Baker, J.
In 2013, Kimberly Snyder, a critically ill patient in need of a lung transplant, was transported by ambulance from Indiana to Pennsylvania. Along the way, the ambulance crew got lost, and the lengthened trip caused the crew to run out of Kimberly’s sedation medication. She ultimately contracted pneumonia and died a week later.
Her husband, Steve Snyder, as personal representative of her estate (the Estate), filed a lawsuit against St. Joseph Regional Medical Center (SJRMC), Prompt Medical Transportation, Inc. (Prompt), and Humana Insurance Company (Humana), alleging that their respective negligence resulted in Kimberly’s wrongful death. A medical review panel unanimously found that Kimberly’s death was not caused by the actions of SJRMC and Prompt.
The trial court dismissed the Estate’s claims against Humana and granted summary judgment in favor of Prompt and SJRMC. We affirm, finding as follows: (1) the trial court did not err by striking the affidavits of the Estate’s untimely disclosed expert witnesses; (2) there is no genuine issue of material fact with respect to the element of causation; and (3) the Estate’s claims against Humana are preempted by federal law governing Medicare Part C.
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The trial court granted Humana’s motion to dismiss for failure to state a claim under Trial Rule 12(B)(6)…
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If a beneficiary elects to participate in a Part C plan, the government pays the plan’s administrator (here, Humana) a flat monthly fee to provide all Medicare benefits for that beneficiary. Because Part C limits the government’s responsibility to the monthly fee, the private health plan assumes the risk associated with insuring the beneficiary. E.g., In re Avandian Mktg., 685 F.3d 353, 357-58 (3rd Cir. 2012). Part C plans must comply with “national coverage determinations” and “[g]eneral coverage guidelines included in original Medicare manuals and instructions . . . .” 42 C.F.R. § 422.101(b).
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Here, as noted above, Medicare Part C includes an express preemption clause. Consequently, we must focus on the plain wording of that clause. And that wording could not be clearer: “[t]he standards established under [Part C] shall supersede any State law or regulation (other than State licensing laws or State laws relating to plan solvency) with respect to [Medicare Advantage] plans which are offered by [Medicare Advantage] organizations under [Part C].” U.S.C. § 1395w-26(b)(3) (emphasis added). Adding even more clarity to that language is the previous version of the statute, which was far narrower regarding what state laws were preempted by Part C. The current version of the statute clearly shows that Congress intended to preempt a broad swath of state laws and regulations with Part C.
As a result, state standards are preempted when they implicate “conduct that was governed by federal Medicare standards.” Haaland v. Presbyterian Health Plan, Inc., 292 F. Supp. 3d 1222, 1231 (D.N.M. 2018). Put another way, “as long as a federal standard exists regarding the conduct at issue,” state law must yield. Morrison v. Health Plan of Nev., 328 P.3d 1165, 1169 (Nev. 2014). Multiple courts have found that the broad language of the Part C preemption provision extends to claims that are grounded in state common law. See, e.g., Uhm v. Humana, Inc., 620 F.3d 1134, 1156 (9th Cir. 2010) (concluding that some state common law claims fall under Part C’s preemption clause); Haaland, 292 F. Supp. 3d at 1230-31 (finding that negligence claims were preempted); Morrison, 328 P.3d at 1171-72 (same). [Footnote omitted.]
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Consequently, to decide whether air transportation was required in Kimberly’s case, Humana had to conduct a case-specific inquiry to determine whether air transportation was medically necessary—in other words, whether ground transportation would have endangered her health. Id. The Estate argues that the result reached by Humana—that ground transportation was not contraindicated—was negligent under Indiana law. But to resolve this argument, a court would have to apply a state law standard of care to a coverage determination governed by federal law. Indeed, if allowed to stand, the Estate’s complaint could theoretically allow Humana to be found negligent even if it fully complied with all federal laws and regulations. Under these circumstances, we can only conclude that the Estate’s claims, which sound in state law that must be applied with respect to Medicare Part C, are preempted pursuant to Part C’s express preemption provision. [Footnote omitted.] Therefore, the trial court did not err by granting Humana’s motion to dismiss. [Footnote omitted.]
The judgment of the trial court is affirmed.
Najam, J., and Robb, J., concur.