DABNEY L. FRIEDRICH, United States District Judge.
The plaintiff Swinomish Indian Tribal Community brings this action under the Contract Disputes Act, 41 U.S.C. § 7101 et seq. and the Declaratory Judgment Act, 28 U.S.C. § 2201, as allowed by the Indian Self Determination and Education Assistance Act, 25 U.S.C. § 5331(a), for an alleged breach of contract and statutory violation by the Indian Health Service (IHS). Before the Court are the parties' cross-motions for summary judgment. Dkts. 21, 28. For the reasons that follow, the Court will grant the defendants' motion and deny the plaintiff's motion.
The Indian Health Service (IHS), an agency in the U.S. Department of Health and Human Services (HHS), delivers health-related programs, services, and activities to American Indians. See Compl. ¶ 11-12, Dkt. 1. When it delivers these services directly to tribal beneficiaries, it operates its own service unit facilities. See id. ¶ 18; see also Pl.'s Mem. at 8, Dkt. 21-2. Alternatively, the Indian Self Determination and Education Assistance Act (ISDEAA), 25 U.S.C. § 5301 et seq., authorizes federally recognized Indian tribes and tribal organizations to assume responsibility for the health care programs that the IHS would otherwise provide.
Title V of the ISDEAA, id. § 5381 et seq., establishes the guidelines for Tribes who wish to enter into self-governance contracts with the IHS. Such tribes do so by negotiating multiyear funding agreements to carry out their contracts. See id. § 5388(a)-(b). Title V entitles tribes with self-governance contracts to two types of funding: "amounts for direct program costs specified under section 5325(a)(1). . . and amounts for contract support costs specified under section 5325(a)(2), (3), (5), and (6)." Id. § 5388(c). Title I, in turn, defines those types of funding. See id. § 5325(a).
The first type of funding, an amount for "direct program costs," id. § 5388(c), includes an "amount of funds" that "shall not
The second type of funding, an amount for contract support costs (CSC), "shall be added" to the Secretarial amount for:
Id. § 5325(a)(2). The CSC amount includes two kinds
Id. § 5325(a)(3)(A). These two expense categories are known as "direct CSC" and "indirect CSC," respectively. Compl. ¶ 16. Direct CSC covers costs incurred to operate a specific program, such as workers' compensation, while indirect CSC covers overhead that benefits more than one program, such as information technology systems. Id.; see also Defs.' Cross-Mot. at 5 n.8, Dkt. 28. Indirect CSC is calculated by "multiplying a negotiated indirect cost rate by the amount of the direct cost base." Compl. ¶ 24. In turn, the direct cost base is defined as "[t]otal direct costs, less capital expenditures and passthrough funds." Id. The ISDEAA further provides that both types of CSC "shall not duplicate any funding provided under" the Secretarial amount in subsection (a)(1). 25 U.S.C. § 5325(a)(3)(A)(ii).
When the IHS provides direct services to beneficiaries, the Indian Health Care Improvement Act (IHCIA) authorizes it to bill and collect reimbursements from Medicare, Medicaid, the Children's Health Insurance Program, and private insurers (third parties) for services it provided to eligible individuals. Compl. ¶ 18. These collections, called program income or third-party revenue,
25 U.S.C. § 5388(j).
The question in this case is whether, when a tribe collects its own third-party revenue pursuant to 25 U.S.C. § 1641(d)(1), its expenditures of those funds on health care services are eligible for CSC funding from the IHS under the ISDEAA, id. §§ 5325, 5388.
The Swinomish Indian Tribal Community is a federally recognized Indian tribe whose reservation is in Skagit County, Washington. Compl. ¶ 10.
Compact, Art. III, § 5.
