Document: 496 U.S. 498 110 S.Ct. 2510 L.Ed.2d 455 L. Douglas WILDER, Governor of Virginia, et al., Petitionersv.VIRGINIA HOSPITAL ASSOCIATION. No. 88-2043. Argued Jan. 9, 1990. Decided June 14, Syllabus To qualify for federal financial assistance to help defray the cost furnishing medical care needy under Medicaid Act, States must submit Secretary Health and Human Services approval a plan which, inter alia, establishes scheme reimbursing health providers. In 1980, Congress passed Boren Amendment which requires provider reimbursement according rates that "State finds, makes assurances satisfactory Secretary," are "reasonable adequate" meet costs "efficiently economically operated facilities." The State also assure individuals have access" facilities "adequate quality." Virginia's plan, providers reimbursed prospective formula, was approved by in 1982 again 1986 after an amendment. 1986, respondent, nonprofit corporation composed public private hospitals operating filed suit against petitioner state officials declaratory injunctive relief 42 U.S.C. § 1983, alleging violates Act because its not adequate." District Court denied petitioners' motion dismiss or summary judgment, based on claim 1983 does afford respondent cause action. Appeals affirmed, concluding may sue compliance with Amendment. Held: is enforceable action brought Pp. 508-524. (a) Section 1983—which provides "deprivation any rights . secured [federal] laws"—is inapplicable if (1) statute question create "rights" within 1983's meaning, (2) has foreclosed such enforcement enactment itself. Wright v. Roanoke Redevelopment Housing Authority, 479 418, 423, 107 766, 770, 93 781. P. 508. (b) creates substantive "right," adoption reasonable adequate rates. There can be little doubt intended beneficiaries amendment, see Golden Tran- sit Corp. Los Angeles, 493 103, 106, 444, 448, 420, since amendment system phrased terms benefiting them. Moreover, imposes "binding obligation" gives rise rights, Pennhurst School Hospital Halderman, 451 1, 19, 101 1531, 1541, 67 694, it cast mandatory rather than precatory terms, provision funds expressly conditioned Petitioners' contention did intend require adopt actually contrary statutory language, find satisfy these requirements entitles reject upon given unsatisfactory, would render those requirements, thus entire provision, essentially meaningless. quickly dispelled review amendment's background legislative history, demonstrate free from restrictive previously imposed relieve them their fundamental obligation pay rates, retain providers' pre-existing right challenge as unreasonable suits 1983. Furthermore, State's flexibility finds not, petitioners contend, too "vague amorphous" judicially enforceable. See State, supra, U.S., at S.Ct., 448. Secretary's regulations set out factors consider adopting making findings, judge rates' reasonableness objective benchmark facility" while ensuring eligible participants. Although some knowledge hospital industry might required evaluate inquiry well competence Judiciary. 509-520. (c) judicial remedy there no express effect Wright, remedial sufficiently comprehensive intent preclude suits, Middlesex County Sewerage Authority National Sea Clammers Assn., 453 20, 2615, 2626, 69 435. Because primary purpose reduce role determining rate payment calculation methods, limited oversight function authorizes him withhold plans curtail cases noncompliance, insufficient foreclose relief. Cf. 428, 773. although regulation appeals procedure individual obtain administrative allows limit issues raised review, most States, including do allow overall method determined. Such procedures cannot considered "comprehensive" precludes reliance 429, 520-523. 868 F.2d 653 (CA4 1989), affirmed. BRENNAN, J., delivered opinion Court, WHITE, MARSHALL, BLACKMUN, STEVENS, JJ., joined. REHNQUIST, C.J., dissenting opinion, O'CONNOR, SCALIA, KENNEDY, joined, post, p. 524. R. Claire Guthrie, Richmond, Va., petitioners. John G. Roberts, Jr., amicus curiae, supporting petitioners, special leave Court. Walter Dellinger, respondent. Justice BRENNAN 1 This case us determine whether bring (1982 ed.)1 reimburses (Act), 79 Stat. 343, amended, 1396 seq. ed. Supp. V). More specifically, presented Secretary, arerea sonable incurred efficiently facilities," 1396a(a)(13)(A) ed., V), pursuant 2 * A. 3 cooperative federal-state program through Federal Government so they furnish individuals. 