State Update

U.S. Court of Appeals for the Ninth Circuit Rules on Certain Dental Procedures Under Medicare

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On May 31, the U.S. Court of Appeals for the Ninth Circuit affirmed that Medicare's broad dental services exclusion does not permit coverage of extensive dental services necessitated by the medical conditions of Medicare beneficiaries (Fournier v. Sebelius, 9th Cir., No. 12-15478).

The Ninth Circuit affirmed the district court’s judgment affirming the decision by the Secretary of the U.S. Department of Health and Human Services (HHS) denying plaintiffs’ claims for Medicare coverage for dental services. In Fournier v. Sebelius, the plaintiffs are Medicare beneficiaries who suffer from medical conditions that caused significant dental problems, and they received dental services to correct those problems. According to the Court’s ruling, the decision by the Secretary of HHS to deny coverage for the Medicare beneficiaries' medically necessary dental procedures was reasonable, given that the Secretary has consistently interpreted the Medicare Act as excluding coverage for such procedures. According to the final ruling by the Secretary of HHS these dental treatments would be covered by Medicare only if they were furnished along with a covered procedure that was performed by the dentist on the same occasion. In addition, the Ninth Circuit held that the secretary’s denial of coverage did not violate the plaintiffs’ equal protection rights under the Fifth Amendment of the U.S. Constitution.