(Slip Opinion) OCTOBER TERM, 2012 1 

Syllabus 

NOTE: Where it is feasible, a syllabus (headnote) will be released, as is

being done in connection with this case, at the time the opinion is issued.

The syllabus constitutes no part of the opinion of the Court but has been

prepared by the Reporter of Decisions for the convenience of the reader. 

See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 337. 

SUPREME COURT OF THE UNITED STATES 

Syllabus 

SEBELIUS, SECRETARY OF HEALTH AND HUMAN 

SERVICES v. AUBURN REGIONAL MEDICAL
 

CENTER ET AL. 

CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR 

THE DISTRICT OF COLUMBIA CIRCUIT 

No. 11–1231. Argued December 4, 2012—Decided January 22, 2013 

The reimbursement amount health care providers receive for inpatient 

services rendered to Medicare beneficiaries is adjusted upward for 

hospitals that serve a disproportionate share of low-income patients.

The adjustment amount is determined in part by the percentage of a 

hospital’s patients who are eligible for Supplemental Security Income

(SSI), called the SSI fraction. Each year, the Centers for Medicare & 

Medicaid Services (CMS) calculates the SSI fraction for an eligible

hospital and submits that number to the hospital’s “fiscal intermediary,” a Department of Health and Human Services (HHS) contractor. 

The intermediary computes the reimbursement amount due and then

sends the hospital a Notice of Program Reimbursement (NPR). A 

provider dissatisfied with the determination has a right to appeal to

the Provider Reimbursement Review Board (PRRB or Board) within

180 days of receiving the NPR. 42 U. S. C. §1395oo(a)(3). By regulation, the Secretary of HHS authorized the PRRB to extend the 180-

day limit, for good cause, up to three years. See 42 CFR 405.1841(b) 

(2007). 

 The Baystate Medical Center—not a party here—timely appealed

its SSI fraction calculation for each year from 1993 through 1996.

The PRRB found that errors in CMS’s methodology resulted in a systematic undercalculation of the disproportionate share adjustment

and corresponding underpayments to providers. In March 2006, the 

Board’s Baystate decision was made public. Within 180 days, respondent hospitals filed a complaint with the Board, challenging 

their adjustments for 1987 through 1994. Acknowledging that their

challenges were more than a decade out of time, they urged that eq-
 

 

 

 

 

 

 

2 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

Syllabus 

uitable tolling of the limitations period was in order due to CMS’s 

failure to tell them about the computation error. The PRRB held that 

it lacked jurisdiction, reasoning that it had no equitable powers save

those legislation or regulation might confer. On judicial review, the

District Court dismissed the hospitals’ claims. The D. C. Circuit reversed. The presumption that statutory limitations periods are generally subject to equitable tolling, the court concluded, applied to the

180-day time limit because nothing in §1395oo(a)(3) indicated that 

Congress intended to disallow such tolling. 

Held: 

1. The 180-day limitation in §1395oo(a)(3) is not “jurisdictional.” 

Pp. 6–9.

(a) Unless Congress has “clearly state[d]” that a statutory limitation is jurisdictional, the restriction should be treated “as nonjurisdictional.” Arbaugh v. Y & H Corp., 546 U. S. 500, 515–516. 

“[C]ontext, including this Court’s interpretations of similar provisions 

in many years past,” is probative of whether Congress intended a 

particular provision to rank as jurisdictional. Reed Elsevier, Inc. v. 

Muchnick, 559 U. S. ___, ___. If §1395oo(a)(3) were jurisdictional, the 

180-day time limit could not be enlarged by agency or court. 

 Section 1395oo(a)(3) hardly reveals a design to preclude any regulatory extension. The provision instructs that a provider “may obtain

a hearing” by filing “a request . . . within 180 days after notice of the 

intermediary’s final determination.” It “does not speak in jurisdictional terms.” Zipes v. Trans World Airlines, Inc., 455 U. S. 385, 394. 

This Court has repeatedly held that filing deadlines ordinarily are

not jurisdictional; indeed, they have been described as “quintessential claim-processing rules.” Henderson v. Shinseki, 562 U. S. ___, 

___. Pp. 6–8.

(b) Court-appointed amicus urges that §1395oo(a)(3) should be

classified as a jurisdictional requirement based on its proximity to

§§1395oo(a)(1) and (a)(2), both jurisdictional requirements, amicus 

asserts. But a requirement that would otherwise be nonjurisdictional 

does not become jurisdictional simply because it is in a section of a

statute that also contains jurisdictional provisions. Gonzalez v. Thaler, 565 U. S. ___, ___. Amicus also urges that the Medicare Act’s express grant of authority for the Secretary to extend the time for beneficiary appeals implies the absence of such leeway for §1395oo(a)(3)’s 

provider appeals. In support, amicus relies on the general rule that 

Congress’s use of “certain language in one part of the statute and different language in another” can indicate that “different meanings 

were intended,” Sosa v. Alvarez-Machain, 542 U. S. 692, 711, n. 9. 

But that interpretive guide, like other canons of construction, is “no

more than [a] rul[e] of thumb” that can tip the scales when a statute 
 

 

 

 

Cite as: 568 U. S. ____ (2013) 3 

Syllabus 

could be read in multiple ways. Connecticut Nat. Bank v. Germain, 

503 U. S. 249, 253. Here, §1395oo(a)’s limitation is most sensibly 

characterized as nonjurisdictional. Pp. 8–9.

