PRECEDENTIAL
UNITED STATES COURT OF APPEALS
FOR THE THIRD CIRCUIT
____________
No. 10-2409
____________
COMMONWEALTH OF PENNSYLVANIA,
DEPARTMENT OF PUBLIC WELFARE,
Appellant.
v.
U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES;
SECRETARY OF THE U.S. DEPARTMENT OF HEALTH
AND
HUMAN SERVICES, in his official capacity.
___________
On Appeal from the United States District Court
for the Middle District of Pennsylvania
(D.C. Civil Action No. 1:08-cv-00791)
District Judge: Honorable Yvette Kane
___________
Submitted Under Third Circuit LAR 34.1(a)
January 13, 2011
Before: SCIRICA, BARRY and VANASKIE, Circuit
Judges.
(Filed June 13, 2011)
Jason W. Manne, Esq.
Office of General Counsel
Department of Public Welfare
300 Liberty Avenue
303 State Office Building
Pittsburgh, PA 15222-0000
Counsel for Appellant
Tony West, Assistant Attorney General
(Did not enter an appearance)
William Kanter, Esq.
Peter R. Maier, Esq.
United States Department of Justice
Civil Division
950 Pennsylvania Avenue, N.W.
Washington, DC 20530-0000
Counsel for Appellee
___________
OPINION OF THE COURT
___________
VANASKIE, Circuit Judge.
The Pennsylvania Department of Public Welfare
(“Pennsylvania”) challenges a decision disallowing federal
reimbursement of occupancy costs incurred in operating
2
community residential facilities for the developmentally
disabled. The District Court, on cross-motions for summary
judgment, affirmed the Secretary of Health and Human
Services‟ (“HHS”) determination that reimbursement of
occupancy expenses is precluded by the statutory exclusion of
room and board set forth in 42 U.S.C. § 1396n(c)(1).
Discerning no error in the District Court‟s well-reasoned
decision, we will affirm.
I.
Pennsylvania, like every other state, participates in the
Medicaid Program, which was established in 1965 under Title
XIX of the Social Security Act, 42 U.S.C. § 1396 et seq.
Medicaid is “a cooperative, jointly funded, federal-state
program to financially assist low income persons in securing
medical care.” Klein v. Califano, 586 F.2d 250, 253 (3d Cir.
1978). Under Medicaid, the federal government reimburses
between 50% and 83% of state costs for patient care on behalf
of eligible low-income individuals. Medicaid is administered
by HHS through its Centers for Medicare and Medicaid
Services (“CMS”).
As part of Medicaid, states are eligible to receive
federal financial participation to assist with medical
assistance expenditures for eligible individuals in hospitals,
nursing facilities, and intermediate care facilities for the
mentally retarded. Federal financial participation was
extended in 1981 to cover developmentally disabled
individuals receiving care in home- and community-based
settings. See 42 U.S.C. § 1396n(c). Pursuant to 42 U.S.C. §
1396n(c)(1), states can opt-in to this coverage program by
obtaining a “waiver” of other provisions of the Medicaid
Statute. Section 1396n(c)(1), in pertinent part, provides:
3
The Secretary may by waiver provide that a
State plan approved under this subchapter may
include as “medical assistance” under such plan
payment for part or all of the cost of home or
community-based services (other than room
and board) approved by the Secretary which are
provided pursuant to a written plan of care to
individuals with respect to whom there has been
a determination that but for the provision of
such services the individuals would require the
level of care provided in a hospital or a nursing
facility or intermediate care facility for the
mentally retarded the cost of which could be
reimbursed under the State plan.
42 U.S.C. § 1396n(c)(1) (emphasis added).
HHS has issued regulations implementing the
exclusion of expenditures of federal funds for “room and
board.” 1 See 42 C.F.R. § 441.310(a)(2). The State Medicaid
Manual, which serves as the official HHS interpretation of the
law and regulations, contains the following explanatory
statement:
Except for respite care furnished in a State
approved facility that is not [a] private
residence (see item 4), [federal financial
participation] is not available for room and
board of the recipient as part of a home and
community-based service. Board means three
1
There are exceptions to this rule with regard to
personal caregivers and respite costs that are not relevant
here.