1396. participation voluntary, participating comply certain promulgated (Secretary). assistance, "plan assistance," 1396a(a), contains statement describing nature scope program. CFR 430.10 (1989). establish, among other things, services provided 4 1902(a)(13) sets As amended 1980 (Boren Amendment),2 section 5 "a must— 6 7 "provide services, nursing facility intermediate mentally retarded use (determined accordance methods standards developed .) order provide conformity applicable laws, regulations, quality safety access inpatient V) (emphasis added). 8 Commonwealth Plan Medical Assistance made. Complaint, ¶ 11, App. 11. Under formula—that is, various types fixed advance. Specifically, divided into "peer groups" size location formula median peer group. 9 Virginia Association (VHA), both id., 3, 4-5, United Eastern several Governor, Resources, members Department (the agency administers system). Respondent contends "rates providing patients care." Id., 4; 17, 13 ("The per diem reasonably nor adequately met standards").3 seeks requiring promulgate new and, interim, reimburse commensurate payments Medicare &Par; 34-39, 20-22. 10 Petitioners alternative judgment ground ed.) Commonwealth's Act. Record, Exh. 36, 1.4 motion. Pet. Cert. D-4—D-6. Fourth Circuit ensure court held language history "enforceable rights" rights. Assn. Baliles, 653, 656-660 We granted certiorari. 808, 49, 18 (1989).5 B 11 useful first provision. When enacted 1965, cost" provided, measured adopted Secretary. Pub.L. 89-97, 1902(13)(B), 346. became concerned, however, wielded much control over H.R.Rep. 92-231, 100 (1971). therefore 1972 give more develop reimbursement, but retained ultimate requirement provided. law "the determined shall reviewed Secretary." 92-603, 232(a), 86 1410-1411. 12 response rapidly rising costs, 1981 extended part Omnibus Budget Reconciliation 1981, 97-35, 95 808.6 blamed mounting complexity rigidity regulations. 97-158, Vol. 2, pp. 292-293 (1981); S.Rep. 96-471, 28-29 (1979). previous version theory afforded degree own found that, fact, had forced principles. "recognize[d] inflationary [then] current intend[ed] greater latitude developing implementing methodologies promote efficient economical delivery services." 293. "delete[d] basis [and] substitute[d] laws standards." 97-139, 478 (1981), U.S.Code Cong. & Admin.News 744. Thus, affirmed desire "reasonable," calculating rates." For example, explained establish statewide classwide cost,7 include incentive provisions encourage operation. 292-293; 29. Flexibility ensured limiting 478, "finds, define declined national definition, should what facilit[ies]." 48 Fed.Reg. 56049 (1983). make finding least annually adequate," 447.253(b)(1) (1989), though only when change 447.253(a); 56047 According "places responsibility development States." 56050. he reviews findings themselves. 447.256(2) focuses "on attest fact States' indeed indicate reasonable" judges "whether satisfactory." 56051 Therefore themselves underlying data.8 II 14 deprivation privileges, immunities Constitution laws" States. Maine Thiboutot, 448 4, 2502, 2504, 65 555 (1980), we violations statutes Constitution. recognized two exceptions this rule. A plaintiff violation will permitted unless [does] meaning 1983," "Congress itself." 781 (1987).9 argue second, address contentions turn. 15 "Section speaks 'rights, immunities,' law." Transit 420 (1989) "federal right" turns benefit putative plaintiff." Ibid. (citations internal quotations omitted). If so, reflects merely "congressional preference" kind conduct binding governmental unit, 694 interest asserts " 'too vague amorphous' 'beyond judiciary enforce.' (quoting 431-432, 774). test, conclude patients. procedural one accompanied (however perfunctory) adequacy; well. 16 providers: It "payment plan." 430, 774. 17 Pennhurst, 111 Developmentally Disabled Bill Rights 6010 (1976 III), 6010, "bill declared made "findings respecting persons developmental disabilities," namely, "appropriate treatment' environment governments institutions failing treatment" receive funds. 