172896P.pdf   08/20/2018  Children's Health Care  v.  Centers for Medicare
   U.S. Court of Appeals Case No:  17-2896
   U.S. District Court for the District of Minnesota - Minneapolis   
   [PUBLISHED] [Wollman, Author, with Arnold and Kelly. Circuit Judges] 
   Civil Case - Administrative Procedure Act. Hospitals which receive 
   Disproportionate Share Hospital payments, challenged the Secretary's 
   Question 33 in 42 C.F.R. sec. 447.299, which included private insurance 
   payments when calculating "uncompensated care costs," as an unauthorized 
   legislative rule subject to notice and comment procedures. Whether 
   Question 33 is a legislative rule or an interpretive rule is subject to de 
   novo review. We join the First and Fourth Circuit Courts of Appeals in 
   concluding Question 33 is a legislative rule subject to notice and comment 
   procedures, not an interpretive rule, as the imposition of new reporting 
   requirements for private insurance payments expanded the rule and 
   constituted a substantive change in the regulation. Thus, we affirm the 
   district court's determination that the Secretary was without authority to 
   adopt the rule as an interpretive rule.