On November 2, 2009, the parties entered into a Funding Agreement for Calendar Year (CY) 2010-2014 (Funding Agreement), Pl.'s Mot. Ex. B, Dkt. 21-4. In accordance with Title V, the Funding Agreement included both the Secretarial amount for direct program costs and CSC funding for direct and indirect administrative costs. See id. § 4. For CY 2010, the Tribe's negotiated indirect cost rate was 31.91%. Compl. ¶ 24; see also Indirect Cost Negotiation Agreement, Pl.'s Mot. Ex. C at 4, Dkt. 21-5. Thus, under the Agreement, the amount of indirect CSC funds that the Tribe received was calculated by multiplying the indirect cost rate by the direct cost base. See Funding Agreement § 6. The CY 2010 award totaled over $3,000,000, including $755,965 for indirect CSC and $153,374 for direct CSC. Defs.' Am. Answer ¶ 27, Dkt. 26-1.
On December 20, 2016, the Tribe submitted a certified claim to the IHS contracting officer for $245,867 in CSC funding, which was on top of the $909,339 in CSC funding that it received under its CY 2010 Funding Agreement. See Pl.'s Mot. Ex. E at 3, Dkt. 21-7.
The Tribe filed its complaint in this action on May 17, 2018 to compel the IHS to pay the additional CSC funds for CY 2010. Compl. ¶ 46(2)(A).
A court must grant summary judgment "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). A fact is "material" if it "might affect the outcome of the suit under the governing law." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986); Holcomb v. Powell, 433 F.3d 889, 895 (D.C. Cir. 2006). And a dispute is "genuine" if "the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson, 477 U.S. at 248, 106 S.Ct. 2505; Holcomb, 433 F.3d at 895. "If there are no genuine issues of material fact, the moving party is entitled to judgment as a matter of law if the nonmoving party fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial." Holcomb, 433 F.3d at 895 (internal quotation marks omitted).
The question in this case is purely legal: Should the Tribe have received CSC funding based on third-party revenue from Medicare, Medicaid, and private insurers that the Tribe collected and then spent on health care services? The parties agree about the relevant material facts but offer competing interpretations of the relevant statutory provisions, including 25 U.S.C. §§ 5388 and 5325(a). For the reasons that follow, the Court concludes that that neither provision entitles the Tribe to CSC based on those expenditures.
As a threshold matter, the Court must determine whether it has subject matter jurisdiction. See Steel Co. v. Citizens for a Better Env't, 523 U.S. 83, 94-95, 118 S.Ct. 1003, 140 L.Ed.2d 210 (1998); see also Fed. R. Civ. P. Rule 12(h)(3) ("If the court determines at any time that it lacks subject-matter jurisdiction, the court must dismiss the action.").
The CDA and the ISDEAA confer subject-matter jurisdiction on this Court. Under the CDA, a tribe seeking underpaid CSC must first "make a claim in writing to a contracting officer at the relevant agency before it may sue in court," Menominee Indian Tribe of Wis. v. United States, 764 F.3d 51, 55 (D.C. Cir. 2014), aff'd, ___, 136 S.Ct. 750, 193 L.Ed.2d 652 (2016) (citing 41 U.S.C. § 7103(a)), which the Tribe did on December 20, 2016, see Pl.'s Mot. Ex. E. Because the contracting officer denied the Tribe's claim, the ISDEAA enabled the Tribe to file directly in federal district court. 25 U.S.C. § 5331.
The claim is also not barred by the six-year time limit in the CDA. See 41 U.S.C. § 7103(a)(4). The IHS incorrectly asserts that because the Tribe did not "even allege[], let alone prove[]," when its claim had accrued, it failed to meet its burden of establishing this Court's jurisdiction under the CDA. Defs.' Cross-Mot. at 33. But filing within the six-year timeframe is not a jurisdictional issue. See Menominee Indian Tribe of Wis. v. United States, 614 F.3d 519, 523 (D.C. Cir. 2010) ("We disagree that the [CDA's] limitations period is jurisdictional."). It is an affirmative defense. Fed. R. Civ. P. Rule 8(c); Gordon v. Nat'l Youth Work All., 675 F.2d 356, 360 (D.C. Cir. 1982). Consequently, the burden is not on a plaintiff to prove timeliness in the complaint; instead, a defendant must raise it in the answer. Long v. Howard Univ., 550 F.3d 21, 24 (D.C. Cir. 2008).
