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\deflang1033\pard\plain\f3\fs17 No. 94-1912
\par 
\par In The Supreme Court of The United States
\par 
\par OCTOBER TERM, 1995
\par 
\par ROBERT C. METCALF, DIRECTOR, VIRGINIA
\par DEPARTMENT OF MEDICAL ASSISTANCE SERVICES,
\par PETITIONER
\par 
\par v.
\par 
\par REHABILITATION ASSOCIATION OF VIRGINIA,
\par INCORPORATED, ET AL.
\par 
\par ON PETITION FOR A WRIT OF CERTIORARI 
\par TO THE UNITED STATES COURT OF APPEALS
\par FOR THE FOURTH CIRCUIT
\par 
\par BRIEF FOR THE FEDERAL RESPONDENT 
\par IN OPPOSITION
\par 
\par DREW S. DAYS, III
\par Solicitor General
\par 
\par FRANK W. HUNGER
\par Assistant Attorney General
\par 
\par BARBARA C. BIDDLE
\par RICHARD A. OLDERMAN
\par Attorneys
\par 
\par Department of Justice
\par Washington, D.C. 20530
\par (202)514-2217
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par QUESTIONS PRESENTED
\par 
\par 1. Whether, in the case of elderly, indigent
\par patients who have been enrolled by a State in Part B
\par of the Medicare Program, the State may limit the
\par reimbursement paid to health care providers to the
\par amount covered by Medicaid.
\par 2. Whether, consistent with the Medicare and
\par Medicaid provisions of the Social Security Act, a
\par State may provide reimbursement for rehabilitation
\par services to the long-term care facilities in which
\par covered patients are located, rather than directly to
\par the health care providers that supply the rehabili-
\par tation services.
\par 3. Whether 42 U.S.C. 1983 provides a cause of
\par action to health care providers seeking to challenge
\par state reimbursement practices under the Medicare
\par and Medicaid statutes.
\par 
\par (I)
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par TABLE OF CONTENTS
\par 
\par Page
\par 
\par Opinions below . . . . 1 
\par Jurisdiction . . . . 1
\par Statement . . . . 2
\par Argument . . . . 7
\par Conclusion . . . . 12
\par 
\par TABLE OF AUTHORITIES
\par 
\par Cases:
\par 
\par Bob Jones Univ. v. United States, 461 U.S. 574(1983) . . . . 11
\par Chevron U.S.A. Inc. v. Natural Resources Defense
\par Council, Inc., 467 U.S. 837 (1984) . . . . 6, 7, 9
\par Haynes Ambulance Serv., Inc. v. Alabama, 36 F.3d
\par 1074 (11th Cir. 1994) . . . . 11
\par Morton v. Ruiz, 415 U. S. 199 (1974) . . . . 7 
\par New York City Health & Hosps. Corp. v. Perales,
\par 954 F.2d 854 (2d Cir.), cert. denied, 113 S. Ct. 461
\par (1992) . . . . 11
\par Pauley v. BethEnergy Mines, Inc., 501 U.S. 680
\par (1991) . . . . 8
\par Pennsylvania Medical Soc'y v. Snider, 29 F.3d 886
\par (3d Cir. 1994) . . . . 11 
\par Wilder v. Virginia Hosp. Ass'n, 496 U. S. 498 (1990) . . . . 5, 12 
\par 
\par Statutes and regulations:
\par 
\par Health Insurance for the Aged Act, Pub. L. No. 89-97,
\par Tit. I, 102(a), 79 Stat. 291 . . . . 2
\par 42 U.S.C. 1395 et seq . . . . 2
\par 42 U.S.C. 1395k(a)(2)(C) . . . . 4 
\par 42 U.S.C. 1395l(a)(l) (1988 & Supp. V 1993) . . . . 2 
\par 42 U.S.C. 1395l(b) (1988 & Supp. V 1993) . . . . 2
\par 42 U.S.C. 1395r (1988 & Supp. V 1993) . . . . 2
\par 42 U.S.C. 1395v (1988 & Supp. V 1993) . . . . 3 
\par 42 U.S.C. 1395w-4 (g)(3)(A) (Supp. V 1993) . . . . 10 
\par 42 U.S.C. 1395x(g) . . . . 4
\par 42 U.S.C. 1395x(p) . . . . 4
\par 42 U.S.C. 1395cc(a)(2)(A) (1988 & Supp. V 1993) . . . . 2 
\par 
\par (III)
\par 
\par ---------------------------------- Page Break ----------------------------------------
\par 
\par IV
\par 
\par Statutes and regulations-Continued:
\par 
\par Medicare Catastrophic Coverage Act of 1988, Pub. L. No.
