Opinion ID: 181254
Heading Depth: 3
Heading Rank: 1

Heading: The PRRB's Jurisdiction

Text: The scope of the PRRB's jurisdiction is established by 42 U.S.C. § 1395 oo (a). The relevant portion of that section specifies that any hospital which receives payments in amounts computed under subsection (b) or (d) of section 1395ww of this title ... may obtain a hearing with respect to such payment by the Board if (1) such provider ... is dissatisfied with a final determination of the Secretary as to the amount of the payment; (2) the amount in controversy is $10,000 or more; and (3) such provider files a request for a hearing within 180 days.... 42 U.S.C. § 1395 oo (a). In other words, this statute requires that the PRRB hear appeals from a hospital dissatisfied with the § 1395ww(b) payment it received, as long as the hospital's appeal meets the amount in controversy requirement ($10,000 or more) and procedural deadlines. The only § 1395 oo (a) requirement in dispute here is the amount in controversy, which, in the context of cases originating in the federal district courts, is normally determined from the face of the pleadings. Pachinger v. MGM Grand Hotel-Las Vegas, Inc., 802 F.2d 362, 363 (9th Cir.1986). In this case, Beacon claimed in its pleadings approximately $164,000 as the amount in controversy. This amount meets the requirements of § 1395 oo (a)(2). Nevertheless, the PRRB dismissed Beacon's suit on jurisdictional grounds because it concluded that Beacon was not in fact entitled to an adjustment of at least $10,000, the PRRB's required amount in controversy. This was error. The PRRB confused the amount in controversy with the remedy. [1] The amount in controversy is judged prospectively: that is, we determine our jurisdiction by asking whether, assuming the petitioner or plaintiff has stated a cause of action, he has pled sufficient damages. Here the PRRB inverted the inquiry. It began by asking if Beacon was entitled to an adjustment of the TEFRA ceiling. Having determined that Beacon was not so entitled, the PRRB dismissed for want of jurisdiction because Beacon had failed to state a claim for the requisite amount in controversy. As Beacon's case met all of the statutory requirements of 42 U.S.C. § 1395 oo (a), it fell within the scope of the Secretary's jurisdiction, and the PRRB erred in finding otherwise.