Document: 451 U.S. 1 101 S.Ct. 1531 67 L.Ed.2d 694 PENNHURST STATE SCHOOL AND HOSPITAL et al., Petitioners,v.Terri Lee HALDERMAN al. MAYOR OF CITY PHILADELPHIA Petitioners, v. Terri PENNSYLVANIA ASSOCIATION FOR RETARDED CITIZENS COMMISSIONERS MENTAL HEALTH/MENTAL RETARDATION ADMINISTRATORS BUCKS COUNTY PARENTS-STAFF ASSOCIATION, Petitioner, Nos. 79-1404, 79-1408, 79-1414, 79-1415 and 79-1489. Argued Dec. 8, 1980. Decided April 20, 1981. Syllabus The Developmentally Disabled Assistance Bill of Rights Act (Act) established a federal-state grant program whereby the Federal Government provides financial assistance to participating States aid them in creating programs care for treat developmentally disabled. is voluntary, are given choice complying with conditions set forth or forgoing benefits federal funding. "bill if rights" provision Act, 42 U.S.C. §§ 6010(1) (2), states that mentally retarded persons "have right appropriate treatment, services, habilitation" "the setting least restrictive . personal liberity." Pennsylvania, State, owns operates Pennhurst State School Hospital, facility care, treatment retarded. Respondent Halderman, resident Pennhurst, brought class action District Court on behalf herself all other residents against various officials responsible its operation. It was alleged, inter alia, at were unsanitary, inhumane, dangerous, such denied members specified constitutional statutory rights, including rights under and, addition seeking injunctive monetary relief, it urged be closed "community living arrangements" residents. found certain claimed violated, granted relief sought. Appeals substantially affirmed, but avoided claims instead held § 6010 created substantive favor retarded, have an implied cause enforce those violated rights. court further Congress enacted pursuant both 5 Fourteenth Amendment spending power. Held: Section does not create any "appropriate treatment" "least restrictive" environment. Pp. 11-32. (a) case inferring congressional intent create, Congress' enacting power Amendment, enforceable obligations weakest where, as here, asserted imposed affirmative fund since may assumed will implicitly attempt impose massive States. Unlike legislation 5, however, much nature contract; return funds, agree comply federally conditions. legitimacy legislate thus rests whether voluntarily knowingly accepts terms "contract," intends condition moneys, must do so unambiguously. 15-18. (b) applying above principles these cases, This fInds nothing legislative history suggest intended require assume high cost providing environment their citizens. There virtually no support Appeals' conclusion Amendment. nowhere purpose, contrary Act's language structure demonstrate mere funding statute. 6010, when read context more specific provisions than express preference kinds treatment. Far from requiring newly declared individual has systematic focus, improve individuals by encouraging better state planning, coordination, demonstration projects. 18-22. (c) merit contention Congress, acting power, conditioned funds State's agreeing underwrite into 6010. As noted, "findings" viewed represent general statements policy, legal duties. Moreover, "plain language" well administrative interpretation provision, also refutes contention. contrast clearly conditions, way suggests "conditioned" described therein. 22-24. (d) rule construction can decide accept applies greatest force potential largely indeterminate. crucial inquiry here would undertake obligation provide setting, spoke fairly said could make informed choice. In this case, fell short clear notice accepting they obligated 24-25. (e) A comparison explicitly demonstrates did intend place either absolute conditional 25-27. (f) Questions addressed Appeals—as bring suit compel compliance contained claims, another statute—and issues law Pennsylvania remanded consideration reconsideration, respectively, light instant decision. 27-31. 612 F.2d 84, reversed remanded. Allen C. Warshaw, Harrisburg, Pa., petitioners No. 79-1404. 2 Thomas M. Kittredge, Philadelphia, 79-1408 79-1415. 3 Joel I. Klein, Washington, D. C., 4 David Ferleger, respondents Halderman Drew S. Days, III, respondent United 6 K. Gilhool, Association Retarded Citizens. 7 [Amicus Curiae Information pages 4-5 intentionally omitted] 8 Justice REHNQUIST delivered opinion Court. 