2. The Secretary’s regulation is a permissible interpretation of 

§1395oo(a)(3). Pp. 10–14.

(a) Congress vested in the Secretary large rulemaking authority 

to administer Medicare. A court lacks authority to undermine the 

Secretary’s regime unless her regulation is “arbitrary, capricious, or 

manifestly contrary to the statute.” Chevron U. S. A. Inc. v. Natural 

Resources Defense Council, Inc., 467 U. S. 837, 844. Here, the regulation survives inspection under that deferential standard. The Secretary brought to bear practical experience in superintending the huge

program generally, and the PRRB in particular, in maintaining a

three-year outer limit for intermediary determination challenges. A 

court must uphold her judgment as long as it is a permissible construction of the statute, even if the court would have interpreted the

statute differently absent agency regulation. Pp. 10–11.

(b) A presumption of equitable tolling generally applies to suits

against the United States, Irwin v. Department of Veterans Affairs, 

498 U.S. 89, 95–96, but application of this presumption is not in order for §1395oo(a)(3). This Court has never applied Irwin’s presumption to an agency’s internal appeal deadline. The presumption was

adopted in part on the premise that “[s]uch a principle is likely to be

a realistic assessment of legislative intent.” Irwin, 498 U. S., at 95. 

That premise is inapt in the context of providers’ administrative appeals under the Medicare Act. For nearly 40 years the Secretary has 

prohibited the Board from extending the 180-day deadline, except as

provided by regulation. In the six times §1395oo has been amended 

since 1974, Congress has left untouched the 180-day provision and

the Secretary’s rulemaking authority. Furthermore, the statutory 

scheme, which applies to sophisticated institutional providers, is not

designed to be “ ‘unusually protective’ of claimants.” Bowen v. City of 

New York, 476 U. S. 467, 480. Nor is the scheme one “in which laymen, unassisted by trained lawyers, initiate the process.” Zipes, 455 

U. S., at 397. 

The hospitals ultimately argue that the Secretary’s regulations fail 

to adhere to “fundamentals of fair play.” FCC v. Pottsville Broadcasting Co., 309 U. S. 134, 143. They point to 42 CFR §405.1885(b)(3),

which permits reopening of an intermediary’s reimbursement determination “at any time” if the determination was procured by fraud or

fault of the provider. But this Court has explained that giving intermediaries more time to discover overpayments than providers have to 

discover underpayments may be justified by the “administrative realities” of the system: a few dozen fiscal intermediaries are charged 
 

4 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

Syllabus 

with issuing tens of thousands of NPRs, while each provider can concentrate on a single NPR, its own. Your Home Visiting Nurse Services, Inc. v. Shalala, 525 U. S. 449, 455, 456. Pp. 11–14. 

642 F. 3d 1145, reversed and remanded. 

GINSBURG, J., delivered the opinion for a unanimous Court. SOTOMAYOR, J., filed a concurring opinion. 
 

 

_________________ 

_________________ 

Cite as: 568 U. S. ____ (2013) 1 

Opinion of the Court 

NOTICE: This opinion is subject to formal revision before publication in the

preliminary print of the United States Reports. Readers are requested to

notify the Reporter of Decisions, Supreme Court of the United States, Washington, D. C. 20543, of any typographical or other formal errors, in order

that corrections may be made before the preliminary print goes to press. 

SUPREME COURT OF THE UNITED STATES 

No. 11–1231 

KATHLEEN SEBELIUS, SECRETARY OF HEALTH
 

AND HUMAN SERVICES, PETITIONER v. AUBURN REGIONAL MEDICAL CENTER ET AL. 

ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF 

APPEALS FOR THE DISTRICT OF COLUMBIA CIRCUIT
 

[January 22, 2013]

 JUSTICE GINSBURG delivered the opinion of the Court. 

This case concerns the time within which health care 

providers may file an administrative appeal from the

initial determination of the reimbursement due them for 

inpatient services rendered to Medicare beneficiaries. 

Government contractors, called fiscal intermediaries, 

receive cost reports annually from care providers and 

notify them of the reimbursement amount for which they

qualify. A provider dissatisfied with the fiscal intermediary’s determination may appeal to an administrative body 

named the Provider Reimbursement Review Board (PRRB

or Board). The governing statute, §602(h)(l)(D), 97 Stat.

165, 42 U. S. C. §1395oo(a)(3), sets a 180-day limit for 

filing appeals from the fiscal intermediary to the PRRB. 

By a regulation promulgated in 1974, the Secretary of the 

Department of Health and Human Services (HHS) authorized the Board to extend the 180-day limitation, for good 

cause, up to three years.1 

—————— 

1The agency was called the Department of Health, Education, and 

Welfare until 1979, but for simplicity’s sake we refer to it as HHS 
 

2 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

Opinion of the Court 

The providers in this case are hospitals who appealed to

the PRRB more than ten years after expiration of the 180-

day statutory deadline. They assert that the Secretary’s

failure to disclose information that made the fiscal intermediary’s reimbursement calculation incorrect prevented 

them from earlier appealing to the Board. Three positions

have been briefed and argued regarding the time for providers’ appeals to the PRRB. First, a Court-appointed 

amicus curiae has urged that the 180-day limitation is 

“jurisdictional,” and therefore cannot be enlarged at all by 

agency or court. Second, the Government maintains that 

the Secretary has the prerogative to set an outer limit of

three years for appeals to the Board. And third, the hospitals argue that the doctrine of equitable tolling applies,

stopping the 180-day clock during the time the Secretary 

concealed the information that made the fiscal intermediary’s reimbursement determinations incorrect. 

