Case brief

BOWEN v. GEORGETOWN UNIVERSITY HOSPITAL Case Brief

Supreme Court of United States • 1988
Holding checked against the opinion
488 U.S. 204 109 S.Ct. 468 102 L.Ed.2d 493
AI-generated from the opinion text. Read the opinion before you rely on it.

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Case Brief Summary & Legal Analysis

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tl;dr: After an earlier Medicare reimbursement rule was invalidated, the Secretary reissued it retroactively and required seven hospitals to return over $2 million. The Court affirmed judgment for the hospitals because the Medicare Act did not authorize retroactive cost-limit rules.

Legal Significance: The decision establishes a presumption against construing legislative rulemaking grants to authorize retroactive rules without express congressional authorization. It also rejects deference to an agency’s convenient litigating position unsupported by administrative practice. The majority resolved the case under the Medicare Act without deciding whether the APA independently prohibited the rule.

Case Facts & Court Holding

Key Facts & Case Background

Medicare reimburses providers for expenses incurred in serving beneficiaries, subject to cost limits established by the Secretary. In 1981, the Secretary changed the wage-index calculation to exclude wages paid by Federal Government hospitals. Hospitals in the District of Columbia area challenged the change. The District Court invalidated it for failure to provide notice and an opportunity for public comment, but declined to enjoin enforcement because administrative reimbursement remedies remained unexhausted. The Secretary did not appeal and settled reimbursement reports using the prior method.

After notice and comment, the Secretary reissued the rule in November 1984, retroactive to July 1, 1981, for a 15-month period. Seven hospitals were required to return over $2 million previously paid following invalidation of the original rule.

After exhausting administrative remedies, the hospitals sought judicial review under the APA, challenging the rule under both the APA and the Medicare Act. The District Court granted them summary judgment. The Secretary appealed, and the Court of Appeals affirmed on alternative statutory grounds. The Supreme Court granted certiorari and affirmed.

Court Holding & Legal Precedent

Issue: Did the Medicare Act authorize the Secretary to reissue an invalidated cost-limit rule retroactively?

The Secretary lacked authority under the Medicare Act to promulgate retroactive cost-limit rules, making the 1984 reinstatement invalid. The corrective-adjustment provision authorized case-by-case reimbursement adjustments rather than changes to computation methods, and the general rulemaking grants contained no express retroactive authority. The Court affirmed the Court of Appeals.

IRAC Legal Analysis

Legal Issue

Did the Medicare Act authorize the Secretary to reissue an invalidated cost-limit rule retroactively?

Conclusion

The case limits retroactive agency rulemaking through the requirement of congressional authorization and distinguishes individualized reimbursement corrections from changes to governing rules. Its controlling disposition rests on the Medicare Act, leaving the APA’s independent prohibition to the concurrence.

Legal Rule

A statutory grant of legislative rulemaking authority generally does not encompass retroactive rulemaking unless Congress conveys that power expressly. See Brimstone R. Co. v. United States, 276 U.S. 104, 122 (1928). Under 42 U. S. C. § 1395x(v)(1)(A)(ii), retroactive corrective adjustments concern individual providers’ reimbursement amounts, not retroactive changes to cost-computation rules; the Medicare Act’s general rulemaking provisions supply no express authority for retroactive cost-limit rules.

Legal Analysis

The Court began with the limits of delegated agency authority. Drawing on Brimstone R. Co. v. United States, it explained that legislative rulemaking grants generally require express congressional authorization to support retroactive rules, even when substantial justification exists.

The corrective-adjustment provision did not supply that authorization. Its reference to reimbursement for “a provider,” contrasted with surrounding plural references, indicated individualized review. Its language authorized adjustment of aggregate reimbursement produced by existing methods, rather than alteration of those methods. The Secretary’s longstanding regulations implementing the provision likewise reconciled interim payments with actual reasonable costs.

The Secretary sought deference under Young, Chemical Mfrs. Assn., and Chevron. The Court rejected that request because the interpretation lacked support in regulations, rulings, or administrative practice and contradicted earlier litigation positions. Relying on Investment Company Institute v. Camp and the related principle in Burlington Truck Lines, it declined to defer to counsel’s unsupported statutory interpretation or post hoc rationalization.

