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Saint Louis University Journal of Health Law & Policy

Document Type

Article

Abstract

The Supreme Court rarely takes a case involving federal quality standards for nursing home care, and that alone would make Health and Hospital Corporation of Marion County v. Talevski (Talevski) a significant case for those interested in long-term care. The Court’s decision in Talevski, however, reaches far beyond long-term care with implications for every federally funded program that relies on the states for administration, delivery of benefits, or enforcement of standards.

Much about the Talevski case signaled that a significant change in law may be coming. The plaintiff’s cause of action relied on a statutory instrument (§1983) frequently used by private parties to enforce federal authority over the states; and the case involved the Medicaid program, a lightning rod in federal-state power struggles. Moreover, the defendant made the extreme argument that §1983 provides no cause of action whatsoever where the source of the claimed rights is federal legislation enacted under the Spending Clause, the authority that underlies the largest portion of federal legislation regarding healthcare. Talevski was closely watched as well because it presented the Court with an opportunity to establish a more stringent standard for deciding when §1983 provides a private cause of action for violation of federal law.

Ultimately, the Court rejected the defendant’s Spending Clause argument and held that §1983 provides a cause of action for violations of two particular provisions of the Federal Nursing Home Reform Act (FNHRA). This article examines the statutory language and context that support the Court’s ruling, providing insights for statutory construction in future §1983 cases and taking the opportunity to revisit the legal and policy origins of the FNHRA, a milestone in long-term care quality regulation. The article concludes that the FNHRA provisions at issue so perfectly fit even the most stringent test for §1983 actions that Talevski does not resolve several significant questions, especially in cases where the statutory language and context do not replicate the Talevski model.

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