Concilio De Salud Integral De Loíza, Inc. (CSILO) v. Perez-Perdomo
2010 U.S. App. LEXIS 22116
| 1st Cir. | 2010Background
- Puerto Rico participates in Medicaid as a state and FQHCs like Loíza and Belaval are eligible for PPS reimbursements.
- PPS requires reimbursement of FQHC costs for Medicaid visits, with wraparound payments when MCOs pay less than PPS amount.
- The district court issued emergency and ongoing injunctions in 2004–2007 mandating wraparound payments using a specific baseline formula.
- Beginning March 27, 2007 and July 3, 2007 the district court vacated the preliminary injunctions but continued to enjoin ongoing wraparound payments under the baseline formula.
- During the gap period (post-vacatur to before our December 2008 Belaval IV ruling) the district court’s status was unclear; the First Circuit later held the wraparound obligation continued.
- Loíza and Belaval challenged the district court’s May 12, 2009 ruling that no wraparound payments were mandatory during the gap; they appealed addressing jurisdiction and merits.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the district court's vacating of the injunctions ended the wraparound payment obligation | Loíza/Belaval contend the obligations continued. | Secretary argues vacatur nullified the obligation. | The obligation continued; remand for amount disputes. |
| Whether the Eleventh Amendment barred retrospective wraparound payments for the gap period | Past-due payments are required by court orders. | Eleventh Amendment bars retroactive relief. | Eleventh Amendment objection fails as to permanent-injunction payments; remand for amounts. |
| Whether the court has jurisdiction to review the district court's denial of wraparound payments on an interlocutory basis | Order modified/injunction-related, thus appealable. | No final judgment; troubling jurisdictional scope. | Jurisdiction proper under 28 U.S.C. § 1292(a)(1); interlocutory review allowed. |
| What the Belaval IV mandate implies for the gap-period payments and remand scope | Gap-period payments must be calculated under continued court formula. | Belaval IV undermined any retroactive payments during gap. | Belaval IV clarifies continued obligation; disputes about amounts/formula remanded. |
Key Cases Cited
- Concilio de Salud Integral de Loíza, Inc. v. Pérez-Perdomo, 551 F.3d 10 (1st Cir. 2008) (Belaval IV; clarifies wraparound obligations during gap period)
- Dr. José S. Belaval, Inc. v. Pérez-Perdomo, 488 F.3d 11 (1st Cir. 2007) (Belaval III; confirms live disputes about calculation)
- Dr. José S. Belaval, Inc. v. Pérez-Perdomo, 465 F.3d 33 (1st Cir. 2006) (Belaval II; addresses PPS and wraparound framework)
- Dr. José S. Belaval, Inc. v. Pérez-Perdomo, 397 F.3d 56 (1st Cir. 2005) (Belaval I; initial PPS wraparound ruling)
- Edelman v. Jordan, 415 U.S. 651 (Supreme Court 1974) (federal courts generally cannot order retroactive payments to cure past violations)
- Khadr v. United States, 529 F.3d 1112 (D.C. Cir. 2008) (reversal can render injunctions null for certain periods but context matters)
- Frew ex rel. Frew v. Hawkins, 540 U.S. 431 (Supreme Court 2004) (principles about injunctive relief and remedies)
- Hutto v. Finney, 437 U.S. 678 (Supreme Court 1978) (limits on retroactive relief and remedial orders)
- United Mtn. Workers of Am. v. United States, 330 U.S. 258 (Supreme Court 1947) (contempt and effect of modified injunctions)
- Carson v. American Brands, Inc., 450 U.S. 79 (Supreme Court 1981) (modification of injunctions and irreparable harms)
- Daubert v. Percy, 713 F.2d 328 (7th Cir. 1983) (contextual considerations on injunctive relief and evidence)