The general rulemaking provisions also lacked express retroactive authority. Committee reports specified prospective cost limits so providers could anticipate reimbursement restrictions. Consistent administrative regulations and statements reinforced that interpretation.

The Secretary argued that judicial invalidation justified curative retroactivity and that the original rule reduced reliance concerns by providing notice. The Court left those arguments’ force in other contexts unresolved because the Medicare Act’s particular statutory scheme controlled. It did not adopt the Court of Appeals’ alternative conclusion that the APA generally forbids retroactive rulemaking.

Separate opinions

Scalia, concurring: Scalia agreed with the Medicare Act analysis but concluded that the APA independently supported affirmance. He read its definition of a rule as requiring future legal consequences, distinguishing retroactive changes in law from prospective rules affecting past transactions. He rejected a curative-rulemaking exception based on notice or fairness, while recognizing that particular statutes might specially authorize retroactive rules.

The Opinions

Summary

  • An agency cannot enact retroactive legislative rules unless Congress provides express statutory authority for it to do so.
  • The Medicare Act’s provision for “retroactive corrective adjustments” authorizes only case-by-case adjudication, not general retroactive rulemaking.
  • An agency’s post hoc “litigating position” that is inconsistent with its prior practice is not entitled to Chevron deference.

Full text

Complete unedited opinion text as published by the court

JUSTICE KENNEDY delivered the opinion of the Court.

JUSTICE KENNEDY delivered the opinion of the Court.

Under the Medicare program, health care providers are reimbursed by the Government for expenses incurred in providing medical services to Medicare beneficiaries. See Title XVIII of the Social Security Act, 79 Stat. 291, as amended, 42 U. S. C. § 1395 et seq. (the Medicare Act). Congress has authorized the Secretary of Health and Human Services to promulgate regulations setting limits on the levels of Medicare costs that will be reimbursed. The question presented here is whether the Secretary may exercise this rulemaking authority to promulgate cost limits that are retroactive.

The Secretary's authority to adopt cost-limit rules is established by § 223(b) of the Social Security Amendments of 1972, 86 Stat. 1393, amending 42 U. S. C. § 1395x(v)(1)(A). This authority was first implemented in 1974 by promulgation of a cost-limit schedule for hospital services; new cost-limit schedules were issued on an annual basis thereafter.

On June 30, 1981, the Secretary issued a cost-limit schedule that included technical changes in the methods for calculating cost limits. One of these changes affected the method for calculating the "wage index," a factor used to reflect the salary levels for hospital employees in different parts of the country. Under the prior rule, the wage index for a given geographic area was calculated by using the average salary levels for all hospitals in the area; the 1981 rule provided that wages paid by Federal Government hospitals would be excluded from that computation. 46 Fed. Reg. 33637, 33638-33639 (1981).

Various hospitals in the District of Columbia area brought suit in United States District Court seeking to have the 1981 schedule invalidated. On April 29, 1983, the District Court struck down the 1981 wage-index rule, concluding that the Secretary had violated the Administrative Procedure Act (APA), 5 U. S. C. § 551 et seq., by failing to provide notice and an opportunity for public comment before issuing the rule. See District of Columbia Hospital Assn. v. Heckler, No. 82-2520, App. to Pet. for Cert. 49a (hereinafter DCHA). The court did not enjoin enforcement of the rule, however, finding it lacked jurisdiction to do so because the hospitals had not yet exhausted their administrative reimbursement remedies. The court's order stated:

The Secretary did not pursue an appeal. Instead, after recognizing the invalidity of the rule, see 48 Fed. Reg. 39998 (1983), the Secretary settled the hospitals' cost reimbursement reports by applying the pre-1981 wage-index method.