4
meals a day or any other full nutritional
regimen. Room means hotel or shelter type
expenses including all property related costs
such as rental or purchase of real estate and
furnishings, maintenance, utilities, and related
administrative services.
(A. 112a.)
Pennsylvania obtained a home and community based
service (“HCBS”) waiver in 2001. The waiver, which was
renewed in 2006, authorized reimbursement of state expenses
for “habilitation services” for developmentally disabled
individuals in home- and community-based treatment
settings. 2
Habilitation services are defined by statute as “services
designed to assist individuals in acquiring, retaining, and
improving the self-help, socialization, and adaptive skills
necessary to reside successfully in home and community
based settings.” 42 U.S.C. § 1396n(c)(5)(A). The waiver
granted to Pennsylvania defined these community habilitation
services as follows:
2
Pennsylvania provides habilitation services to
developmentally disabled individuals in four living
arrangements: intermediate care facilities for the mentally
retarded (“ICF/MRs”), community homes (also called
“community residential facilities”), family living homes, and
supported independent living arrangements. Of these,
funding to the nearly 2,200 non-profit or county-owned
community residential facilities across the state is at issue
here.
5
Community Habilitation means services
designed to assist individuals in acquiring,
retaining, and improving the self-help,
socialization, and adaptive skills necessary to
reside successfully in home and community-
based settings. Habilitation may be provided up
to 24 hours a day based on the needs of the
individual receiving services. Included are
provider training costs, supervisory costs,
purchased personnel costs, and costs of
necessary supplies, equipment and adaptive
appliances. Services may be provided by a
qualified family member or relative,
independent contractor, or services agency.
(A. 62a.)
Pennsylvania provides habilitation services in nearly
2,200 non-profit or county-owned community residential
facilities. From 2001 through part of 2006, Pennsylvania did
not seek federal reimbursement for occupancy costs for
Medicaid recipients living in such facilities. Instead,
Pennsylvania paid for residents‟ room and board in these
facilities using a combination of state funds and the residents‟
Supplemental Security Income.
On March 1, 2006, Pennsylvania began claiming a
portion of occupancy costs as reimbursable “habilitation
services.”3 Specifically, Pennsylvania claimed that 54.1667%
3
Beginning in late 2005, Pennsylvania employed the
consulting firm MAXIMUS to maximize the Medicaid
funding it was receiving from the federal government. The
6
of its occupancy costs, including rent, utilities, interest,
depreciation, building insurance, housekeeping, building
repairs, maintenance and renovation, and furnishings and
equipment were not, in fact, “room” costs, but were
“habilitation costs.” This claim was based on the fact that
residents were engaged in “waiver services” on the premises
for 13 hours in a typical 24-hour day, and, consequently,
room costs for this period actually supported habilitation.
CMS denied the request for inclusion of occupancy
costs by a letter dated July 5, 2006, determining that the costs
constituted “room and board” expenses and were therefore
non-reimbursable under the statute and the State Medicaid
Manual. The letter expressly disapproved Pennsylvania‟s
approach, noting that “[Section 4442.3.B.8 of the State
Medicaid Manual] requires the clear differentiation between
the services covered by the HCBS waiver that are provided in
the residence and the cost of room and board, which by law
cannot be covered.” (A. 80a.) CMS issued a letter dated
August 17, 2006, stating that the State could not include the
$50,939,457 in occupancy costs in its HCBS Medicaid
claims. An additional $9,997,220 was subsequently
disallowed. On June 21, 2007, CMS formally disallowed all
of Pennsylvania‟s claims for occupancy costs.
Pennsylvania appealed the disallowance to the HHS
Departmental Appeals Board (“DAB”), which upheld the
disallowance on February 6, 2008. The DAB explained:
[T]he costs that Pennsylvania is calling
“occupancy” (or “facility”) costs today are the
claim for occupancy costs appears to have been developed
from MAXIMUS‟ analysis and advice.