13, 1538. concluded context revealed neither recognize rights; instead, preference treatment." 22-24, 1542-1543. examined general "findings" "too thin reed support" creation obligations. 1541. corresponding condition receipt funding, reasoned were hortatory, mandatory." 24, 1543. refused infer congressional funding clearly impose conditions grant knowingly decide accept funds." Ibid.10 recently, Brooke 1937, 1437a limits amount rent housing tenant charged, inclusion "reasonable" allowance utilities rent. 769. "mandatory limitation[s] focusing family income." 773-774. addition, rejected argument utility allotment right. guidelines authorities follow allowance, "sufficiently specific definite [an] righ[t] [and was] beyond enforce." 432, 774-775. 19 light terms: "must hospital[s]" adequate. authorized noncompliance 1396c ed.). expressed his intention "noncompliance practice." 430.35 ("A practice arise failure requirement, regardless itself complies requirement"). "The [Boren Amendment's] succinctly forth command, wholly uncharacteristic mere suggestion 'nudge.' West University Hospitals, Inc. Casey, 885 20 (CA3 1989) 1540), cert. granted, 494 1003, 1294, 108 472 (1990). concede level lie failed whatsoever. Tr. Oral Arg. 12. concede, must, Reply Brief 3.11 dissent, acknowledging obligations, apparently hold compel bare requirements. 527-528. think limited. Any nothing need correct. 21 assurances, sense without reason reviewable manner decline interpretation dead letter. Rosado Wyman, 397 397, 412-415, 90 1207, 1217-1219, 25 442 (1970); 2A C. Sands, Sutherland Statutory Construction 45.12 (4th 1984). 22 acknowledge make, on, patently false finding, 7, insist left courts, findings.12 extent bears (as opposed infra, 520-523), supports conclusion entitled 512, notice chooses formality. Rather, plausible adequate, concomitant 23 principles been prior regulation. basis. 744 passing Amendment, sought decentralize eliminate 29 (flexibility "not arbitrary reductions adversely affect care"). words, gave leeway computing rates—they choose between retrospective ratesetting methodologies, example—Congress rates.13 By reducing establishing transferred States; still committee expects keep regulatory minimum necessary proper accountability, overburden unnecessary burdensome paperwork requirements") added); H.R.Conf.Rep. 96-1479, 154 (1980) ("[T]he retains final authority disapprove [them] statute"). correct, point assurances. 24 clear passage able During 1970's, courts commonplace.14 freezing providers, 1975 waive Eleventh immunity 94-1122, (1976); 121 Cong.Rec. 42259 (1975) (remarks Sen. Taft). believed waiver existing means enforcement—noncompliance instituted providers—were deal problem outright included compensation past underpayments. 94-1112, 4. 10% executed March 31, 1976. 94-182, 111, 89 1054. generated great opposition repealed next session Congress. 94-552, 2540; 94-1240, 3-4 (1976) 1976, 5649-5651; 122 13492 Rep. Rogers). But repeal "be construed way contravening constraining agencies, seek prospective, forum. Neither [the section] interpreted placing constraints parties involved relief." 5651.15 experience demonstrates understood before ill-fated requirement.16 Given background, implausible substituting "assurances," deprive Instead, shows, "assurances" prescribe respective roles suggest, 26 Nevertheless, argument. rates.17 facilit[y]" same time That substantial discretion choosing standard unenforceable court. While range certainly outside could ever Act.18 respect 27 merit 'We lightly remedy' federally right." 423-424, 770 Smith Robinson, 468 992, 1012, 104 3457, 3468, 82 746 (1984)). burden show "by evidence enforcement." 770. resort absence 1983." 435 (1981). 28 On occasions established sufficient displace Clammers, Water Pollution Control 33 1251 seq.—which Environmental Protection Agency considerable power orders, civil criminal penalties, citizen-suit evidenced 2622. Similarly 1010-1011, 3467-3468, elaborate Education Handicapped (EHA), 1400 seq., manifested Congress' remedy. EHA contained "carefully tailored mechanism," 1009, 3467, local culminated review. 1011, (citing §§ 1412(4), 1414(a)(5), 1415). comparable enforcement. plans, 1316(a) whose postpayment claims "ensure management program." 1396a(a)(37) regulation, 447.253(c) three-tiered 32-43. 