Stroeder v. Office of Med. Assistance Programs,
Nos. D4-3617-AK7110; A110956 (Or. Ct. App. Dec. 19, 2001)

The Oregon Court of Appeals affirmed the Office of Medical Assistance Programs' ("OMAP") final order in which OMAP denied a claimant's request, under the Oregon Health Plan, for coverage for services related to a combined lung and liver transplant. The court concluded that OMAP properly denied coverage under its administrative rules pertaining to transplants, and that its decision did not violate the Americans with Disabilities Act ("ADA").

Specifically, the court concluded that OMAP did not err in characterizing claimant's request as one for a "simultaneous" lung and liver transplant and in finding that there were no reported cases of successful lung-liver transplants in the U.S. Moreover, OMAP's asserted interpretation of its rule pertaining to organ transplant services -- that it did not authorize coverage for a combined lung and liver transplant -- was consistent with the rule's text as well as with the statutes and rules pertaining generally to the Oregon Health Plan

The court refused to consider claimant's assertion that OMAP's decision constituted an erroneous interpretation of, and thus was in violation of, federal Medicaid statutes and regulations, because the claimant failed to assert before the agency that its decision violated the Medicaid statute or its implementing regulations. Finally, the court held that, because the service that was denied to claimant was not one that was provided to non-disabled persons, the denial did not violate the ADA.