# United States Court of Appeals

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued May 16, 2005 Decided July 13, 2005

No. 04-5366

H EARTLAND R

EGIONAL M EDICAL C ENTER

, F / K / A H EARTLAND

H OSPITAL

, A PPELLANT

v.

M ICHAEL O. L

EAVITT

, IN HIS OFFICIAL CAPACITY AS

S ECRETARY OF H

EALTH AND H

UMAN S ERVICES

, A PPELLEE

Appeal from the United States District Court

for the District of Columbia

(No. 95cv00951)

Donald B. Verrilli, Jr. argued the cause for appellant. With

him on the briefs were Michael B. DeSanctis

, Eli zabeth G.

Porter

, Christopher L. Cr osswhite, a nd David H. Robbins

. Michael F. Ruggio entered an appearance.

Christine N. Kohl

, Attorn ey, U.S. Department of Justice,

argued the cause for appellee. With her on the brief were P eter

D. Keisler

, Assistant Attorney Genera l, K enneth L. Wainstein

, U.S. Attorney, and Barbara C. Biddle , Assistant Director.2

Befo re: S E

NTELLE

, R

ANDOLPH

, and G

ARLAND

, Circuit

Judges

.

Opinion for the Court filed by Circuit Judge G ARLAND

.

G ARLAND

, Circuit Judge :

Heartland Hospital appeals from

the district court’s denial of its motion to enforce a judgment

that it obtained in 1 998. The district court rested its decision on

the ground that the judgment did n ot require the remedy

Heartland se eks -- a direction that it is entitled to “sole

community hospital” status under the Medicare statute and to

reimbursement in accordance with such status. We agree with

the district court and affirm the denial of the hospital’s moti o n.

I

The federal Medicare program reimburses hospita ls for the

cost of medical care for older persons and other eligible

individuals. Medicare operates according to a prospective

paymen t system (PPS), under which hospitals are paid a fixed

rate based on a patient’s diagnosis. 42 U.S.C. § 1395ww(d). A

hospital is exempt from PPS

-- and therefore eligible f or higher

payments based on its historic costs

-- if it qua lifies as a “sole

commun ity hospital” (SCH). I

d. § 1395ww(d)(5)(D)(i). At the

relevant time, the Medi

care statute defined an SCH as any

hospital:

(I) that

[the Department of Health and Human

Services (HHS)] determines is located more than 35

road miles from another hospital, [or]3

1 A h ospital also qualified as an SCH if it was “designated by

[HHS] a s an essential access community hospital.” 42 U.S.C. §

1395ww(d)(5)(D)(iii)(III) (1992). That provision is not at issue in this

case.

2 In 1999, Congress amended the Medicare statute to provide that

an urban hospital that “would [otherwise] qualify

. . . as a sole

community hospital” shall be treated as “being located in [a] rural

area” for purposes of determining SCH status. 42 U.S.C. §

1395ww(d)(8)(E). Based on the new provision, Heartland received

SCH status as of January 1, 2000. This appeal therefore concerns

Heartland’s status only from 1992 through 1999.

(II) that, by reason of factors such as the time

re q uired for an individual to travel to the nearest

alternative source of appr opriate inpatient care . . . ,

location, weather conditions, travel co nditions, or

absence of other like hospitals

. . . , is the sole source

of inpatient hospital services reasonably ava ilable to

individuals in a geographic area.

42 U.S.C. § 1395ww(d)(5)(D)(iii) (1992). 1

The Medicare statute

directed HHS to “promulgate a

standard for determ

ining whether a hospital meets the criteria

f or classification as a sole community hospital under” clause ( II)

of the above definition. Id. § 1395ww(d)(5)(D)(iv). Under the

regulations promulgated pursuant to that direction, and in effect

during t h e relevant period, a hospital qualified as an SCH under

claus e (II) only if it was “located in a rural area” and met other

listed criteria. 42 C.F.R. § 412.92(a) (1992). Thus, under the

regulations, a hospital located fewer than 35 miles from another

hospital

-- and thus ineligible under clause (I) -- could not obtain

SCH status unless it was located in a rural area. I d. 2 HHS4

3 At the time, an MSA was defined as “either a city with a

population of at least 50,000, or a Bureau of the Census urbanized area

of at least 50,000 and a total metropolitan statistical area population

of at least 100,000.”

