Marshall County Health Care Authority v. Donna E. Shalala, Secretary of the Department of Health and Human ServicesMarshall County Health Care Authority v. Donna E. Shalala, Secretary of the Department of Health and Human Services
Lead Opinion
Opinion for the court filed by Circuit Judge SILBERMAN.
Dissenting opinion filed by Chief Judge MIKVA.
Thе Secretary of Health and Human Services denied appellant hospitals’ claims for reimbursement under the Medicare program, and they sought review of the Secretary’s decision in the district court. Appellants claimed that in limiting them to the lower reimbursement rates allowed to rural hospitals, the Secretary ignored appellants’ “urban” character and arbitrarily and capriciously refused to grant them an exception from the classification scheme. The district court dismissed appellants’ complaint for failure to state a claim under
I.
Under the Prospective Payment System implemented in 1983, the Medicare program does not reimburse hospitals for their actual costs. Instead, the Department of Health and Human Services (HHS) pays hospitals fixed rates based on average costs that are calculated according to both the type of service provided and the hospital’s geographic locаtion. See
Appellants are all hospitals in counties classified as rural for purposes of Medicare reimbursement. The statute defines an urban area as “an area within a Metropolitan Statistical Area [ (MSA) ] (as defined by the Office of Management and Budget) [ (OMB) ] or within such similar area as the Secretary has recognized under subsection (a) of this section by regulation.”
As noted, the OMB system is not required by the terms of the statute. The Secretary may define urban areas “similar” to, but not the same as, OMB’s MSAs, see
For the cost years from 1984 to 1988, appellants claimed reimbursement as urban hospitals despite their ineligibility under the then-existing regulations. After their claims for reimbursement were denied, appellants sought review in the district court pursuant to
The Secretary moved to dismiss, both for lack of subject matter jurisdiction and for
II.
Before the district court, appellants argued that the Secretary had illegally (arbitrarily and capriciously) declined to grant an exception to the regulatory scheme for hospitals in counties adjacent to multiple MSAs. Yet the “exception” they called for is a generic modification of the definition of urban areas, a modification which they subsequently obtained by legislative amendment. Of course, as appellants note, the Secretary had, and has, the power to redefine urban areas by regulation — as well as to grant exceptions. Their request could be satisfied, it would seem, by either procedure. And a refusal to engage in rulemaking is, of course, reviewable under the Administrative Procedure Act (APA). See, e.g., American Horse Protection Ass ’n, Inc. v. Lyng,
We agree with the government that the language and structure of the statute suggest a broad delegation of discretion to the Secretary either to modify the regulation or to grant an exception. We disagree, however, that the latter determination is completely unreviewable. But see Columbia-Greene Medical Center, Inc. v. Sullivan,
It is certainly not true, by contrast, that the Medicare statute reflects that degree of fulsome congressional deference to the executive. With respect to the particular provisions relevant to this case, moreover, Congress has provided a rather specific norm — the OMB model — to guide the Secretary’s judgment concerning the definition of urban areas. The Secretary may vary the definition, but we surely can hypothesize forms of regulatory amendments that could be thought unreasonable in light of the statute. Were the Secretary arbitrarily to grant an exception for some hospitals and not for others identically situated, one could expect a successful challenge. To be sure, a refusal to grant any changes in the definition, еither by way of modification of
In sum, the statute outlines a system that groups tоgether hospitals facing similar operating costs to generate average figures that reflect the costs faced by hospitals in different markets. It is conceivable that a petitioner could show that due to peculiarities in the hospital industry, some of the divisions drawn by OMB between urban and rural areas bear a perverse relationship to the cost differentials of hospital markets. In that case, the statutory scheme might provide a sufficient standard for a reviewing court to conclude thаt the Secretary had acted arbitrarily and capriciously by refusing to modify the classification system — either by altering the regulation or by granting an exception. Accordingly, we think that the decision whether to provide exceptions under
III.
As best we understand appellants’ underlying position, it is that in 1986 when the Secretary, in a record proceeding, considered whether to modify the regulation in the direction appellants sought, the Secretary both unreasonably denied the modification and on the same basis rejected appellants’ request for an exception.