In February 1984, the Secretary published a notice seeking public comment on a proposal to reissue the 1981 wage-index rule, retroactive to July 1, 1981. 49 Fed. Reg. 6175 (1984). Because Congress had subsequently amended the Medicare Act to require significantly different cost reimbursement procedures, the readoption of the modified wage-index method was to apply exclusively to a 15-month period commencing July 1, 1981. After considering the comments received, the Secretary reissued the 1981 schedule in final form on November 26, 1984, and proceeded to recoup sums previously paid as a result of the District Court's ruling in DCHA. 49 Fed. Reg. 46495 (1984). In effect, the Secretary had promulgated a rule retroactively, and the net result was as if the original rule had never been set aside.

Respondents, a group of seven hospitals who had benefited from the invalidation of the 1981 schedule, were required to return over $2 million in reimbursement payments. After exhausting administrative remedies, they sought judicial review under the applicable provisions of the APA, claiming that the retroactive schedule was invalid under both the APA and the Medicare Act.

The United States District Court for the District of Columbia granted summary judgment for respondents. Applying the balancing test enunciated in Retail, Wholesale and DepartmentStore Union, AFL-CIO v. NLRB, 151 U. S. App. D. C. 209, 466 F.2d 380 (1972), the court held that retroactive application was not justified under the circumstances of the case.

The Secretary appealed to the United States Court of Appeals for the District of Columbia Circuit, which affirmed. 261 U. S. App. D. C. 262, 821 F.2d 750 (1987). The court based its holding on the alternative grounds that the APA, as a general matter, forbids retroactive rulemaking, and that the Medicare Act, by specific terms, bars retroactive cost-limit rules. We granted certiorari, 485 U.S. 903 (1988), and we now affirm.

It is axiomatic that an administrative agency's power to promulgate legislative regulations is limited to the authority delegated by Congress. In determining the validity of the Secretary's retroactive cost-limit rule, the threshold question is whether the Medicare Act authorizes retroactive rulemaking.

Retroactivity is not favored in the law. Thus, congressional enactments and administrative rules will not be construed to have retroactive effect unless their language requires this result. E. g., Greene v. United States,376 U.S. 149, 160 (1964); Claridge Apartments Co. v. Commissioner,323 U.S. 141, 164 (1944); Miller v. United States,294 U.S. 435, 439 (1935); United States v. Magnolia Petroleum Co.,276 U.S. 160, 162-163 (1928). By the same principle, a statutory grant of legislative rulemaking authority will not, as a general matter, be understood to encompass the power to promulgate retroactive rules unless that power is conveyed by Congress in express terms. See Brimstone R. Co. v. United States,276 U.S. 104, 122 (1928) ("The power to require readjustments for the past is drastic. It . . . ought not to be extended so as to permit unreasonably harsh action without very plain words"). Even where some substantial justification for retroactive rulemaking is presented, courts should be reluctant to find such authority absent an express statutory grant.

The Secretary contends that the Medicare Act provides the necessary authority to promulgate retroactive cost-limit rules in the unusual circumstances of this case. He rests on alternative grounds: first, the specific grant of authority to promulgate regulations to "provide for the making of suitable retroactive corrective adjustments," 42 U. S. C. § 1395x(v)(1)(A)(ii); and second, the general grant of authority to promulgate cost limit rules, §§ 1395x(v)(1)(A), 1395hh, 1395ii. We consider these alternatives in turn.

The authority to promulgate cost-reimbursement regulations is set forth in § 1395x(v)(1)(A). That subparagraph also provides that:

This provision on its face permits some form of retroactive action. We cannot accept the Secretary's argument, however, that it provides authority for the retroactive promulgation of cost-limit rules. To the contrary, we agree with the Court of Appeals that clause (ii) directs the Secretary to establish a procedure for making case-by-case adjustments to reimbursement payments where the regulations prescribing computation methods do not reach the correct result in individual cases. The structure and language of the statute require the conclusion that the retroactivity provision applies only to case-by-case adjudication, not to rulemaking.1