The IHS did not sufficiently raise the statute of limitations defense in its Amended Answer. The defense "need not be articulated with any rigorous degree
"As in all statutory construction cases," the Court must "begin with the language of the statute." Barnhart v. Sigmon Coal Co., 534 U.S. 438, 450, 122 S.Ct. 941, 151 L.Ed.2d 908 (2002); Bullcreek v. Nuclear Regulatory Comm'n, 359 F.3d 536, 541 (D.C. Cir. 2004). "The first step is to determine whether the language at issue has a plain and unambiguous meaning with regard to the particular dispute in the case." Sigmon Coal Co., 534 U.S. at 450, 122 S.Ct. 941 (internal quotation marks omitted). "The structure of the statute is also relevant in understanding" its meaning. Bullcreek, 359 F.3d at 541. "The inquiry ceases if the statutory language is unambiguous and the statutory scheme is coherent and consistent." Sigmon Coal Co., 534 U.S. at 450, 122 S.Ct. 941 (internal quotation marks omitted).
When interpreting the ISDEAA, courts must heed the Indian canon of construction. The ISDEAA specifies that it "shall be liberally construed for the benefit of the Indian tribe participating in self-governance and any ambiguity shall be resolved in favor of the Indian tribe." 25 U.S.C. § 5392(f). Thus, when reviewing an agency decision under the ISDEAA, the court must "give the agency's interpretation careful consideration but . . . not defer to it." Cobell v. Norton, 240 F.3d 1081, 1101 (D.C. Cir. 2001) (internal quotation marks omitted). To succeed, the government agency "must demonstrate that its reading is clearly required by the statutory language." Salazar v. Ramah Navajo Chapter, 567 U.S. 182, 194, 132 S.Ct. 2181, 183 L.Ed.2d 186 (2012). But the Indian canon of construction "need not be conclusive," Chickasaw Nation v. United States, 534 U.S. 84, 94, 122 S.Ct. 528, 151 L.Ed.2d 474 (2001), and it "does not permit reliance on ambiguities that do not exist," South Carolina v. Catawba Indian Tribe, Inc., 476 U.S. 498, 506, 106 S.Ct. 2039, 90 L.Ed.2d 490 (1986).
The Tribe argues that it is entitled to CSC for third-party expenditures on the basis of two provisions of the ISDEAA. First, the Tribe interprets § 5388(j) to consider third-party revenue a part of the Secretarial amount, on which CSC is based, because § 5388(j) requires the Tribe to expend third-party revenue to the Tribe's ISDEAA contract. Second, the Tribe reads the "Secretar[ial]" amount and "Federal program" in § 5325(a) to implicitly include any third-party revenue the
The Court agrees with IHS that § 5388(j)'s text and structure distinguish third-party revenue from the Secretarial amount, rendering third-party revenue not part of the basis for calculating CSC. Because Title V explicitly addresses program income from third-party revenue, the Court examines that provision first. It provides:
25 U.S.C. § 5388(j).
Section 5388(j)'s text explicitly separates third-party revenue from the funding agreement. It clarifies that third-party revenue "shall be treated as supplemental funding to that negotiated in the funding agreement." Id. (emphasis added). And the Tribe's Compact likewise calls third-party revenue "additional supplemental funding to that negotiated in the [funding agreement]." Compact, Art. III, § 5 (emphasis added). A "supplement" is: "[a] thing . . . added to make good a deficiency or as an enhancement" or "an extra payment or charge . . . a sum of money paid to increase a person's income." Oxford English Dictionary (3d ed. 2012).