9 At issue cases scope meaning 1975, 89 Stat. 486, amended, 6000 seq. (1976 ed. Supp.III). Third Circuit judicially enforceable, Hospital (Pennhurst), For reasons stated below, we reverse decision remand proceedings. 10 * Commonwealth Pennhurst. large institution, housing approximately 1,200 Seventy-five percent "severely" "profoundly" retarded—that is, IQ less 35—and number residentsare physically handicapped. About half committed there order parent guardian. 11 1974, minor filed Eastern superintendent, operation (hereafter petitioners). additional (hereinafter referred respondents) persons, States, Citizens (PARC)—subsequently intervened plaintiffs. PARC added several surrounding counties defendants, alleging commitment 12 amended complaint dangerous. Specifically, averred due process equal protection violation inflicted cruel unusual punishment Eighth Amendments, conferred Rehabilitation 1973, 87 355, 29 701 Supp.III), 6001 Mental Health Retardation 1966, Pa.Stat.Ann., Tit. 50, 4101-4704 (Purdon 1969). arrangements"1 13 certified consisting who been become After 32 day trial, issued opinion, reported 446 F.Supp. 1295 (1977), making findings fact conclusions respect Its undisputed: Conditions only often abused drugged staff members, inadequate "habilitation" retarded.2 Indeed, physical, intellectual, emotional skills some deteriorated Id., 1308-1310. 14 went hold provided "minimally adequate environment," regardless involuntarily committed. 1314-1320. existed "be free harm" "nondiscriminatory Equal Protection Clause, 1320-1322. addition, 504 794, 201 4201 1969), minimally habilitation 15 Each existing institution habilitation. F.Supp., 1318. ordered eventually closed, suitable residents, plans removal submitted court, developed each participation his her family, improved interim. appointed Special Master supervise implementation order. 1326-1329. 16 affirmed Court's remedial 84 (1979) (en banc). Court, sought avoid raised rested Supp.III).3 111(1) (2) 502, liberty." test articulated Cort Ash, 422 66, 78, 95 2080, 2088, 45 26 (1975), right. F.2d, 97. Because statute Amendment4 power,5 declined consider alone "could ever predicate private rights." 98. alternative ground, holding "habilitation." 17 concluded except insofar closed. Although "deinstitutionalization favored approach environment, construe closing institutions like 115. "individual determinations Master, appropriateness patient" instructed "engage presumption placing [community arrangements]." 114-115.6 18 Three judges dissented. majority correct right, disagreed duty defendants possible. dissent relevant regulations, indicate own resources treatment." 119. believe declarations designed encourage course conduct used courts States.7 19 We certiorari petitioners' challenges below. 447 904, 100 2984, 64 853. Petitioners first contend Assuming question authority next assert Government, parties. Finally, argue below too broadly far exceeded powers move environments contention—that simply rights—we find unnecessary address remaining issues. II 20 turn brief review Act. Like cooperative programs, voluntary See generally King Smith, 392 309, 88 2128, 1118 (1968); Rosado Wyman, 397 397, 90 1207, 25 442 (1970); Harris McRae, 448 297, 2671, 65 784 (1980). elected participate program. Secretary Department Human Services (HHS), agency administering approved Pennsylvania's plan 1976 disbursed $1.6 million. itself receives allotment though receive $6 million per year Medicaid funds. 21 begins exhaustive statement purposes. 6000(b)(1) ed., "overall purpose" 1978 is: 22 "[T]o assist assure developmental disabilities services necessary enable achieve maximum through system which coordinates, monitors, plans, evaluates ensures human disabilities." (Emphasis supplied.) 23 margin, "specific purposes" "assist" financially "support" activities comprehensive 6000(b)(2) Supp.III).8 24 lists variety receipt Under 6005, example, "as assistance" shall "each recipient take action" hire qualified handicapped individuals. turn, condition" receiving submit evaluate 6009. "provide satisfactory assurances effect disabled person plan." 6011(a) And 6012(a) Supp.III) promise protect advocate course, provision. part: "Congress makes following respecting disabilities: 27 "(1) Persons disabilities. 28 "(2) should maximize person's liberty. "(3) public institutio[n] that—(A) needs person; (B) meet minimum standards ." 30 Noticeably absent suggesting "condition" stands sharp 6009, 6011, 6012. 31 enabling parts sections. 