National Health Law Program

                                                                                                Updated: October 8, 1999

To: Health Advocates
Fr: Jane Perkins

Re: 42 U.S.C. § 1983 and Enforcement of the Medicaid Act


        The Medicaid Act does not include an express cause of action for enforcement. However, since Rosado v. Wyman, 397 U.S. 397 (1970), low income people have enforced the requirements of the Social Security Act against states. Congress has legislated against this backdrop for over twenty years.

        Another federal statute, 42 U.S.C. § 1983, conf2002ers a cause of action for violations of the Constitution and federal laws. E.g. Wright v. Roanoke Housing Authority, 479 U.S. 418 (1987); Maine v. Thiboutot, 448 U.S. 1 (1980) (discussing Social Security Act). To determine whether a federal law is enforceable pursuant to § 1983, the Supreme Court asks: (1) whether the statute creates an enforceable right and (2) whether Congress has foreclosed enforcement of the statute in the enactment itself. Wilder v. Virginia Hospital Ass'n, 496 U.S. 498, 508 (1990). To determine whether there is an enforceable right, the Court requires application of a three-step test:

(1) Was the provision in question intended to benefit the plaintiff?

(2) Does the provision in question contain sufficient mandatory language to create a binding obligation on the state, or does it merely express a congressional preference?

(3) Is the statute's language specific enough to create an enforceable right, or is it too vague and amorphous?

E.g., Wilder, 496 U.S. at 509.

        To decide if Congress has foreclosed enforcement of the statute, the Court asks:

(1) Does the statute expressly foreclose enforcement through § 1983?

(2) Does the statue itself create a comprehensive remedial scheme that demonstrates Congress' intent to preclude the use of § 1983?

E.g. Middlesex County Sewerage Auth. V. National Sea Clammers Ass'n, 453 U.S. 1 (1981). The Supreme Court held in Wilder that the Medicaid Act does not preclude § 1983 enforcement. Wilder, 496 U.S. at 521-23.

Additional cases and statutes:

Pennhurst State School and Hosp. v. Halderman, 451 U.S. 1 (1981) (statutory provision must not be vague and amorphous)

Golden State Transit Cord. v. City of Los Angeles, 493 U.S. 103 (1989) (§ 1983 is to be "broadly construed" however, because § 1983 is addressed to the deprivation of "rights, privileges, or immunities" and not merely the violation of federal law, a plaintiff must show that the federal law violated creates enforceable rights within the meaning of § 1983)

Suter v. Artist M., 503 U.S. 347 (1992) (limiting enforcement of federal programs implemented pursuant to a state plan; finding "reasonable efforts" provision of Adoption Assistance and Child Welfare Act unenforceable)

42 U.S.C. § 1320a(2) (approved December 8, 1994) (Pub. L. No. 103-382, Title V, §555(a), 108 Stat. 4057):

In an action brought to enforce a provision of this chapter, such provision is not to be deemed unenforceable because of its inclusion in a section of this chapter requiring a State plan or specifying the required contents of a State plan. This section is not intended to limit or expand the grounds for determining the availability of private actions to enforce State plan requirements other than by overturning any such ground applied in Suter v. Artist M., 112 S.Ct 1360 (1992), but not applied in prior Supreme Court decisions respecting such enforceability; provided, however, that this section is not intended to alter the holding in Suter v. Artist M., 112 S.Ct 1360 (1992) that section 671(a)(15) of this title is not enforceable in a private right of action.

