Document: 471 U.S. 524 105 S.Ct. 2210 85 L.Ed.2d 577 CONNECTICUT DEPARTMENT OF INCOME MAINTENANCE, Petitioner,v.Margaret M. HECKLER, Secretary, Department of Health and Human Services, et al. No. 83-2136. Argued March 27, 1985. Decided May 20, Syllabus The Medicaid Act does not cover services performed for patients between the ages 21 65 in an "institution mental diseases" (IMD). In absence a statutory definition, Secretary Services (Secretary) has promulgated regulation defining IMD as "an institution that is primarily engaged providing diagnosis, treatment or care persons with whether determined by its "overall character." Middletown Haven Rest Home Connecticut "intermediate facility" (ICF) provides illness well other diseases. Between January 1977 September 1979, paid it provided to eligible patients, including those who had been transferred there from state hospitals. Under program, State received federal reimbursement payments. At completion audit was notified allowable because identified IMD. On administrative review, Department's Grant Appeals Board upheld disallowance. then filed action Federal District Court, which set aside disallowance, but Court reversed. Held: An ICF may be IMD, terms are mutually exclusive. Act's express authorization coverage individuals over uses language plainly indicates hospital, skilled nursing facility, Moreover, Secretary's interpretation comports plain language. And legislative history reveal any clear expression contrary congressional intent. Pp. 528-538. 731 F.2d 1052 (CA2 1984), affirmed. Charles Alvin Miller, Washington, D.C., petitioner. Kathryn Anne Oberly, respondents. Justice STEVENS delivered opinion Court. 1 (IMD) covered Act. adopted definition term broad enough encompass (ICF). narrow question presented this case within meaning broader permits classified consistent intent Congress. 2 During period $1,634,655 3 After receiving information discharging large numbers institutions into ICFs facilities, after numerous meetings officials, selected Haven, certified ICF, review audit. believed financial aid violation applicable regulations prohibited IMDs. 4 privately owned, 180-bed facility licensed "Rest Nursing Supervision" authority "to certain psychiatric conditions."1 years 1977-1979 77% suffered major illness, half were transferees hospitals.2 employed professional staff, three psychiatrists, specialized mentally ill;3 they viewed facility.4 sum, ample evidence team's conclusion "primarily engaged" diagnostic diseases regulations.5 5 audit, gave notice payments ill IMDs participation.6 State's request disallowance decision consolidated similar requests States Illinois, Minnesota, California. disallowance.7 6 obtained judicial filing action.8 United held supported statute v. Schweiker, 557 F.Supp. 1077 (1983). Second Circuit reversed, (1984), expressly rejecting reasoning Eighth Circuit. See Minnesota Heckler, 718 852 square conflict on important construction prompted us grant certiorari. 469 929, 321, 83 258 (1984). 7 contends same cannot both facility"; words, exclusive categories. Because acknowledges concludes our view, however, position foreclosed statute, reasonable longstanding Act, history. We therefore affirm. 8 * 1965 Congress authorized program adding Title XIX Social Security Act;9 established "for purpose assistance choose reimburse costs medical needy persons."10 offers submit have approved plans "medical assistance."11 present form, authorizes 18 categories assistance.12 9 For types services—inpatient hospital services, facilities and, most importantly, intermediate services—the contains exception IMDs.13 thrice-repeated exclusion demonstrates did intend exclusive; if intended separate categories, would unnecessary illogical. 10 Other provisions make covered, Thus, describes "who their physical condition" require institutional do need level hospital.14 § 1396d(a)(18)(B) prohibits under IMDs, while another provision, 1396d(a)(14), also allows such "inpatient age diseases." To accept render 1396d(a)(14) lifeless Congress' approval IMDs.15 11 textual support II 12 diseases," appropriate consider term.16 13 initial shortly enacted 1965. It stated: 14 "Any individual attained patient . diseases; i.e., whose overall character maintained (whether licensed)."17 (Emphasis added.) 15 A few later, following: 16 "Whether one will not). 17 " 'Institution diseases' means diseases, attention, related services."18 19 current definition19—like earlier versions—is essentially original developed almost two decades ago.20 earliest later interpretations consistently emphasized character" when 20 never indicated dissatisfaction undeviating construction. "We often noted agency charged administration entitled substantial deference." Blum Bacon, 457 132, 141, 102 2355, 2361, 72 728 (1982). agency's only order gain approval.21 follows determine available discloses must reject suggestion "institutions Act.22 III elderly contained IMDs.23 Report Senate Committee Finance made applied public private institutions, explained based view long-term responsibility.24 22 provide part requirement plan include adequate provision patient's needs.25 stated develop implement comprehensive health programs.26 These latter conditions components "Long Amendment," contention policy favors transfer patients—at least elderly—from less restrictive facilities.27 23 1967, without amending expanded programs aged, blind, disabled authorizing cost ICFs.28 1967 amendments mention IMDs.29 Four 1971, amendment enlarged ICFs. retained exclusion, remains today.30 24 next year, added 21."31 deliberations 1972 amendments, considered desirability extending "mental coverage" 65, decided so.32 Schweiker Wilson, 450 221, 236, 101 1074, 1083, 67 186 (1981).33 25 points several aspects lengthy argument should narrowly construed traditional custodial places special emphasis surely alternative feasible. notes first no made, text contemplates ill. Finally, number comments legislators indicating assumed referred 26 relies clearly establish ineligible simply his diagnosis illness. perfectly hospitals, patients. However, thrice since accepted proposals lift 65.34 But damaging statement funding IMDs.35 explaining amendment, Conference 27 "The new section House bill chooses hospitals homes."36 28 This long-standing interpretation: can 29 persuasively argued represents sound enlightened policy. not, excluded "hospitals" treated instead IMD; indication unambiguously confirmed fact parenthetical applies all facilities. statute. 