Heartland Regional Medical Center v. Leavitt

United States Court of Appeals
FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued May 16, 2005 Decided July 13, 2005

No. 04-5366

HEARTLAND REGIONAL MEDICAL CENTER, F/K/A HEARTLAND
HOSPITAL,
APPELLANT

v.

MICHAEL O. LEAVITT, IN HIS OFFICIAL CAPACITY AS
SECRETARY OF HEALTH AND HUMAN SERVICES,
APPELLEE

Appeal from the United States District Court
for the District of Columbia
(No. 95cv00951)

Donald B. Verrilli, Jr. argued the cause for appellant. With
him on the briefs were Michael B. DeSanctis, Elizabeth G.
Porter, Christopher L. Crosswhite, and David H. Robbins.
Michael F. Ruggio entered an appearance.

Christine N. Kohl, Attorney, U.S. Department of Justice,
argued the cause for appellee. With her on the brief were Peter
D. Keisler, Assistant Attorney General, Kenneth L. Wainstein,
U.S. Attorney, and Barbara C. Biddle, Assistant Director.
 2

Before: SENTELLE, RANDOLPH, and GARLAND, Circuit
Judges.

Opinion for the Court filed by Circuit Judge GARLAND.

GARLAND, Circuit Judge: Heartland Hospital appeals from
the district court’s denial of its motion to enforce a judgment
that it obtained in 1998. The district court rested its decision on
the ground that the judgment did not require the remedy
Heartland seeks -- a direction that it is entitled to “sole
community hospital” status under the Medicare statute and to
reimbursement in accordance with such status. We agree with
the district court and affirm the denial of the hospital’s motion.

I

The federal Medicare program reimburses hospitals for the
cost of medical care for older persons and other eligible
individuals. Medicare operates according to a prospective
payment system (PPS), under which hospitals are paid a fixed
rate based on a patient’s diagnosis. 42 U.S.C. § 1395ww(d). A
hospital is exempt from PPS -- and therefore eligible for higher
payments based on its historic costs -- if it qualifies as a “sole
community hospital” (SCH). Id. § 1395ww(d)(5)(D)(i). At the
relevant time, the Medicare statute defined an SCH as any
hospital:

(I) that [the Department of Health and Human
Services (HHS)] determines is located more than 35
road miles from another hospital, [or]
 3

(II) that, by reason of factors such as the time
required for an individual to travel to the nearest
alternative source of appropriate inpatient care . . . ,
location, weather conditions, travel conditions, or
absence of other like hospitals . . . , is the sole source
of inpatient hospital services reasonably available to
individuals in a geographic area.

42 U.S.C. § 1395ww(d)(5)(D)(iii) (1992).1

The Medicare statute directed HHS to “promulgate a
standard for determining whether a hospital meets the criteria
for classification as a sole community hospital under” clause (II)
of the above definition. Id. § 1395ww(d)(5)(D)(iv). Under the
regulations promulgated pursuant to that direction, and in effect
during the relevant period, a hospital qualified as an SCH under
clause (II) only if it was “located in a rural area” and met other
listed criteria. 42 C.F.R. § 412.92(a) (1992). Thus, under the
regulations, a hospital located fewer than 35 miles from another
hospital -- and thus ineligible under clause (I) -- could not obtain
SCH status unless it was located in a rural area. Id.2 HHS

1
A hospital also qualified as an SCH if it was “designated by
[HHS] as an essential access community hospital.” 42 U.S.C. §
1395ww(d)(5)(D)(iii)(III) (1992). That provision is not at issue in this
case.
2
In 1999, Congress amended the Medicare statute to provide that
an urban hospital that “would [otherwise] qualify . . . as a sole
community hospital” shall be treated as “being located in [a] rural
area” for purposes of determining SCH status. 42 U.S.C. §
1395ww(d)(8)(E). Based on the new provision, Heartland received
SCH status as of January 1, 2000. This appeal therefore concerns
Heartland’s status only from 1992 through 1999.
 4

justified this “rural location requirement” on the ground that
“urban areas generally have better roads, faster snow-clearing,
and the choice of more available hospitals.” Medicare
Geographic Classification Review Board, Procedures and
Criteria, Final Rule, 56 Fed. Reg. 25,458, 25,483 (June 4, 1991).
For purposes of SCH eligibility, a “rural area” was defined as
“any area outside an urban area,” and an “urban area” was
defined as a “Metropolitan Statistical Area (MSA) . . . as defined
by the Executive Office of Management and Budget.” 42 C.F.R.
§ 412.62(f)(ii), (iii) (1992).3

