Opinion ID: 200155
Heading Depth: 3
Heading Rank: 1

Heading: Requirement of 200 Waiver Slots

Text: Plaintiffs first argue that New Hampshire is required by statute to request a waiver to accommodate at least 200 individuals. They rely on statutory language governing waiver programs, which states: (c) Waiver respecting medical assistance requirement in State plan: scope, etc.; habilitation services defined; imposition of certain regulatory limits prohibited; computation of expenditures for certain disabled patients; coordinated services; substitution of participants . . . (10) The Secretary shall not limit to fewer than 200 the number of individuals in the State who may receive home and community-based services under a waiver under this subsection. -10- § 1396n(c)(10). Plaintiffs interpret this statute to require that states requesting waivers design plans that accommodate at least 200 individuals, arguing that is the plain meaning of the statute itself and the thrust of the surrounding legislative history. The core statutory argument is that because the waiver programs must receive the Secretary's approval, this 200-person minimum should be read as a limit on both the state applying for the waiver as well as on the Secretary. Plaintiffs argue that the states are restricted from offering less than 200 slots and the Secretary is restricted from approving less than 200 slots.
We turn first to the language of the statute itself. If a statute is unambiguous, we use neither legislative history,4 Dep't 4 At times, though, we use legislative history as a check to confirm the correctness of our interpretation in very complex areas of regulation. Cablevision of Boston, Inc. v. Pub. Improvement Comm'n, 184 F.3d 88, 101 (1st Cir. 1999) ([A] court should go beyond the literal language of a statute if reliance on that language would defeat the plain purpose of the statute . . . .). Even were we to rely on the legislative history of § 1396n(c)(10), as plaintiffs request, it would not require the conclusion that § 1396n(c)(10) was meant to mandate that waiver plans serve at least 200 individuals. Paragraph 1396n(c)(10), as originally written, stated that [n]o waiver under this subsection shall limit by an amount less than 200 the number of individuals who may receive home and community-based services. Omnibus Budget Reconciliation Act of 1987, Pub. L. No. 100-203, § 4118(b), 101 Stat. 1330-1, 1330-155. The paragraph was amended to the current language the next year. See Medicare Catastrophic Coverage Act of 1988, Pub. L. No. 100360, § 411(k)(10)(A), 102 Stat. 683, 794. The plaintiffs have submitted no legislative history with regard to this change, and there appears to be little discussion in the relevant committee reports. See H.R. Rep. No. 100-105(I) (1987), reprinted in 1988 -11- of Hous. & Urban Dev. v. Rucker, 122 S. Ct. 1230, 1234 (2002), nor administrative agency interpretation, Chevron, 467 U.S. at 842-43. Neither the language nor the structure of § 1396n(c)(10) supports plaintiffs' reading; the statute does not require applications for state waiver programs to serve at least 200 individuals. The language of the paragraph, by its very terms, governs only the Secretary's ability to deny approval of waiver plans. See § 1396n(c)(10) (The Secretary shall not limit . . . .). The statute does not purport to govern the behavior of the states or the contents of the waiver plans themselves. Moreover, the paragraph does not, by its terms, prevent the Secretary from approving plans unless there are a certain number of slots. It only governs the Secretary's actions when she or he is acting to limit the content of waiver plans as to the number of individuals to be served. Comparing the language of § 1396n(c)(10) to the remainder of § 1396n(c), which governs waiver services, makes this reading U.S.C.C.A.N. 803; H.R. Rep. No. 100-105(II) (1987), reprinted in 1988 U.S.C.C.A.N. 857; H.R. Conf. Rep. No. 100-661, at 269 (1988), reprinted in 1988 U.S.C.C.A.N. 923, 1047. The only legislative history the plaintiffs cite, that of the 1987 statute, see H.R. Conf. Rep. No. 100-495, at 760 (1987), reprinted in 1987 U.S.C.C.A.N. 2313-1245, 2313-1506, is inapposite. All we are left with is the simple fact that Congress altered the language of paragraph 10 by striking language that supported the plaintiffs' contentions. Even were we to construe the legislative history, then, we would find that if it has any effect at all, it is to bolster the interpretation that the statute in its current form governs only the actions of the Secretary. -12- even more compelling. Some provisions of subsection (c) directly govern the content of the waiver plans; these clearly state their purpose in limiting the content of the plans directly. See id. § 1396n(c)(2) (A waiver may not be granted under this subsection unless . . . .). By contrast, § 1396n(c)(10) does not contain such language limiting the content of the plans themselves. Other provisions of subsection (c), like (c)(10), operate to prevent the Secretary from unduly restraining the state plans.5 For instance, the Secretary may not restrict the number of hours or days of respite care provided under a waiver plan, id. § 1396n(c)(4), nor may he require that the waiver plan spend no more money than the approved estimates as a condition of waiver approval, id. § 1396n(c)(6). These provisions merely prevent the Secretary from imposing conditions onto the waiver plans. Similarly, § 1396n(c)(10) restricts the Secretary's ability to limit the size and funding of waiver plans. Read together, these provisions, like paragraph 10, ensure that the states will be able to receive funding for waiver plans up to a certain size and free from restrictions on how much care is provided to each individual. They do not dictate to the states the content of their waiver applications. 5 This is also consistent with the language of § 1396n(c), the title of which includes such subjects as imposition of certain regulatory limits prohibited, obviously a reference to paragraph 10. -13- Finally, it is evident that § 1396n(c) contemplates state waiver plans with definite limits on the number of individuals served. Paragraph 9 permits state plans to replace individuals who die or become ineligible with other individuals [i]n the case of any waiver under this subsection which contains a limit on the number of individuals who shall receive home or community-based services. Id. § 1396n(c)(9). State plans, then, certainly have the right to include a limit on the number of waiver slots they request.6 This statute, § 1396n(c)(10), is most plausibly read as limiting only the ability of the Secretary to impose such restrictions, and not the ability of the states to propose or the Secretary to approve waiver plans serving fewer than 200 individuals.
