ALLINA HEALTH SERVICES v. Sebelius
756 F. Supp. 2d 61
D.D.C.2010Background
- Hospitals challenge CMS's calculation of DSH payments under Part A with SSI fraction including Part C days.
- SSI fraction defined as days entitled to Part A and SSI benefits; Part C days were added starting FY 2007.
- Part C enrollees’ interaction with Medicare Advantage plans creates disputes over payments to hospitals.
- Hospitals seek preliminary injunction to prevent use of the Part C-inclusive SSI fraction; Secretary seeks stay pending Northeast decision.
- Court stays case pending D.C. Circuit ruling in Northeast Hospital Corp. v. Sebelius; denial of preliminary injunction without prejudice.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Likelihood of success on the merits | Hospitals will likely prevail on law. | Northeast decision controls; not ripe yet. | Not granted; stay pending circuit decision. |
| Irreparable harm | Inclusion of Part C days causes irreparable loss of payments. | Economic harm is not irreparable; speculative remedies. | Not shown irreparable harm; remains speculative. |
| Balance of equities | Injunction would prevent harm to hospitals serving low-income patients. | Equities weigh against disrupting DSH payments and third-party plans. | Weighs against injunction. |
| Public interest | Compliance with law and DSH purpose serve public interest. | Uniform, predictable administration supports public interest. | Public interest favors denying injunction; stay. |
| Secretary's motion to stay | Northeast decision will not moot immediate relief. | Await circuit decision to resolve controlling issue. | Stay granted pending Northeast decision. |
Key Cases Cited
- Winter v. NRDC, Inc., 555 U.S. 7 (U.S. 2008) (preliminary injunction standards and sliding scale approach)
- IBT/HERE Employee Representatives' Council v. Gate Gourmet Div. Am., 402 F. Supp. 2d 289 (D.D.C. 2005) (stay decisions and efficiency of docket management)
- Leyva v. Certified Grocers of Cal., Ltd., 593 F.2d 857 (9th Cir. 1979) (stay rationale and balancing harms)
- Amoco Prod. Co. v. Village of Gambell, 480 U.S. 531 (U.S. 1987) (equitable relief requires balancing harms and public interest)
- Virginia Petroleum Jobbers Ass'n v. Federal Power Comm., 259 F.2d 921 (D.C. Cir. 1958) (irreparable injury and equity considerations in stay)
- Romero-Barcelo v. Brown, 456 U.S. 313 (U.S. 1982) (public-interest and administrative restraint in injunctions)
- University of Texas v. Camenisch, 451 U.S. 390 (U.S. 1981) (injunctions’ preservation of status quo; irreparable harm framework)