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Planned Parenthood of New York City Inc. v. State

Decided: January 20, 1976.

PLANNED PARENTHOOD OF NEW YORK CITY, INC., A NON-PROFIT CORPORATION OF THE STATE OF NEW YORK, PLAINTIFF-APPELLANT,
v.
STATE OF NEW JERSEY, DEPARTMENT OF INSTITUTIONS AND AGENCIES, DIVISION OF MEDICAL ASSISTANCE AND HEALTH SERVICES, ET AL, DEFENDANTS-RESPONDENTS



Kolovsky, Bischoff and Botter. The opinion of the court was delivered by Bischoff, J.A.D.

Bischoff

Appellant Planned Parenthood of New York City, submitted a claim to the New Jersey Department of Institutions and Agencies, Division of Medical Assistance and Health Services, seeking reimbursement for abortions performed on New Jersey residents at its clinic in New York City. Following a hearing before a hearing officer the Director of the Division filed a decision denying the application.

A supplemental hearing was held and the Director filed a supplemental decision again denying plaintiff's application. This appeal followed.

Planned Parenthood is a nonprofit corporation of the State of New York. It operates medical clinics in New York City devoted to family planning and fertility services, provides pregnancy termination services and is licensed in New York to perform these services.

On June 5, 1972 plaintiff was accepted as an authorized provider of medical services by the New Jersey Medicaid Program, which indicated that it was eligible, as an out-of-state clinic, to provide health care services for New Jersey residents and receive reimbursement under the New Jersey Medicaid Program.

Plaintiff originally sought reimbursement for services rendered in performing 68 abortions performed on New Jersey residents between January 1972 and December 1972. (Three of the claims were for abortions performed prior to the date when plaintiff was approved as a provider for medical services under the New Jersey Medicaid Program and have been abandoned.)

The claims were denied by the Director of the Division because:

(1) no prior authorization to furnish the services had been sought, as required by the then existing regulations of the Medicaid Program, and

(2) the abortions would have been illegal if performed in New Jersey and, therefore, were not reimburseable under Medicaid guidelines.

The scope of plaintiff's claim was expanded to include 485 additional claims for abortions performed prior to January 22, 1973. Following a supplemental hearing, all 550 claims were denied. While 443 of the claims were found to be exempt from the rule requiring prior authorization, all 550 abortions would have been illegal if performed in New Jersey and, therefore, plaintiff's claims were held not to be reimburseable.

Plaintiff attacks, on multiple grounds, the New Jersey regulations requiring prior approval for the services to be reimburseable and the Director's interpretation of these regulations.

We find it unnecessary to thread our way through the maze of federal and state statutes and regulations existing in this field, for we rest our decision on a different ground and proceed to a ...


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