Notice of Final Standards for Establishing

Metropolitan Statistical Areas Following the 1980 Census, 45 Fed.

Reg. 956, 956 (Dep’t of Commerce Jan. 3, 1980).

4 To obtain SCH status, a hospital must first apply to its Medicare

fiscal intermediary. 42 C.F.R. § 412.92(b)(1)(i). The intermediary

then forwards the application and its recommendation to the

approp riate regional office of the Health Care Financing

Administration (HCFA), s ee infra note 5, which decides whether to

grant the ap plication. I d. § 412.92(b)(1)(iv), (v). The hospital may

appeal HCFA’s decision to the Provider Reimbursement Review

Board, 42 U.S.C. § 1395 oo (a), and ul timately to a federal district

court, id. § 1395 oo (f). ju s tified this “rural location requirement” on the ground that

“urban areas g

enerally have better roads, faster snow-clearing,

and the choice of more available hospital s.” Medicare

Geogra phic Classification Review Board, Procedures and

Criteria, Final Rule, 56 Fed. Reg. 25,458, 25,483 (June 4, 1991).

For purposes of SCH eligibility, a “rural area” was defined as

“any area outside an urban area,” and an “urban area” was

defined as a “Metropolitan Statistical Area (MSA)

. . . as defined

by the Executive Office of Management and Budget.” 42 C.F.R.

§ 412.62(f)(ii), (iii) (1992). 3

Heartland Hospital, located in the city of St . Joseph,

Missouri, is an a cute-care facility situated fewer than 35 miles

from other hospitals. In May 1992, Heartland submitted an

a pplication for SCH status to its Medicare fiscal intermediary,

Mutual of Omaha, in accordance with HHS regulations. 4 The

intermediary rec ommended that the Health Care Financing5

5 In 2002, HHS changed HCFA’s name to the “Centers for

Medicare & Medi

caid Services.” S ee Centers for Medicare and

Medicaid Services, Statement of Organization, Fu n ctions and

Dele gations of Authority, Reorganization Order, 66 Fed. Reg. 35,437

(July 5, 2001). We use “HCFA” throughout this opinion for

consistency with the prior proceedings. Administration (HCFA), 5 an HHS component, deny the

application based on

Heartland’s location. HCFA did so on the

ground that, because Heartland was “located in an urb an area

and the closest like hospital [was] f ewer than 35 miles away,” it

was ineligible under the rural location requirement. Letter from

Edward M. Brennan, HHS, to Richard G. Bath, Mutual of

Omaha (Jan. 22, 1993).

Heartland ap pealed HCFA’s decision to HHS’s Provider

Reimbursement Review Board (PR RB), seeking expedited

judicial review of the denial of SCH status pursuant to 42 U.S.C.

§ 1395 o o (f)(1). Under that provision, a hospital is entitled to

expedited judicial review o f any determination that “involves a

question of law or regulations relevant to the ma tters in

controversy” that the Board “is wi thout authority to decide.” 42

U.S.C. § 1395 oo (f)(1). Because Heartland’s appeal challenged

the validity of the regulatory requirement that a hospital si tuated

w ithin 35 miles of another hospital be located in a rura l area,

and thereby raised “a qu

estion of law or regulations” that the

PRRB lacked authority to decide, the PRRB granted Hear tland’s

request. Letter from Irvin Kues, HHS, to Christopher L.

Crosswhite, Vinson & Elkins (Mar. 29, 1995).

