Opinion ID: 3009724
Heading Depth: 2
Heading Rank: 2

Heading: The Boren Amendment

Text: In undertaking our review of New Jersey's new program, we begin with the pertinent language of the Boren Amendment: A State plan for medical assistance must-- . . . provide-- . . . for payment . . . of the hospital services . . . provided under the plan through the use of rates (determined in accordance with methods and standards developed by the State . . . and which, in the case of hospitals, take into account the situation of hospitals which serve a disproportionate number of low income patients with special needs . . .) which the State finds and makes assurances satisfactory to the Secretary, are reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated 1 While NJHA appears to seek review of procedural compliance alone, it states: The central issue raised below and on appeal is whether DHS properly engaged in an objective review of economy and efficiency, and rendered bona fide `findings' capable of supporting assurances that the resulting rates were `reasonable and adequate' and not likely to impair reasonable `access' to services. Appellant's Brief at 14. As discussed infra, this Court has deemed the reasonable and adequate and the reasonable access requirements as being substantive in nature. Thus, NJHA necessarily seeks review of the State's procedural and substantive compliance. 9 facilities in order to provide care and services . . . and to assure that individuals eligible for medical assistance have reasonable access (taking into account geographic location and reasonable travel time) to inpatient hospital services of adequate quality. 42 U.S.C. § 1396a(a)(13)(A)(emphasis added). Initially, in interpreting a state's plan, we note that the legislative history of the Amendment manifests Congress's strong concern that its procedural and substantive requirements be invariably and fully satisfied. West Va. Univ. Hosps., 885 F.2d at 24. We turn to our interpretive task with that caveat in mind.
This Court has observed that the Boren Amendment authorizes states to develop their own Medicaid reimbursement standards and methodologies for payment for hospital services, but subjects those standards and methodologies to three general federal requirements. Id. at 22. Those requirements mandate that a state's rates
hospitals serving a disproportionate share of low income patients;
necessary costs of an efficiently operated hospital; and
medicaid patients of reasonable access to inpatient hospital care. See Temple Univ., 941 F.2d at 210 (citing West Va. Univ. Hosps., 885 F.2d at 22). The implementing regulations for 10 §1396a(a)(13)(A) reiterate these statutory requirements. See 42