77 N.Y.2d 340 (1991)
When a legislative body has articulated a clear policy, an agency may adopt reasonable regulations to implement that policy, even if those regulations involve setting standards for participation in government programs.
Summary
This case addresses the validity of regulations promulgated by the New York Public Health Council (PHC) requiring nursing homes seeking approval to admit a reasonable percentage of Medicaid patients. The Court of Appeals reversed the lower courts, holding that the regulations were within the scope of the PHC’s delegated authority and did not constitute an unauthorized quota. The court emphasized the legislature’s explicit policy of ensuring access to medical care for needy persons and prohibiting discrimination against Medicaid patients, finding the PHC’s regulations a reasonable means to achieve these legislative goals.
Facts
The Department of Health issued a report in 1986 highlighting difficulties Medicaid patients face in accessing nursing home care. An Ad-Hoc Committee was formed, which concluded that some facilities discriminated against Medicaid patients. The PHC then adopted regulations requiring new nursing home applicants to admit a “reasonable percentage” of Medicaid patients, defined as 75% of the county’s Medicaid nursing home admission rate. The regulations allowed for deviations based on factors like patient case mix and financial impact, and facilities could request adjustments to their Medicaid patient admission standard.
Procedural History
The New York State Health Facilities Association challenged the regulations, first unsuccessfully under the State Administrative Procedure Act. It then filed an Article 78 proceeding, arguing the regulations exceeded the PHC’s authority and constituted an unauthorized quota. The Supreme Court, Albany County, converted the proceeding into a declaratory judgment action and declared the regulations invalid. The Appellate Division affirmed, finding the regulations exceeded the PHC’s rule-making authority. The Court of Appeals granted leave to appeal.
Issue(s)
1. Whether the PHC’s Medicaid Patient Access Regulations exceeded the scope of its delegated legislative authority under the principles established in Boreali v. Axelrod?
2. Whether the regulations constitute an unlawful quota system, violating prior holdings in Broidrick v. Lindsay, Fullilove v. Beame, and Subcontractors Trade Assn. v. Koch?
Holding
1. No, because the legislature clearly articulated a policy of ensuring access to medical care for needy persons and prohibiting discrimination against Medicaid patients, and the PHC’s regulations were a reasonable means to achieve these legislative goals.
2. No, because the regulations implement legislative policy choices rather than enacting new policy, and they serve the purpose of making the legislative program work, not achieving broad social goals through quotas.
Court’s Reasoning
The Court distinguished this case from Boreali v. Axelrod, emphasizing that here, the legislature had articulated a clear policy regarding access to medical care for needy persons and prohibiting discrimination against Medicaid patients. The PHC’s regulations were designed to implement this policy, not create a new one. The Court cited Social Services Law § 363 and Public Health Law § 2801-a (9)(d) as evidence of the legislative direction. The Court noted the importance of considering public need, including socioeconomic conditions and the needs of those on public assistance, when approving nursing homes. The Court also rejected the argument that the regulations constituted an improper quota, distinguishing this case from Broidrick, Fullilove, and Subcontractors. The Court reasoned that the regulations were not imposed by executive fiat but were duly adopted under the State Administrative Procedure Act to make a legislative program work. The regulations aimed to ensure that for-profit corporations providing nursing home care adequately served the needs of economically disadvantaged patients. The Court noted that the regulations did not create rigid requirements but set standards subject to modification and allowed facilities to seek adjustments based on financial factors. It also emphasized that participation in the Medicaid program remained voluntary, and facilities could withdraw without being subject to the regulations. The dissent argued that the PHC exceeded its delegated authority by adopting a quota system, which is a legislative determination. The dissent also stated that the regulations conflicted with the existing policy that Medicaid participation is voluntary.