Second Circuit – Administrative Procedure Act: Safe Haven Home Care Inc. v. U.S. Dept. of Health and Human Services

United States Court of Appeals for the Second Circuit

Administrative Procedure Act — Pre-approval and actuarial soundness

Safe Haven Home Care Inc. v. U.S. Dept. of Health and Human Services

23-1231

Judges Lynch, Perez, and Merriam

Background: At issue on appeal is the defendant’s approval of an application from New York’s Department of Health to pay $361.25 million to managed care organization which assisted the state in administering its Medicaid system. The plaintiffs, licensed home care services agencies who did not satisfy the revenue threshold for eligibility to receive this funding, argue that the approval of the application was unlawful because the class of eligible licensed home care services agencies was improperly defined, and the application was not assessed for actuarial soundness before pre-approval was granted.

Ruling: The Second Circuit affirmed. The court held that summary judgment was proper as the state’s application did not violate the Administrative Procedure Act as neither federal regulations or statutory law require the assessment of actuarial soundness. Furthermore, the district court properly denied the plaintiff’s motion for admission of extra-record evidence.

Derek Adams, of Potomac Law Group, for the plaintiffs-appellants; Mollie Kornreich, assistant United States attorney, and Blair J. Greenwald, of the NYS Office of the attorney general, for the defendants-appellees.

Oral argument audio