Opinion ID: 598999
Heading Depth: 2
Heading Rank: 1

Heading: Summary Judgment Confined to Procedural Defects

Text: 12 In their summary judgment motion, Plaintiffs asserted that Defendant failed to comply with the Boren Amendment's procedural and substantive components. Procedurally, Defendant allegedly failed to make findings and assurances that IDPA's reimbursement rates were reasonable and adequate to meet costs incurred by efficiently and economically operated facilities, as required by the Boren Amendment. Substantively, Defendant allegedly implemented a reimbursement scheme that resulted in inadequate payments and therefore violated the Boren Amendment's standard. 13 The district court limited its review, and final ruling, to the Plaintiffs' procedural claim. Prominent in the court's decision was its belief that it was clearly Congress' intent that methodological decisions be left to state agencies. Illinois Health Care Ass'n, 776 F.Supp. at 417. This position finds support in Wilder v. Virginia Hospital Ass'n, 496 U.S. 498, 110 S.Ct. 2510, 110 L.Ed.2d 455 (1990), where the Supreme Court discussed at length the legislative history of the Boren Amendment. The Court concluded that Congress passed the Amendment in response to rapidly rising Medicaid costs. Congress blamed the inflationary spiral in part on the Secretary's complex and rigid reimbursement regulations. Id. at 506, 110 S.Ct. at 2515. 14 In order to develop alternative reimbursement methodologies that would promote efficient and economical delivery of services, Congress decided to give states more flexibility in calculating reasonable reimbursement rates. Id. States, for instance, could adopt prospective reimbursement rates. Instead of reimbursing health care providers for the actual cost of services already provided, a state could pay providers in advance based on a state's formula for what such services should cost. Id. at 507 n. 7, 110 S.Ct. at 2516 n. 7; Lett v. Magnant, 965 F.2d 251, 253 (7th Cir.1992). 15 Concomitantly, Congress reduced the Secretary's involvement in the rate-setting process. While the Secretary still approves a state's plan for medical assistance, the Secretary does not review the methods by which a state determines its reimbursement rates. Rather than inspecting the finding or the underlying data, the Secretary reviews only the reasonableness of the state's assurance. Wilder, 496 U.S. at 507-08, 110 S.Ct. at 2516-17. 16 Neither party challenges the district court's decision to confine its review to IDPA's procedural compliance. There is no need, therefore, to review whether the court erred in dismissing Plaintiffs' challenge to Defendant's compliance with the substantive requirements of the Boren Amendment. We would note, however, that Wilder does not foreclose such a challenge. See id. at 510, 110 S.Ct. at 2517; Pinnacle Nursing Home v. Axelrod, 928 F.2d 1306, 1317 (2d Cir.1991); Amisub (PSL), Inc. v. Colorado Dep't of Social Servs., 879 F.2d 789, 795 (10th Cir.1989), cert. denied, 496 U.S. 935, 110 S.Ct. 3212, 110 L.Ed.2d 660 (1990); Multicare Medical Center v. Washington, 768 F.Supp. 1349, 1389 (W.D.Wash.1991). 17 With this understanding of the Amendment's history and purpose, we now turn our attention to its procedural requirements.