Document ID: ./input/supremecourt_opinions/opinions/boundvolumes/529bv.pdf
Page Number: 82

529US1

Unit: $U32

[10-04-01 09:20:53] PAGES PGT: OPIN

Cite as: 529 U. S. 1 (2000)

7

Opinion of the Court

may impose lesser remedies, such as civil penalties, transfer
of residents, denial of some or all payment, state monitoring,
and the like. Where a nursing home, though deﬁcient in
some respects, is in “[s]ubstantial compliance,” i. e., where its
deﬁciencies do no more than create a “potential for [causing]
minimal harm,” the Secretary will impose no sanction or
remedy at all. See generally 42 U. S. C. § 1395i–3(h); 42
CFR § 488.301 (1998); § 488.400 et seq.; App. 54, 66 (Manual).
The statute and regulations also create various review pro-
cedures.
42 U. S. C. §§ 1395cc(b)(2)(A), (h); 42 CFR § 431.151
et seq. (1998); § 488.408(g); 42 CFR pt. 498 (1998).

The association’s complaint ﬁled in Federal District Court
In
attacked the regulations as unlawful in four basic ways.
its view: (1) certain terms, e. g., “substantial compliance”
and “minimal harm,” are unconstitutionally vague; (2) the
regulations and manual, particularly as implemented, vio-
late statutory requirements seeking enforcement consist-
ency, 42 U. S. C. § 1395i–3(g)(2)(D), and exceed the legislative
mandate of the Medicare Act; (3) the regulations create ad-
ministrative procedures inconsistent with the Federal Con-
stitution’s Due Process Clause; and (4) the manual and other
agency publications create legislative rules that were not
promulgated consistent with the Administrative Procedure
Act’s demands for “notice and comment” and a statement of
“basis and purpose,” 5 U. S. C. § 553. See App. 18–19, 27–38,
43–49 (Amended Complaint).

B

We next describe the two competing jurisdictional routes
through which the association arguably might seek to mount
its legal attack. The route it has followed, federal-question
jurisdiction, is set forth in 28 U. S. C. § 1331, which simply
states that “district courts shall have original jurisdiction of
all civil actions arising under the Constitution, laws, or treat-
ies of the United States.” The route that it did not follow,
the special Medicare review route, is set forth in a complex