Conahan

Plaintiff-Appellant Heather K.L. Conahan, personal representative of the Estate of Gaye S. Glaser, appeals the district court’s affirmance of the Medicare Appeals Council’s (MAC) ruling that DefendantIntervenor-Appellee Kaiser Foundation Health Plan, Inc. (Kaiser) is not required to pay for Glaser’s liver surgery. Conahan contends that by refusing to cover the procedure, Kaiser failed to comply with 42 C.F.R. § 422.112 (a)(3), which requires Medicare Advantage plans to make their services available, accessible, and adequate, and 42 C.F.R. §§ 422.112 (a)(9) and 422.113(b)(l)(iii), which require the plans to cover “urgently needed services.” We agree with the district court that substantial evidence supports the MAC’s decision, and we affirm.

FACTUAL AND PROCEDURAL BACKGROUND

Health maintenance organizations provide Medicare-covered services through Medicare Advantage plans. See 42 U.S.C. § 1395w-27. Medicare Advantage beneficiaries usually receive medical services within the network of providers established by their HMOs. However, federal regulations require Medicare Advantage plans to cover certain out-of-plan medical care, including emergency and “urgently needed…