Blessing v. Freestone, 117 S.Ct. 1353 (1997) (focusing on 2nd and 3rd criteria, denied enforcement of a Title IV-D provision because statute did not identify with particularity the rights claimed)



Medicaid Cases Follow - Cases added since the January 1999 version
of this memorandum are highlighted in bold.
Medicaid Cases

Provision Enforceable Unenforceable
42 U.S.C. § 1396a(a)(1): statewideness Sobky v. Smoley, 855 F. Supp. 1123 (E.D. Cal. 1994)

Graus v. Kaladjian, 2 F. Supp. 2d 540 (S.D.N.Y. 1998) ("arguably, this section creates a federal right"), settlement accepted sub nom. Graus v. Dowling, 1999 WL 9873 (S.D.N.Y. Jan. 11, 1999)

Discussed: Concourse Rehabilitation & Nursing Center v. Wing, 150 F.3d 185 (2nd Cir. 1998) (assumes, without deciding, that a(a)(1) creates enforceable federal rights)

Harris v. James, 127 F.3d 993 (11th Cir. 1997) (rehearing en banc denied 1997), rev'g, 883 F. Supp. 1511 (M.D. Ala. 1995) (transportation regulation, 42 C.F.R. § 431.53, does not define the content of any specific right conf2002erred on plaintiffs by a federal statute)
42 U.S.C. § 1396a(a)(3): due process Cramer v. Chiles, 33 F. Supp.2d 1342 (S.D. Fla. 1999) (without discussion)
Sobky v. Smoley, 855 F. Supp. 1123 (E.D. Cal. 1994)

Greenstein v. Bane, 833 F. Supp. 1054 (S.D.N.Y. 1993) (implementing regulation, 42 C.F.R. 431.246, requiring corrective action)

Haymons v. Williams, 795 F. Supp. 1511, 1517 (M.D.Fla.1992)

Rodriguez v. DeBuono, 117 F.R.D. 143 (S.D.N.Y. 1997) (statute and implementing regulations, 42 C.F.R. § 431, enforced without discussion in an opinion analyzing other Medicaid Act provisions) [Note: additional case history at § 1396a(a)(10)(B)]

Benjamin H. v. Ohl, No. 3:99-0388 (S.D.W.Va. July 15, 1999) (without extensive discussion)

Daniels v. Wadley, 926 F. Supp. 1305 (M.D. Tenn. 1996)

Cherry v. Tompkins, reprinted at 1995 WL 502403 and Medicare & Medicaid Guide (CCH) ¶43,485 (W.D. Ohio, Mar. 31, 1995) (implementing regulation, 42 C.F.R. § 431.210)

Blanchard v. Forrest, No. 93-3780, reprinted at 1994 WL 495857 (E.D.La. Sept. 6, 1994)

 
42 U.S.C. § 1396a(a)(4): methods of administration Boatman v. Hammons, 164 F.3d 286 (6th Cir. 1998), (implementing regulation, 42 C.F.R. § 431.53 re: transportation; rejecting Harris v. James)

Wood v. Tompkins, 33 F.3d 600 (6th Cir. 1994) (implementing regulation, 42 C.F.R. § 431.12 re: failure to consult medical care advisory committee)

Value Behavioral Health, Inc. v. Ohio Department of Mental Health, 966 F. Supp. 557 (S.D. Ohio 1997) (implementing regulations, 42 C.F.R. Part 74 re: procurement requirements)

Methodist Hospitals v. Indiana Family & Social Serv. Admin., 860 F. Supp. 1309 (M.D.Ind. 1994), aff'd on other grounds, 91 F.3d 1026 (7th Cir. 1996) (implementing regulation 42 C.F.R. § 431.12 re: medical care advisory committee)

Okla. Nursing Home Ass'n v. Depps, 792 F. Supp. 721 (W.D. Okla. 1992)

Harris v. James, 127 F.3d 993 (11th Cir. 1997) (rehearing en banc denied April 1997), rev'g, 883 F. Supp. 1511 (M.D. Ala. 1995) (transportation regulation, 42 C.F.R. § 431.53, does not define the content of any specific right conf2002erred on plaintiffs by a federal statute)

Kansas Hosp. Ass'n v. Whiteman, et al., 835 F. Supp. 1556 (D. Kan. 1993) (medical care advisory committee regulation, 42 C.F.R. § 431.12)

