Source: https://caselaw.findlaw.com/us-supreme-court/16-149.html
Timestamp: 2019-03-25 09:24:30
Document Index: 583698606

Matched Legal Cases: ['§8902', '§8902', '§890', '§8902', '§890', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§8901', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§8902', '§1001', '§1144', '§1', '§2', '§8902', '§8902', '§8959', '§8989', '§9005', '§1103']

COVENTRY HEALTH CARE OF MISSOURI, INC., FKA GROUP HEALTH PLAN, INC. v. NEVILS | FindLaw
COVENTRY HEALTH CARE OF MISSOURI, INC., FKA GROUP HEALTH PLAN, INC. v. NEVILS(2017)
No. 16-149
Argued: March 1, 2017 Decided: April 18, 2017
The Federal Employees Health Benefits Act of 1959 (FEHBA) authorizes the Office of Personnel Management (OPM) to contract with private carriers for federal employees' health insurance. 5 U. S. C. §8902(a), (d). FEHBA contains an express-preemption provision, §8902(m)(1), which states that the "terms of any contract under this chapter which relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law . . . which relates to health insurance or plans."
OPM's contracts have long required private carriers to seek subrogation and reimbursement. Accordingly, OPM's regulations make a carrier's "right to pursue and receive subrogation and reimbursement recoveries . . . a condition of and a limitation on the nature of benefits or benefit payments and on the provision of benefits under the plan's coverage." 5 CFR §890.106(b)(1). In 2015, OPM published a new rule confirming that a carrier's subrogation and reimbursement rights and responsibilities "relate to the nature, provision, and extent of coverage or benefits (including payments with respect to benefits) within the meaning of" §8902(m)(1), and "are . . . effective notwithstanding any state or local law, or any regulation issued thereunder, which relates to health insurance or plans." §890.106(h).
1. Because contractual subrogation and reimbursement prescriptions plainly "relate to . . . payments with respect to benefits," §8902(m)(1), they override state laws barring subrogation and reimbursement. Pp. 6-9.
(a) This reading best comports with §8902(m)(1)'s text, context, and purpose. Contractual provisions for subrogation and reimbursement "relate to . . . payments with respect to benefits" because subrogation and reimbursement rights yield just such payments. When a carrier exercises its right to either reimbursement or subrogation, it receives from either the beneficiary or a third party "payment" respecting the benefits the carrier had previously paid. The carrier's very provision of benefits triggers the right to payment. Congress' use of the expansive phrase "relate to," which "express[es] a broad pre-emptive purpose," Morales v. Trans World Airlines, Inc., 504 U. S. 374, 383, weighs against Nevils' effort to narrow the term "payments" to exclude payments that occur "long after" a carrier's provision of benefits. Nevils' argument that Congress intended to preempt only state coverage requirements, e.g., inclusion of acupuncture and chiropractic services, also miscarries.
The statutory context and purpose reinforce this conclusion. FEHBA concerns "benefits from a federal health insurance plan for federal employees that arise from a federal law." Bell v. Blue Cross & Blue Shield of Okla., 823 F. 3d 1198, 1202. Strong and "distinctly federal interests are involved," Empire HealthChoice Assurance, Inc. v. McVeigh, 547 U. S. 677, 696, in uniform administration of the program, free from state interference, particularly in regard to coverage, benefits, and payments. The Federal Government also has a significant financial stake in subrogation and reimbursement. Pp. 6-8.
(b) McVeigh's suggestion that §8902(m)(1) has two "plausible" interpretations, 547 U. S., at 698, Nevils asserts, supports application of the presumption against preemption here. But the Court never chose between the two readings set out in McVeigh, because doing so was not pertinent to the discrete question whether federal courts have subject-matter jurisdiction over FEHBA reimbursement actions. Having decided in McVeigh that §8902(m)(1) is a "choice-of-law prescription," not a "jurisdiction-conferring provision," id., at 697, the Court had no cause to consider §8902(m)(1)'s text, context, and purpose, as it does here. Pp. 8-9.
2. The regime Congress enacted is compatible with the Supremacy Clause. The statute itself, not a contract, strips state law of its force. FEHBA contract terms have preemptive force only if they fall within §8902(m)(1)'s preemptive scope. Many other federal statutes found to preempt state law, including the Employee Retirement Income Security Act of 1974 and the Federal Arbitration Act, leave the context-specific scope of preemption to contractual terms. While §8902(m)(1)'s phrasing may differ from those other statutes', FEHBA's express-preemption provision manifests the same intent to preempt state law. Pp. 9-11.
COVENTRY HEALTH CARE OF MISSOURI, INC., fka GROUP HEALTH PLAN, INC., PETITIONER v.