We hold that the statutory 180-day limitation is not 

“jurisdictional,” and that the Secretary reasonably construed the statute to permit a regulation extending the 

time for a provider’s appeal to the PRRB to three years. 

We further hold that the presumption in favor of equitable 

tolling does not apply to administrative appeals of the

kind here at issue. 

I 

The Medicare program covers certain inpatient services

that hospitals provide to Medicare beneficiaries. Providers are reimbursed at a fixed amount per patient, regardless of the actual operating costs they incur in rendering

these services. But the total reimbursement amount is 

adjusted upward for hospitals that serve a disproportionate share of low-income patients. This adjustment is 

made because hospitals with an unusually high percent-

—————— 

throughout this opinion. 
Cite as: 568 U. S. ____ (2013) 3 

Opinion of the Court 

age of low-income patients generally have higher perpatient costs; such hospitals, Congress therefore found, 

should receive higher reimbursement rates. See H. R. 

Rep. No. 99–241, pt. 1, p. 16 (1985). The amount of the 

disproportionate share adjustment is determined in part 

by the percentage of the patients served by the hospital 

who are eligible for Supplemental Security Income (SSI)

payments, a percentage commonly called the SSI fraction. 

42 U. S. C. §1395ww(d) (2006 ed. and Supp. V). 

At the end of each year, providers participating in Medicare submit cost reports to contractors acting on behalf of 

HHS known as fiscal intermediaries. Also at year end, 

the Centers for Medicare & Medicaid Services (CMS) calculates the SSI fraction for each eligible hospital and

submits that number to the intermediary for that hospital. 

Using these numbers to determine the total payment due,

the intermediary issues a Notice of Program Reimbursement (NPR) informing the provider how much it will be 

paid for the year.

If a provider is dissatisfied with the intermediary’s reimbursement determination, the statute gives it the right 

to file a request for a hearing before the PRRB within

180 days of receiving the NPR. §1395oo(a)(3) (2006 ed.) 

In 1974, the Secretary promulgated a regulation, after 

notice and comment rulemaking, permitting the Board to

extend the 180-day time limit upon a showing of good 

cause; the regulation further provides that “no such extension shall be granted by the Board if such request is filed 

more than 3 years after the date the notice of the intermediary’s determination is mailed to the provider.” 39 Fed. 

Reg. 34517 (1974) (codified in 42 CFR §405.1841(b)

(2007)).2 

—————— 

2 In 2008, after this case commenced, the Secretary replaced the 1974

regulation with a new prescription limiting “good cause” to “extraordinary circumstances beyond [the provider’s] control (such as a natural or 
 

 

4 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

Opinion of the Court 

For many years, CMS released only the results of its 

SSI fraction calculations and not the underlying data.3 

The Baystate Medical Center—a hospital not party to this 

case—timely appealed the calculation of its SSI fraction 

for each year from 1993 through 1996. Eventually, the

PRRB determined that CMS had omitted several categories of SSI data from its calculations and was using a

flawed process to determine the number of low-income

beneficiaries treated by hospitals. These errors caused a 

systematic undercalculation of the disproportionate share

adjustment, resulting in underpayments to the providers. 

Baystate Medical Center v. Leavitt, 545 F. Supp. 2d 20, 

26–30 (DC 2008); see id., at 57–58 (concluding that CMS 

failed to use “the best available data”).

The methodological errors revealed by the Board’s Baystate decision would have yielded similarly reduced payments to all providers for which CMS had calculated 

an SSI fraction. In March 2006, the Board’s decision in 

the Baystate case was made public. Within 180 days, the 

hospitals in this case filed a complaint with the Board

seeking to challenge their disproportionate share adjustments for the years 1987 through 1994. The hospitals

acknowledged that their challenges, unlike Baystate’s

timely contest, were more than a decade out of time. But 

equitable tolling of the limitations period was in order, 

they urged, due to CMS’s failure to inform the hospitals 

—————— 

other catastrophe, fire, or strike).” 73 Fed. Reg. 30250 (2008) (codified 

in 42 CFR §405.1836(b) (2012)). The new regulation retains the strict 

three-year cutoff for all claims. §405.1836(c)(2). The parties agree that

this case is governed by the 1974 regulation, and our opinion today

addresses only that regulation. 3 In §951 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, 117 Stat. 2427, Congress required the Secretary

to furnish hospitals with the data necessary to compute their own 

disproportionate share adjustment. Pursuant to this congressional

mandate, the Secretary has adopted procedures for turning over the

SSI data to hospitals upon request. 70 Fed. Reg. 47438 (2005). 
Cite as: 568 U. S. ____ (2013) 5 

Opinion of the Court 

that their SSI fractions had been based on faulty data.

The PRRB held that it lacked jurisdiction over the

hospitals’ complaint, reasoning that it had no equitable 

powers save those legislation or regulation might confer,

and that the Secretary’s regulation permitted it to excuse

late appeals only for good cause, with three years as the 

outer limit. On judicial review, the District Court dismissed the hospitals’ claims for relief, holding that nothing in the statute suggests that “Congress intended to

authorize equitable tolling.” 686 F. Supp. 2d 55, 70 (DC 

2010).