Heartl and then filed suit in the United States District Court

for the District of Columbia, challenging the validity of the rural

location requirement on a number of grounds. The case was6

6 Judge Greene noted two alternatives to MSAs that had b een

suggested in comments durin g the 1983 rulemaking: “urbanized

areas,” as the term is used by the Census Bureau; and “health facility

p lanning areas,” as described in the National Health Planning and

Resources Development Act of 1974, Pub. L. No. 93-641, § 3, 88 Stat.

2225, 2229 (1975). assigned to the late Ju

dge Harold Greene, who held that the

requirement was consistent w ith the Medicare statute and that

HHS had established a rat ional basis for adopting it. H eartland

Hospital v. Shalala (

Heartland I

), No. 95-951, slip op. at 15, 19

(D.D.C. June 15, 1998). But the court also found that HHS had

failed to consider reasonable alternatives proposed by

commenters when it chose an MSA-based definition of “urban

area.” 6 “The failure of the Secretary to respond to reasonable

alternative[s]” to MSAs “as the relevant measure of an urban

area,” the court held, “renders the adoption of the regulations

arbitrary and capricious and, conse quently, invalid.” Id. at 23-

24. The order accompanying the district court’s 1998 opinion

granted Heartland’s motion for summary judgme n t and

rema nded the case to HHS “for action consistent with the

foregoing opinion.” Heartland I , order at 1 (June 15, 1998).

Following the district court’s decision, things did not go as

Heartlan d had hoped. In 1999, HHS conducted a rulemaking

regarding a number of Medicare reimbursement iss ues. In the

course of that rul

emaking, the agency considered -- and rejected

-- the alternative defin

itions of “urban area” noted in H eartland

I

. The agency explained why it believed that the MSA-based

definition was the better one , and announced that it would

contin ue to use that definition. S ee Changes to the Hospital7

Inpatient Prospective Payment Systems and Fiscal Year 2000

Rates, Final Rule, 64 Fed. Reg. 41,490, 41 ,513-15 (July 30,

1999); Changes to the Hospital Inpatient Prospective Payment

Systems and Fiscal Year 2000 Rates, Proposed Rule, 64 Fed.

Reg. 24,716, 24,732 (May 7, 1999).

In 2000, HCFA took up the remand from Heartland I

. Once again, the agency concluded that Heartland did not qualify

for SCH status, giving three reason s. First, HCFA determined

that Heartland I did not vacate the SCH regu lation, but merely

remanded t

h e case to HHS to further explain its definition of

“urban area.”

Decision of the Administrator, H eartland Hosp.

v. Blue Cross & Blue Shield Ass’n , PRRB Case No. 93-0648E,

at 21 (Sept. 6, 2000). Finding that, in the 1999 rulemaking,

HHS had “art

iculated a reasonable basis for the use of an MSAbased definition of rural, as opposed to other alternatives,”

HCFA concluded t

hat “the MSA-based rural criteri[on] is

properly applied

in adjudicating this case.” I d. at 27. And

because Heartland was “loca ted in an urban area and [was]

within 35 miles of other like hospitals,” HCFA determined that

it did “not meet the applicable criteria for designation as a sole

community hospital.” Id.

Second, HCFA found that, even if the court’s order did

vacate the regulation, the district co urt “did not order the

payment of money to [Heartla nd] based on designation as a sole

community hospital,” and “did n ot comment on whether

[Heartland] should be designated as a sole communit y hospital.”

Id. At most, HCFA said, “the Court’s action affected that part

of the regulation which defines ‘rural’ within the context of

M SAs,” but “did not invalidate the rural requirement itself.” Id.

at 28. Concluding that “the establishment of a definition of

rural, through adjudication, would not constitute retroactive8

7 Specifically, HCFA said that Heartland had failed to demonstrate

“that no more tha[n] 25 percent of the residents who become hospital

inpatients or no more than 25 percent of the Medicare beneficiaries

who become hospi

tal inpatients in the hospital’s service area are

admitted for care to other like hospitals within a 35 mile radius of the

hospital or, if larger, within its service areas [as] required by 42 C.F.R.

