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Amicus curiae brief filed in nursing home reimbursement case.

The American Association of Homes for the Aging (AAHA) has filed an amicus curiae (friend of the court) brief in a New Jersey Medicaid case that could set a national precedent for nursing home reimbursement.

The New Jersey Hospital Association, the American Health Care Association, and the Catholic Health Association of the United States have joined AAHA in filing the brief in a case brought by the New Jersey Association of Nonprofit Homes for the Aging, the New Jersey Association of Health Care Facilities, and four individual nursing homes against the State's department of human services. The appeal will be heard by the 3rd U.S. Circuit Court of Appeals.

"AAHA entered this suit to help the court understand that the New Jersey opinion, if it stands, could gut providers' last meaningful way of getting sufficient and timely rates for Medicaid residents," said Sheldon L. Goldberg, president of AAHA. "We were delighted that the other groups have joined together with us to make this point with the court."

The plaintiffs believe New Jersey has failed to provide Medicaid reimbursement rates that are reasonable and adequate for economically and efficiently operated facilities, as required by the Federal Boren amendment. In its defense, the State argued that 86 percent of providers' total allowable costs were being paid by the Medicaid program. However, providers maintained that only 10 percent of facilities statewide were reimbursed for their full allowable costs. AAHA and the other associations filed the brief because the associations believe that the district court judge disregarded existing Federal court precedents for what constitutes reasonable and adequate rates for nursing home reimbursement.

In 1990, the Boren amendment was modified to include a provision that a State's allowable nursing facility costs had to include " ... the costs of services required to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident eligible for benefits." The associations were disturbed that the district court judge ruled the "highest practicable level" language was part of a budget reconciliation package intended to cut Federal Medicaid costs; therefore, the judge ruled, it could not have been intended to increase Medicaid rates.

If the court of appeals upholds the district court ruling that New Jersey's Medicaid reimbursement methodology is within a "range of reasonableness," the case could set a new national standard for adequacy of reimbursement under the Medicaid program and have grave implications for quality of care for all nursing home residents, according to AAHA.
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Publication:Health Care Financing Review
Date:Jun 22, 1993
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