6061-6063 Supp.III).9 Those sections describe how allotted desiring overall HHS, accordance plan. To Secretary, 6063. It, establishment Planning Council, 6063(b)(1), out objectives achieved plan, 6063(b)(2)(A) furnished consistent prescribed 6063(b)(5)(A)(i) manner 6063(b)(5)(B) supported protecting 6063(b)(5)(C) Supp.III).10 Council serve 6067 procedures sanctions ensure requirements. may, disapprove 6063(c). If fails satisfy requirements 6063, terminate reduce grant. 6065 Any dissatisfied Secretary's disapproval funding, appeal appeals. 6068. No recognized III 33 broad order, provide, expense, initial before us, then, one construction: Did obligations? A. 34 discerning intent, necessarily possible sources legislate, namely, Spending Clause acted powers, themselves disagree point. Accordingly, mandatory Solicitor General, contrast, concedes alone. Tr. Oral Arg. 54. Thus, view, funds.11 35 previously going secure guarantees Katzenbach Morgan, 384 641, 651, 86 1717, 1723-1724, 828 (1966); Oregon Mitchell, 400 112, 91 260, 272 Fitzpatrick Bitzer, 427 445, 96 2666, 49 614 (1975),12 had little occasion determining guarantees. imposes policy involuntarily, because intrudes traditional authority, quickly attribute unstated act Our previous wholly expressly 5. supra (intent Voting 1965); Amendments 1970); House Senate Reports 1972 Civil 1964); cf. South Carolina Katzenbach, 383 301, 803, 769 (1966) Fifteenth 1965). moreover, involved statutes prohibited conduct. 36 Turning our long fix disburse money See, e. g., Oklahoma CSC, 330 127, 544, L.Ed. 794 (1947); (1970). contract: "contract." Steward Machine Co. Davis, 301 548, 585-598, 57 883, 890-896, 81 1279 (1937); can, knowing acceptance unaware unable ascertain what expected it. unambiguously.13 Cf. Employees Public Welfare, 411 279, 285, 93 1614, 1618, 251 (1973); Edelman Jordan, 415 94 1347, 39 662 (1974). By insisting speak voice, exercise knowingly, cognizant consequences participation. 37 instances where entitlements proved capable saying explicitly. supra, 333, S.Ct., 2141 (Social Security creates "federally [on States] furnish 'aid families dependent children reasonable promptness eligible individuals'," quoting Act). carefully inquire, spend moneys merely precatory terms. B 38 Applying environment" lower court's purpose. Quite contrary, explicit purposes "to assist" use grants 6000(b) Nothing "overall" "specific" reveals new, Surely elaborate incentives 40 Respondents nonetheless insist speaks "rights" supports view. Their reliance misplaced. " 'In expounding statute, guided single sentence member sentence, look whole law, object policy.' Philbrook Glodgett, 421 707, 713, 1893, 1898, 44 525 Heirs Boisdore, How. 113, 122, 1009 (1849). Columbia Carter, 409 418, 420, 602, 604, 613 (1973). Contrary respondents' assertion, ambiguous. persuaded such, thin reed closest come giving justifies appropriation guides applications Carolene Products Co., 304 144, 152, 58 778, 783, 82 1234 (1938).14 413, 1218, sometimes legislates innuendo, indicating while measures that, falling legislating goals, nudge preferred directions." case. 41 buttresses encourage, rather mandate, Committee believed purpose continue program, promote "effective planning initiation needed filling gaps among efforts." H.R.Rep.No.94-58, pp. 6, 8-9 U.S.Code Cong. & Admin.News, 919, 924. passed House, whatsoever. "applauded" efforts others 7. Respondents, vigorously bill evinces levels rely most heavily Title adopted "Bill Rights" over detailed "designed guaranteed Constitution." S.Rep.No.94-160, p. (1975). Report noted "Federal responsibility citizens." 32. Senator Stafford floor "Title Constitution institutionalization." 121 Cong.Rec. 16516 43 scattered bits history. place, means even new disabled.15 Despite discussion Report, Committee's view quite modest. explained stimulate develop retarded." 1. satisfying "need exposition authorities Act." 3. Nor remarks Senators contrary. "assisting" Randolph, introducing Senate, confirmed Senate's limited He said: "[W]e whose thrust, 1970 act, developing together available coordinated appropriately served. goal thorough careful effective evaluation." 16514 (1975) (emphasis supplied). Even Javits, principal proponent II, establishing Constitution. "represents reaffirmation basic civil offers direction valid realistic framework improving situation country's individuals." 