4 12.92(a)(1)(i).” H

eartland Hosp.

, PRRB Case No. 93-0648E, at 34

(Sept. 6, 2000).

8 The district court further stayed the APA action pending

resolution of this appeal. rulemaking,” id.

, HCFA determined tha t “the adoption of a

MSA-bas ed rural definition is appropriate and reasonable for the

reasons” articulated in the 1999 rulemaking. Id. at 29.

Finally, HCFA reasoned that, even if the rural requirement

were deleted from the regulation altogether, Hea rtland still

would not qualify for SCH status b ecause it had failed to

demonst r ate that it met the other regulatory criteria that HHS

had established for qualification under clause (II). Id. 7

Heartland then returned to the district court witha twopronged a ttack on HCFA’s decision. First, it filed a motion to

enforce the Heartland I judgment, see king a declaration of SCH

status as well as reimbursement and interest. Second, Heartland

filed a separate action

challenging HCFA’s decision on remand

under the Administrative Pro cedure Act (APA), 5 U.S.C. §§

701-706. In light of the death of Judge Greene, both matters

were reassigned to another district judge. Heartland and HHS

agreed to stay the APA action pending th e disposition of

Heartland’s motion to enforce the judgment. 89

In A ugust 2004, the district court denied that motion.

Heartland Hosp. v. Thompson ( Heartland II

), 328 F. Supp. 2d

8 (D.D.C. 2004). The court determined that “Judge Greene did

not intend to grant [Heartland] SCH status, reimbursement and

interest.” I

d. at 15. “[A]ll that was required by the prior

judgment,” the court said, was that HHS “reconsider[] the

alternatives to” the MSA-based definition of “urban area.” I d

. Findi ng that HHS had reconsidered those alternatives and

“concluded that they are inferior,” the court held that Heartland

had received all the relief the judgment required. I d. Thereafter,

Heartland filed the instant appeal.

II

The parties spend the bulk of thei r briefs disputing whether

Judge Greene’s 1998 opinion in Heartland I vacated the rural

area requirement. Notwithstanding that the word “vacate” does

not appear in that opinion, Heartland contend s that the decision

vacated the requirement by pronouncing the regulations

“invalid,” and that vacatur en titled the hospital to SCH status

and reimbursement. HHS maintains that the decision did not

vacate the rural area requirement, but merely remanded for

consideration of alternative definitions of “urban area.”

We do not need to resolve this interpr etive dispute in order

to decide this case. Success on a motion to enforce a judgment

gets a plaintiff only “the relief to which [the plaintiff] is entitled

und er [its] original action and the judgment entered therein.”

Watkins v. Washington

, 5 11 F.2d 404, 406 (D.C. Cir. 1975).

Regardless of whether the district court vacated the rule, it is

clear that the Heartland I judgment does not entitle the hospital

to the remedy it seeks: a declaration of SCH status and

reimbursement. Our reasoning is set forth below.10

A

Even if Heartland I vacated the rural area requirement,

nothing on the face

of that decision compelled HHS to grant

Heartland SCH status and reimbursement. The court’s order

merely remanded the case to HHS “for action consistent with the

foregoing opinion.” H

eartland I

, order at 1. The “foregoing

opinion ,” in turn, found the rural area requirement in the HHS

regulati ons invalid solely on the ground that HHS had “failed to

co n sider or respond to reasonable alternatives to the use of

[MSAs] as the relevant measure of an urban area,” and hence as

the definition of a rural area. H eartland I

, slip op. at 24.

Accordingly, even if H eartland I vacated the rural a rea

requirement, the only obligation it expressly imposed on the

agency was to consider the two alternatives suggested during the

comment period.

That is precisely what the agency did. After the court

issued its d ecision in H eartland I

, HHS considered the

alternatives and then reissued i ts MSA-based definition of

“urban area” and “rural area.” S ee 64 Fed. Reg. 24,716, 24,732

(May 7, 1999) (setting forth the proposed definition and

soliciting comments); 64 Fed. Reg. 41,490, 41,513-15 (July 30,

1999) (adopting the definition and rejecting alternatives).