Appellants misunderstand the role the district court plays when it reviews agency action. The district court sits as an appellate tribunal, not as a court authorized to determine in a trial-type proceeding whether the Secretary’s study was factually flawed. Appellants imply that their claims that the Secretary acted arbitrarily and capriciously, or refused to consider material in the record, are similar to factual allegations — allegations they are entitled to “prove” as if the complaint alleged that the Secretary, driving her car negligently, had run into one of their hospitals. Based on this misunderstanding, appellants contend that the district court erred in dismissing their complaint under
The same basic misunderstanding underlies appellants’ claim that by examining the Secretary’s published responses to comments in the rulemaking proceeding, the court exceeded its latitude in ruling on a 12(b)(6) motion. Of course, when a district court is not sitting as an appellate court and the district judge looks outside the complаint to factual matters, he or she must convert a motion to dismiss into a motion for summary judgment, see, e.g., Gordon v. National Youth Work Alliance,
As for appellants’ procedural claim — that they were entitled to discovery and to a trial to test the validity of the Secretary’s study or the reasonableness of the Secretary’s reliance on it — appellants are simply wrong. They were entitled to argue, just as they could оn direct review of agency action in the court of appeals, that the Secretary arbitrarily did not consider material in the record, see, e.g., Motor Vehicles Mfrs. Ass’n v. State Farm Mut. Auto. Ins. Co.,
Appellants did not present any real argument before the district court to show that the Secretary’s determination not to grant them an exception (really to modify generally the regulation) was arbitrary and capricious. They stood on their “right” to proceed through to discovery and to trial to establish that the Secretary’s decision was illegal. Unfortunately for appellants, they had no such right, and the district court correctly so perceived their situation. It seems rather obvious to us, however, that appellants lost nothing by their mistaken posture. Given the extremely narrow scope of review any court is entitled to exercise over the Secretary’s determination not to modify the regulation or to grant exceptions, it does not appear that there is any merit to their claim that the Secretary violated the law.
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Accordingly, the judgment of the distriсt court is affirmed.
Notes
. Under a 1988 revision of the Act, counties adjacent to more than one MSA can have their commuting to multiple MSAs aggregated and, if their total commuting to adjacent MSAs meets the threshold defined by OMB, may be considered a part of the adjacent MSA to which they have the highest commuting level. See Medicare Catastrophic Coverage Act of 1988, § 411(b)(4), Pub.L. No. 100-360, 102 Stat. 683, 770 (1988).
. And the use of the mandatory “shall," in the statute ("the Secretary shall provide ... for such exceptions ... as he deems appropriate”) might be thought to add at least some obligation to consider exceptions. See, e.g., Armstrong v. Bush,
. Appellants claim that prior to 1986 the Secretary merely refused to change the regulation without sufficient "analytical basis.”
.Our dissenting colleague does not disagree with our premise that the issue before the district court is a question of law. He is concerned, however, that on a motion to dismiss the plaintiff might not have as adequate an opportunity to brief and argue the administrative law issues as it would have on summary judgment. We see no reason why that would be so; a district judge can just as easily call for briefing (memoranda) and argument of such issues whether it is under the auspices of a 12(b)(6) or Rule 56 motion. In this case, the government filed a memorandum with its motion, but the appellants declined to engage and claimed instead that they had a right to discovery. Nor does our colleague assert that the outcome of this appeal should be altered, so we assume that the dissent is really a concurrence.
. It is probably the bettеr practice for a district court always to convert to summary judgment so as to avoid the question presented in this case. But even in our earlier opinion in Telecommunications of Key West, we recognized that if we agreed with the district judge on the law when we reviewed a 12(b)(6) dismissal, a remand to convert to a Rule 56 motion would be futile. See Tele-Communications of Key West,
. In any event, as matters of public record, statements in the Federal Register can be examined on 12(b)(6) review. See Mack v. South Bay Beer Distributors, Inc.,
Dissenting Opinion
dissenting:
The majority holds today that on a motion to dismiss under
The appellants in this case filed pleadings in the district court alleging that the Secretary of Health and Human Services arbitrarily and capriciously refused to exercise his statutory authority to grant exceptions to the MSA classification scheme adopted by Congress. The Secretary filed a motion to dismiss under
It is well settled that a district court, when appraising the sufficiency of a complaint under
Generally speaking, under
A narrow exception to this general rule has been crafted, however, to allow courts to take “judicial notice” of facts on the public record. See, e.g., Mack v. South Bay Beer Distributors, Inc.,
Of course, taking “judicial notice” of facts in an administrative record is something quite different from reviewing the entire record upon which an agency decision was based and concluding that, in light of the entire record, the plaintiff could never demonstrate that the agency abused its discretion. By making this logical leap, the majority has transformed the narrow “judicial notice” exception into a new standard of review for complaints alleging arbitrary and capricious agency action under the APA. The majority acknowledges that “[i]t is probаbly better practice for a district court to always convert to summary judgment” but holds that nothing requires a district court to do so. Maj. op. at 1226 n. 5. In reaching this conclusion, the majority ignores the plain language of
The purpose behind the conversion requirement in
The 1946 amendment to
Still, the majority suggests that these concerns are not relevant in this context, where the only question presented to the court is a legal one. In the majority’s view, since the district court is not a fact-finder when reviewing agency action, the
Admittedly, the standard of review articulated in