Heartland Hospital, located in the city of St. Joseph,
Missouri, is an acute-care facility situated fewer than 35 miles
from other hospitals. In May 1992, Heartland submitted an
application for SCH status to its Medicare fiscal intermediary,
Mutual of Omaha, in accordance with HHS regulations.4 The
intermediary recommended that the Health Care Financing

3
At the time, an MSA was defined as “either a city with a
population of at least 50,000, or a Bureau of the Census urbanized area
of at least 50,000 and a total metropolitan statistical area population
of at least 100,000.” Notice of Final Standards for Establishing
Metropolitan Statistical Areas Following the 1980 Census, 45 Fed.
Reg. 956, 956 (Dep’t of Commerce Jan. 3, 1980).
4
To obtain SCH status, a hospital must first apply to its Medicare
fiscal intermediary. 42 C.F.R. § 412.92(b)(1)(i). The intermediary
then forwards the application and its recommendation to the
appropriate regional office of the Health Care Financing
Administration (HCFA), see infra note 5, which decides whether to
grant the application. Id. § 412.92(b)(1)(iv), (v). The hospital may
appeal HCFA’s decision to the Provider Reimbursement Review
Board, 42 U.S.C. § 1395oo(a), and ultimately to a federal district
court, id. § 1395oo(f).
 5

Administration (HCFA),5 an HHS component, deny the
application based on Heartland’s location. HCFA did so on the
ground that, because Heartland was “located in an urban area
and the closest like hospital [was] fewer than 35 miles away,” it
was ineligible under the rural location requirement. Letter from
Edward M. Brennan, HHS, to Richard G. Bath, Mutual of
Omaha (Jan. 22, 1993).

Heartland appealed HCFA’s decision to HHS’s Provider
Reimbursement Review Board (PRRB), seeking expedited
judicial review of the denial of SCH status pursuant to 42 U.S.C.
§ 1395oo(f)(1). Under that provision, a hospital is entitled to
expedited judicial review of any determination that “involves a
question of law or regulations relevant to the matters in
controversy” that the Board “is without authority to decide.” 42
U.S.C. § 1395oo(f)(1). Because Heartland’s appeal challenged
the validity of the regulatory requirement that a hospital situated
within 35 miles of another hospital be located in a rural area,
and thereby raised “a question of law or regulations” that the
PRRB lacked authority to decide, the PRRB granted Heartland’s
request. Letter from Irvin Kues, HHS, to Christopher L.
Crosswhite, Vinson & Elkins (Mar. 29, 1995).

Heartland then filed suit in the United States District Court
for the District of Columbia, challenging the validity of the rural
location requirement on a number of grounds. The case was

5
In 2002, HHS changed HCFA’s name to the “Centers for
Medicare & Medicaid Services.” See Centers for Medicare and
Medicaid Services, Statement of Organization, Functions and
Delegations of Authority, Reorganization Order, 66 Fed. Reg. 35,437
(July 5, 2001). We use “HCFA” throughout this opinion for
consistency with the prior proceedings.
 6

assigned to the late Judge Harold Greene, who held that the
requirement was consistent with the Medicare statute and that
HHS had established a rational basis for adopting it. Heartland
Hospital v. Shalala (Heartland I), No. 95-951, slip op. at 15, 19
(D.D.C. June 15, 1998). But the court also found that HHS had
failed to consider reasonable alternatives proposed by
commenters when it chose an MSA-based definition of “urban
area.”6 “The failure of the Secretary to respond to reasonable
alternative[s]” to MSAs “as the relevant measure of an urban
area,” the court held, “renders the adoption of the regulations
arbitrary and capricious and, consequently, invalid.” Id. at 23-
24. The order accompanying the district court’s 1998 opinion
granted Heartland’s motion for summary judgment and
remanded the case to HHS “for action consistent with the
foregoing opinion.” Heartland I, order at 1 (June 15, 1998).