Thereafter, in its decision on remand from H eartland I

, HCFA

incorporated HHS’s rationale for rejecting the alternatives and

adopting the MSA-ba sed definition. In short, the agency

complied with the judgment in Heartla nd I by filling the

analytical gap identified in that opinion.

No r did H

eartland I imply that anything more was required.

It certainly did not suggest that, after considering th e

alternatives, the agency was barred from reinstat ing the same11

9 See, e.g.

, FEC v. Akins

, 524 U.S. 11, 25 (1998) (noting that, after

vacatur and remand , an agency “might later, in the exercise of its

lawful discretion, reach the same result for a different reason” (citing

SEC v. Chenery Corp.

, 318 U.S. 80 (1943))); NTEU v. FLRA , 30 F.3d

1510, 1514 (D.C. Cir. 1994) (noting that “we frequently remand

matters to agencies while leaving open the possibility that the agencies

can reach exactly the same result as long as they . . . explain

themselves better or develop better evidence for their position”). definition or from reaching the same result through case-by-case

adjudication. To the contrary, the usual rule is that, with or

without vacatur, an agency that cures a problem identified by a

court is free to reinstate the original result on remand. 9 Nothing

in Heartland I suggest

ed that this usual rule would not apply

because, for example, th e rural location requirement was

irredeemable. Rather, Judge Greene held that the requirement

was “well within the realm of permissible int erpretations of” the

Medicare statute, Heartland I

, slip op. at 15, that “the Secretary

[had] established

. . . a rational basis for the . . . requirement,” id.

at 19, and that it was “plausible

. . . that [MSAs] a r e a valid

measure of urban areas,” id. at 23.

This is not to say, of course, that the agency’s reaffirmation

of the same result in this case is invulnerable to attack on a

ground other than the agency’s failure to consider reasonable

alternatives

-- for example, on the ground that the agency

arbitrarily rejec ted those alternatives. S ee Motor Vehicles

Mfrs. Ass’n v. State Farm Mut. Auto. Ins. Co. , 463 U.S. 29, 43,

48, 56 (1983). But whether or not the agency’s post- H eartland

I rejection of the alternatives was arbitrary is a determination

that must be made in Heartland’s separate A P A action

challengi ng HHS’s post-remand decisions. Nothing in

Heartland I itself addresses that question, and therefore a motion12

to enforce the H

eartland I judgment is not the proper means to

answer it.

The same is true for Heartland’s oblique suggestion that if

Judge Greene vacated the rural area re quirement, then HHS’s

attempt to reim

pose the requirement on remand -- whether

t hrough rulemaking or adjudication

-- effectively constitut e d

impermissible retroactive rulemaking. S ee Appellant’s Reply

Br. at 2 n.1; see also Bowen v. Georgetown Univ. Hosp

. , 488

U.S. 204, 21 5 (1988) (holding that HHS “has no authority to

promulgate retroactive cost-li mit rules” under the Medicare

Act). Our cases establish a five-factor “framework for

evaluating retroactive application of rules announced in agency

adjud ications.” C assell v. FCC

, 154 F.3d 478, 486 (D.C. Cir.

1998) (quoting Clark-Cowlitz Joint Operating Agency v. FERC

, 826 F.2d 1074, 1081 (D.C. Cir. 1987) (en banc)). Nothing in

H eartland I indicates whether HCFA’s adjudicatory applicatio n

of the rural requ

irement would survive examination under that

framework. Accordingly, that, too, is a determination that must

await disposition of Heartland’s separate APA action.