JODIE NEVILS
The questions here presented: Does FEHBA's express-preemption prescription, §8902(m)(1), override state law prohibiting subrogation and reimbursement; and if §8902(m)(1) has that effect, is the statutory prescription consistent with the Supremacy Clause, U. S. Const., Art. VI, cl. 2? We hold, contrary to the decision of the Missouri Supreme Court, that contractual subrogation and reimbursement prescriptions plainly "relate to . . . payments with respect to benefits," §8902(m)(1); therefore, by statutory instruction, they override state law barring subrogation and reimbursement. We further hold, again contrary to the Missouri Supreme Court, that the regime Congress enacted is compatible with the Supremacy Clause. Section 8902(m)(1) itself, not the contracts OPM negotiates, triggers the federal preemption. As Congress directed, where FEHBA contract terms "relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits)," §8902(m)(1) ensures that those terms will be uniformly enforceable nationwide, free from state interference.
FEHBA "establishes a comprehensive program of health insurance for federal employees." Empire HealthChoice Assurance, Inc. v. McVeigh, 547 U. S. 677, 682 (2006). As just noted, supra, at 1, FEHBA contains an express-preemption provision, §8902(m)(1). FEHBA assigns to OPM broad administrative and rulemaking authority over the program. See §§8901-8913. OPM contracts with private insurance carriers to offer a range of healthcare plans. §§8902, 8903.
Respondent Jodie Nevils is a former federal employee who enrolled in and was insured under a FEHBA plan offered by petitioner Coventry Health Care of Missouri.1 Nevils v. Group Health Plan, Inc., 418 S. W. 3d 451, 453 (Mo. 2014) (Nevils I ). When Nevils was injured in an automobile accident, Coventry paid his medical expenses. Ibid. Nevils sued the driver who caused his injuries and recovered a settlement award. Ibid. Based on its contract with OPM, see App. to Pet. for Cert. 129a-130a, Coventry asserted a lien for $6,592.24 against part of the settlement proceeds to cover medical bills it had paid. Nevils I, 418 S. W. 3d, at 453. Nevils repaid that amount, thereby satisfying the lien. Ibid.
Nevils then filed this class action against Coventry in Missouri state court, alleging that Coventry had unlawfully obtained reimbursement. Ibid. Nevils premised his claim on Missouri law, which does not permit subrogation or reimbursement in this context, see, e.g., Benton House, LLC v. Cook & Younts Ins., Inc., 249 S. W. 3d 878, 881-882 (Mo. App. 2008). Coventry countered that §8902(m)(1) makes subrogation and reimbursement clauses in FEHBA contracts enforceable notwithstanding state law. The trial court granted summary judgment in Coventry's favor, Nevils v. Group Health Plan, Inc., No. 11SL-CC00535 (Cir. Ct., St. Louis Cty., Mo., May 21, 2012), App. to Pet. for Cert. 28a, 32a, and the Missouri Court of Appeals affirmed, Nevils v. Group Health Plan, Inc., 2012 WL 6689542, *5 (Dec. 26, 2012).
The Missouri Supreme Court reversed. Nevils I, 418 S. W. 3d, at 457. That court began with "the assumption that the historic police powers of the States [are] not to be superseded by . . . Federal Act unless that [is] the clear and manifest purpose of Congress." Id., at 454 (quoting Cipollone v. Liggett Group, Inc., 505 U. S. 504, 516 (1992)) (alterations in original). Finding §8902(m)(1) susceptible to diverse "plausible readings," the court invoked a "presumption against preemption" to conclude that the federal statute's preemptive scope excluded subrogation and reimbursement. 418 S. W. 3d, at 455.
On remand, the Missouri Supreme Court adhered to its earlier decision. Nevils v. Group Health Plan, Inc., 492 S. W. 3d 918, 920, 925 (2016). OPM's rule, the court maintained, "does not overcome the presumption against preemption and demonstrate Congress' clear and manifest intent to preempt state law." Id., at 920.
Judge Wilson again concurred, this time joined by a majority of the judges of the Missouri Supreme Court. Id., at 925.2 In their view, Congress' "attempt to give preemptive effect to the provisions of a contract between the federal government and a private party is not a valid application of the Supremacy Clause" and, "therefore, does not displace Missouri law here." Ibid.
Coventry contends that §8902(m)(1) unambiguously covers the contractual terms at issue here. In any event, Coventry, joined by the United States as amicus curiae, urges that the rule published by OPM in 2015 leaves no room for doubt that insurance-contract terms providing for subrogation and reimbursement fall within §8902(m)(1)'s preemptive scope. See supra, at 3. Deference is due to OPM's reading, Coventry and the United States assert, under Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc., 467 U. S. 837 (1984). In Nevils' view, by contrast, §8902(m)(1) does not preempt state antisubrogation and antireimbursement laws in light of the presumption against preemption. Given that presumption, Nevils maintains, OPM's rule is not entitled to deference. Though we have called Nevils' construction "plausible," McVeigh, 547 U. S., at 698, the reading advanced by Coventry and the United States best comports with §8902(m)(1)'s text, context, and purpose.