42 U.S.C. § 1396a(a)(5): single state agency Health Line Clinical Lab. Inc. v. Connell, No. 98-1620-RJK (C.D. Cal. Apr. 9, 1998) (allowing provider suit) Graus v. Kaladjian, 2 F. Supp. 2d 540 (S.D.N.Y. 1998) (implementing regulation, 42 C.F.R. § 431.10 also unenforceable), settlement accepted sub nom. Graus v. Dowling, 1999 WL 9873 (S.D.N.Y. Jan. 11, 1999)

Sobky v. Smoley, 855 F. Supp. 1123 (E.D. Cal. 1994) (implementing regulation, 42 C.F.R. § 431.10, unenforceable because plaintiffs not intended beneficiaries)

Discussed: Rodriguez v. DeBuono, 117 F.R.D. 143 (S.D.N.Y. 1997) ("highly unlikely that there is a private right of action") [Note: additional case history at § 1396a(a)(10)(B)]

Ralabate v. Wing, No.93-CIV-0035E9H), reprinted at 1996 WL 377204, at *3, n.28, Medicare & Medicaid Guide (CCH) ¶ 44550 (W.D.N.Y. June 27, 1996) ("Court doubts that a single state agency requirement provides a basis upon which relief can be granted")

42 U.S.C. § 1396a(a)(8): reasonable promptness and opportunity to apply without delay Doe v. Chiles, 136 F.3d 709 (11th Cir. 1998) (implementing regulations, 42 C.F.R. §§ 435.911(a)(e), 435.930 (a)-(b))

Albiston v. Maine Comm'r of Health Services
, 7 F.3d 258 (1st Cir. 1993)

Reynolds v. Giuliani, 35 F. Supp. 2d 331 (S.D.N.Y. 1999)

Rolland v. Cellucci, 52 F. Supp. 2d 231 (D. Mass. 1999)

Sobky v. Smoley, 855 F. Supp. 1123 (E.D. Cal. 1994) (implementing regulation, 42 C.F.R. § 435.930)

Wellington v. District of Columbia, 851 F. Supp. 1 (D.D.C. 1994) (discussing reasonable promptness)

Benjamin H. v. Ohl, No. 3:99-0388 (S.D.W.Va. July 15, 1999) (without extensive discussion)

Blanchard v. Forrest, No. 93-3780, reprinted at 1994 WL 495857 (E.D.La., Sept. 6, 1994)

Discussed: Harris v. James, 127 F.3d 993 (11th Cir. 1997) (rehearing en banc denied April 1997), rev'g, 883 F. Supp. 1511 (M.D. Ala. 1995) (statute may create a right but transportation regulation, 42 C.F.R. § 431.53, cannot reasonably be understood as furthering the statutory objective of this provision)

Wood v. Wallace, 825 F. Supp. 177 (S.D. Ohio 1993) (relying without discussion on Hairston), aff'd on other grounds sub nom., Wood v. Thompkins, 33 F.3d 600 (6th Cir. 1994)

Cook v. Hairston, 948 F.2d 1288 (6th Cir. 1991) (case table)(for unpublished decision, see 1991 U.S.App. LEXIS 28537)



Wellington v. District of Columbia, 851 F. Supp. 1 (D.D.C., 1994) (discussing opportunity to apply without delay

42 U.S.C. § 1396a(a)(9): maintaining health standards for private institutions   Evelyn V. v. King County Hospital Center, 956 F. Supp. 288 (E.D.N.Y. 1997)
42 U.S.C. § 1396a(a)(10)(A): Medicaid eligibility for services Miller v. Whitburn, 10 F.3d 1315 (7th Cir. 1993)