Section 1395x(v)(1)(A), of which clause (ii) is a part, directs the Secretary to promulgate regulations (including cost-limit rules) establishing the methods to be used in determining reasonable costs for "institutions" and "providers" that participate in the Medicare program. Clause (i) of § 1395x(v)(1)(A) requires these cost-method regulations to take into account both direct and indirect costs incurred by "providers." Clause (ii) mandates that the cost-method regulations include a mechanism for making retroactive corrective adjustments. These adjustments are required when, for "a provider," the "aggregate reimbursement produced by the methods of determining costs" is too low or too high. By its terms, then, clause (ii) contemplates a mechanism for adjusting the reimbursement received by a provider, while the remainder of § 1395x(v)(1)(A) speaks exclusively in the plural. The distinction suggests that clause (ii), rather than permitting modifications to the cost-method rules in their general formulation, is intended to authorize case-by-case inquiry into the accuracy of reimbursement determinations for individual providers. Indeed, it is difficult to see how a corrective adjustment could be made to the aggregate reimbursement paid "a provider" without performing an individual examination of the provider's expenditures in retrospect.

Our conclusion is buttressed by the statute's use of the term "adjustments." Clause (ii) states that the cost-method regulations shall "provide for the making of . . . adjustments." In order to derive from this language the authority to promulgate cost-limit rules, the "adjustments" that the cost-method regulations must "provide for the making of" would themselves be additional cost-method regulations. Had Congress intended the Secretary to promulgate regulations providing for the issuance of further amendatory regulations, we think this intent would have been made explicit.

It is also significant that clause (ii) speaks in terms of adjusting the aggregate reimbursement amount computed by one of the methods of determining costs. As the Secretary concedes, the cost-limit rules are one of the methods of determining costs, and the retroactive 1984 rule was therefore an attempt to change one of those methods. Yet nothing in clause (ii) suggests that it permits changes in the methods used to compute costs; rather, it expressly contemplates corrective adjustments to the aggregate amounts of reimbursement produced pursuant to those methods. We cannot find in the language of clause (ii) an independent grant of authority to promulgate regulations establishing the methods of determining costs.

Our interpretation of clause (ii) is consistent with the Secretary's past implementation of that provision. The regulations promulgated immediately after enactment of the Medicare Act established a mechanism for making retroactive corrective adjustments that remained essentially unchanged throughout the periods relevant to this case. Compare 20 CFR §§ 405.451(b)(1), 405.454(a), (f) (1967), with 42 CFR §§ 405.451(b)(1), 405.454(a), (f) (1983).2 These regulations provide for adjusting the amount of interim payments received by a provider, to bring the aggregate reimbursement into line with the provider's actual reasonable costs.

These are the only regulations that expressly contemplate the making of retroactive corrective adjustments. The 1984 reissuance of the 1981 wage-index rule did not purport to be such a provision; indeed, it is only in the context of this litigation that the Secretary has expressed any intent to characterize the rule as a retroactive corrective adjustment under clause (ii).

Despite the novelty of this interpretation, the Secretary contends that it is entitled to deference under Young v. Community Nutrition Institute,476 U.S. 974, 980-981 (1986), Chemical Mfrs. Assn. v. Natural Resources Defense Council, Inc.,470 U.S. 116, 125 (1985), and Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc.,467 U.S. 837, 842-844 (1984). We have never applied the principle of those cases to agency litigating positions that are wholly unsupported by regulations, rulings, or administrative practice. To the contrary, we have declined to give deference to an agency counsel's interpretation of a statute where the agency itself has articulated no position on the question, on the ground that "Congress has delegated to the administrative official and not to appellate counsel the responsibility for elaborating and enforcing statutory commands." Investment Company Institute v. Camp,401 U.S. 617, 628 (1971); cf. Burlington Truck Lines, Inc. v. United States,371 U.S. 156, 168 (1962) ("The courts may not accept appellate counsel's post hoc rationalizations for agency [orders]"). Even if we were to sanction departure from this principle in some cases, we would not do so here. Far from being a reasoned and consistent view of the scope of clause (ii), the Secretary's current interpretation of clause (ii) is contrary to the narrow view of that provision advocated in past cases, where the Secretary has argued that clause (ii) "merely contemplates a year-end balancing of the monthly installments received by a provider with the aggregate due it for the year." Regents of the University of California v. Heckler,771 F.2d 1182, 1189 (CA9 1985); see also Whitecliff, Inc. v. United States, 210 Ct. Cl. 53, 60, n. 11, 536 F.2d 347, 352, n. 11 (1976), cert. denied, 430 U.S. 969 (1977). Deference to what appears to be nothing more than an agency's convenient litigating position would be entirely inappropriate. Accordingly, the retroactive rule cannot be upheld as an exercise of the Secretary's authority to make retroactive corrective adjustments.

