Monday, January 4, 2016
New D.C. Circuit Ruling: Denial of Plaintiffs’ Prescription Drug Benefits at Pharmacy Is a Deprivation of a Protected Property Interest and Triggers Due Process Rights.Read more . . .
Wednesday, December 23, 2015
In 2012, PennEnvironment and Sierra Club brought a citizen suit against PPG Industries, Inc. for contamination from PPG’s disposal of waste from its glass manufacturing plant in Ford City, Pennsylvania. From 1949 to 1970, PPG disposed of waste slurry in its former sandstone quarry. PPG created three slurry lagoons that cover approximately 77 acres (“SLA”). From the 1920's to the 1970's, PPG also disposed of solid waste in another area of the Site. Read more . . .
Thursday, April 9, 2015
Terris, Pravlik & Millian, LLP takes pleasure in announcing the promotion of Todd A. Gluckman to partnership in the firm. Mr. Gluckman became a partner in March 2015.
Friday, January 23, 2015
Under the DC Department of Human Services (DHS) new Medicaid renewal system, some beneficiaries are automatically renewed, but others must complete a 19-page form or they will lose their Medicaid coverage.
DHS is reporting that a very low percentage of these forms have been returned and that about one thousand families are at risk of losing their Medicaid coverage effective January 31st. As renewals continue over the next 12 months, the number of those impacted will continue to grow.
If you are eligible for Medicaid and receive a renewal (or recertification) form, you must fill it out and file it online at DC Health Link or take it to one of DHS's Economic Security Administration (ESA) Service Centers. Get a receipt if you take the form to the ESA Service Center.
Set up a DC Health Link My Account by going to dchealthlink.com. This is for DC Medicaid too, not just private health insurance.
For assistance, you can call the DC Health Link Customer Service Line (855-532-LINK) or the ESA Customer Service Line (202-727-5355).
If you have trouble with the renewal (or recertification) form, cannot get through to DC Health Link or ESA, or are told by a medical provider that your DC Medicaid has ended, call us for free help: Terris, Pravlik & Millian, LLP at (202) 682-0578.
There is a 90-day grace period following termination when you can renew and receive retroactive Medicaid coverage back to the date of termination. Therefore, it is important to take action as quickly as possible after termination so that you do not end up with gaps in coverage.
For further information use this link.
Thursday, September 4, 2014
Terris, Pravlik & Millian, LLP takes pleasure in announcing the promotion of Patrick A. Sheldon to partnership in the firm. Mr. Sheldon became a partner in April 2014.
Thursday, March 13, 2014
The District of Columbia issued a document at the Medical Care Advisory Committee (MCAC) meeting on February 26, 2014, which states that certain Medicaid beneficiaries will be subject to passive renewal for Medicaid beginning on July 1, 2014. These Medicaid beneficiaries – who are subject to the MAGI (Modified Adjusted Gross Income) method of determining eligibility for Medicaid – will not be terminated from Medicaid from January 1, 2014, though June 30, 2014, even if they ordinarily would have had to recertify their Medicaid benefits during that time period. Medicaid beneficiaries subject to the MAGI method include families with children under age 21, pregnant women, and childless adults aged 21-64.
On the other hand, Medicaid beneficiaries who are not subject to the MAGI method of determining eligibility for Medicaid, namely, those over age 65, the disabled, the blind, and those receiving long-term care services, are not subject to passive recertification for Medicaid. These Medicaid beneficiaries remain subject to the usual D.C. Medicaid recertification process.
To read the District of Columbia’s document, please click here. If you have questions about or need assistance with Medicaid recertification, contact Terris, Pravlik & Millian, LLP, at 202-682-0578.
Wednesday, March 12, 2014
In the fall of 2013, the District of Columbia failed to update the correct address for submission of Medicaid reimbursement claims on its forms and website for two months after it moved offices. Therefore, in an Order issued on February 18, 2014, the United States District Court for the District of Columbia ruled that Medicaid beneficiaries who were delayed in submitting a Medicaid reimbursement claim because they had the wrong address are entitled to an extension of time to submit reimbursement claims. The Court directed the District of Columbia to place notice of the extension of time to March 31, 2014, on the website of the Department of Health Care Finance (DHCF). Medicaid beneficiaries who are class members may obtain free assistance with submitting reimbursement claims by contacting Terris, Pravlik & Millian, LLP, at 202-682-0578. To read the Court’s Order and see the press release, click here.
