Opinion ID: 3049925
Heading Depth: 2
Heading Rank: 2

Heading: Chevron Step Two: Agency Deference

Text: A) Standard “When relevant statutes are silent on the salient question, we assume that Congress has implicitly left a void for an agency to fill . . . . [and] must therefore defer to the agency’s construction of its governing statutes, unless that construction is unreasonable.” Ass’n of Pub. Agency Customers, Inc. v. Bonneville Power Admin., 126 F.3d 1158, 1169 (9th Cir. 1997) (citing Chevron, 467 U.S. at 843-44). Where “the court determines Congress has not directly addressed the precise question at issue, [it] does not simply impose its own construction on the statute.” Chevron, 467 U.S. at 843. Rather, we examine only “whether the agency’s answer is based on a permissible construction of the statute.” Id. “This test is satisfied if the agency’s interpretation ‘reflects a plausible construction of the statute’s plain language and does not otherwise conflict with Congress’ expressed intent.’ ” Or. Trollers Ass’n v. Gutierrez, 452 F.3d 1104, 1116 (9th Cir. 2006), cert. denied, 127 S. Ct. 2028 (2007) (quoting Rust v. Sullivan, 500 U.S. 173, 183 (1991)). In other words, “[s]o long as the agency’s construction is reasonably consistent with the statute, we defer to it.” Id. RESIDENT COUNCILS OF WASHINGTON v. LEAVITT 11101 B) Analysis Three primary challenges are made to the Secretary’s interpretation: (1) the use of feeding assistants will result in reduced care for nursing home residents; (2) because nurse aide training is currently inadequate, further reducing staff training requirements frustrates congressional intent; and (3) the agency’s interpretation is not entitled to deference because it did not adequately explain its change in policy. 1) Reduced Level of Care No support is offered for this claim. The contention is that (1) feeding assistants, though limited by regulation to feeding residents without complicated feeding problems, will nonetheless “perform tasks for which they are not trained,” and (2) “residents may find themselves monitored by direct-care employees who are trained to do no more than provide minimal assistance with relatively trivial feeding assistance tasks.” [7] The first argument fails because speculation that feeding assistants may exceed their authority under the regulations cannot be a basis for concluding the regulations run afoul of the statute. To hold otherwise would render every regulation an impermissible statutory construction because every regulation can be violated. [8] The second claim is equally unpersuasive. Aside from acknowledging that feeding assistants will be performing only “relatively trivial feeding assistance tasks,” it fails to identify how resident monitoring during feeding by such individuals violates the statute. Nursing homes employing feeding assistants would still be required to adhere to the other regulatory requirements pertaining to resident care and supervision. Feeding assistants are permitted only to supplement, not replace, nurse aides and other professionals. See 68 Fed. Reg. at 55,529. 11102 RESIDENT COUNCILS OF WASHINGTON v. LEAVITT Furthermore, as a general matter, there is no evidence of record to suggest that the use of feeding assistants to feed residents without complicated feeding problems will operate to reduce the level of care for nursing home residents. To the contrary, feeding assistant programs in two states have yielded positive results. Id. at 55,529-30. Further, in response to public commenters’ concerns, the agency modified the regulations to, inter alia, provide examples of conditions that preclude the use of a feeding assistant, require training prior to feeding residents, and require a more frequent assessment by a nurse of a resident’s eligibility for feeding by a feeding assistant. Id. at 55,531-32, 55,534, 55,536. There can be little debate that a shortage of nurse aides has led to a reduced level of care for all nursing home residents. Common sense dictates that easing the burden on nurse aides by delegating non-nursing-related tasks to other workers will enable nurse aides to devote their attention to tasks more important and more difficult than the “relatively trivial feeding tasks” they were previously saddled with. Plaintiffs’ untethered speculation that the regulations will result in a diminished level of care for nursing home residents is insufficient to demonstrate that the Secretary’s interpretation of the Reform Law was unreasonable.9 9 The related argument that permitting paid feeding assistants will lead to a proliferation of other single-task workers, resulting in reduced care for nursing home residents, is also unpersuasive. We are asked to review only the Secretary’s decision that feeding residents without complicated feeding problems does not constitute a “nursing-related service” and therefore can be performed by a paid feeding assistant. Should the Secretary subsequently decide that other services are similarly not “nursing-related,” we may ultimately be asked to determine the reasonableness of such decisions. But that is not the case before us. To conclude that a reasonable construction of a statute in this case is impermissible based solely on the possibility that the Secretary may later use our decision to attempt to justify an unreasonable interpretation of the statute would be to eschew our current judicial responsibilities. RESIDENT COUNCILS OF WASHINGTON v. LEAVITT 11103 2) Inadequate Nurse Aide Training Plaintiffs further contend that the unreasonableness of the Secretary’s interpretation permitting the use of feeding assistants is especially pronounced because the required training of nurse aides has “not kept pace with nursing home industry needs,” presumably suggesting that the Secretary should be increasing training requirements, rather than reducing them for certain tasks. The alleged inadequacy of nurse aide training generally is irrelevant to this court’s inquiry as to whether the agency’s feeding assistant regulations frustrate congressional intent. 3) The Secretary’s Explanation of HHS’s Change in Policy “An agency interpretation of a relevant provision which conflicts with the agency’s earlier interpretation is entitled to considerably less deference than a consistently held agency view.” INS v. Cardoza-Fonseca, 480 U.S. 421, 446 n.30 (1987) (internal quotations omitted). This court has held that an agency’s “new” position is entitled to deference “so long as the agency acknowledges and explains the departure from its prior views.” Seldovia Native Ass’n v. Lujan, 904 F.2d 1335, 1346 (9th Cir. 1990) (internal quotations omitted). However, “[a]n initial agency interpretation is not instantly carved in stone,” but rather “the agency . . . must consider varying interpretations and the wisdom of its policy on a continuing basis.” Chevron, 467 U.S. at 863-64. To that end, an agency “must be given ample latitude to adapt its rules and policies to the demands of changing circumstances.” Rust, 500 U.S. at 186-87 (internal quotations omitted). The Secretary acknowledged that the new regulations constituted a policy change in the preambles to both the proposed and final rules. 