APMA News - September 2013 - (Page 28)
I
Center for Professional Advocacy
Reviews Recent California Medicaid Lawsuit
n 2009, California changed its state Medicaid program
and no longer provided coverage for what are considered “optional services” within Medicaid, including services performed by podiatrists. Following the elimination of
optional benefits, federally qualified health centers (FQHC)
and rural health clinics (RHC) filed a lawsuit against the state
to prevent these cuts with regard to services they furnish. The
US District Court found for the state and the petitioners filed
an appeal to the 9th Circuit Court. The 9th Circuit held that
Medicaid must reimburse for services by podiatrists when
furnished by an FQHC and RHC.
On July 5, the US Court of Appeals for the 9th Circuit
rendered a decision in California Association of Rural Health
Clinics v. Douglas:
We hold that Medicaid imposes on participating states
an obligation to cover “rural health clinic services” and
“Federally-qualified health center services,” and Medicaid imports the Medicare definition of those terms.
Thus, Medicare unambiguously defines the Clinics’
services to include services performed by dentists, podiatrists, optometrists and chiropractors, in addition to
services performed by doctors of medicine and osteop-
athy. Any alternate reading of the statute would do violence to Medicaid’s command that the terms “rural
health clinic services,” “rural health clinic,” and “Federally-qualified health center services” shall have the
meanings given those terms in Medicare. 42 U.S.C. §
1396d(l)(1), (l)(2). We therefore reverse the district
court grant of summary judgment to the department.
The full text of the decision can be found at http://docs.
justia.com/cases/federal/appellate-courts/ca9/10-17574/1017574-2013-07-05.pdf.
Thus, because the Medicaid statute refers to Medicare law
for the definitions of “RHC services” and “FQHC services,”
and those Medicare definitions include “physician services,”
the Medicare definition of physician services applies. Because
podiatrists are defined as physicians under Medicare, services
by podiatrists must be covered and reimbursed by Medicaid
when furnished by RHCs and FQHCs.
The decision is limited to Medicaid reimbursement for
services provided by podiatrists in RHCs and FQHCs. The
Medicaid definition of physician is narrow and only includes
services performed by MDs and DOs, and as such, services
performed by podiatrists in private offices or in-patient settings are not affected by the decision.
Further, the 9th Circuit Court of Appeals’ decision only
affects states that sit in the 9th Circuit, which include Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada,
and Washington. States outside the 9th Circuit are not
bound by this decision; however, other jurisdictions may decide to follow this opinion.
Recommendations
APMA’s Center for Professional Advocacy recommends
that state component societies’ leadership work with other
stakeholders, including state community center associations,
state optometric associations, and state chiropractic associations to approach their state Medicaid departments and inform them of this decision.
In addition, state component societies in the 9th Circuit
should work with other stakeholder associations to ensure the
state implements this decision fully and appropriately. Members
are encouraged to use APMA’s eAdvocacy tool at www.apma.
org/eAdvocacy to contact Congress and ask for its support for
the Helping Ensure Life- and Limb-Saving Access to Podiatric
Physicians (HELLPP) Act so all Medicaid beneficiaries can have
access to necessary foot and ankle care provided by a podiatrist.
APMA will continue to monitor the status of this litigation
to see whether the state of California will appeal to the US
Supreme Court. Visit APMA’s Center for Professional Advocacy at www.apma.org/cpa, and send questions or comments
to advocacy@apma.org.
n
28 APMA News September 2013
http://docs.justia.com/cases/federal/appellate-courts/ca9/10-17574/10-17574-2013-07-05.pdf
http://docs.justia.com/cases/federal/appellate-courts/ca9/10-17574/10-17574-2013-07-05.pdf
http://www.aens.us
http://www.apma.org/eAdvocacy
http://www.apma.org/eAdvocacy
http://www.apma.org/cpa
http://www.aens.us
Table of Contents for the Digital Edition of APMA News - September 2013
APMA News - September 2013
President’s Message
Contents
What Happens in Vegas: The 2013 Annual Scientific Meeting
Annual Scientific Meeting Sponsors
Humanitarian Surgical Missions: A Different Kind of Residency Training
Collaboration is Key at Limb Salvage Clinic
Center for Professional Advocacy Reviews Recent California Medicaid Lawsuit
Oregon Podiatrists Achieve Physician Status
Letters to the Editor: Solving Our Residency Crisis; Remembering Our Heroes
Resolutions Submission Deadlines
Reimbursement
ICD-10: How to Code for Painful Hammer Toes
Federal Advocacy Forum
Cosponsors to the Helping Ensure Life- and Limb-Saving Access to Podiatric Physicians Act
APMAPAC Chair Report
Coverage Corner
Bylaws Propositions Due
IT Consultant
Website Wisdom
On the Road with APMA
Small Business 101
CPME Update
In Short
Worthy of Note
Affiliates Corner
New Members
Death Notices
APMAPAC Update
Development Update
Classified Advertising
Dates to Remember
Advertising Index
10 Questions
Your APMA
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