Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1641_3314.pdf
Page Number: 7.0

Cite as:  596 U. S. ____ (2022) 

5 

Opinion of the Court 

The Marietta Plan provides the same benefits, including
the  same  outpatient  dialysis  benefits,  to  individuals  with
and without end-stage renal disease.  Indeed, DaVita does 
not  dispute  that  the  Plan’s  terms  apply  uniformly  to  all
Plan participants.  Therefore, the Plan does not “differenti-
ate  in  the  benefits  it  provides  between  individuals”  with 
and  without  end-stage  renal  disease. 
42  U. S. C. 
§1395y(b)(1)(C)(ii).

In response, DaVita primarily argues that the statute au-
thorizes liability even when a plan limits benefits in a uni-
form way if the limitation on benefits has a disparate im-
pact on individuals with end-stage renal disease.  

To begin with, the text of the statute cannot be read to 
encompass  a  disparate-impact  theory.    That  text  requires
inquiry  into  whether  a  plan  provides  different  benefits  to 
(i) those with end-stage renal disease and (ii) those without
end-stage renal disease.  The text does not ask about “the 
effects of non-differentiating plan terms that treat all indi-
viduals equally.”  978 F. 3d, at 363 (opinion of Murphy, J.); 
see also Amy’s Kitchen, 981 F. 3d, at 674−675.  In light of 
that plain text, it comes as no surprise that the Centers for 
Medicare and Medicaid Services have never adopted a dis-
parate-impact theory in their longstanding regulations im-
plementing this statute.

The disparate-impact theory not only is atextual but also
would be all but impossible to fairly implement.  The prem-
ise of the disparate-impact theory is that the plan’s benefits
for  outpatient  dialysis  are  inadequate.    But  what  level  of 
benefits  would  be  adequate,  and  how  would  courts  deter-
mine the level of benefits that qualifies as adequate? 

Neither  the  statute  nor  DaVita  offers  a  basis  for  deter-
mining when coverage for outpatient dialysis could be con-
sidered  inadequate.  And  neither  the  statute  nor  DaVita 

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this statutory provision appears to be whether the plan differentiates in
benefits between those with and those without end-stage renal disease.