Source: https://healthlaw.org/resource/a-medicaid-advocates-guide-to-deference/
Timestamp: 2019-04-22 12:08:26+00:00

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 The purpose of this Guide is to summarize and explain deference standards. Part I of this Guide discusses the deference issue with selected case examples. Part II is a chart of cases organized by the type of sub-regulatory guidance at issue in the case and the level of deference given to each. Part III is a circuit-by-circuit docket summaries of Medicaid and Medicare deference cases since 1990. Pre-1990 cases and cases that are not directly on point but may be helpful to advocates are included.
interpretation set forth in the guidance.
It should be noted that deference has historically been a popular topic with the Supreme Court, so the standards may change over time.2 Moreover, while courts are controlled by Supreme Court precedent, deference standards differ somewhat from circuit to circuit. The purpose of this Guide is to summarize and explain these standards. Part I of this Guide discusses the deference issue with selected case examples. Part II is a chart of cases organized by the type of sub-regulatory guidance at issue in the case and the level of deference given to each. Part III is a circuit-by-circuit docket summaries of Medicaid and Medicare deference cases since 1990. Pre-1990 cases and cases that are not directly on point but may be helpful to advocates are included.
Over the years, the Supreme Court has made several attempts to clarify the standards for according deference to federal agency interpretations of federal statutes. The most important case is Chevron U.S.A. v. Natural Resources Defense Council, in which the Court articulated a two-step inquiry for judicial review of administrative interpretations of federal statutes. 3 Under the Chevron analysis, a court must first determine whether Congress has spoken to the specific issue. If so, the congressional statement must prevail over any contrary administrative interpretation. However, if Congress has not spoken to the issue or if its statements are ambiguous, the court must defer to (meaning follow) the administrative interpretation as long as it is ?reasonable.?4 The administrative interpretation therefore has the force of law.
statements of policy and interpretation.
contain provisions that in fact do violate the federal law. In these circumstances, advocates may argue that courts should not defer to the suggestion implicit in plan approval that CMS has actually determined that the plans or waivers comply with Medicaid law.
agency as CMS. 2 NHeLP co-authors an annual summary of significant Supreme Court cases that appears in the Clearinghouse Review at the end of each year. See, e.g., Jane Perkins et al., The Supreme Court?s 2006-2007 Term: The Shift to the Right Takes Shape, 41 J.POV.LAW & POLICY 442 (2007); Gary Smith et al., The 2005-2006 U.S. Supreme Court Decisions on Access to the Federal Courts: The First Term of the John Roberts Era, 40 J.POV.LAW & POLICY 394 (2006); Matthew Diller et al., Win Some, Lose Some: The Rehnquist Court?s Final Chapter on Access to Courts, 30 J.POV.LAW &POLICY 389 (2005); Gill Deford et al., Federal Court Access Issues in the U.S. Supreme Court?s 2003-2004 Term, 38 J.POV. LAW &POLICY 464 (2004); Gary F. Smith et al., Highlights from the U.S. Supreme Court?s 2001-2002 Decisions on Federal Court Access, 36 J.POV.LAW &POLICY 375 (2002); Jane Perkins et al., Beyond Bush v. Gore: Highlights from the Supreme Court?s 2000-2001 Decisions Concerning Access to the Courts, 35 J.POV.LAW &POLICY 373 (2001); Matthew Diller et al., Decisions on Federal Access During the Supreme Court?s 1999-2000 Term: Some Social Security, A Little Federalism, and More of the Usual, 34 J.POV.LAW &POLICY 405 (2000); Gill Deford et al., The Supreme Court?s 1999-1998 Term: Federalism, State Action, and Other Cases Affecting Access to Justice, 33 J.POV. LAW &POLICY 359 (1999).
3 467 U.S. 837 (1984).
5 529 U.S. 576, 587 (2000).
7 Id. (quoting Skidmore v. Swift, 323 U.S. 134, 140 (1944)).
8 323 U.S. 134 (1944).
10 533 U.S. 218 (2001).
16 Id. at 234. For an interesting post-Mead case, see Barnhart v. Walton, 535 U.S. 212 (2002), which accorded Chevron deference to a Social Security regulation promulgated in response to the very case that was before the Court: ?In this case, the interstitial nature of the legal question, the related expertise of the Agency, the importance of the question to administration of the statute, the complexity of that administration, and the careful consideration the agency has given the question over a long period of time all indicate that Chevron provides the appropriate legal lens through which to review the legality of the Agency interpretation here at issue.? Id. at 222.
17 For more information on the state plan process, see NHeLP, ?State Medicaid Plans,? April 25, 2006, at www.healthlaw.org.
Medicaid Manual) (not specifying the level of deference but following the agency position); Bray v. Dowling, 25 F.3d 135, 143 (2d Cir. 1994) (agency memorandum) (stating that ?[c]onsistent interpretations by the agencies entrusted with the administration of the Social Security Act are due deferential treatment in the courts.?) (citations omitted); Liegl v. Webb, 802 F.2d 623, 625-26 (2d Cir. 1986) (discussing the Medical Assistance Manual, which pre-dated the State Medicaid Manual); Wisconsin Dep?t of Health and Social Services v. Bowen, 797 F.2d 391, 398 (7th Cir. 1986), cert. dismissed, 485 U.S. 1017 (1988) (Medicaid Action Transmittal) (finding that Secretary?s interpretation is warranted deference if reasonable and permitted by the statute, without citing Chevron or Skidmore); Smith v. Miller, 665 F.2d 172, 179 (7th Cir. 1981) (Medical Assistance Manual) (affording judgment of the agency considerable weight); Philadelphia Welfare Rights Org. v. Shapp, 602 F.2d 1114, 1122 (3d Cir. 1979), cert. denied, 444 U.S. 1026 (1980) (Medical Assistance Manual); Stanton v. Bond, 504 F.2d 1246, 1249 (7th Cir. 1974), cert. denied, 420 U.S. 984 (1975). For district court cases, see Salazar v. District of Columbia, 954 F. Supp. 278, 328-34 (D.D.C. 1996) (State Medicaid Manual) (using the standards established in the Manual without citing Chevron); State of New York Dep?t of Social Servs. v. Sullivan, 811 F. Supp. 964, 975 (S.D.N.Y. 1993) (State Medicaid Manual) (Chevron); Sundberg v. Mansour, 627 F. Supp. 616, 619-20 (W.D. Mich. 1986) (regional office memorandum) (stating that deference is due the Secretary?s interpretation unless plainly erroneous or inconsistent and rejecting the agency interpretation, without citing Chevron or Skidmore); Olson v. Reagen, 631 F. Supp. 154, 157-58 (S.D. Iowa 1986), aff?d in part, rev?d in part sub nom., Olsen v. Norman, 830 F.2d 811 (8th Cir. 1987) (regional office memorandum) (according the same level of deference to informal statements of policy as it does regulations, without citing Chevron); Smith v. Vowell, 379 F. Supp. 139 (W.D. Tex. 1974), aff?d mem., 504 F.2d 759 (5th Cir. 1974) (Medical Assistance Manual) (finding that the administrative requirements expressed in the Manual are to be given full force and effect if consistent with the overriding purpose of the legislation).
19 Blumer v. Wisconsin Dep?t of Health and Social Services, 122 U.S. 962 (2001).

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