30 withdraw "generalized powers" Urban Development (HUD) audit cut off vindicate noted HUD exercise auditing frequently, require, provide, mechanism problems attention HUD. Ibid.; Rosado, 420-423, 1221-1224. even appropriate above, 515-518, follows altogether 1983.19 31 existence whereby evidences courts. availability ordinarily Patsy Board Regents Fla., 457 496, 516, 102 2557, 2568, 73 172 (1982). Nor indication specifically replace remedies available proceeding. Most determined.20 American Care al. Amici Curiae 20-24, B. manifests 773 (availability grievance prevent 1983). III 32 right, provider. accordingly Affirmed. 34 Chief whom KENNEDY join, dissenting. 35 relevant portion using 36 facilities. ." 37 notes ante, 504, permanent form court-ordered seeks, interim relief, Complaint 34-39; 22. And respondent's prayer example good today's decision, every hereafter enforce inevitably substitution preferred chosen State. whenever prevails action, defendant enjoined implement "determined State," "satisfactory." 1396a(a)(13)(A). orders entered actions systems different above-quoted language. 38 reasons policy thwarted unavailable adequacy sort reasoning, hitherto thought deciding conferred party. 39 Before seeking implied Satisfaction now familiar from, e.g., Cort Ash, 422 66, 2080, 45 (1975), requisite showing. Court's "to imply where explicitly directly class case." Cannon Chicago, 441 677, 690, n. 99 1946, 1954, 60 560 crucial demonstration contain "in favor of" particular plaintiff. See, Cort, 78, 2088 ("First, plaintiff?"). then three additional vindicating ibid. removed latter showings holding generally (with exception subsequently (1981)) supplies vindication arising statutes. 40 Thiboutot rendered obsolete pertaining significant area overlap remained. either implication used confer identifiable 432-433, 775-776, (1987) (O'CONNOR, dissenting) ("Whether confers issue unique actions. cases, asked, 2087, 'the create[s] plaintiff' "). regard, said 1540, (1981)). 41 Cannon, right- duty-creating accurate indicator propriety action." 13. suggestive traditional rule step our exposition always look statute's text stop fully reveals meaning. Tobacco Co. Patterson, 456 63, 68, 1534, 1537, 71 748 (1982) (" '[O]ur starting employed Congress,' assume 'that ordinary words used' ") (internal citations apparent deviate sound Yet virtually ignores case. appropriations submit, Services, assistance." specifies contents plans. 1396a(a). here, 1396a(a)(13)(A), simply thirteenth listed placement structure statute, 1540 (emphasizing "context" review), addressed many receiving funds; structural buttressed "focus" beneficiary 774 (finding "focusing" dispositive class). 43 Even guarantee places limitation very plain reimbursement. findings. second Secretary—not courts—to logic law, arguably process. Indeed, establishment process discernible accruing anyone illustrates, avoid implementation. approves challenges despite plaintiff's success results displacement created order. support looks unambiguous relies considerations purportedly derived superseded versions statute. 515-520. 44 concludes, position equates proposition obligated theme enforceability, trusted 1396a(a)(13)(A)'s command creating states "[i]t letter." Ante, 514. refers, scarcely "dead reading nullifies "letter" Apart previously, deliberately disregard incorporated less justice recognizes basic takes far liberties advanced I reverse Appeals. part: "Every person who, color ordinance, custom, usage, Territory Columbia, subjects causes subjected, citizen jurisdiction thereof immunities, liable party injured equity, proceeding redress." changed 96-499, 962(a), 94 2650. following year Amendment's hospitals. 2173, 808. Since applied retarded. 100-203, 4211(h)(2)(A), 1330-205. each group computed adjusts account inflation. figures calculated patient adjusting inflation Consumer Price Index (CPI). Until annual baseline adjusted CPI. index tied costs. 24-26. argues hospital. challenges: 1982; CPI adjust years 1982-1986; (3) 1986. 20-26, 14-16. inadequate excludes 32, 19. initially grounds collateral estoppel. Exhs. 21. reversed. 830 1308 1987). remand numerous justiciability lawsuit, officials. 