Supreme Court: Challenges to the Validity of Medicare Regulations Are to Be Made through Special Review Channel Created by Medicare Statutes-Shalala V. Illnois Council on Long Term Care, Inc

By Ferreira, Lucy | American Journal of Law & Medicine, January 1, 2000 | Go to article overview
Save to active project

Supreme Court: Challenges to the Validity of Medicare Regulations Are to Be Made through Special Review Channel Created by Medicare Statutes-Shalala V. Illnois Council on Long Term Care, Inc


Ferreira, Lucy, American Journal of Law & Medicine


Supreme Court: Challenges to the Validity of Medicare Regulations Are to be Made Through Special Review Channel Created By Medicare Statute--Shalala v. Illinois Council on Long Term Care, Inc.1--The Supreme Court of the United States, reversing the Seventh Circuit Court of Appeals, held that claims against the Secretary of Health and Human Services (HHS) alleging violations against Medicare, first had to be brought through a special review channel developed by Medicare statutes.2 Only then could the association seek judicial review if they were not satisfied with the Secretary's final decision after the initial hearing.

The Illinois Council on Long Term Care (Council), an association of nursing homes, sued the Secretary of HHS challenging the validity of the Medicare regulations which impose sanctions or remedies on nursing homes that violate certain standards. The Council alleged that certain Medicare-related regulations were in violation of statutes and the Constitution. The association had attempted to bring their claim under section 1331,(3) the federal question jurisdiction statute. The Court, however, ruled that the association was required to proceed under section 1395ii,(4) which incorporates section 405(h) of the Social Security Act5 prohibiting initial review in a federal court. The Council argued that it is able to obtain no review at all unless it obtains section 1331 review because it is entitled to review under the Medicare Act only when the Secretary terminates the home's provider contract. However, the Court agreed with the Secretary's interpretation of the statute that a dissatisfied home is entitled to review whether termination "or some other remedy is imposed" and that the language of the statute supports this interpretation.6

Under the Medicare Act, nursing homes complying with its numerous regulatory and statutory requirements will receive payments for providing care to Medicare beneficiaries after hospital stays. The requirements at issue dealt with the imposition of sanctions or remedies on nursing homes. If a home is dissatisfied with a determination made under the Act, it is entitled to a hearing and to judicial review of the Secretary's final decision. The association brought the action in federal district court attacking the regulations, saying they were unlawful in the following ways:

(1) certain terms, e.g., `substantial compliance' and `minimal harm' are unconstitutionally vague; (2) the regulations and manual, particularly as implemented, violate statutory requirements seeking enforcement consistency and exceed the legislative mandate of the Medicare Act; (3) the regulations create administrative procedures inconsistent with the Federal Constitution's Due Process Clause; and (4) the manual and other agency publications create legislative rules that were not promulgated consistent with the Administrative Procedure Act's demands for `notice and comment' and a statement of `basis and purpose.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

Supreme Court: Challenges to the Validity of Medicare Regulations Are to Be Made through Special Review Channel Created by Medicare Statutes-Shalala V. Illnois Council on Long Term Care, Inc
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?