Court Says Local Health Centers Can Challenge AHCCCS Over Reimbursements – Cronkite News

Optometric care is one of the services –– along with chiropractic, podiatry and dental care — that a group of local health centers has not reimbursed, according to Arizona’s Medicaid agency. They claim the law requires the services to be covered. (Photo by Leonardo Munoz/EPA/Shutterstock)

WASHINGTON — A federal appeals court on Friday ordered a new hearing for community health centers in Arizona alleging the state’s Medicaid system wrongly denies reimbursement for chiropractic, dental, optometric and podiatry care.

A three-judge panel of the 9th US Circuit Court of Appeals reversed a lower court decision dismissing the Arizona Alliance for Community Health Centers’ lawsuit against the Arizona Health Care Cost Containment System, the state’s Medicaid provider.

in the his opinion, District Judge Richard R. Clifton commended the district judge and attorneys on both sides “for their skillful handling of the unusually complex issues raised by this case.” But he said the decision to dismiss the case was wrong and remanded the case to the district court for a new hearing.

An attorney for the health centers declined to comment on the case Friday until she could speak to her clients. AHCCCS officials said they are still studying the verdict and would not be able to comment until next week.

The case was filed in 2019 by the health care Centers, federally qualified health centers, which said they have “an enforceable federal claim for reimbursement of FQHC services, which include (but are not limited to) the services of their dentists, podiatrists, optometrists and chiropractors.”

They said AHCCCS had “categorically excluded” chiropractors from coverage and unreasonably restricted reimbursement for adult dental, podiatric and optometric services, all of which are required under Medicaid and the state plan for Medicaid.

but AHCCCS Attorneys contended that the agency “does not, as plaintiffs allege, ‘categorically exclude’ dental, podiatry, optometry or chiropractic services” — it includes those services, the agency said, but it only covers those services “with limitations.” away”.

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The district court judge agreed with the health centers that AHCCCS cannot exclude those services, but she said the law doesn’t prohibit her from limiting coverage. And she dismissed claims that the chiropractors had been excluded, noting that coverage for services for patients under the age of 21 was included in the state plan.

She dismissed the case, triggering an appeal from the health centers.

The appellate panel disagreed with the district court judge, finding that “Arizona’s categorical exclusion from adult chiropractic services … violates the Medicaid Act.” Clifton, in his statement, also opposed the AHCCCS’s interpretation of the Medicaid Act, which he said would “enable a state to categorically exclude any coverage for all FQHC services.”

Finally, the appeals court said the lower court had wrongly requested “Chevron Awe” Legal principle that requires courts to generally rely on an administrative authority’s interpretation of the rules they are enforcing.

AHCCCS had argued that its restrictions were approved by the regional administrator for the Centers for Medicare and Medicaid Services (CMS) the federal agency that oversees states’ Medicaid plans and enforcement.

But the appeals court said for Chevron to apply there must be a clear record of the decision-making that went into the approval. Clifton said the record lacks “no evidence of CMS’s reasoning” on Arizona’s rules.

“We conclude that the records we have do not support Chevron’s compliance with Arizona’s restrictions on adult dental, optometric and podiatry services,” Clifton wrote.

While the Supreme Court “has long held that ‘nothing in the (Medicaid) statute indicates that participating states are required to fund all medical procedures'” included in the prescribed categories, CMS needs to explain the reason for the Justify decision to exclude coverage. Clifton said that was not the case.

The case was remanded to the district court to determine, among other things, whether there was sufficient evidence to support the application of the Chevron Doctrine in this case.

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