16519 46 event, whatever bill, adopt Conference rejected compromised later became H.R.Conf.Rep.No.94-473, 41, Javits compromise, agreement establishes habilitation." 29820 47 sum, something typical statute.16 Much considered (1980), "was shared responsibilit[ies], device unwilling fund." 2684. 48 remains General without merit. amply demonstrated above, General's When 6012, 6067, doing marked existence throughout absence manifest 50 Equally telling specifically position General. according coordinate CFR 1385.1 (1979). acknowledges "[n]o included [the 1975] allow withhold basis failure [of 6010]." Fed.Reg. 31006 cannot terminated hardly funds.17 reaching compromise proposal failed enumerated see n. 15, supra. eliminating sanction, made hortatory, mandatory.18 51 1976, sum woefully enormous burden "appropriate" confirms usually substantial contribution defray costs. defies common sense, short, suppose 52 buttressed That canon difficult know meant bY unlikely accepted known bound inquiry, obligation, say they, indeed Not lack language, strains credulity "obligations" governmental administration contact, never understood Though broad, include surprising post "retroactive" 53 Appeals, persons. But required 6011 "only contributes portion person." H.R.Conf.Rep.No. 94-473, 43, Admin.News 963 correct, all, requirement automatically mandated inclusive 54 Second, requires 55 "contain habilitation, assisted chapter protected section title (relating disabled)." 56 Once again, limitations—both affording "consistent 6010"—would if, ruled, third, deinstitutionalization most, originally "for assisting implementing eliminate inappropriate placement 6062(a)(4).19 years later, relieved modest duty. Instead deinstitutionalization, concentrate four areas, arrangements." 6063(b)(4)(A)(ii) Had choices contemplated 1975 meaningless. recognize well-settled distinction between "encouragement" imposition binding Relying distinction, insoutheastern community coLlege dAvis, u.s. 99 S.CT. 2361, 60 980 (1979), claim bars discrimination funded obligates schools steps problems applicant's hearing disability. Finding "state agencies Southeastern 'encourage[d] implement policies procedures.' 410, 2369 (quoting Act), stressed [that] accommodation knew wished so." 411, 2369. Likewise aware need plainly difference, otherwise, type mandating IV 59 Of particular relevance quoted 12-13, 26.20 raises First, determined conditions.21 remedy noncompliance State. Just last Term, Maine Thiboutot, 1, 2502, 555 1983 deprivations "rights secured" laws" U.S., 4, 2504. Whether Thiboutot controls depends two factors. unlike plaintiffs alleged prevented him he entitled, "assurances" Secretary. open individual's interest having "right laws within 1983. POWELL suggested "governing exclusive violations terms." 22, 11, 2513. unclear exclusive. 61 sections, terms, refer "programs assisted" arguably "program assisted." being 6010.22 62 Third, remedy. Respondents' enjoining Commonwealth. 1222, welfare claimants "entitled declaratory injunction payment monies conforming period time." original.) There, suggestion pay sums demanded standards. (1968), assuming cost" standard "or using funds." 420-421, 1222. 63 instances, departed decisions enforcing conflict Supremacy Carleson Remillard, 406 598, 92 1932, 352 (1972). still struck down addressing form Townsend Swank, 404 282, (1971). open-ended potentially burdensome anything prospective pose serious questions Eleventh (1974).23 These questions. issues, here. V finding examined requirement. 100-103. looked pertinent 66 "The department [Public Welfare] be: availability equitable mental health retardation them, religion, race, color, national origin, settlement, residence, economic social status." 68 conclude unavailable adequately Appeals. are, difficulties argument. colored "treatment," independent ground state-law reconsideration here.24 69 similar reasons, address, VI 70 recent Nation treats retarded.25 law. induce so. that. attributing proceedings opinion. 71 Reversed 72 BLACKMUN, concurring part judgment. 73 I judgment reversed, although am accord says about confused confusing legislation, ante, 11-27, join advisory Part Part, properly correctly notes, 30, leaves whether, form, 6063 parties up plaintiff classes. seems me strongly intimate kindly future positive direction. presented today decided, decline appears negative attitude 74 plain politically self-serving essentially meaningless deserve hands authorities. perfectly judicial odd perhaps dangerous precedent ascribing enactment, observe give linkage points out, 12, becomes legally containing "assurances Supp. III). 