Thirty-one nursing homes argued that under a 1987 amendment to the Social Security Act, any CMS survey of a nursing home must be conducted by a multidisciplinary team that includes one registered nurse. They claimed a 2017 rule violated that requirement by seeking to "clarify" that the requirement for a nurse to be part of the team applied only to surveys used to assess Medicare eligibility, not to investigate complaints. District Court Judge Laura Swain held that she lacked jurisdiction to hear the case because the nursing homes failed to exhaust their administrative remedies.