Document ID: ./input/supremecourt_opinions/opinions/21pdf/21a240_d18e.pdf
Page Number: 16

6 

BIDEN v. MISSOURI 

THOMAS, J., dissenting 

provisions.  §1395i–3(d)(3).  But that infection-control pro-
vision  focuses  on  sanitizing  the  facilities’  “environment,”
not its personnel.  Ibid.  In any event, even if this statutory
language justified a vaccine mandate in long-term care fa-
cilities, it could not sustain the omnibus rule.  Neither the 
“infection  control”  language  nor  a  reasonable  analog  ap-
pears in any of the other facility-specific provisions.  Basic 
interpretive  principles  would  thus  suggest  that  CMS 
lacks  vaccine-mandating  authority  with  respect  to  the 
other types of facilities.  See Russello v. United States, 464 
U. S. 16, 23 (1983).  And, of course, the omnibus rule cannot 
rest on the long-term care provision alone.  By CMS’ own 
estimate, long-term care facilities employ only 10% of the 
10 million healthcare workers that the rule covers.  86 Fed. 
Reg. 61603.  Put simply, the oblique reference to “infection 
control” in the definitional provision for long-term care fa-
cilities cannot authorize an omnibus vaccine mandate cov-
ering every type of facility that falls within CMS’ purview. 
For its part, the Court does not rely on the Government’s
proffered statutory provisions.  Instead, it asserts that CMS 
possesses  broad  vaccine-mandating  authority  by  pointing
to a handful of CMS regulations.  To begin, the Court does
not explain why the bare existence of these regulations is
evidence of what Congress empowered the agency to do.  Re-
lying on them appears to put the cart before the horse. 

Regardless,  these  regulations  provide  scant  support  for
the sweeping power the Government now claims.  For ex-
ample, CMS regulations that mandate the number of hours 
a dietician must practice under supervision, ante, at 6 (cit-
ing  42  CFR  §483.60  (2020)),  or  that  prescribe  “the  tasks
that may be delegated . . . to a physician assistant or nurse 
practitioner,” ante, at 6 (citing §483.30(e)), cannot support 
a vaccine mandate for healthcare personnel.

The Court also invokes a regulation requiring hospitals 
to implement programs that “govern the ‘surveillance, pre-
vention, and control of . . . infectious diseases,’ ” ante, at 6