B

Heartland contends t

hat, even if the face of H

eartland I did

not require HHS to grant the hospital SCH status, vacation of the

rural area requirement would have “eliminat[ed] the only

remaining barrier to SCH status for Heartland.” Appellant’s Br.

at 14. That is so, the hospital maintains, because “[u]nder the

applicable statute and regulations, the [PRRB] can grant

expedited judicial

review only if it first determines that there are

no disputed issues of fact a nd no disputed legal issues that the

Board is authorized to resolve.” I d. at 14-15. Thus, Heartland

insists, by grant ing its request for expedited review, the PRRB13

10 See Letter from Linda Richter, Mutual of Omaha, to Christopher

Crosswhite, Vinson & Elkins, at 2-3 (Feb. 1, 1994) (“HCFA’s denial

of SCH status was based on [Hear tland] being located in an u rban

area with like hospitals located closer tha n 35 miles . . . . HCFA has

made no determination as to whether [Heartland] met all criteria other

than being located in a rural area.”). “necessarily determined that Heartland had met all t he statutory

and regulatory criter

ia to obtain SCH status and that the only

remai ning question was the validity of [HHS’s] rural

requirement.” Id. at 21.

There are two problems with this argument. First, even if

Heartland i

s correct that at the time of H eartland I the rural area

requirement was the only hurdle still standing between it and

SCH status, the judgment did not say so. Even if the agency had

implicitly decide d prior to H eartland I that the hospital met all

the other SCH criteria, at best that would mean the p ost-remand

denial was inconsistent with those implicit findings. And while

such inc onsistency might justify a court in concluding that

HCFA’s post- Heartland I den ial of the hospital’s SCH status

was arbitrary and capricious (and thus in violation of the APA),

that is a conclusion Judge Gre ene did not reach in H eartland I

itself.

The second

-- and more significant

-- problem with

Heartland’s argument is that it reads too much into the PRRB’s

e xpedited judicial review determination. In denying Heartland

SCH status, both HCFA and the intermediary relied solely on

the hospital’s failure to satisfy the regulation’s rural location

requir ement. Neither considered whether there might be other

reasons for denial; neither said that, but for the regulation, the

hospital’s application would have been gra n ted. 10 Similarly,14

when Heartland asked th

e PRRB to grant expedited review, it

emphasized tha t “the sole basis for its appeal of HCFA’s denial

is that the regula tory requirement of location in a rural area is

invalid.” Provider’s Request for Expedited Judicial Review,

Heartland Hosp. v. Mutual of Omaha Ins. Co. , PRRB Case No.

93-0648, at 10-11 (Mar. 6, 1995). And when the PRRB granted

Heartland’s request, it did so on the ground that it was “without

authori ty to decide the legal question of whether the Medicare

r egulation governing the classification as a sole com munity

hospital . . . is valid.” Letter from Kues to Crosswhite at 2.

Nor is Heartland correc t that the statute and regulation

required the PRRB to decide every factual and legal quest ion

withi n its power -- including those on which the intermediary

did not rely in recomme nding denial of Heartland’s SCH status

-- befor e it could grant expedited review regarding the validity

of the lega l ground on which the intermediary did rely. The

statute itself states only that health care providers “have the right

to obtain judicial review of any action of the fiscal intermediary

which involves a question of l aw or regulations relevant to the

matters in controversy whenever the Board determ ines . . . that

it is without authority to dec ide the question.” 42 U.S.C. §

1395 oo (f)(1). Here, the intermediary’s denial of Heartland’s

ap plication on the basis of the rural location requirement plainly

involved “a question of law or regulations,” that was “relevant

to the matters in controvers y ,” and that the PRRB was “without

authority to decide.” S ee Bethesda Hosp. Ass’n v. Bowen

, 485

U.S. 399, 406 (1988) (“Neither the fiscal intermediary nor the

Board has the authority to declare regulations invalid.”). Thus,

Heartland’ s appeal fell squarely within the expedited review15

1 1 Although Heartland correctly notes that “the Board c an ‘ make

any other revisions on matters covered by [a] cost report . . . even

though such matters were not c onsidered by the intermediary in

making such

final determination,’” B ethesda Hosp. Ass’n v. Bowen

, 485 U.S. 399, 405-06 (1988) (quoting 42 U.S.C. § 1395 o o (d))

(emphasis added), the statute does not compel the Board to do so, see

42 U.S.C. § 1395 oo (d) (“The Board shall have the power to [consider]

matters

. . . not considered b y the intermediary.” (emphasis added)).

