Articles Posted in Health Law

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The Supreme Court rejected a constitutional challenge to the provision in Ariz. Rev. Stat. 36-2901.08(A) that the director of Arizona’s indigent health care program, Arizona Health Care Cost Containment System (AHCCCS), “shall establish, administer and collect an assessment” from Arizona hospitals (the hospital assessment). The legislature added this provision to fund the costs remaining after federal monies to expand coverage under AHCCCS, as provided for in H.B. 2010, which the legislature enacted in 2013 by a simple majority vote. The Supreme Court held that the hospital assessment is not subject to Ariz. Const. art. IX, 22, which generally requires that acts providing for a net increase in state revenues be approved by a two-thirds vote in each house of the legislature, because the exception set forth in Ariz. Const. art. IX, 22(C)(2) that the above requirement does not apply to statutorily authorized assessments that “are not prescribed by formula, amount or limit, and are set by a state officer or agency” applied in this case. View "Biggs v. Betlach" on Justia Law

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Premier Physicians Group, a non-hospital health care provider, treated Mandy Gipson for injuries sustained in a car accident allegedly caused by Kimberly Navarro. Premier was statutorily entitled to record a lien for its customary charges in treating Gipson, and the lien applied to claims Gipson may have had for damages related to her injury. Ariz. Rev. Stat. 33-932(A) requires that such liens must be recorded “before or within thirty days after the patient has received any services relating to the injuries….” The Navarros’ insurer paid Gipson to settle her claim but did not satisfy the lien, and Gipson failed to pay Premier for its services. Premier sued the Navarros to enforce the lien. The trial court dismissed the complaint because the lien was recorded more than thirty days after Premier first provided services to Gipson. Premier appealed, arguing that section 33-932() allowed it to perfect with lien within thirty days after services were last provided. The court of appeals agreed with Premier and reversed. The Supreme Court vacated the court of appeals’ opinion and affirmed the trial court’s dismissal of the complaint, holding that section 33-932(A) requires non-hospital providers to record liens before services are first provided or within thirty days thereafter. View "Premier Physicians Group, PLLC v. Navarro" on Justia Law

Posted in: Health Law

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Medicare Part C, 42 U.S.C. 1395w-21 et seq., permits enrollees to obtain Medicare-covered healthcare services from private healthcare organizations and their third-party contractors. The Employee Retirement Income Security Act (ERISA), 29 U.S.C. 1001 et seq., regulates health plans offered by private employers to employees. At issue is whether continued inpatient treatment by Providers was medically necessary, and therefore compensable, for several MA Plan Members and ERISA Plan Members initially hospitalized for mental health evaluations or treatment. The court held that the administrative appeals process provided under the Medicare Act preempts arbitration of Medicare-related coverage disputes between private healthcare administrators and providers, even though arbitration would otherwise be required by the parties’ contracts and the Federal Arbitration Act (FAA), 9 U.S.C. 1 et seq. In this case, Providers’ coverage claims are inextricably intertwined with claims for Medicare benefits, and they therefore are subject to the Medicare Act. The Act provides mandatory administrative review procedures for these disputes, which preempt arbitration. The court concluded, however, that the court of appeals erred by deciding that whether Aurora’s ERISA-related claims are arbitrable depends on whether Aurora has standing to assert this claim. The court of appeals should decide on remand whether this claim is arbitrable without considering the standing issue or whether any valid defenses to the claim exist. Therefore, the court remanded to the court of appeals to decide whether ERISA similarly preempts arbitration of ERISA-related coverage disputes. View "United Behavioral Health v. Maricopa Integrated Health Sys." on Justia Law

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Patients filed suit to set aside accord and satisfaction agreements and to recover the amounts paid to release liens. Hospitals, health care providers who treated patients injured by third parties, were paid by the Patients' insurer, AHCCCS, which had negotiated reduced rates with the Hospitals. The Hospitals then recorded liens against the Patients pursuant to A.R.S. 33-931 and A.R.S. 36-2903.01(G) for the difference between the amount typically charged for their treatment and the reduced amount paid by AHCCCS. In order to receive their personal injury settlements with the third parties, Patients settled with the Hospitals by paying negotiated amounts to release the liens. At issue is the validity of these accord and satisfaction agreements. The court assumed, without deciding, that Arizona’s lien statutes are preempted by federal law. But, because there was a bona fide dispute about the enforceability of these liens when the Patients and Hospitals entered into settlement agreements to achieve lien releases, the agreements were supported by adequate consideration and addressed a proper subject matter. Therefore, the accord and satisfaction agreements are valid. View "Abbott v. Banner Health Network" on Justia Law

