Supreme Court Ruling Could Complicate CMS Efforts to Regulate Hospices

A U.S. Supreme Court ruling handed down today will make it more difficult for agencies like the U.S. Centers for Medicare & Medicaid Services (CMS) to regulate health care providers.

The 6-3 ruling overturned a 1984 decision that established the “Chevron Doctrine,” which instructed lower courts to defer to executive branch agencies to resolve ambiguities in laws passed by Congress. Historically, the doctrine has been used to uphold numerous federal regulations under legal challenge.

Chief Justice John Roberts indicated in the decision that federal judges “must exercise their independent judgment in deciding whether an agency has acted within its statutory authority.”


This ruling, however, does not overturn prior cases that invoked the Chevron Doctrine, according to Roberts.

The case leading to this decision began with a group of fishermen who disputed regulations requiring them to pay for independent watchdogs to monitor their catches.

The ruling could open the door to legal challenges against a host of federal rules, including those related to the environment, health care, food and workplace safety, among many others. The case also represents a significant shift of power from the executive branch of government to the judicial.


Justice Elena Kagan, writing for the dissent, wrote that the decision represented a roll back of agency authority “despite congressional direction to the contrary.”

“Congress knows that it does not — in fact cannot — write perfectly complete regulatory statutes,” she wrote. “It knows that those statutes will inevitably contain ambiguities that some other actor will have to resolve, and gaps that some other actor will have to fill. And it would usually prefer that actor to be the responsible agency, not a court.”

The decision sparked concern in the health care community, according to a joint statement from: American Academy of Pediatrics, American Cancer Society, American Cancer Society Cancer Action Network, ALS Association, American Heart Association, American Lung Association, American Public Health Association, American Thoracic Society, Bazelon Center for Mental Health Law, Campaign for Tobacco-Free Kids, Child Neurology Foundation, Epilepsy Foundation, Muscular Dystrophy Association, National Health Law Program, Physicians for Social Responsibility, The Leukemia & Lymphoma Society and Truth Initiative.

“Before today, Chevron deference protected the legal stability of public health programs such as Medicare and Medicaid. It ensured that laws passed by Congress were interpreted and implemented by expert federal agencies such as [CMS],” the statement indicated. “As our Amicus Brief noted, large health programs such as Medicaid and Medicare, as well as issues related to the Food, Drug and Cosmetic Act, are extremely complex, so it is key that decisions about how to interpret and implement relevant laws are made by experts at government agencies. Yet today’s majority opinion explicitly ends the use of this sensible doctrine.”