VICTORY! Legal decision in CDPAANYS, et al v McDonald
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Posted: March 20, 2025 |
We have news!!! In the case in Albany County Supreme Court, CDPAANYS, et al. v McDonald, relating to the change in reimbursement methodology via imposition of cuts to managed care plans and payment of administrative fees via a pass-through of the per member, per month methodology, we have won.
While this is somewhat bittersweet as of this time, it is significant. The judge in the case steadfastly rejected the Department’s claims that they were not imposing any new rules and that their directive was completely legal in relation to the contract they maintain with the plans. Indeed, Judge Joyce said, “In doing so, DOH was not exercising its discretion but instead adopted a “rigid quasi-legislative norm” by imposing a non-negotiable contractual term on all FIs contracting with MMCPs. Respondents have not demonstrated that any exception to the State Administrative Procedure Act applies.”
The decision is notably retroactive to the date that the contractual provisions took effect; however, reimbursement will not be completely clear cut. The decision voids the Department’s directive to plans and voids any contractual changes that took place outside of the 30 day notice period and/or cited DOH directives as a reason. However, FIs will need to work with plans to determine how reimbursement is distributed. Plans may wait for guidance or directives from the Department, and to determine whether or not the Department is going to appeal. Notably, any changes the plan wishes to make would not be applicable until 30 days from now, as there is no longer a state directive that would provide cover for them to behave differently.