ACDL - Arizona Court of Appeals Victory
Last week, says the Arizona Center for Disability Law, the Arizona Court of Appeals struck down Arizona’s restrictive denture coverage rules, which required a beneficiary to show more than an inability to chew and eat normally to establish a medical necessity for dentures. In relevant part, the Court found that:
“We hold in this case that AHCCCS exceeded its statutory authority by requiring Sharpe to establish a medical need in addition to the ability to chew. Therefore, to the extent that A.A.C. R9-22-201, Medical Policy 310, and A.A.C. R9-22-101(B) either expressly state or are interpreted to require a medical need in addition to the inability to chew, they are invalid…Based on the factual record before us, the undisputed facts show that dentures here were (1) ordered by a dentist, and (2) medically necessary.”
Our client is a 32-year old woman with a disability who has severely decayed teeth and needs all of her teeth removed and whose primary care and dentist have recommended dentures as medically necessary.