Nossaman Scores Landmark Medi-Cal Victory
In a landmark decision, Nossaman received the final decision in its client’s favor in the longest-running Medi-Cal appeal ever, Sutter Medical Center Sacramento (SMCS) v. Maxwell-Jolly. The case began in August 2002 and the Department issued its final decision in September 2010.
The SMCS decision is of major significance to all California hospitals having Neonatal Intensive Care Units (NICUs) because it distinguishes two significant courts of appeal decisions that had severely limited Medi-Cal reimbursement for the advanced services provided in sophisticated NICUs.
The two decisions, known as Sierra Vista and Kern County, held Medi-Cal did not have to provide the special NICU rate when nurse-staffing ratios were greater than one nurse to two patients (1:1-2). Arguing on behalf of Sutter Medical Center Sacramento, Nossaman demonstrated the SMCS NICU had met requirements entitling it to reimbursement for the special NICU rate for NICU days when the staffing ratio was at one nurse to three or four patients (1:3-4) as well.
Approximately 70 percent of most NICUs days are at the 1:3-4 staffing ratio. As a result, all California hospitals having sophisticated NICUs will benefit from this major clarification of the law.
During the litigation, Nossaman had to overcome numerous hurdles and had to appeal to the Superior Court twice in order to receive a fair hearing. Nossaman even proved that, prior to this litigation, the Department's policy was precisely the same as the legal position Nossaman argued. The Department attempted to hide that policy, and the related "smoking gun" evidence, in order to deny SMCS's appeal. Nossaman's victory amounted to a ringing declaration that the Government cannot disregard its own policies and [like everyone else,] must follow the law.
More information about this landmark victory can be found on the Nossaman website.
