Therese M. Waters, on Behalf of Kelly E. Waters v. Xavier Becerra, Secretary of Health and Human Services

The questions presented are: (1) Is the Secretary statutorily authorized, or entitled to deference, to deny benefit coverage for an entire group of benefits (here, enteral nutrition) which the Medicare Act recognizes as being within a benefit category and (2) Is the Secretary statutorily authorized to exclude an entire class of Medicare beneficiaries from coverage for a benefit (here, enteral nutrition) by imposing a coverage requirement for that benefit (here, a feeding tube) that is relevant to the treatment of only one internal organ (here, a gastrointestinal tract dysfunction which requires a feeding tube to deliver enteral nutrition) and excludes coverage for that same medically necessary benefit for the treatment of a different internal organ (here, a liver dysfunction which is treated with an orally ingested enteral nutrition) based upon a Medicare Contractor’s non-evidence-based Policy Article when: (i) The Act covers all internal organ dysfunctions, excluding only dental, (ii) 42 U.S.C. §1395x(s)(8) provides benefit coverage for “prosthetic devices (other than dental) which replace all or part of an internal body organ,” (iii) 42 U.S.C. §1395m(h)(4)(B) identifies enteral nutrition as a covered prosthetic device within 42 U.S.C. §1395x(s)(8), (iv) 42 U.S.C. §1395u(s)(2)(D) identifies “Parenteral and enteral nutrients,