Following the district court’s decision, things did not go as
Heartland had hoped. In 1999, HHS conducted a rulemaking
regarding a number of Medicare reimbursement issues. In the
course of that rulemaking, the agency considered -- and rejected
-- the alternative definitions of “urban area” noted in Heartland
I. The agency explained why it believed that the MSA-based
definition was the better one, and announced that it would
continue to use that definition. See Changes to the Hospital

6
Judge Greene noted two alternatives to MSAs that had been
suggested in comments during the 1983 rulemaking: “urbanized
areas,” as the term is used by the Census Bureau; and “health facility
planning areas,” as described in the National Health Planning and
Resources Development Act of 1974, Pub. L. No. 93-641, § 3, 88 Stat.
2225, 2229 (1975).
 7

Inpatient Prospective Payment Systems and Fiscal Year 2000
Rates, Final Rule, 64 Fed. Reg. 41,490, 41,513-15 (July 30,
1999); Changes to the Hospital Inpatient Prospective Payment
Systems and Fiscal Year 2000 Rates, Proposed Rule, 64 Fed.
Reg. 24,716, 24,732 (May 7, 1999).

In 2000, HCFA took up the remand from Heartland I.
Once again, the agency concluded that Heartland did not qualify
for SCH status, giving three reasons. First, HCFA determined
that Heartland I did not vacate the SCH regulation, but merely
remanded the case to HHS to further explain its definition of
“urban area.” Decision of the Administrator, Heartland Hosp.
v. Blue Cross & Blue Shield Ass’n, PRRB Case No. 93-0648E,
at 21 (Sept. 6, 2000). Finding that, in the 1999 rulemaking,
HHS had “articulated a reasonable basis for the use of an MSA-
based definition of rural, as opposed to other alternatives,”
HCFA concluded that “the MSA-based rural criteri[on] is
properly applied in adjudicating this case.” Id. at 27. And
because Heartland was “located in an urban area and [was]
within 35 miles of other like hospitals,” HCFA determined that
it did “not meet the applicable criteria for designation as a sole
community hospital.” Id.

Second, HCFA found that, even if the court’s order did
vacate the regulation, the district court “did not order the
payment of money to [Heartland] based on designation as a sole
community hospital,” and “did not comment on whether
[Heartland] should be designated as a sole community hospital.”
Id. At most, HCFA said, “the Court’s action affected that part
of the regulation which defines ‘rural’ within the context of
MSAs,” but “did not invalidate the rural requirement itself.” Id.
at 28. Concluding that “the establishment of a definition of
rural, through adjudication, would not constitute retroactive
 8

rulemaking,” id., HCFA determined that “the adoption of a
MSA-based rural definition is appropriate and reasonable for the
reasons” articulated in the 1999 rulemaking. Id. at 29.

Finally, HCFA reasoned that, even if the rural requirement
were deleted from the regulation altogether, Heartland still
would not qualify for SCH status because it had failed to
demonstrate that it met the other regulatory criteria that HHS
had established for qualification under clause (II). Id.7

Heartland then returned to the district court with a two-
pronged attack on HCFA’s decision. First, it filed a motion to
enforce the Heartland I judgment, seeking a declaration of SCH
status as well as reimbursement and interest. Second, Heartland
filed a separate action challenging HCFA’s decision on remand
under the Administrative Procedure Act (APA), 5 U.S.C. §§
701-706. In light of the death of Judge Greene, both matters
were reassigned to another district judge. Heartland and HHS
agreed to stay the APA action pending the disposition of
Heartland’s motion to enforce the judgment.8

7
Specifically, HCFA said that Heartland had failed to demonstrate
“that no more tha[n] 25 percent of the residents who become hospital
inpatients or no more than 25 percent of the Medicare beneficiaries
who become hospital inpatients in the hospital’s service area are
admitted for care to other like hospitals within a 35 mile radius of the
hospital or, if larger, within its service areas [as] required by 42 C.F.R.
412.92(a)(1)(i).” Heartland Hosp., PRRB Case No. 93-0648E, at 34
(Sept. 6, 2000).
8
The district court further stayed the APA action pending
resolution of this appeal.
 9

In August 2004, the district court denied that motion.
Heartland Hosp. v. Thompson (Heartland II), 328 F. Supp. 2d
8 (D.D.C. 2004). The court determined that “Judge Greene did
not intend to grant [Heartland] SCH status, reimbursement and
interest.” Id. at 15. “[A]ll that was required by the prior
judgment,” the court said, was that HHS “reconsider[] the
alternatives to” the MSA-based definition of “urban area.” Id.
Finding that HHS had reconsidered those alternatives and
“concluded that they are inferior,” the court held that Heartland
had received all the relief the judgment required. Id. Thereafter,
Heartland filed the instant appeal.

