Raybin & Weissman

Applicability of Uniform Administrative Procedures Act

CaseThe Chattanooga-Hamilton County Hospital Authority D/B/A Erlanger Health System v. United Healthcare Plan of The River Valley, Inc. D/B/A Americhoice and Tennessee Attorney General

Issue:  Did Hospital challenge the applicability of TennCare regulations so as to divest the trial court of jurisdiction under the UAPA?

Facts:  Hospital filed an action against TennCare managed care organization (“MCO”) for breach of contract and unjust enrichment when MCO refused to pay Hospital’s standard charges for emergency services and follow-up care.  Hospital was not part of MCO’s “provider network”

under the TennCare regulations and therefore was a “non-contract” provider.  MCO alleged Hospital was required to accept as payment the rate TennCare specified in its regulations. MCO filed motion for summary judgment, and the trial court dismissed the portion of the complaint to which the TennCare regulations may apply due to lack of subject matter jurisdiction.  The trial court determined the Uniform Administrative Procedures Act (“UAPA”) divested it of jurisdiction because Hospital did not first seek a declaratory order from the Bureau of TennCare regarding the applicability of its regulations to Hospital’s dispute with MCO.

Appellate Decision:  On Hospital’s appeal of the dismissal of its claims, the intermediate court reversed, finding that because Hospital was not challenging applicability or validity of TennCare regulations, UAPA did not divest the trial court of jurisdiction.

Review Granted:  October 23, 2014.

Prediction:  David believes that the Court will reverse finding that Hospital was, in fact, challenging the applicability and validity of TennCare regulations to specified circumstances and therefore, the trial court was divested of jurisdiction as a result of Hospital’s failure to first seek a declaratory order from the Bureau of TennCare.