Document ID: ./input/supremecourt_opinions/opinions/22pdf/21-806_2dp3.pdf
Page Number: 73.0

Cite as:  599 U. S. ____ (2023) 

5 

ALITO, J., dissenting 

noncompliance  will  be  taken  away  from  federal  and  state
authorities and given to courts.  And because the remedies 
offered under §1983 will often dwarf the relief available un-
der  FNHRA’s  reticulated  balance  of  remedies,  §1983  will 
swallow  the  centralized  state  and  federal  review  mecha-
nisms the Act imposes.

The  exclusivity  of  FNHRA’s  enforcement  regime  is 
buttressed  by  the  grievance  remedy  FNHRA  gives  to
nursing-home  residents.  Residents  have  the  “[r]ight  to
voice grievances with respect to treatment or care” and “the
right to prompt efforts by the facility to resolve grievances.”
§1396r(c)(1)(A)(vi).  States, in turn, are obligated to “inves-
tigate complaints of violations of requirements by nursing
facilities” and to take enforcement actions to correct those 
violations.  §§1396r(g)(4), (h)(1); see also 42 CFR §483.10(j) 
(2021)  (obligating  States  to  provide  a  “grievance  process”
that includes a “written decision” in response to complaints 
that provides a full summary of findings, conclusions, and 
reasoning).

This  grievance  process  dovetails  neatly  with  FNHRA’s
centralized enforcement regime because it funnels private
complaints to the same state authorities that the Act tasks
with enforcement.  Indeed, respondent in this case wielded 
FNHRA’s grievance process to obtain relief for both of the 
rights  petitioners  allegedly  violated.    See  App.  to  Pet.  for
Cert. 79a–80a.  But because FNHRA’s remedies are more 
limited than the direct judicial highway that §1983 offers, 
it is hard to see why anyone would use them in the future. 
See Rancho Palos Verdes, 544 U. S., at 122–123. 

The only textual evidence the majority can identify in re-
sponse  to  this  tailored  remedial  framework  is  FNHRA’s 
saving clause, which states that the Act’s remedies “are in 
addition  to  those  otherwise  available  under  State  or  Fed-
eral  law.”  §1396r(h)(8).  But  this  provision  only  begs  the
question  whether  relief  under  §1983  is  “otherwise  availa-