II

The parties spend the bulk of their briefs disputing whether
Judge Greene’s 1998 opinion in Heartland I vacated the rural
area requirement. Notwithstanding that the word “vacate” does
not appear in that opinion, Heartland contends that the decision
vacated the requirement by pronouncing the regulations
“invalid,” and that vacatur entitled the hospital to SCH status
and reimbursement. HHS maintains that the decision did not
vacate the rural area requirement, but merely remanded for
consideration of alternative definitions of “urban area.”

We do not need to resolve this interpretive dispute in order
to decide this case. Success on a motion to enforce a judgment
gets a plaintiff only “the relief to which [the plaintiff] is entitled
under [its] original action and the judgment entered therein.”
Watkins v. Washington, 511 F.2d 404, 406 (D.C. Cir. 1975).
Regardless of whether the district court vacated the rule, it is
clear that the Heartland I judgment does not entitle the hospital
to the remedy it seeks: a declaration of SCH status and
reimbursement. Our reasoning is set forth below.
 10

A

Even if Heartland I vacated the rural area requirement,
nothing on the face of that decision compelled HHS to grant
Heartland SCH status and reimbursement. The court’s order
merely remanded the case to HHS “for action consistent with the
foregoing opinion.” Heartland I, order at 1. The “foregoing
opinion,” in turn, found the rural area requirement in the HHS
regulations invalid solely on the ground that HHS had “failed to
consider or respond to reasonable alternatives to the use of
[MSAs] as the relevant measure of an urban area,” and hence as
the definition of a rural area. Heartland I, slip op. at 24.
Accordingly, even if Heartland I vacated the rural area
requirement, the only obligation it expressly imposed on the
agency was to consider the two alternatives suggested during the
comment period.

That is precisely what the agency did. After the court
issued its decision in Heartland I, HHS considered the
alternatives and then reissued its MSA-based definition of
“urban area” and “rural area.” See 64 Fed. Reg. 24,716, 24,732
(May 7, 1999) (setting forth the proposed definition and
soliciting comments); 64 Fed. Reg. 41,490, 41,513-15 (July 30,
1999) (adopting the definition and rejecting alternatives).
Thereafter, in its decision on remand from Heartland I, HCFA
incorporated HHS’s rationale for rejecting the alternatives and
adopting the MSA-based definition. In short, the agency
complied with the judgment in Heartland I by filling the
analytical gap identified in that opinion.

Nor did Heartland I imply that anything more was required.
It certainly did not suggest that, after considering the
alternatives, the agency was barred from reinstating the same
 11

definition or from reaching the same result through case-by-case
adjudication. To the contrary, the usual rule is that, with or
without vacatur, an agency that cures a problem identified by a
court is free to reinstate the original result on remand.9 Nothing
in Heartland I suggested that this usual rule would not apply
because, for example, the rural location requirement was
irredeemable. Rather, Judge Greene held that the requirement
was “well within the realm of permissible interpretations of” the
Medicare statute, Heartland I, slip op. at 15, that “the Secretary
[had] established . . . a rational basis for the . . . requirement,” id.
at 19, and that it was “plausible . . . that [MSAs] are a valid
measure of urban areas,” id. at 23.

This is not to say, of course, that the agency’s reaffirmation
of the same result in this case is invulnerable to attack on a
ground other than the agency’s failure to consider reasonable
alternatives -- for example, on the ground that the agency
arbitrarily rejected those alternatives. See Motor Vehicles
Mfrs. Ass’n v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29, 43,
48, 56 (1983). But whether or not the agency’s post-Heartland
I rejection of the alternatives was arbitrary is a determination
that must be made in Heartland’s separate APA action
challenging HHS’s post-remand decisions. Nothing in
Heartland I itself addresses that question, and therefore a motion

9
See, e.g., FEC v. Akins, 524 U.S. 11, 25 (1998) (noting that, after
vacatur and remand, an agency “might later, in the exercise of its
lawful discretion, reach the same result for a different reason” (citing
SEC v. Chenery Corp., 318 U.S. 80 (1943))); NTEU v. FLRA, 30 F.3d
1510, 1514 (D.C. Cir. 1994) (noting that “we frequently remand
matters to agencies while leaving open the possibility that the agencies
can reach exactly the same result as long as they . . . explain
themselves better or develop better evidence for their position”).
 12

to enforce the Heartland I judgment is not the proper means to
answer it.