\par 100-360, 301, 102 Stat. 748 . . . . 3, 9 
\par Omnibus Budget Reconciliation Act of 1989, Pub. L. No.
\par 101-239,  6102(a), 103 Stat. 2169 . . . . 10
\par Technical and Miscellaneous Revenue Act of 1988,
\par Pub. L. No. 100-347, 8434, 102 Stat. 3805 . . . . 3-4 
\par 42 U.S.C. 1320a-7b(d) (1988& Supp. V 1993) . . . . 3 
\par 42 U.S.C. 1396 et seq . . . . 2
\par 42 U.S.C. 1396a(a)(10)(E) (1988 & Supp. V 1993) . . . . 3, 8 
\par 42 U.S.C. 1396a(n) . . . . 8
\par 42 U.S.C. 1396d(p) (1988 & Supp. V 1993) . . . . 8 
\par 42 U.S.C. 1396d(p)(3) (1988 & Supp. V 1993) . . . . 8 
\par 42 U.S.C. 1983 . . . . 4, 5, 7, 12
\par 42 C.F.R.:
\par Pt. 407:
\par Sections 407.40-407.50 . . . . 3
\par Pt. 431 . . . . 4
\par 
\par Miscellaneous:
\par 
\par 52 Fed. Reg. 47,926 (1987) . . . . 4
\par 53 Fed. Reg. 657(1988) . . . . 4
\par H.R. Conf Rep. No. 1104, 100th Cong., 2d Sess. (1988) . . . . 4 
\par H.R. Rep. No. 105, 100th Cong., 1st Sess, Pt. 2 (1988) . . . . 10
\par H.R. Rep. No. 247, 101st Cong., 1st Sess. (1989) . . . . 10
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par In the Supreme Court of the United States
\par 
\par OCTOBER TERM, 1995
\par 
\par No. 94-1912
\par 
\par ROBERT C. METCALF, DIRECTOR, VIRGINIA
\par DEPARTMENT OF MEDICAL ASSISTANCE SERVICES,
\par PETITIONER
\par 
\par v.
\par 
\par REHABILITATION ASSOCIATION OF VIRGINIA,
\par INCORPORATED, ET AL.
\par 
\par ON PETITION FOR A WRIT OF CERTIORARI
\par TO THE UNITED STATES COURT OF APPEALS
\par FOR THE FOURTH CIRCUIT
\par 
\par BRIEF FOR THE FEDERAL RESPONDENT
\par IN OPPOSITION
\par 
\par OPINIONS BELOW
\par 
\par The opinion of the court of appeals (Pet. App. 1-71)
\par is reported at 42 F.3d 1444. The order and memo-
\par randum of the district court (Pet. App. 79-107) are
\par reported at 838 F. Supp. 243.
\par 
\par JURISDICTION
\par 
\par The judgment of the court of appeals was entered on
\par December 5, 1994. A petition for rehearing and sug-
\par 
\par (1)
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 2
\par 
\par gestion of rehearing en banc was denied on February
\par 23, 1995. Pet. App. 72-73. The petition for a writ of
\par certiorari was filed on May 22, 1995. The jurisdiction
\par of this Court is invoked under 28 U.S.C. 1254(1).