The statutory provisions establishing the Secretary's general rulemaking power contain no express authorization of retroactive rulemaking.3 Any light that might be shed on this matter by suggestions of legislative intent also indicates that no such authority was contemplated. In the first place, where Congress intended to grant the Secretary the authority to act retroactively, it made that intent explicit. As discussed above, § 1395x(v)(1)(A)(ii) directs the Secretary to establish procedures for making retroactive corrective adjustments; in view of this indication that Congress considered the need for retroactive agency action, the absence of any express authorization for retroactive cost-limit rules weighs heavily against the Secretary's position.

The legislative history of the cost-limit provision directly addresses the issue of retroactivity. In discussing the authority granted by § 223(b) of the 1972 amendments, the House and Senate Committee Reports expressed a desire to forbid retroactive cost-limit rules: "The proposed new authority to set limits on costs . . . would be exercised on a prospective, rather than retrospective, basis so that the provider would know in advance the limits to Government recognition of incurred costs and have the opportunity to act to avoid having costs that are not reimbursable." H. R. Rep. No. 92-231, p. 83 (1971); see S. Rep. No. 92-1230, p. 188 (1972).

The Secretary's past administrative practice is consistent with this interpretation of the statute. The first regulations promulgated under § 223(b) provided that "[t]hese limits will be imposed prospectively . . . ." 20 CFR § 405.460(a) (1975). Although the language was dropped from subsection (a) of the regulation when it was revised in 1979, the revised regulation continued to refer to "the prospective periods to which limits are being applied," and it required that notice of future cost limits be published in the Federal Register "[p]rior to the beginning of a cost period to which limits will be applied. . . ." 42 CFR §§ 405.460(b)(2), (3) (1980). Finally, when the regulations were amended again in 1982, the Secretary reinserted the requirement that the limits be applied with prospective effect, noting that the language had been "inadvertently omitted" in the previous amendment but that the reinsertion would "have no effect on the way we develop or apply the limits." 47 Fed. Reg. 43282, 43286 (1982); see 42 CFR § 405.460(a)(2) (1983).

Other examples of similar statements by the agency abound. Every cost-limit schedule promulgated by the Secretary between 1974 and 1981, for example, included a statement that § 223 permits the Secretary to establish "prospective" limits on the costs that are reimbursed under Medicare.4 The Secretary's administrative rulings have also expressed this understanding of § 223(b). See Beth Israel Hospital v. Blue Cross Assn./Blue Cross/Blue Shield of Massachusetts, CCH Medicare and Medicaid Guide ¶ 31,645 (Nov. 7, 1981).

The Secretary nonetheless suggests that, whatever the limits on his power to promulgate retroactive regulations in the normal course of events, judicial invalidation of a prospective rule is a unique occurrence that creates a heightened need, and thus a justification, for retroactive curative rulemaking. The Secretary warns that congressional intent and important administrative goals may be frustrated unless an invalidated rule can be cured of its defect and made applicable to past time periods. The argument is further advanced that the countervailing reliance interests are less compelling than in the usual case of retroactive rulemaking, because the original, invalidated rule provided at least some notice to the individuals and entities subject to its provisions.

Whatever weight the Secretary's contentions might have in other contexts, they need not be addressed here. The case before us is resolved by the particular statutory scheme in question. Our interpretation of the Medicare Act compels the conclusion that the Secretary has no authority to promulgate retroactive cost-limit rules.

The 1984 reinstatement of the 1981 cost-limit rule is invalid. The judgment of the Court of Appeals is

Affirmed.