The Court of Appeals reversed. 642 F. 3d 1145 (CADC 

2011). It relied on the presumption that statutory limitations periods are generally subject to equitable tolling and

reasoned that “‘the same rebuttable presumption of equitable tolling applicable to suits against private defendants 

should also apply to suits against the United States.’” Id., 

at 1148 (quoting Irwin v. Department of Veterans Affairs, 

498 U. S. 89, 95–96 (1990)). The presumption applies

to the 180-day time limit for provider appeals from reimbursement determinations, the Court of Appeals held,

finding nothing in the statutory provision for PRRB review indicating that Congress intended to disallow equitable tolling. 642 F. 3d, at 1149–1151. 

We granted the Secretary’s petition for certiorari, 567

U. S. ___ (2012), to resolve a conflict among the Courts of

Appeals over whether the 180-day time limit in 42 U. S. C.

§1395oo(a)(3) constricts the Board’s jurisdiction. Compare

642 F. 3d 1145 (case below); Western Medical Enterprises, 

Inc. v. Heckler, 783 F. 2d 1376, 1379–1380 (CA9

1986) (180-day limit is not jurisdictional and the Secretary

may extend it for good cause), with Alacare Home Health 

Servs., Inc. v. Sullivan, 891 F. 2d 850, 855–856 (CA11 

1990) (statute of limitations is jurisdictional and the Secretary lacked authority to promulgate good-cause exception); St. Joseph’s Hospital of Kansas City v. Heckler, 786 
 

 

6 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

Opinion of the Court 

F. 2d 848, 852–853 (CA8 1986) (same). Beyond the jurisdictional inquiry,4 the Secretary asked us to determine

whether the Court of Appeals erred in concluding that

equitable tolling applies to providers’ Medicare reimbursement appeals to the PRRB, notwithstanding the 

Secretary’s regulation barring such appeals after three 

years. 

II
 

A 

Characterizing a rule as jurisdictional renders it unique

in our adversarial system. Objections to a tribunal’s jurisdiction can be raised at any time, even by a party that 

once conceded the tribunal’s subject-matter jurisdiction 

over the controversy. Tardy jurisdictional objections can 

therefore result in a waste of adjudicatory resources and 

can disturbingly disarm litigants. See Henderson v. 

Shinseki, 562 U. S. ___, ___ (2011) (slip op., at 5); Arbaugh 

v. Y & H Corp., 546 U. S. 500, 514 (2006). With these 

untoward consequences in mind, “we have tried in recent 

cases to bring some discipline to the use” of the term

“jurisdiction.” Henderson, 562 U. S., at ___ (slip op., at 5); 

see also Steel Co. v. Citizens for Better Environment, 523 

U. S. 83, 90 (1998) (jurisdiction has been a “word of many, 

too many, meanings” (internal quotation marks omitted)).

To ward off profligate use of the term “jurisdiction,”

we have adopted a “readily administrable bright line” for 

determining whether to classify a statutory limitation as

jurisdictional. Arbaugh, 546 U. S., at 516. We inquire

whether Congress has “clearly state[d]” that the rule is

jurisdictional; absent such a clear statement, we have 

—————— 

4Because no party takes the view that the statutory 180-day time

limit is jurisdictional, we appointed John F. Manning to brief and argue 

this position as amicus curiae. 567 U. S. ___ (2012). Amicus Manning 

has ably discharged his assigned responsibilities and the Court thanks

him for his well-stated arguments. 
 

Cite as: 568 U. S. ____ (2013) 7 

Opinion of the Court 

cautioned, “courts should treat the restriction as nonjurisdictional in character.” Id., at 515–516; see also Gonzalez 

v. Thaler, 565 U. S. ___, ___ (2012) (slip op., at 6); Henderson, 562 U. S., at ___ (slip op., at 6). This is not to say that 

Congress must incant magic words in order to speak

clearly. We consider “context, including this Court’s interpretations of similar provisions in many years past,” as 

probative of whether Congress intended a particular

provision to rank as jurisdictional. Reed Elsevier, Inc. v. 

Muchnick, 559 U. S. 154, 168 (2010); see also John R. 

Sand & Gravel Co. v. United States, 552 U. S. 130, 133– 

134 (2008).

We reiterate what it would mean were we to type the governing statute, 42 U. S. C. §1395oo(a)(3), “jurisdictional.”

Under no circumstance could providers engage PRRB review more than 180 days after notice of the fiscal intermediary’s final determination. Not only could there be no

equitable tolling. The Secretary’s regulation providing for 

a good-cause extension, see supra, at 3, would fall as well. 

The language Congress used hardly reveals a design to 

preclude any regulatory extension. Section 1395oo(a)(3)

instructs that a provider of services “may obtain a hearing” by the Board regarding its reimbursement amount if 

“such provider files a request for a hearing within 180

days after notice of the intermediary’s final determination.” This provision “does not speak in jurisdictional 

terms.” Zipes v. Trans World Airlines, Inc., 455 U. S. 385, 

394 (1982). Indeed, it is less “jurisdictional” in tone than 

the provision we held to be nonjurisdictional in Henderson. 

