{
  "id": "R41923",
  "type": "CRS Report",
  "typeId": "REPORTS",
  "number": "R41923",
  "active": false,
  "source": "EveryCRSReport.com",
  "versions": [
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      "source": "EveryCRSReport.com",
      "id": 389552,
      "date": "2011-07-18",
      "retrieved": "2016-04-07T00:42:26.016185",
      "title": "Medicaid Reimbursement Rate Litigation: An Overview of Douglas v. Independent Living Center of Southern California ",
      "summary": "Given declining state revenues and increased demand for public programs like Medicaid, states have been faced with difficult choices about how to allocate limited funds. To address budget shortfalls, many states have sought to shrink their Medicaid costs in various ways, including reducing the rates at which health care providers are reimbursed for the services they provide to Medicaid beneficiaries. In several instances, providers and others have argued that the reduced rates do not comply with federal Medicaid requirements and have turned to the courts to challenge these reductions. \nWhen challenging these reimbursement rates, Medicaid providers have often claimed that the rates violate the requirements of Section 1902(a)(30)(A) of the Social Security Act, commonly referred to as Medicaid\u2019s \u201cequal access provision.\u201d This provision compels state Medicaid programs to assure that Medicaid payments \u201care consistent with efficiency, economy, and quality of care,\u201d and are \u201csufficient to enlist enough providers\u201d so that care and services are available at least to the extent that they are available to an area\u2019s general population. Based on this provision, Medicare providers have argued that because of cuts in reimbursement rates, the state Medicaid program does not provide the level of care or services to beneficiaries that is required under federal law. \nHowever, an important question arises in these cases: whether Medicaid beneficiaries and health care providers can sue state officials to enforce the equal access provision. Because the Medicaid Act contains no express language that allows private parties to challenge reimbursement rate cuts, plaintiffs desiring to challenge cuts in Medicaid payment rates under the equal access provision have sought out other legal vehicles to bring their claims. Since 2002, courts have often barred these suits when based on \u201csection 1983.\u201d But on January 18, 2011, the Supreme Court granted certiorari in Douglas v. Independent Living Center of California, a set of consolidated cases in which plaintiffs took a different approach to challenging provider reimbursement rates. In Douglas, health care providers and Medicaid beneficiaries challenged cutbacks in reimbursement rates for certain health care providers, arguing that since the reduced reimbursement rates do not comply with Medicaid\u2019s equal access provision, they are preempted under the Supremacy Clause of the Constitution. The Ninth Circuit agreed, and blocked implementation of the reduced rates, explaining that the Supremacy Clause provides a basis for challenging a state\u2019s purported failure to abide by Medicaid\u2019s equal access provision. \nSome commentators have noted that the Court\u2019s decision in Douglas may be significant, as the case could determine whether the Supremacy Clause provides a basis for judicial review of various issues related to a state\u2019s Medicaid program\u2014issues that may have been immune from review because, for example, there appeared to be no private right of action. It has also been observed that the possible implications of Douglas go beyond the Medicaid program, as the Supreme Court\u2019s decision could determine whether a private party may bring a preemption challenge with respect to federal statutes that these parties could not otherwise enforce. This report provides relevant background on the Medicaid program and an overview of the Douglas case. \nIn addition, it may be noted that the Centers for Medicare and Medicaid Services (CMS) recently issued proposed regulations that address the equal access provision. Although proposed regulations do not address whether a private party may bring an enforcement action under the equal access provision, the regulations do provide guidance on how states can comply with it.",
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      "typeId": "REPORTS",
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