\par 
\par  STATEMENT
\par 
\par 1. Persons who are at least 65 years of age or
\par disabled, and who meet certain other eligibility re-
\par quirements, are automatically enrolled in Part A of
\par the Medicare program, a federally funded hospital
\par insurance program. See Health Insurance for the
\par Aged Act, Pub. L. No. 89-97, Tit. I,  102(a), 79 Stat.
\par 291 (codified, as amended, at 42 U.S.C. 1395 et seq.).
\par Persons who are covered by Medicare Part A (and
\par certain other persons) may purchase supplementary
\par insurance for additional medical services under Part
\par B of the Medicare program by paying premiums to the
\par Supplementary Medical Insurance Trust Fund. A
\par provider of medical services to Medicare Part B
\par beneficiaries receives the federal Medicare pay-
\par ment-typically 80% of "reasonable charges" for the
\par services rendered-and then may seek payment of the
\par remaining amount due (coinsurance) from the patient.
\par See 42 U.S.C. 1395l(a)(1), 1395l(b), 1395cc(a)(2)(A)
\par (1988 & Supp. V 1993). In addition to paying coin-
\par surance, Medicare Part B enrollees must pay a
\par monthly premium and an annual deductible. See 42
\par U.S.C. 1395l(b), 1395r (1988& Supp. V 1993).
\par Medicaid is a need-based program funded jointly by
\par the federal government and participating state gov-
\par ernments. See 42 U.S.C. 1396 et seq. Under Medicaid,
\par health care providers receive a specified sum for
\par covered services that is established by the State
\par through a fee schedule or other methodology. The
\par reimbursement rate for services to patients under the
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 3
\par 
\par Medicaid program is almost always less than the
\par "reasonable charge" that is the basis for reimburse-
\par ment for services under Medicare. Providers must
\par accept the Medicaid sum as payment in full, and may
\par not seek to recover any additional amount from
\par patients. See 42 U.S.C. 1320a-7b(d) (1988 & Supp. V
\par 1993).
\par Some persons, such as the elderly poor, are eligible
\par for coverage under both Medicare Part A and Medi-
\par caid. Those individuals may, however, lack the funds
\par to pay Medicare Part B premiums. Congress addres-
\par sed that problem by requiring participating States to
\par enter into "buy-in" agreements with the Secretary of
\par Health and Human Services, under which the States
\par enroll Medicaid recipients and others who are eligible
\par for Medicare, and who meet statutory income and re-
\par source requirements, in the Medicare Part B pro-
\par gram. 42 U.S.C. 1395v (1988 & Supp. V 1993); 42
\par C.F.R. 407.40-407.50. Medicaid funds are then used to
\par pay those persons' Medicare Part B insurance
\par premiums.
\par Initially, the only individuals who qualified for
\par Medicare "cost-sharing''-under which state Medi-
\par caid funds are used to pay Medicare Part B insurance
\par premiums-were those persons who were "dually
\par eligible" for both Medicaid and Medicare. Pet. App.
\par 86. In 1988, however, Congress broadened the class of
\par persons potentially eligible for Medicaid-financed en-
\par rollment in the Medicare Part B program beyond
\par "dual eligibles" to include a larger class of individ-
\par uals known as Qualified Medicare Beneficiaries, or
\par "QMBs." See Medicare Catastrophic Coverage Act of
\par 1988, Pub. L. No. 100-360,  301, 102 Stat. 748 (codified
\par at 42 U.S.C. 1396a(a)(10)(E), 1396d(p) (1988 & Supp. V
\par 1993)); Technical and Miscellaneous Revenue Act of
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 4
\par 
\par 1988, Pub. L. No. 100-647, 8434, 102 Stat. 3805; H.R.
\par Conf. Rep. No. 1104, 100th Cong., 2d Sess. 284 (1988).
