Document ID: ./input/supremecourt_opinions/opinions/22pdf/21-806_2dp3.pdf
Page Number: 72

4 

HEALTH AND HOSPITAL CORPORATION OF MARION 
CTY. v. TALEVSKI 
ALITO, J., dissenting 

B 
When all is said and done, my disagreement with the ma-
jority is thus narrowly focused on how this standard applies 
to  this  case.  In  my  view,  FNHRA  “foreclose[s]  a  private
cause  of  action”  even  though  it  “admittedly  create[s]  sub-
stantive private rights.”  Alexander, 532 U. S., at 290.  The 
Act  creates  a  reticulated  remedial  regime  that  both  bal-
ances federal and state enforcement and channels disputes
through that regime.  Allowing §1983 suits will upend this 
careful balance. 

Consider the remedial provisions that the Act provides. 
When  federal  officials  find  that  a  nursing  home  does  not 
comply  with  FNHRA,  the  Act  enumerates  certain  limited 
remedies  they  can  pursue,  such  as  withdrawing  federal
funding and imposing civil penalties “in an amount not to 
exceed  $10,000 
for  each  day  of  noncompliance.”
§1396r(h)(3)(C).  FNHRA obligates States to establish cer-
tain remedies for noncompliance (including civil penalties),
but  otherwise  leaves  them  free  to  “specify  criteria,  as  to
when and how each of [the required] remedies is to be ap-
plied, the amounts of any fines, and the severity of each of 
these remedies, to be used in the imposition of such reme-
dies.”  §1396r(h)(2)(A).  It also empowers States to “provide 
for other . . . remedies” as they see fit.  Ibid.  Finally, the
Act provides “[s]pecial rules where [s]tate and [federal offi-
cials]  do  not  agree  on  [a]  finding  of  noncompliance.” 
§1396r(h)(6) (boldface deleted).

By specifying limited remedies for federal authorities and 
tasking  States  with  otherwise  determining  the  conse-
quences for violations, the Act creates a clear division of au-
thority  that  ensures  States  retain  their  historical  control
over  nursing-home  regulation.  Allowing  §1983  suits  will
upset this balance by allowing any plaintiff to demand dam-
ages regardless of the remedial regime that States establish
pursuant to their explicit authority under the Act.  Moreo-
ver, whenever a plaintiff files suit, the determination about