75 parties, beneficiaries content application precedents, scheme involves regulatory supervision operations. Cannon University Chicago, 441 677, 1946, 560 (1979); 76 difficulty suggestion, 28-29, directly Commonwealth's institutionalized unified administration. restrict definition insulate substandard allocating acceptable premises ones. 77 WHITE, whom BRENNAN MARSHALL join, dissenting part. 78 residential operated serving five county area. Roughly admitted upon parents guardians remainder extensive discovery lengthy confinement Constitution, law,1 entered eventual arrangements Pennhurst's displaced (ED Pa.1978). On appeal, result reached proper (Act), initially court. cognizable significant exception.2 abandonment institutional facilities, erred ordering Rather, afforded determine level institutionalization community-based proper. 79 essence, concludes so-called serves establish guidelines endeavor fulfill, real extent chooses criteria my reading misconceives important serve. section, history, generalized minutia nugatory actions undertaken. 80 matter, duties concerning action, reasoning 'to from, obtain for, unjustified intrusions security,' 98, Ingraham Wright, 430 673, 97 1401, 1413, 711 passage indicated desire interest.3 Congressional Enforcement very consequences, (1976), ramifications, lightly passing Here, conclusive refers underlying extend modify unquestionably 6010(3) limitation spending. cross-referenced details program.4 objective considerations connected powers. resolution Art. I, cl. While ramifications follow impact besides served maintained cooperation Government. 83 enough couched deadly stating doubted. involvement began 1963 Facilities Construction Pub.L. 88-164, 282. facilities encouraged development programs.5 technically amendment continued concern quality increased. central expression declares that: 85 2. Treatment "in Governments six respects diet, dental chemical restraints. 4. Rehabilitative favorable outcome patients, served, depending involved.6 words ensuing declaration. 6010(3), carry specifically, aspects custody. Sections 6010(2) (4) phrased former unmistakably latter assuring relation involved. Both delineating envisioned Hence, neither ignored carrying Standing bottom, therefore, treated wishful thinking playing fanciful role stand isolation. Other confirm account integral cast pattern extending 6063(a) advantage "plan 6063(b) entitled "Conditions Approval," "[i]n must" filed; original numbered paragraphs. 24th specification protected." doubts 6063(b)(24) corresponded removed WAS restate satisfy. now provides: contain (especially familial protection) Pennsylvania. allocated supporting "programs" 6063(b)(5)(C); institutions, respect. true share allocation. 6063(b)(3)(A) paid 6062 toward strengthening political subdivisions State." received improvement Pennhurst.7 significance. Representatives versions character H.R. 4005, 94th Cong., 1st Sess. akin did, 10% respective allotments 5(b)(4). Debate restriction counteract unfortunate practice widespread persons.8 ¢s43¢s version 462, separate called Mentally Developmental Disabilities," detail meet. impetus behind recognition tragic faced many institutions.9 An repeated foster disabled.10 same time, realization play disabled.11 methods wishing opt 210(a). Alternatively, Parts C D relating respectively. encompassed hortatory. after achieving date enactment 203(a). 5year period, "no payments indirectly unless meets promulgated time actively implemented B." 206(a). Following passage, different bills came Committee. resulting kept 952. replaced comparatively disabled's expressed mechanism omitted. II. conference substitute contains enumerates habilitation; liberty; government medical restraints, visiting hours fire safety codes; adjusted size "These conferees disabled, particularly misfortune institutionalization, institutionalized, assured courts." 41-42 961. 98 minimal debate.12 hundreds constituted define precision great detail. rejected, extended concerns encountering inflexibility legislatively care. considering shortened qualitatively lesser best rejection ability specify resembling regulations.13 stated, None present sufficient reason overcome mandate. "treatment, entitlement self-defining. ignore them. 6010(3)(A), already indicated, "obligation" "does persons." (1) setting; (3) 6010(3)(B); 6010(4), guidance furnishing entitled. 