Yet the statute makes clear that CSC is negotiated and calculated within the funding agreement. Subsection (c) defines the "[a]mount of funding" provided under a funding agreement, and it explicitly includes "amounts for contract support costs specified under section 5325(a)(2), (3), (5), and (6) of this title." 25 U.S.C. § 5388(c). The parties' own Funding Agreement accordingly included negotiated calculations for CSC. See Funding Agreement § 6. ("The parties agree that under this [Funding Agreement] the Swinomish Indian Tribal Community will receive direct CSC in the amount of $141,514 . . ., and indirect CSC in the amount of $645,489."). Because third-party revenue is supplemental to the amount negotiated in the funding agreement, 25 U.S.C. § 5388(j), and CSC is negotiated within the funding agreement, id. § 5388(c), expenditures of such third-party revenue are not amounts eligible to be included in the amount from which CSC is calculated.
Although § 5388(j) prohibits the IHS from reducing CSC to which the Tribe is otherwise entitled because of third-party revenue, it does not require the IHS to provide additional CSC when the Tribe expends third-party revenue. First, if the IHS could treat the IHS and third-party revenue funds as truly "interchangeable," it could reduce appropriations when a tribe's third-party income increased. But § 5388(j) expressly prohibits such treatment. This provision requires the IHS to negotiate funding agreements without regard to third-party revenue, as its appropriation must remain the same regardless of how much a tribe earns, or if it earns any at all. Cf. 25 U.S.C. § 1641(a) (stipulating that the IHS's own collections of Medicare and Medicaid reimbursements "shall not be considered in determining appropriations for the provision of health care and services to Indians"). Any collection of third-party revenue thereby provides the Tribe with resources beyond those that it receives under the Funding Agreement.
Rather than requiring extra CSC payment on third-party revenue, § 5388(j) is better understood as an override of the normal Office of Management and Budget (OMB) cost principle that any federal program income can be grounds to reduce appropriations. See 2 C.F.R. § 200.307(e)(1) (establishing the OMB cost principle that income earned by a federal program "[o]rdinarily . . . must be deducted" from a federal funding recipient's otherwise allowable costs "to determine the net allowable costs"); 25 U.S.C. § 5386(c)(2) (requiring all tribes operating under Title V of the ISDEAA to "apply cost principles under the [OMB], except as modified by section 5325"). It prohibits the IHS from reducing the Secretarial amount or CSC otherwise provided by the funding agreement based on the third-party revenue a tribe earns. But nowhere does it specify that the Tribe should receive IHS funds in addition to third-party revenue.
For these reasons, the Court reads § 5388(j) to define third-party revenue as a source of funding that is supplemental to and separate from the amount negotiated in the funding agreement under § 5388(c) and thus ineligible for CSC.
The Court also agrees with the IHS that § 5325(a) does not entitle the Tribe to collect CSC for its expenditure of third-party revenue, as that section's references to the "Secretarial amount" to which CSC must be added and the "Federal program" that generates CSC do not
The Tribe's arguments to the contrary fail. To start, § 5388(j)'s explicit textual reference to third-party revenue overrides the Tribe's general arguments about § 5325(a). "[I]t is a commonplace of statutory construction that the specific governs the general." Morales v. Trans World Airlines, Inc., 504 U.S. 374, 384, 112 S.Ct. 2031, 119 L.Ed.2d 157 (1992). For statutes "in which a general authorization and a more limited, specific authorization exist side-by-side," the terms of the specific authorization govern. RadLAX Gateway Hotel, LLC v. Amalgamated Bank, 566 U.S. 639, 645, 132 S.Ct. 2065, 182 L.Ed.2d 967 (2012). Here, § 5325(a) generally entitles a tribe to receive CSC on expenditures of funds that are received as a result of the terms of its funding agreement with the IHS. The Tribe would have that provision govern its expenditure of third-party revenue also. But § 5388(j) specifically deals with third-party revenue in a "more limited, specific authorization." Id. at 645, 132 S.Ct. 2065. That subsection says that the Tribe "may retain all such income and expend such funds," § 5388(j) (emphasis added), but it does not mention CSC payments. This specific provision governs and, as addressed above, excludes third-party revenue from CSC calculations.
