### The Honorable James M. Moody, United States District Judge * 

### for the Eastern District of Arkansas, sitting by designation. No. 96-1736

Minnesota Homecare Association, * Inc. CommuniCare Home Care; * First Respiratory Services, * Inc.; Kanabec County Public * Health; Metropolitan Visiting * Nurse Association; Pine to * Prairie Home Health Care; * PrairieLand Home Care, Inc.; * R.E.M. Health, Inc.; Saint * Cloud Hospital Home Care * Services; St. Joseph’s Hospital * St. Mary’s Medical Center Home * Appeal from the United States Care; Samaritan Bethany Home * District Court for the Health Services; Shamrock * District of Minnesota. In-Home Nursing Care, Inc.; * Sibley County Public Health * [PUBLISHED] Department, * *

Appellants, * * V. * * Maria Gomez, Commissioner, * State of Minnesota Department * of Human Services * *

Appellee. *

Submitted: November 21, 1996 Filed: March 14, 1997
Before BEAM and LOKEN, Circuit Judges, and MOODY, District Judge. *

PER CURIAM.

Home heal th care agencies in Minnesota and the state association of home h ealth care providers brought an action against Minnesota' s Commissioner of the Department of Human Services ("DHS"

### The Honorable Paul A. Magnuson, United States District 1 

### Judge for the District of Minnesota.
-2- or the State), claiming that the State's rate-setting methodology governin g reimbursements for home health care providers under the State’s Medicaid pro gramviolates the statutory mandates of the Federal Medicaid Act, 4 2 U.S.C. § 13 96 et seq . The agencies alleged that the DHS violated § 1396a(a)(30)(A) of the Act, referred to as the “equal access” provision, by implem enting a change in the rates of payment without a mandate d
con sideration of its effect on efficiency, economy, quality of care an d access to services. They further alleged that D HS violated the statute by failing to maintain a monitoring system that ass ures that rates of payment continue to meet the goals of fostering quality care and access to service s as required by the equal access provision.

On cross motions for summary judgment, the district court grante d 1 summary judgment in favor of the State, concluding that the Medicaid Act does not require the kind of formal analysis advocated by the plaintiffs and finding that defendant's rate-setting method ology does not violate the Act.

We review the district court’s grant ing of summary judgment de novo. Beyerbach v. Sears Co . II , 49 F.3d 1324, 1325 (8th Cir. 1995). After due consideration of the undisputed facts, arguments, and exhibits submitted by the parties, we affirm.

The Medic aid Act mandates consideration of the equal access factors of efficie ncy, economy, quality of care and access to services in th e process of setting or changing payment rates, see Arkansas Med. Soc’y, Inc

. v. Reynolds , 6 F.3d 519, 530 (8th Cir. 1993); ho wever, it does not require the State to utilize any prescribed method of analyzing and considerin g said factors. In

### -3-

the instant case, it is undisputed that the DHS had informal monitorin g procedures in effect to evaluate the operation o f its Medicaid program and to gauge the adequacy of its reimbursement rates.

Although the DHS did not provide any formal analysis of the equa l
access factors to the legislature in support of its consideration of the 1994 rate increase, the Minnesota HomeCare Association, and others lobbyin g
on behalf of home care providers, actively participated in the 199 3 legislative session d uring which the rate change was considered such that
concerns of efficiency, economy, quality of care, and access to services
were before the Legislature when it determined to raise the home healt h care reimbursement rates by three percent.

Under the circumstances of this case, we find that the State’ s methodology for estab lishing and maintaining home health care rates under its Medicaid program meets the requirements of 42 U.S.C. § 1396a(a)(30)(A)

. Ac cordingly, we conclude that summary judgment was properly entered i n favor of defendant.
LOKEN, Circuit Judge, concurring.

Alt hough I agree that appellants have insufficient evidence DH S viola ted 42 U.S.C. § 1396a(a)(30), I write separately because I do no t believe appellants have stated a claim under § 1983. Their cause of actio n is premised on Wilder v. Virginia Hosp. Ass'n , 496 U.S. 498, 524 (1990), in which the Supreme Court held that the Boren Amendment, § 1396a(a)(13), created an enforceabl e right "to have the State adopt rates that it finds
are reaso nable and adequate rates to meet the costs of an efficient an d economical health care provider." In Suter v. Artist M. , 503 U.S. 347, 35 9 (1992), the Court exp lained that Wilder turned on the fact that the Boren Amendment "actually required the States to adopt reasonable

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and ad equate rates," and "set forth in some detail the factors to b e considered in determining the methods for calculating rates."

Like the Boren Amendment, § 1396a(a)(30) "requires each state t o produce a result , not to employ any particular methodology for gettin g there." Methodist Hosps., Inc. v. Sullivan , 91 F.3d 1026, 1030 (7th Cir. 1996). One result -- the one providers such as appellants care about -- is the establishment of reimbursement rates that "are consistent wit h efficie ncy, economy, and quality of care and are sufficient to enlis t enough providers so that care and services are a vailable under the plan at least to the extent that such care and services are available to th e general population in the geographical area." § 1396a(a)(30(A). That is the result the state agency failed to produce in Arkansas Med. Soc'y, Inc.

v. Reynol ds , 6 F.3d 519 (8th Cir. 1993); we therefore held that th e challenged rate violated federal law.

Here, on the other hand, appellants do not claim that Minnesota' s rates violate § 1396a(a)(30) standards. They challenge DHS's "methodology " for assisting in rate development. However, thi s methodology was approved when the responsible federal agency approved Min nesota's plan. Appellants chall enge process, not result. Their asserted right is "merely a procedural one," and the procedural interest they assert is so "vague and amorphous" as to be "beyond the competence of the judiciary to enforce." Wilder , 496 U.S. at 509-10.

That appellants have failed to state a § 1983 cause of action i s confirmed by recalling that the Minnesota Legislature, not DHS, sets the reimbursement rates in question. Arkansas Medic al Society involved agency ratemaking, and our decision applied administrative law principles (perhap s incorrectly, but that is a digression I need not pursue) in deciding that the r ates were not adopted in compliance with § 1396a(a)(30). Federa l courts do not undertake

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administrative law re view of legislative action, certainly not the action of a state legislature. Review of statutory rates must be limited t o whether their result in the marketplace is consi stent with the substantive requ irements of federal law. Thus, appellants would engage us in a n exercise in futility -- review of the "methodology" by which DHS gathers and feeds market info rmation to the Legislature which the Legislature may then ign ore when adopting statutory rates. In reality, of course , appellant s want the federal courts to force DHS to gather data tha t appellants' lobbyists can use in persuading the Legislature to raise the rates. That is not the proper basis for a § 1983 claim.

A true copy.

Attest:

CLERK, U.S. COURT OF APPEALS, EIGHTH CIRCUIT.