There, the statute provided that a veteran seeking Veterans Court review of the Department of Veterans Affairs’ 

determination of disability benefits “shall file a notice of 

appeal . . . within 120 days.” 562 U. S., at ___ (slip op., at 

9) (quoting 38 U. S. C. §7266(a) (emphasis added)). Section 1395oo(a)(3), by contrast, contains neither the mandatory word “shall” nor the appellation “notice of appeal,” 
 

 

8 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

Opinion of the Court 

words with jurisdictional import in the context of 28

U. S. C. §2107’s limitations on the time for appeal from a

district court to a court of appeals. See Bowles v. Russell, 

551 U. S. 205, 214 (2007).

Key to our decision, we have repeatedly held that filing

deadlines ordinarily are not jurisdictional; indeed, we have

described them as “quintessential claim-processing rules.” 

Henderson, 562 U. S., at ___ (slip op., at 6); see also Scarborough v. Principi, 541 U. S. 401, 414 (2004) (filing deadline for fee applications under Equal Access to Justice 

Act); Kontrick v. Ryan, 540 U. S. 443, 454 (2004) (filing 

deadlines for objecting to debtor’s discharge in bankruptcy); Honda v. Clark, 386 U. S. 484, 498 (1967) (filing 

deadline for claims under the Trading with the Enemy 

Act). This case is scarcely the exceptional one in which a “century’s worth of precedent and practice in American courts”

rank a time limit as jurisdictional. Bowles, 551 U. S., at 

209, n. 2; cf. Kontrick, 540 U. S., at 454 (a time limitation 

may be emphatic, yet not jurisdictional). 

B 

Amicus urges that the three requirements in §1395oo(a)

are specifications that together define the limits of the

PRRB’s jurisdiction. Subsection (a)(1) specifies the claims

providers may bring to the Board, and subsection (a)(2) 

sets forth an amount-in-controversy requirement. These 

are jurisdictional requirements, amicus asserts, so we 

should read the third specification, subsection (a)(3)’s 

180-day limitation, as also setting a jurisdictional 

requirement.

Last Term, we rejected a similar proximity-based argument. A requirement we would otherwise classify as

nonjurisdictional, we held, does not become jurisdictional 

simply because it is placed in a section of a statute that 

also contains jurisdictional provisions. Gonzalez, 565 

U. S., at ___ (slip op., at 11); see Weinberger v. Salfi, 422 
 

Cite as: 568 U. S. ____ (2013) 9 

Opinion of the Court 

U. S. 749, 763–764 (1975) (statutory provision at issue 

contained three requirements for judicial review, only one

of which was jurisdictional). 

Amicus also argues that the 180-day time limit for provider appeals to the PRRB should be viewed as jurisdictional because Congress could have expressly made the 

provision nonjurisdictional, and indeed did so for other

time limits in the Medicare Act. Amicus notes particularly

that when Medicare beneficiaries request the Secretary

to reconsider a benefits determination, the statute gives

them a time limit of 180 days or “such additional time as 

the Secretary may allow.” 42 U. S. C. §1395ff(b)(1)(D)(i);

see also §1395ff(b)(1)(D)(ii) (permitting Medicare beneficiary to request a hearing by the Secretary within “time

limits” the Secretary “shall establish in regulations”). We 

have recognized, as a general rule, that Congress’s use of 

“certain language in one part of the statute and different 

language in another” can indicate that “different meanings

were intended.” Sosa v. Alvarez-Machain, 542 U. S. 692, 

711, n. 9 (2004) (internal quotation marks omitted). Amicus notes this general rule in urging that an express grant 

of authority for the Secretary to extend the time for beneficiary appeals implies the absence of such leeway for

provider appeals.

But the interpretive guide just identified, like other 

canons of construction, is “no more than [a] rul[e] of

thumb” that can tip the scales when a statute could be

read in multiple ways. Connecticut Nat. Bank v. Germain, 

503 U. S. 249, 253 (1992). For the reasons earlier stated, 

see supra, at 6–8, we are persuaded that the time limitation in §1395oo(a) is most sensibly characterized as a 

nonjurisdictional prescription. The limitation therefore 

does not bar the modest extension contained in the Secretary’s regulation. 
 

 

10 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

Opinion of the Court 

III 

We turn now to the question whether §1395oo(a)(3)’s

180-day time limit for a provider to appeal to the PRRB is 

subject to equitable tolling. 

A 

Congress vested in the Secretary large rulemaking

authority to administer the Medicare program. The PRRB 

may adopt rules and procedures only if “not inconsistent” 

with the Medicare Act or “regulations of the Secretary.”

42 U. S. C. §1395oo(e). Concerning the 180-day period 

for an appeal to the Board from an intermediary’s reimbursement determination, the Secretary’s regulation implementing §1395oo, adopted after notice and comment,

speaks in no uncertain terms: 

“A request for a Board hearing filed after [the 180-day

time limit] shall be dismissed by the Board, except 

that for good cause shown, the time limit may be extended. However, no such extension shall be granted

by the Board if such request is filed more than 3 years

after the date the notice of the intermediary’s determination is mailed to the provider.” 42 CFR 

§405.1841(b) (2007). 

