The Pennsylvania Supreme Court upheld DHS’s nursing-facility inflation methodology while clarifying how state courts evaluate an agency’s reading of its own ambiguous regulation.
The Third Department confirms OMIG’s recoupment of 51,000 in Medicaid payments from a wheelchair provider that failed to obtain original wet-signed practitioner orders, holding the documentation guidelines were interpretive statements not requiring SAPA rulemaking.
The Texas Fifteenth Court of Appeals held that a Medicaid pharmacy has no vested right to individualized notice of Provider Manual changes, that its pre-enforcement due process and declaratory judgment claims were barred by sovereign immunity, and that dismissal with prejudice was proper after the pharmacy amended its pleadings but still failed to state a cognizable claim.