102 Furthermore, approving himself identified Why "condition," lacks, touchstone identifying fathom.14 stronger indicia "conditions." 103 obligate unknown unpersuasive. calls detailed, spell others, Beyond this, reach will, practical emerge preparing securing approval "standards" Secretary; evident, option respected courts. indication record us "massive." noninstitutional located communities significantly expensive operate 1312. best, 104 apparently reduced hope cut off event determines observing approve protected, failing live 105 matter moment 6012 III) "a disabilities," pursue legal, administrative, remedies insure 6012(a)(2)(A). goes systems contemplates ongoing oversight enforcement otherwise. 106 determinative significance once recognizes, amendments convinced respected;15 think was, foreclose injured representative permitted do, determination 715, n.11, 1899, (1975); 1935, (1972); 286, n.3, 505, Electric Gilbert, 429 125, 140-146, 401, 410-413, 343 (1976). 107 Given manner, enforced 1983, factors enunciated Subsequently, encompasses law." 2504, acknowledged cause-of-action intervening Thiboutot. 108 federal-court jurisdiction safeguards suits recipients. Shea Vialpando, 416 251, 1746, 120 (1974); action. sure, direct 2513, (POWELL, J., dissenting). Chapman Houston Welfare Organization, 600, 672, 1905, 1944, 508 (§ protections apply secured "unless inconsistent intention") (WHITE, judgment). Preiser Rodriguez, 475, 1827, 439 (1973), habeas corpus sole challenging duration confinement. Adickes H. Kress 398 150, 1598, 1604, 142 Attempting fit exception, According petitioners, incompatible especially amorphous 109 oversee state-federal venture mean "most reluctant avenue affected program[s]" noncompliance. supra,, part, reluctance founded perception cutoff drastic injurious supposed 708, 42, 1963, litigation, cutoff, which, agency, correcting reveal 46; (the "should courts"). Ac- cordingly , invoked 110 vacate litigation involve held, What might fail limits perform commerce measure undertaken arise until obligations, accrued, withdrawing terminating settled termination cases. "It peculiarly tribunal, field areas resolve disputes expended consonance attached use." 422-423, 1222-1223. equally clear, privilege withdraw enjoin discrete regulation prospectively incident injunctions survive identifiable prohibited. there, Social "afford State] opportunity revise [federal requirements]" construed be, retain revised or, choose revamped date, restraining 421-422, 1222-1223; Lau Nichols, 414 563, 786, 111 major proceeded far-reaching remedy, appointment inmates remain moved facilities. More properly, announced thought then go route. not, propose compliance, satisfied decree incorporating unsatisfactory, enjoined. task managing deciding instance patients removed. recently Parham J. R., 584, 2493, (1979): mode procedure diagnostic business judges. child left physicians emphasize information traditionally relied behavorial specialists consulted." 607-608, 2506. Addington Texas, 429, 1804, 1811, 323 (commitment "on facts interpreted expert psychiatrists psychologists"). eschewed leaving instance. court-appointed approach. 112 "Community smaller, isolated residences nonretarded technical difference curable illness, "habilitation," consists education training those, ill. opinions interchangeably. "developmentally disabled" retardation. 6001(7)(A)(i). 1978, satisfies suggestive novelty none briefed nor applicability requested supplemental briefs rehearing en banc. contended implication sheds Act]." Supplemental Brief 78-1490 (CA3), "[t]he enforce, article." Power States." somewhat owe directed waiting list. entitle citizens currently setting." portions creation "how requirements" possibility able show rationally related confining them." 131. are— "(A) disabilities, priority covered otherwise met Education All Handicapped Children 1973 ., health, education, programs; "(B) activities; "(C) private, nonprofit model innovative techniques, train professional paraprofessional personnel disabilities; "(D) university affiliated operating interdisciplinary specialized persons; "(E) 6031-6043 authorize university-affiliated reworded recodified 1978. 