Opinion ID: 765833
Heading Depth: 3
Heading Rank: 1

Heading: HCFA's Interpretation of the Boren Amendment.

Text: 67 HCFA, in concluding that the Amendment does not apply to out-of-state hospitals, based its position upon the tenet that the Boren Amendment was enacted to provide greater flexibility to the participating states and that applying the Amendment to out-of-state hospitals would have created an administrative morass that Congress could not have intended. The Boren Amendment, to repeat, required a state to audit every provider of health care services to Medicaid patients to determine whether the provider charges reasonable rates. In its brief to the district court, HCFA noted that if it required states to apply this rubric to out-of-state providers, states such as California would have to analyze data for each out-of-state facility even if that facility ultimately cares for only one of its residents. Moreover, HCFA noted that if it required states to apply the Boren Amendment to out-of-state hospitals, states would need to employ experts to learn licensure laws of other states to determine whether facilities in other states have adequate staff and are running efficiently and economically. In short, according to HCFA, the costs would be overwhelming and would defeat the purpose of the Boren Amendment. 68 The legislative history of the Boren Amendment also influenced HCFA in formulating its interpretation of the statute. It pointed out that the stated intent of the Amendment was to provide states with the maximum amount of flexibility in setting payment rates. HCFA noted that it would make little sense under this framework to require states to obtain information regarding every out-of-state provider that provides services to even one Medicaid eligible resident. 69 Instead, HCFA concluded that another provision, known as the equal-access provision, governs the reimbursement of out-of-state providers. It relied on 42 U.S.C. S 1396a(a)(30)(A), and argued to the district court that this statute, not the Boren Amendment, regulates state payments to out-of-state providers. That provision, requires, in pertinent part that a state plan 70 provide for methods and procedures relating to . . . the payment for[ ] care and services available under the plan . . . to assure that payments are consistent with efficiency, economy and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area. 71 42 U.S.C. S 1396a(a)(30)(A) (1998). 72 HCFA concluded that this equal access provision is better tailored to ensure that states are providing adequate reimbursement to out-of-state providers of medical services to Medicaid patients because it is less burdensome than applying the Boren Amendment. In short, in the view of HCFA, this provision requires a state to ensure that its payments to out-ofstate providers are reasonable without requiring the state to engage in a facility-specific analysis for every provider in every state where a patient may receive services. 73 This interpretation of the Medicaid statutory scheme is reasonable. Whether it is the best interpretation or the most fair interpretation is not controlling. It is a reasonable one. Therefore, in obedience to the Supreme Court's dictates in Chevron, I would hold that it is a permissible interpretation of an ambiguous statute. Because HCFA, not the courts, is entrusted with carrying out the provisions of Medicaid, I would defer to its interpretation of this ambiguous statutory provision. 74