7
same as the costs that Pennsylvania previously
has treated as room costs. They have the same
component parts: rent, utilities, interest,
depreciation, building insurance, housekeeping,
building repairs and maintenance, building
renovations, furnishings and equipment, and
repairs of furnishings and equipment. For all
intents and purposes, Pennsylvania‟s occupancy
costs in community residential facilities are
room costs; they are the costs of providing
housing to the Medicaid recipients who live
there.
(A. 37a-38a.)
Pennsylvania next brought suit in the U.S. District
Court for the Middle District of Pennsylvania, alleging that
the DAB‟s decision violated the Administrative Procedure
Act as an action that was arbitrary, capricious, an abuse of
discretion, or otherwise unlawful. The District Court
awarded summary judgment to HHS on March 31, 2010. The
court initially concluded that “[room and board]
unambiguously means the provision of living space and
meals.” (A. 14a.) The court further found that, even if the
term “room” was ambiguous, under the deferential Chevron
standard of review, the DAB‟s construction of the statutory
term “room and board” was reasonable, supported by the
language of the State Medicaid Manual, and entitled to
deference.
8
II.
In this appeal from the decision of an administrative
4
board, “we apply de novo review to the district court's ruling,
and in turn apply the applicable standard of review to the
underlying agency decision.” Cyberworld Enter. Techs., Inc.,
v. Napolitano, 602 F.3d 189, 195-96 (3d Cir. 2010). Under
the Administrative Procedure Act, we must determine
whether the Board‟s action was “arbitrary, capricious, an
abuse of discretion, or otherwise not in accordance with law.”
5 U.S.C. § 706(2)(A).
Our review of whether an administrative board
committed an abuse of discretion is governed by Chevron,
U.S.A., Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837,
842-43 (1984). Under Chevron, we follow a two-step
analysis. First, we determine “whether Congress has directly
spoken to the precise question at issue.” Id. at 842. If it has,
we must effectuate the intent of Congress. If not, we must
determine whether the agency‟s construction of the statute is
“permissible.” Id. at 843. Notably, we “need not conclude
that the agency construction was the only one it permissibly
could have adopted to uphold the construction, or even the
reading the court would have reached if the question initially
had arisen in a judicial proceeding.” Id. at 843 n.11.
Our first inquiry is whether Congress has directly
spoken to the issue of whether the “room and board”
exclusion encompasses the “occupancy costs” which
Pennsylvania seeks to claim. “We determine whether
Congress has unambiguously expressed [its] intent by looking
4
The District Court had jurisdiction under 28 U.S.C. §
1331. We have jurisdiction under 28 U.S.C. § 1291.
9
at the plain and literal language of the statute.” United States
v. Geiser, 527 F.3d 288, 294 (3d Cir. 2008) (internal
quotation marks and citations omitted). “When determining a
statute's plain meaning, our starting point is the ordinary
meaning of the words used. We refer to standard reference
works such as legal and general dictionaries in order to
ascertain the ordinary meaning of words.” Id. (internal
quotation marks and citations omitted).
Webster‟s defines “room and board” as “lodging and
food usu[ally] specifically earned or furnished.” Webster‟s
Third New International Dictionary 1972 (1993). The
applicable definition of “room” is given as “lodging
consisting of a room usu[ally] specifically earned or
furnished,” id. at 1972, and the applicable definition of
“board” is given as “food in the form of daily meals often
provided as payment for services,” id. at 243. The Oxford
English Dictionary, which dates the term back at least to the
year 1795, defines “room and board” as “accommodation and
meals,” and compares it to the phrase “bed and board,”
meaning “entertainment with lodging and food,” which has
been in existence since at least circa 1403. See Room, n. and
Bed, n., Oxford English Dictionary (2d ed. 1989), online
version available at http://www.oed.com/.5
The plain meaning of “room and board,” therefore,
encompasses not mere “living space,” but “lodging” that has
been especially furnished together with food. Lodging is
defined as “a place to live” and “a room or rooms in the house
of another used as a place of residence.” Webster‟s Third
5
Black‟s Law Dictionary does not define the term.