The same is true for Heartland’s oblique suggestion that if
Judge Greene vacated the rural area requirement, then HHS’s
attempt to reimpose the requirement on remand -- whether
through rulemaking or adjudication -- effectively constituted
impermissible retroactive rulemaking. See Appellant’s Reply
Br. at 2 n.1; see also Bowen v. Georgetown Univ. Hosp., 488
U.S. 204, 215 (1988) (holding that HHS “has no authority to
promulgate retroactive cost-limit rules” under the Medicare
Act). Our cases establish a five-factor “framework for
evaluating retroactive application of rules announced in agency
adjudications.” Cassell v. FCC, 154 F.3d 478, 486 (D.C. Cir.
1998) (quoting Clark-Cowlitz Joint Operating Agency v. FERC,
826 F.2d 1074, 1081 (D.C. Cir. 1987) (en banc)). Nothing in
Heartland I indicates whether HCFA’s adjudicatory application
of the rural requirement would survive examination under that
framework. Accordingly, that, too, is a determination that must
await disposition of Heartland’s separate APA action.

B

Heartland contends that, even if the face of Heartland I did
not require HHS to grant the hospital SCH status, vacation of the
rural area requirement would have “eliminat[ed] the only
remaining barrier to SCH status for Heartland.” Appellant’s Br.
at 14. That is so, the hospital maintains, because “[u]nder the
applicable statute and regulations, the [PRRB] can grant
expedited judicial review only if it first determines that there are
no disputed issues of fact and no disputed legal issues that the
Board is authorized to resolve.” Id. at 14-15. Thus, Heartland
insists, by granting its request for expedited review, the PRRB
 13

“necessarily determined that Heartland had met all the statutory
and regulatory criteria to obtain SCH status and that the only
remaining question was the validity of [HHS’s] rural
requirement.” Id. at 21.

There are two problems with this argument. First, even if
Heartland is correct that at the time of Heartland I the rural area
requirement was the only hurdle still standing between it and
SCH status, the judgment did not say so. Even if the agency had
implicitly decided prior to Heartland I that the hospital met all
the other SCH criteria, at best that would mean the post-remand
denial was inconsistent with those implicit findings. And while
such inconsistency might justify a court in concluding that
HCFA’s post-Heartland I denial of the hospital’s SCH status
was arbitrary and capricious (and thus in violation of the APA),
that is a conclusion Judge Greene did not reach in Heartland I
itself.

The second -- and more significant -- problem with
Heartland’s argument is that it reads too much into the PRRB’s
expedited judicial review determination. In denying Heartland
SCH status, both HCFA and the intermediary relied solely on
the hospital’s failure to satisfy the regulation’s rural location
requirement. Neither considered whether there might be other
reasons for denial; neither said that, but for the regulation, the
hospital’s application would have been granted.10 Similarly,

10
See Letter from Linda Richter, Mutual of Omaha, to Christopher
Crosswhite, Vinson & Elkins, at 2-3 (Feb. 1, 1994) (“HCFA’s denial
of SCH status was based on [Heartland] being located in an urban
area with like hospitals located closer than 35 miles. . . . HCFA has
made no determination as to whether [Heartland] met all criteria other
than being located in a rural area.”).
 14

when Heartland asked the PRRB to grant expedited review, it
emphasized that “the sole basis for its appeal of HCFA’s denial
is that the regulatory requirement of location in a rural area is
invalid.” Provider’s Request for Expedited Judicial Review,
Heartland Hosp. v. Mutual of Omaha Ins. Co., PRRB Case No.
93-0648, at 10-11 (Mar. 6, 1995). And when the PRRB granted
Heartland’s request, it did so on the ground that it was “without
authority to decide the legal question of whether the Medicare
regulation governing the classification as a sole community
hospital . . . is valid.” Letter from Kues to Crosswhite at 2.

Nor is Heartland correct that the statute and regulation
required the PRRB to decide every factual and legal question
within its power -- including those on which the intermediary
did not rely in recommending denial of Heartland’s SCH status
-- before it could grant expedited review regarding the validity
of the legal ground on which the intermediary did rely. The
statute itself states only that health care providers “have the right
to obtain judicial review of any action of the fiscal intermediary
which involves a question of law or regulations relevant to the
matters in controversy whenever the Board determines . . . that
it is without authority to decide the question.” 42 U.S.C. §
1395oo(f)(1). Here, the intermediary’s denial of Heartland’s
application on the basis of the rural location requirement plainly
involved “a question of law or regulations,” that was “relevant
to the matters in controversy,” and that the PRRB was “without
authority to decide.” See Bethesda Hosp. Ass’n v. Bowen, 485
U.S. 399, 406 (1988) (“Neither the fiscal intermediary nor the
Board has the authority to declare regulations invalid.”). Thus,
Heartland’s appeal fell squarely within the expedited review
 15