\par The issue in this ease is how much health care
\par providers must receive for medical services rendered
\par to QMBs when, as is usually the case, the amount
\par payable under Medicaid is less than the "reasonable
\par charge" for the services that would be payable under
\par Medicare. Since 1971, the Secretary has interpreted
\par the provisions of the Medicaid and Medicare statutes
\par as allowing States to limit payments for medical
\par services rendered to dual eligibles (and, later, to
\par QMBs) to the amount by which the state Medicaid
\par rate exceeds the amount reimbursed by Medicare, or,
\par in the States' discretion, to pay the full amount of
\par "cost-sharing," which includes Medicare Part B
\par deductibles and coinsurance costs. See generally 42
\par C.F.R. Pt. 431; 52 Fed. Reg. 47,926 (1987) (corrected at
\par 53 Fed. Reg. 657 (1988)). Under that framework, the
\par Commonwealth of Virginia has chosen to limit its
\par reimbursement of service providers to the level of
\par reimbursement the providers would receive under
\par Medicaid. That decision was effectuated by an amend-
\par ment to the Virginia Medicaid plan, which was
\par approved by the Secretary. Pet. App. 9-10.
\par 2. On June 7, 1993, respondent Rehabilitation
\par Association of Virginia, Inc., representing various
\par providers of rehabilitation services, 1. brought this
\par action under 42 U.S.C. 1983 against the Director of
\par the Virginia Department of Medical Assistance
\par Services (petitioner here) and the Secretary of
\par 
\par ___________________(footnotes)
\par 
\par 1 Those services include speech therapy, physical therapy
\par and occupational therapy. They are considered outpatient ser-
\par vices under Medicare Part B. See 42 U.S.C. 1395k(a)(2)(C),
\par 1395x(g) and (p).
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 5
\par 
\par Health and Human Services. Pet. App. 11. Respon-
\par dent claimed that the Secretary's position-under
\par which Virginia could limit the reimbursement paid
\par for Medicaid services to QMBs to the amount allowed
\par under the State's Medicaid program-violated the
\par Medicaid and Medicare provisions of the Social
\par Security Act. Respondent alleged that individuals
\par enrolled in Medicare Part B by virtue of Medicaid
\par payments were subject to the more generous payment
\par provisions of Medicare Part B i.e., that the State
\par was obligated to pay the full amount of the patient's
\par coinsurance and deductibles, after the federal gov-
\par ernment paid the Medicare amount. Id. at 11, 84.
\par Respondent also challenged Virginia's method of
\par reimbursement for rehabilitation services provided to
\par QMBs who are nursing home residents. Under Vir-
\par ginia's state plan, reimbursement for rehabilitation
\par services provided to those patients is made directly to
\par the nursing home (by including the amounts in the
\par calculation of the nursing home's Medicaid per diem
\par rate), rather than directly to the provider of ser-
\par vices. Respondent asserted that that method of reim-
\par bursement violated applicable Medicare and Medicaid
\par provisions. Pet. App. 11, 84.
\par 3. The district court ruled in favor of respondent
\par on both issues, rejecting the Secretary's interpreta-
\par tion of the relevant Medicare and Medicaid provisions.
\par Pet. App. 82-107.
\par 4. A divided panel of the court of appeals affirmed.
\par The court first rejected petitioner's argument that
\par 42 U.S.C. 1983 does not provide a cause of action for
\par alleged violations of the Medicare and Medicaid pro-
\par visions. It concluded that such a defense was fore-
\par closed by this Court's decision in Wilder v. Virginia
\par Hosp. Ass'n, 496 U.S. 498 (1990). Pet. App. 12.