67 Fed. Reg. at 15,150-51; 68 Fed. Reg. at 55,528-29. The Secretary explained that changed circumstances in the nursing home industry—i.e., a shortage of nurse 11104 RESIDENT COUNCILS OF WASHINGTON v. LEAVITT aides and a higher percentage of nursing home residents who require a greater level of care—necessitated a reexamination of the agency’s prior opinion that all resident feeding must be performed by a nurse aide. 68 Fed. Reg. at 55,529-30. The Secretary noted that some residents require only minimal assistance during mealtimes and that such assistance does not require nursing training. Id. By nonetheless requiring that nurse aides feed such residents, the Secretary concluded that the realities of the nursing home industry meant that those residents without complicated feeding problems were receiving little or no assistance at mealtimes and that nurse aide attention was being diverted from those residents who needed it most. Id. [9] The Secretary ultimately concluded that employing feeding assistants, specially trained in feeding techniques and elder care, to feed those residents without complicated feeding problems would free the nurse aides to focus their attention on the more difficult patients, while also ensuring that residents with minimal problems receive adequate attention, resulting in better care for all. Id. Although the agency did not specifically state why it had changed its interpretation of “nursing-related services” to exclude feeding of residents without complicated feeding problems, it did note that it did “not consider the kinds of tasks facilities may ask feeding assistants to provide [to be] either nursing or nursing related.” Id. at 55,530-31. In response to comments, the agency further noted: While feeding has been part of the nurse aide training curriculum, that requirement was predicated on the nurse aide having to tend to persons with pro- nounced eating complications (such as swallowing disorders) for which specialized training is essential. What facilities would be free to do as a result of this rule, however, is to use persons who have had a lesser level of training to assist residents who have no feeding issues that require any specialized attenRESIDENT COUNCILS OF WASHINGTON v. LEAVITT 11105 tion. Thus, we do not consider feeding assistants who may be used by facilities under this rule to be engaged in nursing or nursing related activities. Id. at 55,531. This explanation clearly reveals the agency’s reasoning in determining that feeding residents without complicated feeding problems does not constitute a nursingrelated service. Further, as noted above, “nursing-related services” has not been previously defined by statute or regulation.10 As such, the agency’s change in policy with the current rule is only a change insofar as it diverges from past interpretations in informal letters by agency administrators. Such pronouncements, of course, “lack the force of law,” Christensen v. Harris County, 529 U.S. 576, 587 (2000), and are entitled to respect only insofar as they have the “power to persuade,” which is a function of “the thoroughness evident in [their] consideration” and “the validity of [their] reasoning.” Skidmore v. Swift & Co., 323 U.S. 134, 140 (1944). Here, the agency letters offer virtually no evidence or reasoning in support of their conclusions, but simply state that nurse aides must perform feeding tasks. If reviewing courts accord less deference to informal agency pronouncements, it logically follows that the agency itself is also entitled to give prior informal interpretations less deference, permitting it to change 10 As Plaintiffs note, the Secretary has stated by formal rule that individuals providing “nursing or nursing-related services” must meet the nurse aide requirements “regardless of . . . the scope of services provided.” 56 Fed. Reg. at 48,890. However, this statement was made as part of the Secretary’s response to a request to further define “nurse aide” and does not purport to be a definition of “nursing-related services.” See id. Quite the contrary, the Secretary expressly declined to refine the definition of “nursing-related services.” See id. The new rule does not alter the Secretary’s conclusion that anyone performing nursing-related services, regardless of their scope, must meet the nurse aide requirements. Rather, the new rule determines that a certain activity—feeding residents without complicated feeding problems—does not constitute a “nursing-related service.” 11106 RESIDENT COUNCILS OF WASHINGTON v. LEAVITT course when both necessary and consistent with the governing statute. The letters in question, though they address resident feeding generally, do not specifically answer whether feeding residents without complicated feeding problems—the sole focus of the new rule—constitutes a “nursing-related service.” In this sense, the Secretary’s current interpretation is less a break with the past than a refinement of it. The current regulations are the first agency statement to address the precise question at issue—whether feeding residents without complicated feeding problems is a “nursing-related service”—and are the only examination of nursing home feeding practices and statutory definitions to be supported by evidence and analysis.11 4) Conclusion [10] The Secretary’s interpretation of the undefined statutory phrase “nursing or nursing-related services” to exclude feeding of nursing home residents without complicated feeding problems is a permissible construction of the statute. The Secretary reasonably concluded that such services do not necessitate the extensive training required of nurse aides and that permitting trained feeding assistants to assume such tasks would advance the overall goals of the Reform Law in light of changing circumstances in the nursing home industry. In this respect, the Secretary’s construction is “reasonably consistent with the statute” and is accordingly entitled to deference. See Or. Trollers, 452 F.3d at 1116. 11 Plaintiffs’ additional objection that “the phrase ‘nursing or nursingrelated’ was understandable and enforceable from 1991 through 2001, but suddenly ambiguous in 2002” is baseless. The Secretary has never suggested that the phrase “nursing or nursing-related” is unambiguous. To the contrary, since the first regulations issued under the Reform Law, the scope of the term has been debated and questioned as demonstrated by public comments seeking clarification, 56 Fed. Reg. at 48,890, and the letters in the record responding to such inquiries. RESIDENT COUNCILS OF WASHINGTON v. LEAVITT 11107