Supreme Court of the United States
Shalala v. Illinois Council on Long Term Care, Inc.
February 29, 2000529 U.S. 1
Summary
The Court, in an opinion by Justice Breyer joined by Chief Justice Rehnquist and Justices O'Connor, Souter, and Ginsburg, held that § 405(h), incorporated into Medicare by § 1395ii, bars federal-question jurisdiction over the Council's challenge to nursing-home enforcement regulations. The claims must proceed through Medicare's administrative and judicial review channels. Michigan Academy permits an exception when channeling would mean no judicial review at all, but the Council failed to establish that circumstance. Justice Stevens separately dissented, also joining Justice Thomas, arguing that providers' regulatory challenges differ from patients' actions to recover benefits. Justice Scalia separately dissented and joined Thomas except for Part III, concluding that statutory stare decisis required following Michigan Academy while rejecting Thomas's reliance on a presumption favoring preenforcement review. Justice Thomas, joined by Stevens and Kennedy and by Scalia except for Part III, argued that Michigan Academy permits general regulatory challenges under federal-question jurisdiction and that the presumption favoring preenforcement review resolves any remaining ambiguity.
Holding
- Whether the Council may invoke federal-question jurisdiction to challenge Medicare enforcement regulations.. Section 405(h), incorporated by § 1395ii, bars the Council's § 1331 action and requires its claims to proceed through Medicare's special review channels.
- The scope of Michigan Academy's exception to Medicare's channeling requirement.. The exception applies when channeling would mean no judicial review at all, not merely because a claimant brings a general challenge to regulations or faces delay and expense.
- Whether the Council established that Medicare's review channels would deny judicial review of its claims.. The Council did not establish complete preclusion of review. The Secretary permissibly interprets the statute to allow review of substantial-noncompliance determinations resulting in remedies short of termination, and the members can ultimately obtain judicial consideration of their statutory and constitutional objections.
Docket 98-1109
Cited authorities
- 42 U.S.C. §§ 416
- 42 C.F.R. §§ 498.3
- 42 C.F.R. §§ 488.402
- 42 C.F.R. §§ 431.153
- 42 C.F.R. § 488.440(b)
- CA11
- 42 C.F.R. § 498.1(a)
- 42 C.F.R. § 488.456(b)(ii)
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