provision of the statute whether or not Heartland met the other
SCH criteria.11

The HHS regulation that governs expedited review similarly
permits expedition if there are no “factual or legal issues in
dispute on an issue within the authority of the Board to decide.”
42 C.F.R. § 405.1842(g)(2) (emphasis added). The regulation
does not suggest that the PRRB is barred from granting
expedited review unless it first decides all factual questions
within its competence, including those regarding other issues not
relied upon by HCFA or the intermediary. Indeed, the
12
regulatory language is to the contrary. As Heartland stresses,
HHS did state at the time the regulation was promulgated that
the statute’s expedited judicial review provision “authorizes the

11
Although Heartland correctly notes that “the Board can ‘make
any other revisions on matters covered by [a] cost report . . . even
though such matters were not considered by the intermediary in
making such final determination,’” Bethesda Hosp. Ass’n v. Bowen,
485 U.S. 399, 405-06 (1988) (quoting 42 U.S.C. § 1395oo(d))
(emphasis added), the statute does not compel the Board to do so, see
42 U.S.C. § 1395oo(d) (“The Board shall have the power to [consider]
matters . . . not considered by the intermediary.” (emphasis added)).

12
See 42 C.F.R. § 405.1842(g)(2) (“The Board has the authority
to decide when two or more issues are sufficiently related to preclude
separation for purposes of an expedited review determination on one
or more of them and a hearing on the other or others.”); id. §
405.1842(h)(6) (“The Board’s determination [to grant expedited
judicial review] does not affect the right of the provider to a Board
hearing for issues for which the provider did not request expedited
review, or for which the Board determines it does have the authority
to decide, or for which the Board did not make a determination and the
provider did not request judicial review.”).
 16

bypassing of the required Board hearing only with respect to
those matters in dispute for which the sole issue to be resolved
is the validity of the law, regulations, or HCFA rulings which
the Board cannot decide.” Appellant’s Br. at 7 (quoting
Provider Reimbursement Review Board, Expedited
Administrative Review, Final Rule, 48 Fed. Reg. 22,920, 22,922
(May 23, 1983)) (emphasis added in Appellant’s Br.). But in
this instance, the sole issue to be resolved -- because it was the
sole basis for Heartland’s appeal -- was the validity of the rural
location requirement, an issue that involved no factual or legal
issues within the Board’s competence.

In sum, both the statute and the regulation permitted the
Board to grant expedited review regarding the validity of the
rural location requirement without first deciding all other
possible bases for denying Heartland SCH status -- none of
which were addressed by the intermediary, by HCFA, or by
Heartland. Hence, in granting expedited review, the Board did
not determine -- “necessarily” or otherwise -- that Heartland had
met all the statutory and regulatory criteria for such status.13

13
Tucson Medical Center v. Sullivan, 947 F.2d 971 (D.C. Cir.
1991), is not to the contrary. In Tucson, we stated in dictum that, by
granting petitions for expedited review, the PRRB had “necessarily
found that there existed an amount in controversy in excess of
$10,000” because “the PRRB does not have jurisdiction to hear an
appeal from the fiscal intermediary’s determination unless ‘the amount
in controversy is $10,000 or more.’” Id. at 980 (quoting 42 U.S.C. §
1395oo(a)(2)). Although the statute expressly predicates PRRB
jurisdiction on a $10,000 amount in controversy, it does not -- as
discussed above -- predicate jurisdiction or anything else upon the
resolution of every possible alternative basis for denial of a hospital’s
SCH application.
 17

III

For the foregoing reasons, we conclude that, regardless of
whether the district court intended to vacate the rural area
requirement in Heartland I, the court’s judgment did not entitle
Heartland Hospital to the relief it seeks on this appeal. What the
judgment did require was what Heartland received -- HHS’s
reconsideration of the alternatives to the MSA-based definition
of “urban area.” Accordingly, if Heartland is to obtain further
relief, it must seek it through a separate APA challenge to
HCFA’s post-Heartland I decisions, rather than through a
motion to enforce the Heartland I judgment itself. The district
court’s denial of Heartland’s motion is therefore

Affirmed.