10
New International Dictionary 1329 (1993). The original
phrase, “bed and board,” encompassed the furnishing of
entertainment as part of one‟s lodging. Indeed, as HHS
points out, “the rent paid by the lodger at the boarding house
of yesteryear entitled him to his seat at the dinner table and a
chair in the parlor after dinner, not just the room where he
slept.” (Appellee‟s Br. at 26.) The plain meaning of the term
has never been limited to the actual hours occupied by
sleeping and eating, but extends to the activities or
entertainments incidental to the provision of lodging.6
Because the plain meaning of the statute leaves no
doubt that the costs at issue here were meant to be excluded
from reimbursement, we find that the District Court did not
err.
Even if the definition of “room and board” were
deemed ambiguous, however, we would still find that the
DAB did not abuse its discretion. Under the second prong of
Chevron, if the agency‟s construction of the term “room and
board” is permissible, we must allow it to stand. A
“„reasonable interpretation‟” of the statute is permissible.
Pareja v. Attorney General, 615 F.3d 180, 193 (3d Cir. 2010)
(quoting Chevron, 467 U.S. at 844). Indeed, in this Circuit,
6
Even Pennsylvania‟s own Administrative Code
defines “room” as “[t]he client‟s share of lodging costs, utility
costs – for example, electricity, heating, water and sewage –
and annual upkeep costs of the community residential mental
retardation facility – for example, trash collection, general
maintenance including necessary repairs and renovation
costs.” 55 Pa. Code § 6200.3. It defines “board” as “[t]he
client‟s share of his food and food preparation costs.” Id.
11
statutory construction has been deemed permissible when it
“is based on an accepted dictionary definition of the term . . .
and does not impermissibly strain the plain language of the
regulation.” Secretary of Labor v. Beverly Healthcare-
Hillview, 541 F.3d 193, 200 (3d Cir. 2008).
Here, the DAB construed the word “room” to include
what Pennsylvania called “occupancy costs” because “[t]hey
have the same component parts: rent, utilities, interest,
depreciation, building insurance, housekeeping, building
repairs and maintenance, building renovations, furnishings
and equipment, and repairs of furnishings and equipment.”
(A. 37a.) The DAB added that these costs “are the costs of
providing housing to the Medicaid recipients who live there.”
(Id. at 38a.) The DAB further distinguished “room” costs
from reimbursable “habilitation services” costs, such as
“provider training costs, supervisory costs, purchased
personnel costs, and costs of necessary supplies.” (Id.)
The interpretation given to the phrase “room and
board” is plainly reasonable. It is consistent with the
dictionary definitions mentioned above. It is also consistent
with the congressional determination to limit reimbursement
to habilitation “services” exclusive of room and board.
Accordingly, the District Court did not err in according
deference to the HHS interpretation.7
7
Pennsylvania argues that the State Medicaid Manual
authorizes it to “allocate” its room costs between
reimbursable and non-reimbursable expenses. According to
Pennsylvania, the State Medicaid Manual, which contains
“[i]nstructions [which] are official interpretations of the law
and regulations, and, as such, are binding on Medicaid State
12
Pennsylvania argues, however, that it is inappropriate
to analyze this matter under the second step of Chevron
because this issue concerns a federal grant to the states, which
essentially involves a contract between Congress and the
states. Pennsylvania argues that “[t]he legitimacy of
Congress‟ power to legislate under the Spending Clause rests
upon whether States voluntarily and knowingly accept the
terms of the contract,” that “[s]tates cannot accept terms of
which they are unaware or unable to ascertain,” and that
“obligations under Federal grants generally should be judged
by reference to the law in effect when the grants were made.”
(Appellant‟s Br. at 15-16 (internal citations and quotation
marks omitted).) Accordingly, Pennsylvania claims that
agencies,” State Medicaid Manual, Foreword, quoted in Sai
Kwan Wong v. Doar, 571 F.3d 247, 253 n.6 (2d Cir. 2009),
states that “[t]here must also be a detailed cost allocation
strategy provided as part of the waiver request to explain how
the cost of waiver services in the residential setting will be
determined and segregated from ineligible waiver costs.”