Cherry v. Tompkins, reprinted at 1995 WL 502403 and Medicare & Medicaid Guide (CCH) ¶43,485 (W.D. Ohio, Mar. 31, 1995) (implementing regulation, 42 C.F.R. § 431.210)
K&A Radiologic Technology Services., Inc v. Wing, 1999 U.S.. App. LEXIS 19652 (2d Cir. Aug. 19, 1999), vacating, 13 F. Supp. 2d 264 (N.D.N.Y. 1998) (health care providers are not intended beneficiaries of the provision; only Medicaid recipients are)
42 U.S.C. § 1396a(a)(10)(B): amount, duration, and scope Parry v. Crawford, 990 F. Supp. 1250 (D. Nev. 1998) (implementing regulation, 42 CFR 440.240, also creates enforceable right)

Rodriguez v. DeBuono, - F.3d- (2d Cir. Oct. 6, 1999) rev'g on other grounds, 44 F. Supp. 2d 601 (S.D.N.Y. 1999) (permanent injunction) (also discussing 42 C.F.R. § 440.230(b) and (c) and finding these regulations to derive from §§ 1396a(a)(10)(B) and a(a)(17) and are enforceable), same case, 177 F.R.D. 143 (S.D.N.Y. 1997) (additional case history omitted)

Rolland v. Cellucci, 52 F. Supp. 2d 231 (D. Mass. 1999) (without discussion)

Sobky v. Smoley, 855 F. Supp. 1123 (E.D. Cal. 1994) (with respect to comparability for categorically needy groups, comparability with eligibility groups, and medical assistance in equal amount, duration, and scope; court refused to decide whether 42 C.F.R. § 440.230(b) creates enforceable right)

Benjamin H. v. Ohl, No. 3:99-0388 (S.D.W.Va. July 15, 1999) (without extensive discussion)

Cherry v. Tompkins, reprinted at 1995 WL 502403 and Medicare & Medicaid Guide (CCH) ¶43,485 (W.D. Ohio, Mar. 31, 1995) (implementing regulation, 42 C.F.R. § 431.210) (implementing regulations, 42 C.F.R. §§ 440.230(b), 440.230(c))

Greenstein v. Bane, 833 F. Supp. 1054 (S.D.N.Y. 1993)

Esteban v. Cook, No. 97-2830-CIV-GRAHAM, slip op. at 8 (S.D. Fla. June 9, 1998) (discussing 42 C.F.R. § 440.230(b) and 42 U.S.C. § 1396)

Discussed: Ralabate v. Wing, No.93-CIV-0035E9H), reprinted at 1996 WL 377204, at *3, n.28, Medicare & Medicaid Guide (CCH) ¶ 44550 (W.D.N.Y. June 27, 1996) (expressing doubt regarding enforcement of 42 C.F.R. § 440.230(b))

42 U.S.C. § 1396a(a)(10)(C): medically needy coverage Tinoco v. Belshe, No. C-94-0947 (N.D. Cal., Jan. 4, 1996)  
42 U.S.C. § 1396a(a)(10)(E): QMB cost-sharing Paramount Health Systems, Inc. v. Wright, 138 F.3d 706 (7th Cir. 1998)

Rehabilitation Ass'n of Virginia v. Kozlowski, 838 F. Supp. 243 (E.D. Va. 1993), aff'd, 42 F.3d 1444 (4th Cir. 1994), cert. denied, 516 U.S. 811 (1995)
 
42 U.S.C. § 1396a(a)(13)(A): Boren Amendment Wilder v. Virginia Hospital Ass'n, 496 U.S. 498 (1990)

Oregon Ass'n of Homes for the Aged v. Oregon Health Care Ass'n
, 884 F. Supp. 382 (D. Ore. 1994)
 
42 U.S.C. § 1396a(a)(17): reasonable standards Smith v. Rasmussen, No. C-97-3055-MWB, 1999 U.S. Dist. Lexis 11357 (N.D. Iowa July 14, 1999) (permanent injunction) (regulations, 42 C.F.R. 430.230(b), (c), and (d) further defines this right and are enforceable), aff'g, Smith v. Palmer, 24 F. Supp. 2d 955 (N.D. Iowa 1998)