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 6
\par 
\par Relying on the language of the Medicaid and Medi-
\par care statutes, and on its reading of the relevant legis-
\par lative history, the court next determined that QMBs
\par should be regarded as full Medicare enrollees, not-
\par withstanding that their enrollment is financed by
\par state Medicaid funds. Accordingly, the court rea-
\par soned, payment must be made at the Medicare rate,
\par and the State must pay the difference between the
\par payment by Medicare (typically 80% of the "rea-
\par sonable charge" for purposes of Medicare) and the
\par total "reasonable charge." Pet. App. 34-35. While
\par noting the extreme complexity of the statutory
\par provisions at issue (id. at 12-13), the court concluded
\par that it need not defer to the Secretary's
\par interpretation of the provisions under Chevron
\par U.S.A. Inc. v. Natural Resources Defense Council,
\par Inc., 467 US. 837 (1984). In the court's view, the text
\par and legislative history of the provisions disclosed a
\par clear congressional intent that state co-payments
\par under the buy-in program be "complete," and, there-
\par fore, deference to the Secretary's contrary view was
\par not warranted. Pet. App. 34.
\par The court acknowledged. that the House Committee
\par Report that accompanied the 1988 amendments to the
\par Social Security Act "state[d], in unequivocal terms,
\par an understanding of the buy-in program such that the
\par states did not need to pay above the Medicaid cap"
\par (Pet. App. 29), and that the legislative history of the
\par 1989 amendments contained similar language (id. at
\par 33). The court concluded, however, that the state-
\par ments contained in that history were not controlling
\par because, in its view, they constituted "post enactment
\par legislative history" that mischaracterized pre-
\par existing law. Id. at 31.
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 7
\par 
\par Judge Niemeyer filed a lengthy opinion concurring
\par in part and dissenting in part. Pet. App. 44-71. He
\par joined in the majority's conclusion that Section 1983
\par provides a cause of action for respondent's claim, but
\par would have reversed the district court's decision that
\par Virginia's plan violated the Medicaid and Medicare
\par provisions.  Specifically, although he arrived at a
\par somewhat different interpretation of the statutes
\par than did the Secretary or the panel majority, Judge
\par Niemeyer concluded that the Secretary's reading of
\par the statutes "is nonetheless a reasonable and there-
\par fore a permissible one; to which the court owed
\par deference under Chevron. Pet. App. 46.
\par 
\par ARGUMENT   
\par 
\par We believe the court of appeals erred in its con-
\par struction of the relevant Medicare and Medicaid
\par provisions, and in failing to defer to the Secretary's
\par long-standing interpretation of the provisions under
\par Chevron. Nonetheless, because there is no conflict
\par among the courts of appeals regarding the questions
\par presented, and because the decision below does not
\par directly conflict with any decision of this Court,
\par further review is not warranted.
\par 1. "The power of an administrative agency to
\par administer a congressionally created * * * program
\par necessarily requires the formulation of policy and the
\par making of rules to fill any gap left, implicitly or
\par explicitly, by Congress." Morton v. Ruiz, 415 U.S.
\par 199, 231 (1974).  Accordingly, this Court held in
\par Chevron that where Congress has not expressed its
\par intention as to the precise question at issue, the
\par courts are to defer to a reasonable interpretation by
\par the agency charged with administering the program.
\par 467 U.S. at 844. "[T]he Secretary's interpretation
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 8
\par 
\par need not be the best or most natural one by gram-
\par matical or other standards. Rather, the Secretary's
\par view need be only reasonable to warrant deference."
\par Pauley v. BethEnergy Mines, Inc., 501 U.S. 680, 702
\par (1991) (citation omitted).
\par a. Contrary to the court of appeals' conclusion
\par (Pet. App. 12-38), the statutory provisions at issue in
\par this case are, at least, ambiguous as to whether
\par States must provide reimbursement to providers for
\par services they render to QMBs in an amount that
\par ensures that the total reimbursement received by the
\par providers will be the amount that they would receive
\par under Medicare Part B. Pet. App. 86. Under 42
\par U.S.C. 1396a(a)(10)(E) (1988 & Supp. V 1993), a state
\par Medicaid plan "must" make Medicaid funds available
\par for Medicare cost-sharing on behalf of QMBs.
\par "Medicare cost-sharing" is defined in 42 U.S.C.