30 judgment 31 so ordered. App. 35a-37a. Id., at 17a. 22a-23a. 14a. Although hold itself out media institution, although than typical specializing sources referral. 15a. cared could admitted population uncharacteristic homes. 20a. regulations, 42 CFR 435.1009(e) define follows: services. Whether such." criteria designed focus what constitutes team utilized following evaluating Haven: 1. That institution; 2. advertises holds 3. more 50% disability functioning; 4. used care; 5. entered directly community; 6. proximity (within 25-mile radius); 7. distribution home patients; 8. basis eligibility due disability, disease; 9. hires staff ill; 10. independent reviews conducted teams report preponderance facility. 12a-13a, 1e-6e. letter that, participation "is aged 64, eligible" participation. 2e. Pet. Cert. 40d-44d. addition sought direct appellate review. dismissed want jurisdiction. 1052, 1055 1984). 79 Stat. 343. Harris McRae, 448 297, 301, 100 2671, 2680, 784 (1980). U.S.C. §§ 1396, 1396a. 1905(a) 1396d(a) (1982 ed. Supp. III), further amended Medicare Budget Reconciliation Amendments 1984, Pub.L. 98-369, 2335(f), 98 1091. definitions these service read 'medical assistance' payment individuals[:]. "(1) inpatient (other diseases); "(4)(A) diseases) older ; "(15) care. ." 1396d(a)(1), (a)(4)(A), (a)(15) ed., III) (emphasis added). Section 1905(c) forth 1396d(c), part: "For purposes subchapter 'intermediate facility' (1) law provide, regular basis, health-related degree condition (above room board) them through includes meets requirements proceeding [sic] sentence. With respect furnished shall include, except subsection (d) section, distinct thereof defects." familiar principle courts give effect, possible, every word See, e.g., Reiter Sonotone Corp., 442 330, 339, 99 2326, 2331, 60 931 (1979). Cf. Chevron U.S.A. Inc. Natural Resources Defense Council, Inc., 467 837, 843-845, 104 2778, 2781-2783, 81 694 "make publish rules inconsistent with" "as necessary [for its] efficient administration." 1302. Dept. Health, Education & Welfare, Handbook Public Assistance Administration, Supplement D—Medical Programs ¶ D-4620.2 (1966). Regulations fashioned thereafter restated essence definition: '[i]npatient services' items ordinarily inpatients disorders 45 249.10(b)(1) (1970) added); see 249.10(b)(4)(i) (skilled "those diseases"). 248.60(a)(3)(ii) (b)(7) (1972). n. 5, supra. recognizes "substance changed materially adoption." Brief Petitioner Unemployment Compensation Comm'n Alaska Aragon, 329 143, 153, 245, 250, 91 L.Ed. 136 (1946); American Paper Institute, Electric Power Service 461 402, 423, 103 1921, 1933, 76 (1983) ("We conclude [the interpretation] relevant provisions"). undermines cooperative federalism concept based. More specifically, argues crystallize until spent money. sufficient clarity untenable. general federal-state cooperation underlies entire favor liberal true favoring development reflected infra, 534, we nevertheless apparent limits placed own fund implementation 352. assistance" "(A) inmate (except institution); "(B) tuberculosis Ibid. prohibition against rendered 351-352. "Since enactment titles prior 1951 reason traditionally responsibility States." S.Rep. 404, 89th Cong., 1st Sess., pt. 1, p. 144 (1965). H.R.Rep. 213, 126 (1965), U.S.Code Cong. Admin.News 1965, pp. 1943, 2084. continued: "A second safeguard, committee's bill, each assure him best interests periodic needs. committee particularly concerned receive meet particular needed needs essential met redetermination hospital. believes hospitals—whether recipients—is State." 145-146 128 2085-2086. move ahead promptly contemplated Community Mental Centers 1963. planning required become 1963, makes approvability dependent upon showing satisfactory progress toward developing implementing utilization community centers, homes, forms care." 146 129 2086. 110 Cong.Rec. 21346-21348 (1964); 347; 1396a(a)(20), 1396a(a)(21). Commenting stated, methods requires maximum use existing resources offer ways caring longer can, help social extent needed, way community." 920-921. did, provide: "(d) Except modification, pursuant subject conditions, limitations, rights, obligations obtain plan." 920. actually signed 2, 1968, generally described "1967 amendments." 809. largely tracks amendments. comment 65: "With (d), straightforward reading sentence strongly implies qualify ICF. 86 1460-1461. 32 statement: potential economic benefits medicaid deserves evaluated demonstration projects purpose." 92-1230, 281 id., 57. proposal was, rejected conference. H.R.Conf.Rep. 92-1605, (1972), 1972, 4989. 33 various suggests refer argue confined. confident "public" well. 34 1971: Hearings H.R. before Finance, 92d 2d 924-941 (1972) (statements Dr. Jonathan Leopold, Commissioner, Vermont Kenneth Gaver, Ohio Hygiene Corrections); 1970: 17550 91st 500-550 (1970); 1967: 12080 90th 3, 1741 (1967) (statement Robert W. Gibson, Psychiatric Association). 35 1971 technically corrected explain prevent 1329, 1459-1460; 320-321 36 64 5397.

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