NEW YORK CITY HEALTH AND HOSPITALS CORPORATION, ET AL., APPELLANTS, v. MARY
JO BANE, AS COMMISSIONER OF SOCIAL SERVICES OF THE STATE OF NEW YORK,
RESPONDENT.
MEDICAL SOCIETY OF THE STATE OF NEW YORK, ET AL., APPELLANTS, v. MARY JO
BANE, AS COMMISSIONER OF SOCIAL SERVICES OF THE STATE OF NEW YORK,
RESPONDENT.
87 N.Y.2d 399, 663 N.E.2d 297, 639 N.Y.S.2d 985
December 21, 1995
1 No. 314(1995 NY Int. 295)
Decided December 21, 1995
_________________________________________________________________
This opinion is uncorrected and subject to revision before publication
in the New York Reports.
Peter F. Nadel, for Appellants NYCH&HC, et al.
Jay G. Safer, for Appellants Medical Society, et al.
Robert A. Forte, for Respondent.
CIPARICK, J.:
Plaintiffs, Medicare and Medicaid services providers, obtained a
Federal court judgment declaring invalid a regulation adopted by
defendant Commissioner of the Department of Social Services which
limited defendant's responsibility for coinsurance payments incurred
in connection with Medicare Part B services rendered to certain
"dually eligible" elderly and poor patients. After the declaration of
invalidity, plaintiffs submitted coinsurance claims for services
rendered during the period when the invalidated regulation was in
effect. Defendant refused to pay these claims. We must decide whether
plaintiffs' first cause of action challenging defendant's refusal to
pay their coinsurance claims is time-barred.
Medicare is a federally funded and administered medical insurance plan
for persons 65 years of age or older and certain disabled individuals
(42 USC §§ 1395-1395ccc). Medicare consists of two components, Parts A
and B. Part A is an inpatient hospital insurance plan that pays 100%
of reasonable inpatient costs (see 42 USC §§ 1395c-1395i-4). Part B is
a supplementary insurance plan that pays 80% of reasonable costs for
other services not covered by Part A, including physician and hospital
out-patient services (see 42 USC §§ 1395j-1395w-4(j)). Enrollees in
Part B pay an annual deductible and the remaining coinsurance fee of
20% of the reasonable costs or charges for services rendered.
SNIPPETS:
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION, ET AL., APPELLANTS, v. MARY
JO BANE, AS COMMISSIONER OF SOCIAL SERVICES OF THE STATE OF NEW YORK, RESPONDENT.
Plaintiffs, Medicare and Medicaid services providers, obtained a Federal court judgment
We must decide whether plaintiffs' first cause of action challenging defendant's refusal to
Part B is a supplementary insurance plan that pays 80% of reasonable costs for other services
Medicaid is a joint federal and state funded system which subsidizes medical care for the
Health care providers who treat Medicaid patients must accept the scheduled rate as payment
Because the reasonable Medicare charge for a particular service was almost always more than
plaintiffs New York City Health and Hospitals Corporation and Medical Society of the State of
The District Court granted defendants' motion for summary judgment dismissing the complaint.
Corp. v Perales, 954 F2d 854, cert denied 113 S Ct 461).
The Court of Appeals held that the crossover payment limitations violated the Medicare and
On August 13, 1992, shortly before commencement of Perales II, plaintiffs HHC and certain
The court concluded that because plaintiffs' claim for declaratory relief was based on the
the court concluded that the billing regulation's 90-day limitation period could not be used
Corp. v McBarnette, the court concluded that even if plaintiffs were correct in their
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