In addition, "[w]here Congress includes particular language in one section of a statute but omits it in another section of the same Act, it is generally presumed that Congress acts intentionally and purposely in the disparate inclusion or exclusion." Russello, 464 U.S. at 23, 104 S.Ct. 296 (alteration and internal quotation marks omitted). Section 5325(a)(1), which defines the Secretarial amount and CSC, does not reference third-party revenue. And § 5388(j), which deals with third-party revenue, does not reference the Secretarial amount or CSC. This separate provision directly addressing third-party revenue "demonstrates that Congress knew how to differentiate between" different funding sources, and the distinction "should be given effect." Jones v. Bock, 549 U.S. 199, 222, 127 S.Ct. 910, 166 L.Ed.2d 798 (2007). Here, Congress has "described with some care the various situations" in which CSC is available in § 5325(a)(2)-(3), and separately described the uses of third-party income in Title V. Nat'l R.R. Passenger Corp. v. United States, 431 F.3d 374, 378 (D.C. Cir. 2005). The statute omits any provision of CSC for third-party expenditures and does not tie the Secretarial amount or CSC, which are both defined at § 5325(a), to third-party revenue, which is defined elsewhere at § 5388(j). Thus, what the Tribe seeks "is not a construction of a statute, but, in effect, an enlargement of it by the court, so that what was omitted . . . may be included within its scope." Id. (internal quotation marks omitted). "To supply omissions transcends the judicial function." Id. (internal quotation marks omitted).
The statutory context as a whole further clarifies that the Secretarial amount in § 5325(a) refers to funds that the IHS pays the Tribe, not to third-party
Read together, the ISDEAA's various provisions clearly limit the Secretarial amount to funds that the IHS appropriates and exclude from that amount any third-party revenue that the Tribe collects on its own. Title V clarifies that "the [IHS] Secretary shall transfer to the Indian tribe all funds provided for in the funding agreement, pursuant to subsection (c) of this section," 25 U.S.C. § 5388(a) (emphasis added), and sheds light on the word "provided" used in connection with the funding agreement in subsection (c) and § 5325(a)(1). And the other sections that refer to the funding agreement describe funds "transfer[red]" or "paid" by the Secretary under the compact or funding agreement, see id. §§ 5388(g), (h), (i). By contrast, the subsection describing third-party revenue refers to "income earned by an Indian tribe," id. § 5388(j) (emphasis added). Notably, § 5388(k) also specifies that "[a]n Indian tribe shall not be obligated to continue performance that requires an expenditure of funds in excess of the amount of funds transferred under a compact or funding agreement," id. § 5388(k) (emphasis added), implying that the total amount of funding provided to accomplish contractual obligations is what "the Secretary. . . transferred under the under the funding agreement," id. See also 42 C.F.R. § 137.75 ("[T]he Secretary must transfer to a Tribe all funds provided for in the funding agreement." (emphasis added)); Funding Agreement § 4, 7 (noting that "the amounts available to the Tribe pursuant to the Compact and in accordance with Section [5388(c)] of Title V" "shall be paid in advance to the Tribe in one lump sum payment").
Moreover, additional CSC for third-party expenditures would violate § 5325(a)(3)(A) because it would at least partially "duplicate any funding provided under subsection (a)(1)." 25 U.S.C. § 5325(a)(3)(A)(ii). The third-party revenue already includes reimbursement for direct and indirect costs incurred by the Tribe. Defs.' Cross-Mot. at 15-16.
First of all, providing CSC for additional future services would duplicate reimbursements for past services. Under Title V of the ISDEAA, the IHS compensates a tribe for both direct and indirect costs associated with the health-related programs it provides. The IHCIA requires the tribe to use the revenue it collects from third-party insurers for health care services, and it permits the third-party revenue to be used to cover indirect as well as direct costs. Interpreting Title V to require the IHS to provide a tribe additional CSC for future expenditures financed by third-party revenue thus would result in duplicative payments. A tribe could use the initial CSC provided under its funding agreement to cover the indirect costs of its past services and then use the third-party revenue to cover the indirect costs of future health-related expenditures.