Even if there were doubt as to the plain meaning of § 1396n(c)(10) on its face, the administrative interpretation of HHS does not support the plaintiffs' position. If Congress has not spoken on the precise question at issue, we respect the statutory 6 Our reading is also most consistent with another paragraph of subsection (c), which plainly permits states to set limits on the number of individuals served. Section 1396n(c)(4)(A) permits waiver plans to limit the individuals served to those for whom the state has determined that the amount of medical assistance under the waiver will not exceed the amount that would be provided if the waiver did not apply. This paragraph does not reference § 1396n(c)(10), nor does it restrict a state's ability to limit the number of individuals served by waiver plans. -14- interpretation of the federal administrative agency given that interpretative task, unless the interpretation is unreasonable. Chevron, 467 U.S. at 842-44. Congress has authorized HHS to interpret the statutes in question and implement regulations in this area. 42 U.S.C. § 1302. HHS has interpreted § 1396n(c)(10) through a regulation governing model waivers, which decrees that the number of individuals served under a model waiver program may not exceed 200 recipients. 42 C.F.R. § 441.305(b). It is possible to read the regulation, which permits no more than 200 recipients under a model waiver program, and § 1396n(c)(10), which plaintiffs urge permits no fewer than 200 under any waiver program, to result in a scheme in which all model programs must serve exactly 200 individuals. Nonetheless, that is not the most likely reading. The regulation's use of the term exceed indicates that HHS contemplates model waiver programs that serve fewer than 200 individuals. This conclusion is bolstered by the comments accompanying the announcement of the final rule. HHS concluded that while § 1396n(c)(10) could, arguably, be read to limit the actual number of individuals who may receive model waiver services to no less than 200, . . . we believe that this reading is unsupportable. Medicaid Program; Home and Community-Based Services and Respiratory Care for Ventilator-Dependant Individuals, 59 Fed. Reg. 37,702, 37,711 (July 25, 1994). -15- HHS's interpretation of this statute is certainly not unreasonable. HHS reads § 1396n(c)(10) as allowing states to choose the size of their waiver programs, rather than requiring that the waiver programs be at least a certain size. This interpretation is consistent with the agency's longstanding interpretation of the waiver program. See Medicaid Program; Home and Community-Based Services, 50 Fed. Reg. 10,013, 10,021 (Mar. 13, 1985) (stating that HHS believes that Congress intended to give the States maximum flexibility in operating their waiver programs). The policy reasons are obvious: states, and particularly small states, may be discouraged from applying for model waiver programs at all if the choices are a program serving 200 individuals at the partial expense of the state, or not creating a model program at all and providing only the standard Medicaid services. Rather, Congress wished to encourage the states to pursue waiver programs, so that the states would create the types of model programs contemplated. Sympathetic as these plaintiffs are, the long-term logic of their argument may lead to the constriction, not the expansion, of these types of alternative programs. In sum, even were we to find this statute ambiguous, the interpretation offered by HHS is reasonable, given the structure and language of the statute. The Secretary has also interpreted this statute in a different context. He has approved waiver plans that anticipate -16- serving fewer than 200 individuals, such as the plan at issue here. Because the approval process did not utilize formal procedures, it may not be entitled to Chevron deference, see Christensen v. Harris County, 529 U.S. 576, 587 (2000), but there remains the deference owed agencies due to their specialized experience. Skidmore v. Swift & Co., 323 U.S. 134, 139 (1944); see United States v. Mead Corp., 533 U.S. 218, 234-39 (2001) (applying Skidmore deference). The Secretary has interpreted the statute to permit waiver plans with fewer than 200 slots, and we defer to his expertise in the construction and purpose of the statute.