The Secretary allowed only a distinctly limited extension of time to appeal to the PRRB, cognizant that “the 

Board is burdened by an immense caseload,” and that

“procedural rules requiring timely filings are indispensable devices for keeping the machinery of the reimbursement appeals process running smoothly.” High Country 

Home Health, Inc. v. Thompson, 359 F. 3d 1307, 1310 

(CA10 2004). Imposing equitable tolling to permit appeals 

barred by the Secretary’s regulation would essentially gut

the Secretary’s requirement that an appeal to the Board 

“shall be dismissed” if filed more than 180 days after the

NPR, unless the provider shows “good cause” and requests 
Cite as: 568 U. S. ____ (2013) 11 

Opinion of the Court 

an extension no later than three years after the NPR. A 

court lacks authority to undermine the regime established

by the Secretary unless her regulation is “arbitrary, capricious, or manifestly contrary to the statute.” Chevron 

U. S. A. Inc. v. Natural Resources Defense Council, Inc., 

467 U. S. 837, 844 (1984).

The Secretary’s regulation, we are satisfied, survives

inspection under that deferential standard. As HHS has 

explained, “[i]t is in the interest of providers and the program that, at some point, intermediary determinations 

and the resulting amount of program payment due the

provider or the program become no longer open to correction.” CMS, Medicare: Provider Reimbursement Manual, 

pt. 1, ch. 29, §2930, p. 29–73 (rev. no. 372, 2011); cf. Taylor 

v. Freeland & Kronz, 503 U. S. 638, 644 (1992) (“Deadlines

may lead to unwelcome results, but they prompt parties 

to act and produce finality.”). The Secretary brought to

bear practical experience in superintending the huge program generally, and the PRRB in particular, in maintaining 

three years as the outer limit. A court must uphold the

Secretary’s judgment as long as it is a permissible construction of the statute, even if it differs from how the 

court would have interpreted the statute in the absence of 

an agency regulation. National Cable & Telecommunications Assn. v. Brand X Internet Services, 545 U. S. 967, 980 

(2005); see also Chevron, 467 U. S., at 843, n. 11. 

B 

Rejecting the Secretary’s position, the Court of Appeals

relied principally on this Court’s decision in Irwin, 498 

U. S., at 95–96. Irwin concerned the then 30-day time

period for filing suit against a federal agency under Title 

VII of the Civil Rights Act of 1964, 42 U. S. C. §2000e–

16(c) (1988 ed.). We held in Irwin that “the same rebuttable presumption of equitable tolling applicable to suits 

against private defendants should also apply to suits 
 

 

12 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

Opinion of the Court 

against the United States.” 498 U. S., at 95–96. Irwin 

itself, and equitable-tolling cases we have considered both

pre- and post-Irwin, have generally involved time limits 

for filing suit in federal court. See, e.g., Holland v. Florida, 560 U. S. ___ (2010) (one-year limitation for filing 

application for writ of habeas corpus); Rotella v. Wood, 528 

U. S. 549 (2000) (four-year period for filing civil RICO

suit); United States v. Beggerly, 524 U. S. 38 (1998) (12-

year period to bring suit under Quiet Title Act); Lampf, 

Pleva, Lipkind, Prupis & Petigrow v. Gilbertson, 501 U. S. 

350 (1991) (one- and three-year periods for commencing

civil action under §10(b) of the Securities Exchange Act of

1934); Honda v. Clark, 386 U. S. 484 (1967) (60-day period 

for filing suit under Trading with the Enemy Act); Kendall 

v. United States, 107 U. S. 123 (1883) (six-year period for 

filing suit in Court of Claims). Courts in those cases rendered in the first instance the decision whether equity 

required tolling.

This case is of a different order. We have never applied 

the Irwin presumption to an agency’s internal appeal deadline, here the time a provider has to appeal an intermediary’s reimbursement determination to the PRRB. Cf. 

United States v. Brockamp, 519 U. S. 347, 350 (1997) 

(assuming, arguendo, that Irwin presumption applied to

time limit for filing an administrative claim for a tax refund, but concluding based on statutory text, structure, 

and purpose that there was “good reason to believe that 

Congress did not want the equitable tolling doctrine to 

apply”).

The presumption of equitable tolling was adopted in 

part on the premise that “[s]uch a principle is likely to be

a realistic assessment of legislative intent.” Irwin, 498 

U. S., at 95. But that premise is inapt in the context of 

providers’ administrative appeals under the Medicare Act.

The Act, until 1972, provided no avenue for providers to

obtain administrative or judicial review. When Congress 
Cite as: 568 U. S. ____ (2013) 13 

Opinion of the Court 

first directed the Secretary to establish the PRRB, Congress simultaneously imposed the 180-day deadline, with

no statutory exceptions. For nearly 40 years the Secretary has prohibited the Board from extending that deadline, except as provided by regulation. And until the D. C. 

Circuit’s decision in this case, no court had ever read 

equitable tolling into §1395oo(a)(3) or the Secretary’s 

implementation of that provision. Congress amended

§1395oo six times since 1974, each time leaving untouched

the 180-day administrative appeal provision and the 

Secretary’s rulemaking authority. At no time did Congress express disapproval of the three-year outer time 

limit set by the Secretary for an extension upon a showing 

of good cause. See Commodity Futures Trading Comm’n v. 

Schor, 478 U. S. 833, 846 (1986) (“[W]hen Congress revisits 

a statute giving rise to a longstanding administrative

interpretation without pertinent change, the congressional 

failure to revise or repeal the agency’s interpretation is 

persuasive evidence that the interpretation is the one intended by Congress.” (internal quotation marks omitted)). 

