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Tuesday, October 29, 2013

Court Terminates Oversight of Medicaid Recertification, But Rules that Salazar Class Members May Continue to Receive Assistance from Class Counsel

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

Due Process Rights Are Protected by a Recent Decision of the DC Office of Administrative Hearings (OAH) for a Salazar Class Member

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

District Court in Salazar Will Hear Concerns Regarding Chartered’s Pull Out of DC’s Medicaid Program

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.


Tuesday, June 18, 2013

Court of Appeals Issues Decision in the Child Find Class Action

D.L. v. District of Columbia, D.D.C., Civ. No. 05-1437

In 2005, the firm brought D.L. v. District of Columbia in the District Court for the District of Columbia.  The case is a class action challenging the District of Columbia’s systemic failure to identify, locate, and evaluate three to five year old children with disabilities, and offer them a free appropriate public education, in violation of the Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act, and other law.

On August 10, 2010, the district court granted plaintiffs’ motion for partial summary judgment, finding the defendants liable through 2007 for violating plaintiffs’ rights under the IDEA, the Rehabilitation Act, and District of Columbia law.  The court subsequently held a trial on liability related to subsequent years.

On November 16, 2011, after trial, the district court ruled for the plaintiff class, finding that defendants had violated the IDEA, Section 504 of the Rehabilitation Act, and District of Columbia law through the date of the trial.  The district court ordered the District of Columbia to cease these violations and required the District of Columbia to take significant steps to ensure that it complies with its obligations to provide special education and related services.  The district court did not address the process for awarding compensatory education or reimbursement relief to individual members of the class.

Before the district court issued its decision after the trial, the Supreme Court issued its decision inWal-Mart Stores, Inc. v. Dukes, which related to class certification.  Before trial, defendants had moved to decertify the class and that motion was still pending when Wal-Mart was decided.  Plaintiffs opposed defendants’ motion and moved to amend the initial class certification to add subclasses and to recertify the existing Rule 23(b)(2) class as a hybrid class, with claims for comprehensive declaratory and injunctive relief certified under Rule 23(b)(2) and individual claims for compensatory education and/or reimbursement certified under Rule 23(b)(3).  The court granted plaintiffs’ motion for hybrid certification and denied in part defendants’ motion to decertify the class.  The district court concluded that the requested subclasses were unnecessary.

The District of Columbia appealed the district court’s decisions to the U.S. Court of Appeals for the District of Columbia Circuit (case numbers 11-7153 and 12-7042), arguing that the case was wrongly certified as a class action.  AARP, the Bazelon Center for Mental Health Law, the Council of Parent Attorneys and Advocates, the Lawyers’ Committee for Civil Rights Under Law, the National Disability Rights Network, the National Health Law Program, the National Federation for the Blind, and the University Legal Services Protection & Advocacy Program filed an amici curiae brief in support of plaintiffs-appellees.

On April 12, 2013, the court of appeals issued its opinion that “vacate[d] the order certifying the class and, consequently, the orders finding liability and ordering relief to that class” and “remand[ed] the case to the district court for reconsideration of whether a class, classes, or subclasses may be certified, and if so, thereafter to redetermine liability and appropriate relief.”

On June 4, 2013, plaintiffs moved in the district court for recertification based on four subclasses, each class related to one of four claims, and for reinstatement of the liability and injunctive determinations. 

If you have any questions about the case, please call Todd Gluckman at 202-204-8482.

Related Documents

Court of Appeals’ Opinion, dated April 12, 2013

Amended Complaint

Memorandum Opinion Granting Class Certification, dated August 25, 2006

Memorandum Opinion (Class Action Issues), dated November 16, 2011

Memorandum Opinion & Findings of Fact And Conclusions of Law, dated November 16. 2011

 


Monday, January 28, 2013

Terris, Pravlik & Millian, LLP Is Pleased to Announce Three New Partners

Terris, Pravlik & Millian, LLP takes pleasure in announcing the promotion of three associate attorneys to partnership.  Alicia C. Alcorn became a partner in the firm on August 1, 2012.  Zenia Sanchez Fuentes and Jane M. Liu became partners on January 1, 2013.


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