662 1989). certiorari Coos Bay Center Oregon Dept. 803 1060 (CA9 1986), vacated moot, 484 806, 52, 98 (1987). supra. basis; nature, paid advance cost. typical plan. information assurances: estimated average proposed type provider, increased decreased relation preceding year, estimate short-term, feasible, long-term, furnished, participation, covered serve disproportionate number low-income 447.255 may, request believes complete 56050 (1975). employ four-factor test asserted" Transamerica Mortgage Advisors, Lewis, 444 15-16, 242, 245-246, 62 146 (1979); Touche Ross Redington, 560, 575-576, 2479, 2488-2489, 61 concern, grounded separation powers, controls Thompson Thompson, 174, 191-192, 513, 522-523, 512 (1988) (SCALIA, concurring judgment); 742-749, 1981-1985, (1979) (Powell, dissenting). "alternative source authorization suits," 2625, separation-of-powers concerns present Consistent view, affirmatively withdrawn 106-107, 448-449, (1989); 770-771, $1.6 million, sum woefully enormous 'appropriate' treatment 'least restrictive' supported mind 6010. contrast, program, cover 50% 83% care. 1396d(b) 1988, contribution totaled approximately $29 billion. Amicus 2. ("By therefore, Amendment] vests ratemaking subject 'assurances' Secretary"). facilities" services. 447.253(b) (1983) facilities"). prerequisite subsequent separate obligations annually, amended. 447.253(a), statute—that themselves—is entirely understanding ("Because explicit result further detailed reporting add substantially evaluation assurances"). suggest decision approve Administrative Procedure (APA), 701-706. APA entrusted agency's discretion. 18-19. dispute, irrelevant House Senate Reports replete indications Conference Committee Report explains conferees policies efficiently-administered medicaid eligibles requirements." 97-208, 962 1324; (amendment "States facilities"); 293-294 (1981) ("In permitting design, intends fair beneficiaries. manner"); Amendments: Hearings H.R. 4000 Subcommittee Environment Interstate Foreign Commerce, 96th Cong., 1st Sess., 845 (statement Boren) squarely payments"); 126 17885 "amendment achieves law's assuring high-quality care" "differs rates") (colloquy Pryor Boren). Alabama Nursing Home Harris, 617 388, 395-396 (CA5 1980); California Obledo, 602 1357, 1363 1979); Minnesota Facilities Public Welfare, 150, (CA8 New York Toia, 577 790 (CA2 1978); Massachusetts General Weiner, 569 1156, 1157-1158 (CA1 St. Mary's East Louis, Ogilvie, 1324, 1326-1328 (CA7 1974); Catholic Brooklyn Queens, Inc., Div. Rockefeller, 430 1297, 1298 (CA2), app. dism'd, 400 931, 91 246, 262 (1970). Union Employees, RWDSU, AFL-CIO Carey, 557 278, 280-281 1977) (although sue, union representing employees sue). ("[P]roviders continue, course, institute necessary") (letter Health, Welfare); Compliance Requirements: Finance, 94th 2d (providers' recourse, includes "injunctive officials") Assistant Kurzman); ("Although enjoin [sic] recover 'lost funds' 11th Amendment") continued entertain All Circuits AMISUB (PSL), Colorado Social 879 789, 793 (CA10 1989); 17-22 (1990); Center, F.2d, 1061-1063; Nebraska Dunning, 778 1291, 1295-1297 1985), denied, 1063, 947, 996 Other entertained separately considering Hoodkroft Convalescent Hampshire Division 968, 972-975 1020, 720, 740 842 1158, 1165 1988); Hillhaven Wisconsin 733 1224, 1225-1226 1984); Beasley, 702 955, 955-962 (CA11 1983); Mississippi Heckler, 701 511, 517-520 Charleston Memorial Conrad, 693 324, 326 1982); Washington 698 964, 965 1982). related hospital, consider: situation (financial otherwise) serves low income patients, home, long-term home unavailable. provides, anything, guidance vested setting allowances. 437, 777, 965.476(d) (1986)). AMISUB, 796, invalidated conceded "Budget Adjustment Factor" half absolutely relevance 22-23 (invalidating Pennsylvania justification treating out-of-state differently in-state hospitals), errs supplying invalidate note Courts agree complied employs deferential 795-801; 23-24; 1294; Ass'n Reivitz, 1226 516. correct articulation apt existed 516-518, today. reasons, forecloses Putting aside available, 12, sole reduced role, APA. dispute payments. appeal issues: organization groups; plan; initial ceilings (4) consumer price index; (5) Finally, Monroe Pape, 365 167, 183, 81 473, 481, 492 (1961).

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