Congress' use of the expansive phrase "relate to" shores up that understanding. We have "repeatedly recognized" that the phrase "relate to" in a preemption clause "express[es] a broad pre-emptive purpose." Morales v. Trans World Airlines, Inc., 504 U. S. 374, 383 (1992); accord Northwest, Inc. v. Ginsberg, 572 U. S. ___, ___, ___ (2014) (slip op., at 5, 9). Congress characteristically employs the phrase to reach any subject that has "a connection with, or reference to," the topics the statute enumerates. Morales, 504 U. S., at 384. The phrase therefore weighs against Nevils' effort to narrow the term "payments" to exclude payments that occur "long after" a carrier's provision of benefits (Brief for Respondent 27 (quoting McVeigh, 547 U. S., at 697)). See Nevils I, 418 S. W. 3d, at 460 (Wilson, J., concurring); cf. Hillman v. Maretta, 569 U. S. ___, ___ (2013) (slip op., at 10) (in the Federal Employees' Group Life Insurance Act context, it "makes no difference" whether state law withholds benefits in the first instance or instead takes them away after they have been paid). Given language notably "expansive [in] sweep," Morales, 504 U. S., at 384 (internal quotation marks omitted), Nevils' argument that Congress intended to preempt only state coverage requirements (e.g., for acupuncture and chiropractic services, see Brief for Respondent 36) also miscarries.
Without §8902(m)(1), there would be no preemption of state insurance law. FEHBA contract terms have preemptive force only as they "relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits)," §8902(m)(1)--i.e., when the contract terms fall within the statute's preemptive scope. It is therefore the statute that "ensures that [FEHBA contract] terms will be uniformly enforceable nationwide, notwithstanding any state law relating to health insurance or plans." Brief for United States as Amicus Curiae 28 (internal quotation marks omitted).
Many other federal statutes preempt state law in this way, leaving the context-specific scope of preemption to contractual terms. The Employee Retirement Income Security Act of 1974 (ERISA), 29 U. S. C. §1001 et seq., for example, preempts "any and all State laws insofar as they . . . relate to any employee benefit plan." §1144(a). And the Federal Arbitration Act (FAA), 9 U. S. C. §1 et seq., limits the grounds for denying enforcement of "written provision[s] in . . . contract[s]" providing for arbitration, thereby preempting state laws that would otherwise interfere with such contracts. §2. This Court has several times held that those statutes preempt state law, see, e.g., Gobeille v. Liberty Mut. Ins. Co., 577 U. S. ___, ___-___ (2016) (slip op., at 5-12) (ERISA); Marmet Health Care Center, Inc. v. Brown, 565 U. S. 530, 532-534 (2012) (per curiam) (FAA), and Nevils does not contend that those measures violate the Supremacy Clause, see Brief for Respondent 22.
COVENTRY HEALTH CARE OF MISSOURI, INC., fka GROUP HEALTH PLAN, INC., PETITIONER v. JODIE NEVILS
I join the opinion of the Court with one reservation. A statute that confers on an executive agency the power to enter into contracts that pre-empt state law--such as the Federal Employee Health Benefits Act of 1959, 5 U. S. C. §8902--might unlawfully delegate legislative power to the President insofar as the statute fails sufficiently to constrain the President's contracting discretion. See Department of Transportation v. Association of American Railroads, 575 U. S. ___, ___-___ (2015) (Thomas, J., concurring in judgment) (slip op., at 11-22); see also Whitman v. American Trucking Assns., Inc., 531 U. S. 457, 472 (2001). Respondent, however, failed to make that argument. The Court therefore appropriately leaves that issue to be decided, if at all, on remand.
Under Missouri law, a "concurring opinion" in which "a majority of the court concur[s]" is binding precedent. Mueller v. Burchfield, 359 Mo. 876, 880, 224 S. W. 2d 87, 89 (1949).
Congress' choice of language is not unique to §8902(m)(1). Several related statutes governing federal-employee and military-member benefits employ similar formulations. See §8959 ("The terms of any contract that relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law, or any regulation issued thereunder, which relates to dental benefits, insurance, plans, or contracts."); §8989 (same for vision); §9005(a) (same for long-term care); 10 U. S. C. §1103(a) (certain state laws "shall not apply to any contract entered into pursuant to this chapter").