We note, furthermore, that unlike the remedial statutes 

at issue in many of this Court’s equitable-tolling decisions, 

see Irwin, 498 U. S., at 91; Bowen v. City of New York, 476 

U. S. 467, 480 (1986); Zipes, 455 U. S., at 398, the statutory scheme before us is not designed to be “‘unusually 

protective’ of claimants.” Bowen, 476 U. S., at 480. Nor is 

it one “in which laymen, unassisted by trained lawyers, 

initiate the process.” Zipes, 455 U. S., at 397 (internal 

quotation marks omitted). The Medicare payment system 

in question applies to “sophisticated” institutional providers assisted by legal counsel, and “generally capable 

of identifying an underpayment in [their] own NPR 

within the 180-day time period specified in 42 U. S. C.

§1395oo(a)(3).” Your Home Visiting Nurse Services, Inc. v. 

Shalala, 525 U. S. 449, 456 (1999). As repeat players who

elect to participate in the Medicare system, providers can 
 

 

 

 

 

14 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

Opinion of the Court 

hardly claim lack of notice of the Secretary’s regulations. 

The hospitals ultimately argue that the Secretary’s

regulations fail to adhere to the “fundamentals of fair 

play.” FCC v. Pottsville Broadcasting Co., 309 U. S. 

134, 143 (1940). They point, particularly, to 42 CFR 

§405.1885(b)(3) (2012), which permits reopening of an

intermediary’s reimbursement determination “at any time

if it is established that such determination . . . was 

procured by fraud or similar fault of any party to the 

determination.”5 

We considered a similar alleged inequity in Your Home 

and explained that it was justified by the “administrative

realities” of the provider reimbursement appeal system.

525 U. S., at 455. There are only a few dozen fiscal intermediaries and they are charged with issuing tens of thousands of NPRs, while each provider can concentrate on

a single NPR, its own. Id., at 456. The Secretary, Your 

Home concluded, could reasonably believe that this asymmetry justifies giving the intermediaries more time to 

discover overpayments than the providers have to discover 

underpayments. Moreover, the fraud exception allowing

indefinite reopening does apply to an intermediary if it 

“procured” a Board decision by “fraud or similar fault.”

Although an intermediary is not a party to its own determination, it does rank as a party in proceedings before the 

Board. 42 CFR §405.1843(a).6 

—————— 

5Because neither the Secretary nor the intermediary counts as a

party to the intermediary’s determination, 42 CFR §405.1805, providers

alone are subject to this exception to the time limitation. 6The fraud exception apart, reopening time is limited to three years. 

§405.1885(a). Within that time, reopening may be sought by the 

intermediary, the Board, the Secretary, or the provider. Thus an 

intermediary determination or Board decision could not be reopened if,

outside the three-year window, the Secretary discovered errors in

calculating the SSI fraction that resulted in overpayments to providers. 
 

 

Cite as: 568 U. S. ____ (2013) 15 

Opinion of the Court 

* * * 

We hold, in sum, that the 180-day statutory deadline

for administrative appeals to the PRRB, contained in 42 

U. S. C. §1395oo(a)(3), is not “jurisdictional.” Therefore 

the Secretary lawfully exercised her rulemaking authority

in providing for a three-year “good cause” extension. We 

further hold that the equitable tolling presumption our 

Irwin decision approved for suits brought in court does not

similarly apply to administrative appeals of the kind

here considered, and that the Secretary’s regulation, 42 

CFR §405.1841(b), is a permissible interpretation of the 

statute. 

The judgment of the United States Court of Appeals for 

the District of Columbia Circuit is therefore reversed, and 

the case is remanded for further proceedings consistent

with this opinion. 

It is so ordered. 
_________________ 

_________________ 

Cite as: 568 U. S. ____ (2013) 1 

SOTOMAYOR, J., concurring 

SUPREME COURT OF THE UNITED STATES 

No. 11–1231 

KATHLEEN SEBELIUS, SECRETARY OF HEALTH
 

AND HUMAN SERVICES, PETITIONER v. AUBURN REGIONAL MEDICAL CENTER ET AL. 

ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF 

APPEALS FOR THE DISTRICT OF COLUMBIA CIRCUIT
 

[January 22, 2013]

 JUSTICE SOTOMAYOR, concurring. 

The Court holds that the presumption in favor of equitable tolling that we adopted in Irwin v. Department of 

Veterans Affairs, 498 U. S. 89, 95–96 (1990), does not 

apply to 42 U. S. C. §1395oo(a)(3)’s nonjurisdictional 180-

day deadline for health care providers to file administrative appeals with the Provider Reimbursement Review 

Board (PRRB), and that the Secretary’s regulation limiting “good cause” extensions of that deadline to three years 

is a permissible interpretation of the statute. I agree with

those holdings and join the Court’s opinion in full. I write 

separately to note that the Court’s decision in this case 

does not establish that equitable tolling principles are

irrelevant to internal administrative deadlines in all, or 

even most, contexts. 

The Court is correct that our equitable tolling cases

have typically involved deadlines to bring suit in federal 

court. Ante, at 12. But we have never suggested that 

the presumption in favor of equitable tolling is generally 

inapplicable to administrative deadlines. Cf. Henderson v. 

