Emergency Med. Care Facilities, P.C. v. BlueCross BlueShield of Tenn., Inc. — Jan. 2017 (Summary)

EMTALA

Emergency Med. Care Facilities, P.C. v. BlueCross BlueShield of Tenn., Inc.
No. 15-1014 (W.D. Tenn. Jan. 19, 2017)

The United States District Court for the Western District of Tennessee refused to accept federal jurisdiction over a lawsuit brought by a provider of emergency care services (hospital emergency department screenings and treatment) against a Medicaid MCO, challenging the MCO’s unilateral decision to limit payments for emergency medical screenings performed in hospital emergency departments to $50 whenever the visit is afterwards determined to be non-emergent.

The MCO claimed that since the limit on payment was dictated by the state of Tennessee’s Medicaid managed care system, it was a directive from the state and had the force of law and, in turn, was automatically incorporated into the parties’ contractual agreement.  The provider of emergency care services disagreed that the payment cap had the force of law and instead argued that the MCO breached the contract by unilaterally implementing the payment change.  But, in the alternative, the emergency care provider claimed that if the cap on payment implemented by the MCO did have the force of law, then it was contrary to state law defining “emergency medical condition,” as well as the federal Emergency Medical Treatment and Active Labor Act (“EMTALA”).  In response to this argument, the MCO issued a notice to remove the lawsuit from state to federal court, on the basis that the arguments made by the provider of emergency care services referred to federal law and, in turn, presented federal questions.

The federal court declined jurisdiction.  Among other things, the court held that simply because the contract between the MCO and the provider of emergency care services required the provider to abide by EMTALA did not mean that federal question jurisdiction exists.  Accordingly, it remanded the case to state court for further proceedings.