Cherry v. Tompkins, reprinted at 1995 WL 502403 and Medicare & Medicaid Guide (CCH) ¶43,485 (W.D. Ohio, Mar. 31, 1995)

Tinoco v. Belshe, No. C-94-0947 (N.D. Cal., Jan. 4, 1996)

Gamma v. Belshe, No. C-94-0852 (N.D. Cal., Nov. 16, 1995)

 
42 U.S.C. § 1396a(a)(19): administration in best interest of recipients Greenstein v. Bane, 833 F. Supp. 1054 (S.D.N.Y. 1993)

Harris v. James, 127 F.3d 993. 1010 (11th Cir. 1997) (rehearing en banc denied April 1997), rev'g, 883 F. Supp. 1511 (M.D. Ala. 1995) (transportation regulation, 42 C.F.R. § 431.53, does not define the content of any specific right conf2002erred on plaintiffs by this federal statute)

Stewart v. Bernstein, 769 F.2d 1088, 1093 (5th Cir. 1985) (citing Bumpus with approval)

Bumpus v. Clark, 681 F.2d 679, 683 (9th Cir. 1982), opinion withdrawn as moot, 702 F.2d 826 (9th Cir. 1983)

Wood v. Wallace, 825 F. Supp. 177 (S.D. Ohio 1993) (relying without discussion on Hairston), aff'd on other grounds sub nom., Wood v. Thompkins, 33 F.3d 600 (6th Cir. 1994)

Cook v. Hairston, 948 F.2d 1288 (6th Cir. 1991) (case table)(for unpublished decision, see 1991 U.S.App. LEXIS 28537)

Graus v. Kaladjian, 2 F. Supp. 2d 540 (S.D.N.Y. 1998) (refusing to enforce 42 C.F.R. § 435.930(b) -- "continue to furnish Medicaid regularly to all eligible individuals until they are found to be ineligible"), settlement accepted sub nom. Graus v. Dowling, 1999 WL 9873 (S.D.N.Y. Jan. 11, 1999)

Jordano v. Steffan, 787 F. Supp. 886 (D. Minn. 1992)

42 U.S.C. § 1396a(a)(23): freedom of choice Discussed: Harris v. James, 127 F.3d 993 (11th Cir. 1997) (rehearing en banc denied April 1997), rev'g, 883 F. Supp. 1511 (M.D. Ala. 1995) (statute may create a right but transportation regulation, 42 C.F.R. § 431.53, cannot reasonably be understood as furthering the statutory objective of this provision)  
42 U.S.C. § 1396a(a)(28): nursing facility compliance Martin v. Voinovich, 840 F. Supp. 1175 (S.D. Ohio 1993)  
42 U.S.C. § 1396a(a)(30): equal access Visiting Nurse Association of North Shore, Inc. v. Bullen, 93 F.3d 997 (1st Cir., Aug. 22, 1996), cert. denied, 117 S.Ct. 955 (1997)

Methodist Hospitals v. Sullivan, 91 F.3d 1026 (7th Cir. 1996)

Arkansas Medical Society, Inc. v. Reynolds, 6 F.3d 519 (8th Cir. 1993)

Rite Aid of Pennsylvania, Inc. v. Houstoun, 998 F. Supp. 522 (E.D. Pa. 1997) (regarding fee for service rates)

Moody Emergency Medical Service v. City of Millbrook, 967 F. Supp. 488 (M.D. Ala. 1997)

Sobky v. Smoley, 855 F. Supp. 1123 (E.D. Cal. 1994)

Oklahoma Nursing Home Ass'n v. Demps, 792 F. Supp. 721 (W.D. Okla. 1992)

Fulkerson v. Comm'r, 802 F. Supp. 529 (D. Me. 1992)

Illinois Hosp. Ass'n v. Edgar, 765 F. Supp. 1343 (N.D. Ill. 1991)

Pennsylvania Pharmacists Ass'n, et al. v. Commonwealth of Pennsylvania, 733 A.2d 666 (1999) (regarding HMO rates)