Shinseki, 562 U. S. ___, ___, n. 4 (2011) (slip op., at 12, 

n. 4) (noting that the Government did not dispute whether 

the statutory filing deadline in the Article I Veterans 

Court was subject to equitable tolling if the deadline was 
 

2 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

SOTOMAYOR, J., concurring 

nonjurisdictional); United States v. Brockamp, 519 U. S. 

347, 350–353 (1997) (assuming without deciding that the 

Irwin presumption applied to administrative tax refund

claims but finding based on statutory text, structure, and 

the underlying subject matter that tolling was unavailable); see also ante, at 12 (discussing Brockamp). And we 

have previously applied the Irwin presumption outside the

context of filing deadlines in Article III courts. See Young 

v. United States, 535 U. S. 43, 49–53 (2002) (applying the

presumption to a limitations period in bankruptcy proceedings); cf. Zipes v. Trans World Airlines, Inc., 455 U. S. 

385, 392–398 (1982) (holding that the statutory time limit

for filing charges with the Equal Employment Opportunity 

Commission was “not a jurisdictional prerequisite to suit 

in federal court, but a requirement that, like a statute of 

limitations, is subject to waiver, estoppel, and equitable

tolling”).

In administrative settings other than the one presented 

here, I believe the “background principle” that limitations periods “are customarily subject to equitable tolling,” 

Young, 535 U. S., at 49–50 (internal quotation marks

omitted), may limit an agency’s discretion to make filing 

deadlines absolute. The Court quite properly observes

that the question whether equitable tolling is available 

turns on congressional intent. See ante, at 13. “[A] realistic assessment” of that intent, Irwin, 498 U. S., at 95, may 

vary by context.

In this case, given the nature of the statutory scheme,

which “applies to ‘sophisticated’ institutional providers”

who are “repeat players” in the Medicare system, and the 

statute’s history, I agree that it would distort congressional intent to presume that the PRRB’s administrative 

deadline should be subject to equitable tolling. Ante, at 

12–14 (quoting Your Home Visiting Nurse Services, Inc. v. 

Shalala, 525 U. S. 449, 456 (1999)). By contrast, with

respect to remedial statutes designed to protect the rights 
 

Cite as: 568 U. S. ____ (2013) 3 

SOTOMAYOR, J., concurring 

of unsophisticated claimants, see ante, at 13, agencies 

(and reviewing courts) may best honor congressional

intent by presuming that statutory deadlines for administrative appeals are subject to equitable tolling, just as

courts presume comparable judicial deadlines under such

statutes may be tolled. Because claimants must generally 

pursue administrative relief before seeking judicial review, see Woodford v. Ngo, 548 U. S. 81, 88–91 (2006), a

contrary approach could have odd practical consequences

and would attribute a strange intent to Congress: to protect a claimant’s ability to seek judicial review of an agency’s decision by making equitable tolling available, while 

leaving to the agency’s discretion whether the same claimant may invoke equitable tolling in order to seek an administrative remedy in the first place. 

Even in cases where the governing statute clearly delegates to an agency the discretion to adopt rules that limit 

the scope of equitable exceptions to administrative deadlines, I believe “cases may arise where the equities in

favor of tolling the limitations period are ‘so great that 

deference to the agency’s judgment is inappropriate.’” 

Bowen v. City of New York, 476 U. S. 467, 480 (1986) 

(quoting Mathews v. Eldridge, 424 U. S. 319, 330 (1976)). 

In particular, efforts by an agency to enforce tight filing 

deadlines in cases where there are credible allegations 

that filing delay was due to the agency’s own misfeasance may not survive deferential review. While equitable 

tolling extends to circumstances outside both parties’

control, the related doctrines of equitable estoppel and 

fraudulent concealment may bar a defendant from enforcing a statute of limitation when its own deception prevented a reasonably diligent plaintiff from bringing a 

timely claim. See United States v. Beggerly, 524 U. S. 38, 

49–50 (1998) (Stevens, J., concurring) (noting that these

doctrines are distinct); see generally 2 C. Corman, Limitation of Actions §§9.1, 9.7 (1991) (describing the doctrines). 
 

4 SEBELIUS v. AUBURN REGIONAL MEDICAL CENTER 

SOTOMAYOR, J., concurring 

In Bowen, we applied the basic principle underlying these

doctrines to an agency’s conduct, as we concluded that a

60-day deadline to seek judicial review of the administrative denial of disability benefits should be tolled because 

the Social Security Administration’s “‘secretive conduct prevent[ed] plaintiffs from knowing of a violation of rights.’” 

476 U. S., at 481 (quoting New York v. Heckler, 742 F. 2d 

729, 738 (CA2 1984)).

While the providers in this case allege that the agency’s

failure to disclose information about how it calculated the 

Supplemental Security Income fraction prevented them

from bringing timely challenges to reimbursement determinations, I am satisfied that the Secretary’s 3-year

good-cause exception is a reasonable accommodation of the

competing interests in administrative efficiency and fairness. We would face a different case if the Secretary’s

regulation did not recognize an exception for good cause or 

defined good cause so narrowly as to exclude cases of

fraudulent concealment and equitable estoppel. See ante, 

at 3, n. 2 (explaining that the Secretary’s amended regulation limiting the scope of “‘good cause,’” 73 Fed. Reg.

30250 (2008) (codified in 42 CFR §405.1836(b) (2012)), is

not before us). 

With these observations, I join the Court’s opinion in 

full.