Optometry care is one of the services that includes chiropractic, podiatry, and dental care, and a group of local medical centers say Arizona’s Medicaid agency does not offer reimbursement. They argue that the law requires the service to be covered. (Photo by Leonardo Munoz/EPA/Shutterstock)

WASHINGTON – A federal appeals court on Friday ordered a new hearing for the Arizona Community Health Care Center, which alleges Arizona’s Medicaid system wrongfully denied reimbursement for chiropractic, dental, optometry, and podiatric care. I was.

A three-member panel of the 9th U.S. Court of Appeals for the Circuit overturned a lower court’s decision dismissing the Arizona Alliance for Community Health Centers’ lawsuit against state Medicaid provider Arizona Healthcare Cost Containment System.

In his opinion, Circuit Judge Richard R. Clifton commended the district court judges and attorneys on both sides “for their deft handling of the highly complex issues presented in this case.” . However, he said the decision to dismiss the case was wrong and ordered the case to be returned to the district court for a new hearing.

An attorney for the health care center declined to comment on the case on Friday until it was able to speak with a client.

The lawsuit, filed in 2019 by the Center for Health Care, a federally accredited health center, states that it has “enforceable federal rights to FQHC services, including dentists, podiatrists, optometrists, and chiropractors.” It includes the services of the tar.”

They said AHCCCS “absolutely excludes” chiropractors from coverage and inappropriately limits reimbursement for adult dental, podiatry and optometry services.

However, AHCCCS attorneys argued that the agency “does not ‘firmly exclude’ dental, podiatric, optometric, or chiropractic services, as plaintiffs allege.”

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A district court judge agreed with the medical center’s opinion that AHCCCS cannot exclude these services, but said the law does not forbid limiting coverage. And she rejected claims that chiropractors were excluded, noting that coverage for services to patients under the age of 21 is included in the state’s plans.

She dismissed the lawsuit, sparking the medical center’s appeal.

The appellate panel disagreed with the district court judge, finding that “Arizona’s adamant exclusion of adult chiropractic services… violates Medicaid law.” Clifton’s opinion rejects AHCCCS’s interpretation of Medicaid law, which he said “allows the state to categorically exclude all coverage for all his FQHC services.”

Finally, the Court of Appeals said the lower court had misapplied “chevron compliance” to this case.

AHCCCS claimed its limits were approved by the regional administrators of the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees state Medicaid plans and their implementation.

But the appeals court said Chevron needed a clear record of the decisions that led to the approval in order to apply. There is a lack of evidence regarding

“We conclude that the record before us does not demonstrate that Chevron’s deference applies to restrictions on adult dental, optometry, and podiatry services in Arizona,” Clifton wrote. increase.

The Supreme Court long held that “there is nothing in the (Medicaid) law to suggest that participating states are required to fund all medical procedures that fall within the mandated category.” CMS has argued, but CMS must justify its decision to exclude coverage.

The case has been ordered to be remanded to the district court to consider, among other things, whether there is sufficient evidence for the Chevron doctrine to be used in this case.