Smith v. Becerra, 44 F.4th 1238

Linda Smith, a long-time diabetic with hypoglycemic unawareness, purchased a Medtronic MiniMed CGM and sensors and sought Medicare Part B reimbursement for items obtained in 2016–2018; Medicare denied her claims under CMS-1682-R.
CMS-1682-R (2017) excluded CGMs that were “adjunctive” (i.e., required fingerstick confirmation) from durable medical equipment (DME) coverage; Smith exhausted administrative appeals and sued the Secretary seeking payment and to set aside CMS-1682-R.
The Secretary admitted error as to Smith’s claims and asked for remand for payment; while suit was pending, CMS initiated rulemaking and issued a December 2021 Final Rule classifying CGMs as DME effective Feb 28, 2022 (not retroactive).
The district court remanded for payment and dismissed Smith’s equitable motions as moot in Jan 2022; Smith appealed, arguing unresolved risk to pre-Feb 28, 2022 claims.
CMS issued a Technical Direction Letter instructing contractors to approve pending pre-February 28 claims and then, on May 13, 2022, published CMS-1738-R rescinding CMS-1682-R and applying the Final Rule retroactively to pending claims.
The Tenth Circuit held Smith’s equitable claims moot in light of the Final Rule, the Technical Direction Letter, and CMS-1738-R, and rejected Smith’s invocation of the voluntary cessation exception.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Mootness of equitable relief (vacatur/declaratory relief)	Smith: not moot because CMS-1682-R remained in effect for pre-2/28/22 claims and pending claims could still be denied	Secretary: Final Rule, Technical Direction Letter, CMS-1738-R and confession of error remove any redressable injury	Moot — intervening rule and ruling eliminate a live controversy; relief would have no real-world effect
Applicability of voluntary cessation doctrine	Smith: CMS changed policy to evade review and will likely resume prior policy after litigation	Secretary: policy change was genuine, began with preexisting rulemaking, and reversal is unlikely given formal rulemaking and binding ruling	Voluntary cessation does not apply — risk of recurrence speculative and minimal
Collateral estoppel re duty to pay (ALJ prior ruling)	Smith: Secretary should be collaterally estopped from relitigating coverage because an ALJ found coverage	Secretary: moot and regulatory changes supersede need to decide estoppel	Not reached as live issue; moot because regulatory and payment remedies afford full relief
District court’s January 2022 mootness ruling	Smith: district court erred because Final Rule was not retroactive and pre-2/28/22 claims remained at risk	Secretary: Final Rule and remand resolved matters	Appellate court: district court prematurely deemed equitable claims moot in Jan 2022, but subsequent CMS-1738-R (May 2022) rendered appeal moot overall

Genesis Healthcare Corp. v. Symczyk, 569 U.S. 66 (2013) (Article III case-or-controversy requirement; mootness)
Spencer v. Kemna, 523 U.S. 1 (1998) (plaintiff must maintain injury through all stages of litigation)
Lewis v. Cont'l Bank Corp., 494 U.S. 472 (1990) (redressability requirement for standing)
Already, LLC v. Nike, Inc., 568 U.S. 85 (2013) (voluntary cessation doctrine — defendant bears heavy burden to show no reasonable chance of recurrence)
Church of Scientology of Cal. v. United States, 506 U.S. 9 (1992) (no effectual relief requires dismissal as moot)
West Virginia v. EPA, 142 S. Ct. 2587 (2022) (defendant bears burden to show a once-live case has become moot)
Prison Legal News v. Fed. Bureau of Prisons, 944 F.3d 868 (10th Cir. 2019) (mootness standards; voluntary cessation analysis)
Rio Grande Silvery Minnow v. Bureau of Reclamation, 601 F.3d 1096 (10th Cir. 2010) (agency rescission/modification of policy can moot challenges)
Jordan v. Sosa, 654 F.3d 1012 (10th Cir. 2011) (injunctive/declaratory relief mootness standards)
Brown v. Buhman, 822 F.3d 1151 (10th Cir. 2016) (timing and catalyst considerations in voluntary cessation analysis)