criteria and failed to afford adequate notice either to the patients or their attending physicians.
8. Ten individuals, who are also respondents in this Court, later intervened in the suit. Each intervenor was a resident of either an SNF or an HRF, and had been the subject of a URC decision recommending transfer to a lower level of care. The intervenors all were afforded administrative hearings resulting in affirmance of petitioners' decisions to reduce or terminate Medicaid benefits if the intervenors did not follow URC recommendations.
9. The class was defined to include
10. The court also required the defendants to afford class members access to all pertinent case files and medical records. Id. at 101-102. The Court of Appeals for the Second Circuit upheld portions of the injunction challenged by petitioners. Yaretsky v. Blum, 592 F.2d 65 (1979).
11. The pretrial order also redefined the class to include "all residents of skilled nursing and health related nursing facilities in New York State who are recipients of Medicaid benefits." App. 151.
12. The court modified the injunction by relieving petitioners of obligations that, in the opinion of federal authorities, would render the State ineligible for Medicaid funding. 629 F.2d at 822. The court also reversed the District Court's holding that state administrators were precluded by due process or state law from rejecting a hearing officer's recommendation favorable to a patient without reading a verbatim transcript of the hearing and the exhibits. Id. at 822-825. This holding is not before us.
13. Respondents suggest that members of the class they represent have been transferred to higher levels of care as a result of URC decisions. Respondents, however,