Katz v. New Mexico Department of Human Services

624 P.2d 39, 95 N.M. 530
CourtNew Mexico Supreme Court
DecidedJanuary 26, 1981
Docket13177
StatusPublished
Cited by41 cases

This text of 624 P.2d 39 (Katz v. New Mexico Department of Human Services) is published on Counsel Stack Legal Research, covering New Mexico Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Katz v. New Mexico Department of Human Services, 624 P.2d 39, 95 N.M. 530 (N.M. 1981).

Opinion

OPINION

EASLEY, Chief Justice.

Beverly Katz applied to the New Mexico Department of Human Services (DHS) for Medicaid benefits for medical services rendered to her by a chiropractor and a physical therapist. The DHS denied her the benefits following an administrative hearing. She appealed the DHS ruling to the Court of Appeals which affirmed. We granted certiorari and affirm in part and reverse in part.

The issues presented are: (1) whether state and federal statutes and regulations require the DHS to pay for the services rendered by the chiropractor and the physical therapist; (2) whether the denial of Medicaid benefits violates the constitutional guaranty of equal protection; (3) whether Katz was denied due process of law by reason of inadequate notice of the administrative hearing held by the DHS; and (4) whether she is entitled to Medicaid benefits for laboratory and X-ray services.

Katz became ill and the DHS found her to be a “categorically needy” person qualified to receive benefits under the DHS Medical Assistance Program. She sought the aid of various licensed physicians who were unable to improve her condition other than by giving her drugs to mask the pain. The DHS paid for services by these physicians. She then began receiving treatment from a licensed chiropractor and a licensed physical therapist. According to her testimony at the DHS hearing, she experienced relief from pain for the first time in over two years by virtue of their treatments. The DHS refused to approve payment of these services. She requested and received an administrative hearing, but the denial of benefits was confirmed on the basis that the services of chiropractors and physical therapists are not covered by the Medical Assistance Program.

1. Whether State and Federal Law Mandates DHS Payment of Chiropractors’ and Physical Therapists’ Services.

The New Mexico Medical Assistance Program is operated by the DHS as part of a joint federal-state program established by Title XIX of the Social Security Act. Compliance with the federal requirements is a condition to the receipt of federal funds. 42 U.S.C. § 1396c (1976). Section 27-2-12, N.M.S.A.1978, therefore requires that the DHS must operate the program consistent with the federal act.

Participating states are required to provide financial assistance to qualified individuals in five general categories of medical services: inpatient hospital services; outpatient hospital services; other laboratory and X-ray services, skilled nursing facility services, specified screening services and family planning services; and physicians’ services. 42 U.S.C. §§ 1396a(a)(13)(B), 1396d(a)(l)-(5). Of these categories, only “physicians’ services” arguably includes the services of a chiropractor and a physical therapist.

“Physicians’ services” as used in Section 1396d(a)(5) is limited to those services furnished by a physician as defined in Section 1395x(r)(l). Physician is therein defined as “a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function or action . . . . ” By limiting the definition of physician to subsection (1) of § 1395x(r), Congress explicitly excluded chiropractors. See § 1395x(r)(5).

Katz points to the regulations promulgated by HEW under the act which define physicians’ services as services provided “[wjithin the scope of practice of medicine or osteopathy as defined by State law ____” 42 C.F.R. § 440.50 (1979). Katz argues that, under state law, the practice of medicine includes chiropractors’ services. The practice of medicine is defined by Section 61-6-15, N.M.S.A.1978, and might arguably include chiropractic practices. However, Section 61-6-16, N.M.S.A.1978, expressly excludes chiropractic practices from the application of Sections 61-6-1 through 61-6-18, N.M.S.A.1978.

We therefore conclude that chiropractors’ services are not physicians’ services under the Medicaid program. Chiropractors’ services thus are not included in the five general categories of medical treatment which must be included in the state plan.

Section 1396d(a) lists seventeen categories of medical services. Physical therapy is listed in subsection (11). As noted previously, only the first five categories, subsections (1) through (5), are required to be included in the state plan. We therefore also conclude that the services of a physical therapist are not required to be included in the state plan.

Having determined that payment for services of chiropractors and physical therapists under the Medicaid program is optional and not mandated by federal law, the next question is whether this state has chosen to provide Medicaid payments for those services.

The only applicable state statute is Section 27-2-12, which provides that the DHS may by regulation provide medical assistance to persons eligible under the federal act. The DHS has promulgated such regulations in the Income Support Division (I.S.D.) Manual §§ 300, et seq.

The regulations contain a detailed explanation of services covered by the state Medicaid plan, but do not list all those medical services not covered. I.S.D. Manual § 310. But I.S.D. Manual § 303(B) states that the “Medical Assistance Program will not pay for service(s) that are not covered under the program.” No provision is made for payment of the services of chiropractors or physical therapists. Thus, Katz is not entitled to financial assistance for those services.

Katz cites to a DHS regulation which allows coverage of chiropractic services for Medicare crossover claims. I.S.D. Manual § 300.33. Medicare crossover claims are claims paid by the DHS for those persons eligible for both Medicare and Medicaid. I.S.D. Manual § 300.3. There is no evidence in the record that Katz is eligible for Medicare. Section 300.33 thus has no bearing on her claim.

Katz nevertheless argues that the denial of these benefits is inconsistent with Congressional intent and the purposes and policies of the program. She points to 42 U.S.C. § 1396 as an expression of the aims of Congress in establishing the program. That section provides that the purpose of the program is:

[to enable] each State, as far as practicable ..., to furnish (1) medical assistance on behalf of families with dependent children and of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services .... (Emphasis added.)

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Bluebook (online)
624 P.2d 39, 95 N.M. 530, Counsel Stack Legal Research, https://law.counselstack.com/opinion/katz-v-new-mexico-department-of-human-services-nm-1981.