Tuesday, December 3, 2013
In a decision issued on November 8, 2013, the United States District Court for the District of Columbia certified four subclasses challenging failures by the District of Columbia to provide required special education services to preschool-aged children in the District. The prior class was de-certified by the United States Court of Appeals for the District of Columbia Circuit following the Supreme Court’s decision in Wal-Mart Stores, Inc. v. Dukes and remanded for reconsideration of certification of classes or sub-classes. The district court will commence proceedings to make findings of fact with regard to each subclass since the April 2011 trial. To learn more about this case, click here, and, to read the Court’s decision, click here.
Tuesday, October 29, 2013
In a decision rendered on October 18, 2013, the United States District Court for the District of Columbia ruled that it would end its oversight of the protection of due process rights of the Salazar plaintiff class at the time of recertification for Medicaid benefits because of a new federal regulation changing the procedures for Medicaid recertification to a passive system. The District of Columbia stated in court papers that the new passive system will be fully in place for the Salazar plaintiff class by October 2014. Although the district court ended its oversight of the Medicaid recertification system, it stated: “members of the plaintiff class can also contact Plaintiffs' counsel, as they have been doing over the years, to obtain legal assistance.” Therefore, Terris, Pravlik & Millian, LLP will continue to assist Medicaid beneficiaries in the Salazar class who have problems recertifying their Medicaid benefits. To read the Court’s decision, use this link.
Thursday, July 18, 2013
A recent order of the Office of Administrative Hearings (John P. Dean, Administrative Law Judge) signifies strong support for the due process rights of DC Medicaid beneficiaries.
BR, a Salazar class member and DC Medicaid beneficiary, filed for a fair hearing after her managed care organization (MCO), Health Services for Children with Special Needs, Inc. (HSCSN), stopped payment to her therapy provider, effectively terminating her prescribed services. Although HSCSN refused to pay for any visits occurring in October 2012 or later, the provider was only notified of that fact in January 2013. The beneficiary received a copy of the letter denying payment sent to the provider. In February 2013, the beneficiary filed for a fair hearing because her services had been terminated without notice, requesting that her services continue pending the resolution of the hearing.
HSCSN resisted this request, claiming that the beneficiary’s claim for continued services pending the resolution of the hearing was barred, because she filed the request more than ten days after she received notice of the action in a letter to the provider denying payment. The Department of Health Care Finance (DHCF) filed a paper supporting the position of the Medicaid beneficiary that benefits pending the resolution of the fair hearing were appropriate.
Although the ALJ agreed with HSCSN that the beneficiary had requested the continued services more than ten days after she received the denial letter, because that denial letter was addressed to, and intended for, the provider, and only discussed the provider’s rights in relation to the decision, the ALJ held that the beneficiary had never received notice within the meaning of the Medicaid statutes and regulations, and so the ten-day deadline had never begun to run, entitling the beneficiary to benefits pending the resolution of the hearing. The ALJ held that, under the DC Public Assistance Act, no deadline regarding administrative hearings may start to run until the beneficiary receives clear notice of the deadline and of how to file the hearing request. To see the decision, use this link.
Monday, July 15, 2013
WASHINGTON--U.S. District Judge Gladys Kessler will hold a public status conference on Thursday July 25, 2013 at 10:00 AM in response to Chartered Healthcare’s decision to pull out of the District of Columbia’s Medicaid managed care program. At the conference, the District of Columbia will present its plan to ensure that, despite the fact that Chartered is no longer participating in the District’s program, Medicaid beneficiaries will continue to receive the health care services they are entitled to, uninterrupted.
Click here to read more.
Terris, Pravlik & Millian, LLP is a public interest law firm that litigates cases for clients with matters involving Environmental Law, Civil Rights Law, and Employment Law.