Discussed: Florida Pharmacy Ass'n v. Cook, 17 F. Supp. 2d 1293 (N.D. Fla. 1998) (at least arguable that § 1396a(a)(30)(A) requirement, that payment be sufficient to enlist enough providers, is enforceable)

Florida Pharmacy Ass'n v. Cook, 17 F. Supp. 2d 1293 (N.D. Fla. 1998) (discussing § 1396a(a)(30)(A) requirement that state assure that payments are "consistent with efficiency, economy, and quality of care")
42 U.S.C. § 1396a(a)(31): PASARR Martin v. Voinovich, 840 F. Supp. 1175 (S.D. Ohio 1993) (implementing regulation, 42 C.F.R. § 456.609) Martin v. Voinovich, 840 F. Supp. 1175 (S.D. Ohio 1993) (implementing regulations, 42 C.F.R. § 456.613, corrective action)
42 U.S.C. § 1396a(a)(34): retroactive coverage Blanchard v. Forrest, No. 93-3780, reprinted at 1994 WL 495857 (E.D.La., Sept. 6, 1994)  
42 U.S.C. § 1396a(a)(43): EPSDT informing Wellington v. District of Columbia, 851 F. Supp. 1 (D.D.C., 1994)

Jeremy and Darvin J. v. Morse, No. 96-48 (E.D. Ky., Mar. 26, 1997)
 
42 U.S.C. § 1396a(a)(55): outstationing Wellington v. District of Columbia, 851 F. Supp. 1 (D.D.C., 1994)  
42 U.S.C. § 1396a(c)(1): maintenance of effort   Stowell v. Ives, 976 F.2d 65 (1st Cir. 1992)

Audette v. Sullivan , 19 F.3d 254 (6th Cir. 1994)
42 U.S.C. § 1396a(e)(4): deemed eligibility of newborns Wellington v. District of Columbia, 851 F. Supp. 1 (D.D.C., 1994)  
42 U.S.C. § 1396b(i)(1): organ transplants Pereira v. Kozlowski, 996 F.3d 723 (4th Cir. 1993)

Warren v. Palmer
, No. 039-22962 (Iowa D. Ct., Aug. 4, 1992)
 
42 U.S.C. § 1396d Conner v. Branstad, 839 F. Supp. 1346 (S.D. Iowa 1993) (implementing regulation, 42 C.F.R. § 483, requirements for long term care facilities)  
42 U.S.C. §1396d(a)(4)(A): nursing facility services Cherry v. Tompkins, reprinted at 1995 WL 502403 and Medicare & Medicaid Guide (CCH) ¶43,485 (W.D. Ohio, Mar. 31, 1995)  
42 U.S.C. § 1396d(a)(4)(B), 1396d(r): EPSDT services Miller v. Whitburn, 10 F.3d 1315 (7th Cir. 1993) (EPSDT statute and implementing regulations, 42 C.F.R. § 451 et seq.)

Wellington v. District of Columbia, 851 F. Supp. 1 (D.D.C., 1994)

Benjamin H. v. Ohl, No. 3:99-0388 (S.D.W.Va. July 15, 1999) (without extensive discussion)

Jeremy and Darvin J. v. Morse, No. 96-48 (E.D. Ky., Mar. 26, 1997)

 
42 U.S.C. § 1396d(a)(13): diagnostic, preventive, rehab services   Jordano v. Steffen, 787 F. Supp. 886 (D. Minn. 1992)
42 U.S.C. § 1396n(b)(4): restricted provider waiver   Illinois Hospital Association v. Edgar, 765 F. Supp. 1343 (N.D. Ill. 1991)
42 U.S.C. § 1396n(c): home and community based waiver provisions Wood v. Tompkins, 33 F.3d 600 (6th Cir. 1994), aff'g in part and rev'ing in part, Wood v. Wallace, 825 F. Supp. 177 (S.D. Ohio 1993) (§§ 1396n(c)(2)(A), (B), (C), and (E) 42 C.F.R. §§ 441.302(a), (c), (d), and (f)(2)