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Petitioners were each charged with two counts of driving under the influence (DUI). Count two alleged a violation of Ariz. Rev. Stat. 28-1381(A)(3), which prohibits driving a vehicle while there is cannabis (marijuana) or its metabolite in the defendant’s body. Both petitioners were medical marijuana cardholders. Petitioners were each convicted. At issue on appeal was whether the Arizona Medical Marijuana Act (AMMA) immunizes a medical marijuana cardholder from DUI prosecution under section 28-1381(A)(3). The Supreme Court affirmed Petitioners’ conviction, holding (1) the AMMA does not shield a medical marijuana cardholder from prosecution under section 28-1381(A)(3); but (2) the AMMA does but does afford an affirmative defense for those patients who can show that the marijuana or its metabolite was in a concentration insufficient to cause impairment. View "Dobson v. Hon. Crane McClennen" on Justia Law

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At the time of Petitioner’s arrest, she had a registry identification card allowing her to use medical marijuana in compliance with the Arizona Medical Marijuana Act (AMMA). Petitioner pleaded guilty to three charges, including driving under the influence (DUI). Petitioner signed a plea agreement containing a provision that, as a condition of probation, she would not use marijuana in any form, whether or not she had a medical marijuana card issued by the State. Before sentencing, Petitioner filed a motion to strike the marijuana condition as prohibited by AMMA. The trial court granted the motion and struck the condition. The court of appeals reversed, concluding that the condition was justified in a DUI case. The Supreme Court vacated the court of appeals’ opinion and affirmed in part and reversed in part the trial court’s order, holding (1) the trial court properly rejected the marijuana condition to the extent it prohibited Petitioner from using marijuana in compliance with AMMA during her probation; but (2) the trial court erred by refusing to permit the State to withdraw from the plea agreement after the court rejected the marijuana condition. View "State ex rel. Polk v. Hon. Cele Hancock" on Justia Law

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While Petitioner was serving a prison term, the people passed the Arizona Medical Marijuana Act (AMMA). Petitioner obtained a registry identification card identifying him as a registered qualifying patient under the AMMA so that he might obtain medical marijuana for his chronic pain from a fractured hip. During his probation, Petitioner's probation officer added as a condition of probation that Petitioner “not possess or use marijuana for any reason.” Petitioner asked the superior court to amend his probation conditions to delete the “no marijuana” term. The superior court denied relief. The court of appeals, however, granted relief. The Supreme Court affirmed, holding (1) the immunity AMMA provides to qualified patients does not exclude probationers; (2) any probation term that threatens to revoke probation for medical marijuana use that complies with the terms of AMMA is unenforceable and illegal; (3) AMMA provides immunity for charges of violating Ariz. Rev. Stat. 13-3408(G), which might otherwise subject a person to revocation of probation for marijuana use; and (4) by removing the probation condition at issue in this case, the trial court would not be authorizing a violation of federal law but would be recognizing that the court’s authority to impose probation conditions is limited by statute. View "Reed-Kaliher v. Hon. Wallace R. Hoggatt" on Justia Law

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Two estates filed separate wrongful death actions against two acute care hospitals alleging violations of Arizona’s Adult Protective Services Act (APSA). The trial court granted summary judgment for the hospitals, concluding that APSA does not apply to acute care hospitals. The court of appeals reversed, ruling that the APSA subjects acute care hospitals to potential liability. The Supreme Court vacated the opinion of the court of appeals and remanded, holding that the APSA does apply to acute care hospitals because they provide care to vulnerable adults and are not expressly exempted by the statutory language of Ariz. Rev. Stat. 46-455(B). View "Wyatt v. Vanguard Health Sys., Inc." on Justia Law

Posted in: Health Law