In addition, the very nature of indirect CSC is that it does not necessarily create meaningful new overhead costs for pooled resources, such as information technology or human resources departments and audits.
The Tribe principally relies on two district court cases to support its statutory arguments that the Tribe's collection and expenditure of third-party revenue should be considered part of the federal program for purposes of calculating CSC. They are inapposite.
The first, Pyramid Lake Paiute Tribe v. Burwell, 70 F.Supp.3d 534 (D.D.C. 2014), addressed a narrower issue than the one before this Court. There the district court considered only whether a tribe was entitled to an IHS Secretarial appropriation to run a certain program; it addressed neither the source of funds nor CSC. The court held that the IHS Secretary could
The Tribe's other main case, Navajo Health Foundation—Sage Memorial Hospital, Inc. v. Burwell, 263 F.Supp.3d 1083 (D.N.M. 2016), is also distinguishable on several grounds. There the IHS reduced otherwise allocable CSC based on third-party revenue using an "allocation ratio." See id. at 1092. For example, if the tribe was otherwise entitled to $25 for CSC to support a $100 Secretarial amount, and the tribe raised and expended $100 more in third-party revenue, then IHS would reduce the previously allocated CSC to $12.50 because 50% of expenditures were now attributable to the third-parties. Id. at 1113 n.32. The Sage Memorial court held that the allocation ratio violated the ISDEAA when applied to third-party revenue because it directly contravened the provision that "program income ... shall not be a basis for reducing the amount of funds otherwise obligated to the contract." Id. at 1167-68 (citing 25 U.S.C. § 5325(m), previously codified at 25 U.S.C. § 450j-1(m)).
In addition, what the Sage Memorial tribe sought, the Swinomish Tribe already receives. The tribe in Sage Memorial argued that "the IHS needs to pay the full contracted CSC amount regardless how much [the tribe] is able to expand its programmatic budget via third party collections." Id. at 1113. In other words, it "should receive $25.00 for CSC whether [it] only has a $100.00 programmatic budget from the Secretarial amount or a $200.00 programmatic budget from adding $100.00 in third-party revenues to the $100.00 Secretarial amount." Id. at 1113 n.33. But the Tribe would have this Court go further, seeking in effect $50 in CSC (an added $25) because of its added $100 expenditure of third-party revenue. The Sage Memorial court's ultimate conclusion that third-party expenditures were "eligible to be reimbursed as CSC without use of an allocation ratio," id. at 1162 (emphasis added), does not apply here.
Also, the Sage Memorial decision was under Title I of the ISDEAA, while this decision is under Title V. Though this fact is not dispositive, it means that the Sage Memorial court did not address the specific textual and structural implications of § 5388 as discussed above. Title I's provision notably lacks the "supplemental" language included in Title V, and it also contains a stronger statement about the use of third-party revenue to further the purposes of the ISDEAA contract. Compare 25 U.S.C. § 5325(m) ("[P]rogram income earned by a tribal organization in the course of carrying out a self-determination contract ... shall be used ... to further the general purposes of the contract.") with id. § 5388(j) ("[P]rogram income earned by an Indian tribe shall be treated as supplemental funding to that negotiated in the funding agreement. The Indian tribe
In sum, the text, structure, and logic of § 5325(a) counsel against treating the Tribe's collection and expenditure of third-party revenue as part of the Secretarial amount or federal program for the purposes of calculating CSC owed. And because the statute is clear, the Indian canon of construction does not bear on the out-come. See Montana v. Blackfeet Tribe of Indians, 471 U.S. 759, 766, 105 S.Ct. 2399, 85 L.Ed.2d 753 (1985) (holding that "ambiguous provisions" should be interpreted to the benefit of the Indian tribe (emphasis added)); see also Pl.'s Mot. at 26 ("In the event the Court finds the statute ambiguous, the Court must construe it in favor of the Tribe.").
For the foregoing reasons, the Court grants the defendants' motion for summary judgment and denies the plaintiff's motion for summary judgment. A separate order consistent with this decision accompanies this memorandum opinion.