Court Opinion

ID: 9480216
Source: CourtListenerOpinion
Date Created: 2023-08-05 07:41:28.226871+00
Date Added: 2024-06-11T17:47:32.999368
License: Public Domain

BEAM, Circuit Judge
dissenting.
I respectfully dissent. I believe that our opinion in Ellis v. Patterson, 859 F.2d 52 (8th Cir.1988) controls this case. In Ellis, we held that “the State of Arkansas is not required to fund organ transplants under Medicaid, and that it may choose which kinds of organ transplants, if any, to cover.” Id., 859 F.2d at 55. Thus, Iowa was not required to fund any pancreas transplant, other than on its own terms. Iowa was free to adopt its own policy. Once Iowa decided to pay for some types of organ transplants, however, Title XIX of the Social Security Act regulated Iowa’s decision by requiring that Iowa must provide “written standards respecting the coverage of such procedures,” and that such standards must treat similarly situated individuals alike. 42 U.S.C. § 1396b(i) (Supp. V 1987).
Iowa enacted Iowa Admin.Code rr. 441-78.1(l)(f), 441-78.1(20), and 441-78.3(10). As the majority opinion correctly states, these sections of the Iowa Code constitute Iowa’s required written standard. The Iowa Code provides, in relevant part, that “[pjayment will be made for organ and tissue transplants and related services which are designated nonexperimental by Medicare.” Id. r. 441-78.1(20).
Iowa has complied with 42 U.S.C. § 1396b(i) and provided written standards for organ transplant coverage. The issue in this case, therefore, is whether Iowa’s written criteria is objective or subject to challenge as being arbitrary or unreasonable. I believe that a state standard, which consistently refers to the federal Medicare guidelines for transplant coverage, is objec*1285tive and reasonable. Thus, the only remaining question is whether Iowa followed the Medicare guidelines in Meusberger’s case, as it proposed to do in its written Code. In this case, Iowa examined the Medicare Coverage Issues Manual, 35-82, which provided that “[p]ancreas transplants of any type are considered investiga-tional and are, therefore, not covered under Medicare.”8 As a result, Iowa declined to cover Meusberger’s pancreas transplant. Pursuant to the Iowa Code, Iowa did not arbitrarily grant some pancreas transplants and deny others. Rather, Iowa consistently and reasonably followed the federal Medicare guidelines as set forth in Iowa’s written standards. The analysis need go no further. In this case, it does not matter how much expert testimony was produced on whether pancreas transplants should still be considered experimental or investigational in nature. That testimony is relevant only for the question of whether Medicare is correct in its characterization of pancreas transplants, an issue not before us today. Iowa did not write the Medicare Coverage Issues Manual. Iowa simply adopted these objective federal standards. Accordingly, I believe that the judgment of the district court should be reversed.

. The majority opinion emphasizes the Medicare term "investigational," and attempts to distinguish this word from the term "experimental” as used in the Iowa Code. However, in the 1989 Department of Health and Human Services regulations, which set forth the criteria as to whether specific health care technologies were covered by Medicare, the regulation states that "[f]or Medicare coverage purposes, the term 'experimental’ is used synonymously with the term ‘investigational.’ ” 54 Fed.Reg. 4302 (Jan. 30, 1989). Thus, I do not find that Medicare's use of the term "investigational” changes my analysis of whether Iowa was reasonable in adopting a written standard which denies coverage for transplants that are deemed "experimental” by Medicare.