\par 1396d(p)(3) (1988 & Supp. V 1993) to include Part B
\par premiums, coinsurance, and deductibles, as well as
\par "[t]he difference between the amount that is paid
\par under section 1395l (a) of this title and the amount
\par that would be paid under such section if any reference
\par to '80 percent' therein were deemed a reference to '100
\par percent.'" The court of appeals read that provision as
\par creating an affirmative obligation on the part of the
\par States to pay in full all Medicare Part B premiums,
\par coinsurance, and deductibles for QMBs. Pet. App. 22,
\par 36-38. That language, however, provides only that,
\par under certain circumstances, the State is obliged to
\par pay premiums, deductibles, and coinsurance. It does
\par not specify whether the State must pay the coin-
\par surance amount to the extent it would exceed the
\par generally applicable payment ceilings under Medicaid.
\par In contrast, 42 U.S.C. 1396a(n), on which the
\par Secretary and petitioner relied below, is pertinently
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 9
\par 
\par titled "Payment amounts," and permits, but does not
\par require, a state plan to make payments in excess of
\par amounts paid under Medicaid. That Section expressly
\par provides that "the State [Medicaid] plan may provide
\par payment in an amount * * * exceeding the amount
\par that is otherwise payable under the State plan for
\par the item or service for eligible individuals." Ibid.
\par (emphasis added).
\par Taken together, those provisions support the
\par Secretary's construction and, at the very least,
\par demonstrate that Congress did not intend to mandate
\par the contrary position adopted by the court of appeals.
\par In light of that textual ambiguity, and the "technical
\par and complex" nature of the programs at issue, see
\par Chevron, 467 U.S. at 865, the court of appeals erred in
\par failing to defer to the Secretary's interpretation of
\par the provisions.
\par b. The legislative history of the relevant pro-
\par visions strongly supports the Secretary's inter-
\par pretation. In 1988, Congress enacted the Medicare
\par Catastrophic Coverage Act, Pub. L. No. 100-360, 301,
\par 102 Stat. 748, which required participating States to
\par provide Medicare cost-sharing to dual eligibles. The
\par House Committee Report that accompanied that leg-
\par islation acknowledged the existence of an optional
\par "Medicaid cap" on reimbursements to providers ser-
\par ving those individuals, and expressed the intention
\par that that system would continue under the amended
\par legislation:
\par 
\par It is the understanding of the Committee that,
\par with respect to dual Medicaid-Medicare eligibles,
\par some States pay the coinsurance even if the
\par amount that Medicare pays for the service is
\par higher than the State Medicaid payment rate,
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 10
\par 
\par while others do not. Under the Committee bill,
\par States would not be required to pay the Medi-
\par care coinsurance in the case of a bill where the
\par amount. reimbursed by Medicare-i.e., 80
\par percent of the reasonable charge-exceeds the
\par amount Medicaid would pay for the same it item
\par or service. However, if a State chooses to pay
\par some or all of the coinsurance in this cir-
\par cumstance, Federal matching funds would, as
\par under current law, be available for this cost.
\par 
\par H.R. Rep. No. 105, 100th Cong., 1st Sess. Pt. 2, at 61
\par (1988) (emphasis added).
\par Similarly, when it passed the Omnibus Budget
\par Reconciliation Act of 1989 (OBRA), Pub. L. No. 101-
\par 239, 6102(a), 103 Stat, 2169, Congress was aware of,
\par and deliberately left intact, the Secretary's con-
\par struction of the cost-sharing provisions. OBRA in-
\par cluded the enactment of 42 U.S.C. 1395w-4(g)(3)(A)
\par (Supp. V 1993), which provides that "[p]ayment for
\par physicians' services" to dual eligible patients and
\par QMBs "may only be made on an assignment-related
\par basis."  Under Medicaid, a provider who receives
\par reimbursement on the basis of an assignment of the
\par claim from the patient cannot seek reimbursement
\par beyond what is made by the State under Medicaid.