Rolland v. Cellucci
, 52 F. Supp. 2d 231 (D. Mass. 1999)

Cramer v. Chiles, 33 F. Supp.2d 1342 (S.D. Fla. 1999) (discussing § 1396n(c)(2)(C), freedom of choice provision)

Benjamin H. v. Ohl, No. 3:99-0388 (S.D.W.Va. July 15, 1999) (without extensive discussion allowing enforcement of § 1396n(c)(2))

Cherry v. Thompkins, No. C-1-94-460 (S.D. Ohio, Mar. 31, 1995), reprinted at Medicare & Medicaid Guide (CCH) ¶ 43,485 (§ 1396n(c)(2))

Wood v. Tompkins, 33 F.3d 600 (6th Cir. 1994), aff'g in part and rev'ing in part, Wood v. Wallace, 825 F. Supp. 177 (S.D. Ohio 1993) (§§ 1396n(c)(2)(D), 1396n(f)(1) and 42 C.F.R. §§ 441.302(b), (e), 441.303(f)(1))
42 U.S.C. § 1396n(d): home and community based services for elderly   Frances J. v. Bradley, No. 92 C5190, reprinted at 1992 WL 390875 and Medicare & Medicaid Guide (CCH) ¶40,972 (N.D. Ill., Dec. 15, 1992)
42 U.S.C. § 1396o: cost sharing Greenstein v. Bane, 833 F. Supp. 1054 (S.D.N.Y. 1993)  
42 U.S.C. § 1396r(c): nursing home notices to residents Linton v. Comm'r of Health and Enforcement, 65 F.3d 508 (6th Cir. 1995)  
42 U.S.C. § 1396r(d): PASARR Martin v. Voinovich, 840 F. Supp. 1175 (S.D. Ohio 1993)  
42 U.S.C. § 1396r(e)(7): PASARR Rolland v. Cellucci, 52 F. Supp. 2d 231 (D. Mass. 1999)

Martin v. Voinovich, 840 F. Supp. 1175 (S.D. Ohio 1993) (implementing regulation, 42 C.F.R. 483.100-.138)
Bock Associates v. Chronister, 951 F. Supp. 969 (D. Kan. 1993) (provider not intended beneficiary of PASARR provisions
42 U.S.C. 1396r(h)(2):
nursing home sanctions
Ottis v. Shalala, 862 F. Supp. 182 (W.D. Mich. 1994)  
Hyde Amendment: Little Rock Family Planning Services, PA v. Dalton, 60 F.3d 497 (8th Cir. 1995), rev'd in part on other grounds, 116 S.Ct. 1063 (1996)

Orr v. Nelson
, 874 F. Supp. 998 (D. Neb. 1995), aff'd, 68 F.3d 479 (8th Cir. 1995)
 
42 C.F.R. §§ 455.13, 455.23: fraud investigation Health Line Clinical Lab. Inc. v. Connell, No. 98-1620-RJK (C.D. Cal. Apr. 9, 1998)  
42 C.F.R. § 447.205: public notice of changes in rates   Florida Pharmacy Ass'n v. Cook, 17 F. Supp. 2d 1293 (N.D. Fla. 1998)
42 C.F.R. § 430.12: failure to obtain prior federal approval for change in rates   Florida Pharmacy Ass'n v. Cook, 17 F. Supp. 2d 1293 (N.D. Fla. 1998)
42 C.F.R. § 431.12(b):
Medical Care Advisory Committee
  Florida Pharmacy Ass'n v. Cook, 17 F. Supp. 2d 1293 (N.D. Fla. 1998)
42 U.S.C. § 1395z:   Evelyn V. v. King County Hospital Center, 819 F. Supp. 183 (E.D.N.Y. 1993) (federal statute does not convert state regulations into privately enforceable federal rights)

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