State Medicaid Manual § 4442.3(B)(8) (reproduced in A.
111a-12a). Pennsylvania concludes that it is permitted to
allocate “occupancy costs” between the permitted objective of
habilitation services and the unpermitted objective of room
and board, and this triggers the application of Office of
Management and Budget Circular No. A-87 (“OMB A-87”),
which governs the allocation process. OMB-87, however,
speaks only to “allowable costs.” See Office of Mgmt. &
Budget, Executive Office of the President, OMB Cir. No. A-
87, Revised (2004). Because room costs are, by statute, not
allowable, OMB-87 does not apply here. The State Medicaid
Manual does not generally enable ineligible costs to be
bifurcated, as Pennsylvania now proposes.
13
because the definition of “room” did not definitely exclude
what it now calls “occupancy costs,” to so find now would
force Pennsylvania to accept a term which was not
ascertainable at the time of agreement. To support its
argument, Pennsylvania cites Bennett v. New Jersey, 470 U.S.
632 (1985), and Bennett v. Kentucky Department of
Education, 470 U.S. 656 (1985).
These cases are inapposite. Bennett v. New Jersey
dealt with whether states were obligated to repay grants
issued under Title I of the Elementary and Secondary
Education Act. In that case, New Jersey was the recipient of
Title I grant monies which it distributed to numerous school
districts. New Jersey argued that substantive statutory
changes made by Congress should retroactively govern the
court‟s determination of whether New Jersey‟s distribution
was in violation of Title I. The Supreme Court disagreed,
finding that “changes in substantive requirements for federal
grants should not be presumed to operate retroactively.
Moreover, practical considerations related to the
administration of federal grant programs imply that
obligations generally should be determined by reference to
the law in effect when the grants were made.” New Jersey,
470 U.S. at 638.
Bennett v. Kentucky Department of Education, a
companion case to Bennett v. New Jersey, also addressed a
potential misuse of Title I funds. The Court determined that
Kentucky had used Title I funds to supplant, rather than
supplement, existing educational funding. Kentucky, 470
U.S. at 660-61. The Court expressed concern about a
requirement that the funds be repaid, however, noting that “a
demand for repayment is more in the nature of an effort to
14
collect upon a debt than a penal sanction.” Id. at 662-63.
While the Court agreed that “Congress must express clearly
its intent to impose conditions on the grant of federal funds so
that the States can knowingly decide whether or not to accept
those funds,” id. at 665-66 (internal quotation marks
omitted), it found that “[t]here was no ambiguity with respect
to [the] condition” imposed, id. at 666. The Court further
observed that “[u]nlike normal contractual undertakings,
federal grant programs originate in and remain governed by
statutory provisions expressing the judgment of Congress
concerning desirable public policy.” Id. at 669.
Here, we do not deal at all with the retroactivity of
statutory amendments or the issue of retroactive punitive
sanctions. On the contrary, the case before us involves a
consistent interpretation of a statutory provision that has been
applied throughout Pennsylvania‟s participation in the waiver
program. Indeed, prior to March 1, 2006, Pennsylvania‟s
reimbursement applications excluded the very occupancy
costs to which it now claims entitlement. Thus, this case is
unlike Bennett v. New Jersey, in which the Court recognized
the concern that arises when a party had “a right that had
matured or become unconditional.” 470 U.S. at 639 (internal
quotation marks omitted). Moreover, the interpretation of the
room and board exclusion is by no means as uncertain as that
of the provisions of Title I at issue in the Bennett decisions,
which were the focus of considerable debate before Title I
was updated and clarified. See Bennett v. Ky. Dep’t of Educ.,
470 U.S. at 667-69 (reviewing history of Title I from its 1965
enactment, noting “uncertainty” compounded by selective
enforcement and 1978 statutory amendments based upon
extensive study of inconsistent administration of statute).
15
Thus, Pennsylvania‟s argument that we should not apply
Chevron here is unavailing.
III.
For the foregoing reasons, we will affirm the judgment
of the District Court.
16