\par The House Committee Report on the 1989 legislation
\par explained that because "the Medicaid rules that
\par result in assignment being accepted for all dual
\par eligibles are not applicable to qualified Medicare
\par beneficiaries * * *, physicians are able to bill these
\par patients directly and to charge amounts in excess of
\par what Medicare determines to be reasonable and what
\par Medicaid will reimburse." H.R. Rep. No. 247, 101st
\par Cong., 1st Sess. 364 (1989). The House Committee
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 11
\par 
\par Report expressly recognized that state Medicaid
\par programs "typically pay the Medicare coinsurance
\par only to the extent that their payment, plus the
\par Medicare payment, does not exceed what the Medicaid
\par program would pay for the service in question." Ibid.
\par With that background in mind, OBRA was intended to
\par "codif[y] the current practice with respect to dual
\par eligibles and extend[] it to qualified Medicare
\par beneficiaries. It does not change the current policy
\par regarding the amount which a Medicaid program
\par must reimburse on such claims." Ibid. (emphasis
\par added).
\par Congress's repeated expansion of the cost-sharing
\par provisions, with full cognizance of the Secretary's
\par long-standing construction of that program, "make[s]
\par out an unusually strong case of legislative acqui-
\par escence in and ratification by implication of" the
\par Secretary's position. Bob Jones Univ. v. United
\par States, 461 U.S. 574, 599 (1983). In light of that
\par history, the court of appeals' substitution of its own
\par interpretation for that of the Secretary was error.
\par 2. Although, in our view, the court of appeals erred
\par in failing to defer to the Secretary's reasonable inter-
\par pretation of the Medicaid and Medicare provisions,
\par this case does not warrant further review. Each of
\par the other courts of appeals that have considered the
\par question has rejected the Secretary's position. See
\par New York City Health & Hosps. Corp. v. Perales, 954
\par F.2d 854 (2d Cir.), cert. denied, 113 S. Ct. 461 (1992);
\par Haynes Ambulance Serv., Inc. v. Alabama, 36 F.3d
\par 1074 (11th Cir. 1994); Pennsylvania Medical Soc'y v.
\par Snider, 29 F.3d 886 (3d Cir. 1994). Because there is
\par no conflict among the circuits, and because the court
\par of appeals' decision does not directly conflict with any
\par 
\par ---------------------------------------- Page Break ----------------------------------------
\par 
\par 12
\par 
\par decision of this, Court, certiorari is not warranted at
\par this time.
\par Two newly filed cases raise the same issue of
\par statutory interpretation in other circuits.  See
\par Michigan Ass'n of Ambulance Servs. v. Michigan,
\par No. 5:95-CV-48 (W.D. Mich.); Paramount Health
\par Systems v. Wright, No. 95-C-1620 (N.D. III.). Should
\par the Secretary's position prevail in one or more of
\par those cases, this Court's review might become
\par warranted. 2.
\par 
\par CONCLUSION
\par 
\par The petition for a writ of certiorari should be
\par denied.
\par Respectfully submitted.
\par 
\par DREW S. DAYS, III
\par Solicitor General
\par 
\par FRANK W. HUNGER
\par Assistant Attorney General
\par 
\par BARBARA C. BIDDLE
\par RICHARD A. OLDERMAN
\par Attorneys
\par 
\par JULY 1995
\par 
\par ___________________(footnotes)                                         
\par 
\par 2 Petitioner's other claims do not merit further review.
\par The district court, incorrectly we believe, invalidated
\par Virginia's direct-payment rule. However, that issue is not of
\par national importance, and may be remedied by the State without
\par recourse to the Court. Petitioner's contention that, notwith-
\par standing this Court's decision in Wilder v. Virginia Hosp.
\par Ass'n, 496 U.S. 498 (1990), 42 U.S.C. 1983 does not provide a
\par cause of action to health care providers seeking to challenge a
\par State's alleged failure to comply with the Medicare and Medi-
\par caid provisions at issue here, likewise has not given rise to a
\par circuit conflict that would warrant resolution by this Court.
\par 
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\par 
\par }