133(b)(24) renumbered, 491, 506, 6063(b)(24), "assurance." reference money. cross-petitioners arguing authorized improper authority. "section beyond [F]ourteenth [A]mendment," treatment," Sanchez New Mexico, 396 276, 588, 469 (1970), dismissing want question, N.M. 438, 457 P.2d 370 O'Connor Donaldson, 587-589, 2486, 2499-2500, (BURGER, concurring). amici purports whatsoever, question. 585, 890; 569, 789, Fullilove Klutznick, 448, 2758, 902 (1980) J.); National League Cities Usery, 426 833, 2465, 245 respondents, "constitutional difficulties" imposing 45. issue, us. passed, codified, 94-103, 486. three Titles. Establishment "cannot enlarge confer powers." California R. 164 526, 541, 165, 170, 541 (1896); Cornell Coyne, 192 430, 383, 385-386, (1904). Fisher, Cranch 358, 386, (1805); Yazoo Mississippi Valley Thomas, 132 174, 188, 68, 73, 302 (1889). location 6010's meaning. preamble followed codified seem rationale lose Medicaid. 206. sanction argument 3007. expresses "all recognizes "described" inference policy. recodification But, discussed infra, note despite apparent so, 6063(b)(5)(C). relies 13. contends Medicaid, "obligations," ultimately concedes, 6010(3). institutions. feasible," recognizing "prompt movement back communities." H.R.Rep.No. 94-58, 928. concluding error bypassing resting confers Community College 404, 2366, WHITE Post, 41-42, Curiously, simultaneously assumes 41. assisted," understand why 6063(b)(5)(C), applicable. differ Brother argues rejecting agreed subscribing believes Rosado, suggests. photocopies Supreme characterize "state-funded individualized services." re Schmidt, 494 Pa. 86, A.2d 631 (1981). late submission Rule 35.5, affect reversal, E. 1974 Supp.III); 1401-1420; 1396d(d) 1397; Centers 2689 overturned employment employees "interests" allegedly San Antonio Independent Dist. 1278, (1973) (right education); Jackson Indiana, 1845, 435 (1972) bears purpose); nondangerous free). 6063(b)(24). text, infra. 1967 professionals 90-170, 527. 1970, second adopting formula system. broadened afflicted covered. 91-517, 1316. text that— standards: "(i) Provision nourishing, well-balanced daily diet "(ii) services. "(iii) Prohibition physical restraint absolutely prohibition "(iv) excessive restraints quantities interfere "(v) Permission close relatives visit prior notice. "(vi) Compliance "(4) and— health-related, habilitative, rehabilitative equivalent applicable intermediate regulations taking service delivery humane sanitary, rights; nonresidential programs." add paragraph: 95-602, 507, "curious" coming plans. project, allotment, formulated carried monitored. asserts means, it, allocation must, 9976 (remarks Rogers) (percentage overcoming misuse caused tendency resort institutionalization); ibid. Carter) (treatment conducted unnecessarily institutionalizing him"). concerned lead genesis narrow convincing. analogue comments irrelevant 16518 Sen. Javits) ("The shocking Willowbrook York, inspired ended"); id., 16521 Schweiker) seen dramatic increase awareness highlighted scandals communications media"); Williams) ("Over past few years, horrifying exist testimony inhuman [the] shown shadow doubt worse (sic ) admit"). "establish needing normalization." 16518. conclusion, legislators speaking bill: "Progress slow. abrogated regard initiatives reaffirm belief citizens—including leadership change warehousing beings product insensitive inhumane 462 represents direction, reaffirmation." 16519. 16520 Cranston) (Senate moving away "long-term utilizing home community"). 16522 ("It alternatives locking institutions"); ("[I]n long-term remain. appropriate, planned full potential"); Stafford) "assist ."). Prior final Congressman Rogers "brief care," "modest requirements." 29309 added). announcing "This 'Bill Rights' programs" 29820. 29818 Randolph) (compromise reorganized reflect essential elements facilities"); 29821 "basic statement" "will process"). report proposed changes. 204, 504. recommendations presented, took enact again demonstrating unwillingness uniform Disabilities 1978: Hearings 11764 Interstate Foreign Commerce, 95th 2d Sess., 471-475 (1978). determine, amend assurance cited suggest, hold, contract-like exactitude. evidence costs abortions withheld Hyde needs. situations waived fundamental (1974) (Eleventh sovereign immunity); Health, (same). implicated citation Department's amendments. explanation rulemaking follows: "No findings. amendments, people [§ 6010]. decided advocacy systems, 6010] exempted extension 'Rights' Congress. Recipients Commissioner Failure loss

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