If Congress Says No Judicial Review, They Mean No Judicial Review – Sayeth the Fifth Circuit

The United States Fifth Circuit Court of Appeals issued a ruling Friday in Paladin Community Mental Health Centers v. Sebelius, a case out of the Western District of Texas.  Basically, the ruling holds that if Congress says No Judicial Review, then they mean no judicial review . . . except within some very narrow circumstances, and this isn’t one of them.

Basically, Paladin, a provider of mental health services, filed for an injunction to prevent the Department of Health and Human Service from using cost data from other community mental health providers rather than hospital data. The Secretary of HHS moved to dismiss for lack of subject matter jurisdiction based on the statutory language in section 1395l(t)(12), which expressly precludes judicial review of payment-weight determination.

The 5th Circuit affirmed on appeal, basically for the same reasons which the District Court dismissed the case.  The 5th Circuit explained that Congress was pretty clear with regards to the preclusion of judicial review of these payment-weight determinations and that there was good public policy behind these reasons. In a footnote, the Court noted that to allow judicial review would “likely wreak havoc on the already complex administration of Medicare Part B’s outpatient prospective payment system.”

Link to the Courts opinion.

What does this mean for ambulance services?  If CMS decides to change the way they pay ambulance services across the board, the courts are not an avenue where that battle can be fought.


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