12 See 42 C.F.R. § 405.1 842(g)(2) (“The Board has the authority

to decide when two or more issues are sufficiently related to preclude

separation for purposes of an expedited review determi nation on one

or more of t h em and a hearing on the other or others.”); id. §

405.1842(h)(6) (“The Board’s determination [to grant expedited

judicial review] does not affect the right of the provider to a Board

hearing for issues for which the provider did not requ est expedited

review, or for which the Board determines it does have th e authority

to decide, or for which the Board did not make a determination and the

provider did not request judicial review.”). provision of the statute whether or not Heartland met the other

SCH criteria. 11

The HHS regulation that gove rns expedited review similarly

permits expedi

tion if there are no “factual or legal issues in

dispute on an issue w ithin the authority of the Board to decide.”

42 C.F. R. § 405.1842(g)(2) (emphasis added). The regulation

does not suggest that the PRRB is barred from granting

expedited review unless it first decides all factual questions

within its compet ence, including those regarding other issues not

relied upon by HCFA or the intermediary. Indeed, the

regulatory language is to the contrary. 12 As Heartland stresses,

HHS did state at the time the regulation was pr omulgated that

the statute’s expedited ju

dicial review provision “authorizes the16

13 Tucson Medical Center v. Sullivan , 947 F.2d 971 (D.C. Cir.

1991), is not to the contrary. In Tucson

, we stated in dictum that, by

granting petitions for expedited review, the PRRB had “necessarily

found that there existed an amount in co ntroversy in excess of

$10,000” because “the PRRB do es not have jurisdiction to hear an

appeal from the fiscal intermediary’s determination unless ‘the amount

in controversy is $10,000 or more.’” Id. at 980 (quoting 42 U.S.C. §

1395 oo (a)(2)). Although the statute expressly predicates PRRB

ju risdiction on a $10,000 amount in controversy, it does not -- as

disc u ssed above

-- predicate jurisdiction or anything else upon the

reso lution of every possible alternative basis for denial of a hospital’s

SCH application. bypassing of the required Board hearing only with respect to

those m atters in dispute for which t he sole issue to be resolved

is the validity of the law, regulations , or HCFA rulings which

the Board cannot decide.” Appellant’s Br. at 7 (quoting

Provider Reimbursement Review Board, Expedited

Administrative Review, Final Rul e, 48 Fed. Reg. 22,920, 22,922

(May 23, 1983)) (emphasis added in Appellant’s Br.). But in

this instance, the sole issue to be r esolved -- because it was the

sole basis for Heartland’s appeal

-- was the validity of the rural

location requirement, an i ssue that involved no factual or legal

issues within the Board’s competence.

In sum, both the statute and t he regulation permitted the

Board to grant expedited review regarding the validity of the

rural location requirement without first deci ding all other

possible bases f

or denying Heartland SCH status -- none of

whi ch were addressed by the intermediary, by HCFA, or by

Heart land. Hence, in granting expedited review, the Board did

not determine

-- “necessarily” or otherwise

-- that H eartland had

met all the statutory and regulatory criteria for such status. 1317

III

For the f oregoing reasons, we conclude that, regardless of

whether the district court intended to vacate the rural area

requirement in H

eartland I

, the court’s judgment did not entit l e

Heartland Hospital to the relief it seeks on this appeal. What the

judgment did require was what Heartland received -- HHS’s

reconsideration of the alternatives to the MSA-based definition

of “urba n area.” Accordingly, if Heartland is to obtain further

relief, it m

ust seek it through a separate APA challenge to

HCFA ’s post- H

eartland I decisions, rather than through a

motion to enforce the H

eartland I judgment itself. The district

court’s denial of Heartland’s motion is therefore

Affirmed.