Class Actions

Friday, July 28, 2017

March 2017 D.C. District Court Ruling: Medicaid Plaintiffs Have Stated a Claim that Due Process Requires Individualized Written Notice When Prescribed Drugs Denied Medicaid Coverage at Pharmacy

On March 26, 2017, the United States District Court for the District of Columbia issued a decision in N.B. v. District of Columbia in favor of plaintiffs represented by Terris, Pravlik & Millian, LLP, and the National Health Law Program.  Plaintiffs allege that the District of Columbia has systematically failed to provide Medicaid recipients with due process when a prescribed medication is denied Medicaid coverage at the pharmacy.  Defendants, the District of Columbia and the Department of Health Care Finance, had filed a renewed motion to dismiss on a second remand from the United States Court of Appeals for the District of Columbia Circuit (“the D.C. Circuit”).  The district court partially denied defendants’ renewed motion to dismiss, finding that plaintiffs have stated a claim that the District’s current system violates the Fifth Amendment’s Due Process Clause by not providing individualized written notice to Medicaid recipients.  

Read more . . .

Monday, June 26, 2017

Appeals Court Affirms that DC Underserves Preschoolers with Disabilities

D.L. v. District of Columbia is a class action brought by the firm seeking to remedy the District of Columbia’s failure to provide and timely provide special education services to preschoolers with disabilities in violation of the Individuals with Disabilities Education Act (IDEA) and other laws.

On Friday, June 23, 2017, the court of appeals, in a unanimous decision, affirmed the lower court decision in all respects.

Read more . . .

Monday, February 6, 2017

Notice to Plaintiff Subclasses in DL v. District of Columbia of Plaintiffs’ Motion for an Award of Litigation Costs, Including Attorneys’ Fees and Related Expenses

Plaintiffs’ counsel filed a motion for an award of litigation costs, including attorneys’ fees and related expenses, in DL v. District of Columbia, a class action related to special education services for preschool-aged children in the District of Columbia.  Defendants are scheduled to file an opposition to that motion.  In addition, subclass members may file objections to that motion.  For additional detail, click here for a copy of the notice related to this motion.  Click here for additional information regarding this case.

Read more . . .

Thursday, August 25, 2016

Federal Court Ruling Provides Immediate Relief to District of Columbia Medicaid Applicants and Beneficiaries

On July 12, 2016, the District Court entered an Order in the long-running Salazar v. District of Columbia class action case providing immediate relief to self-identified Medicaid applicants and beneficiaries who cannot access their benefits as a result of the District of Columbia government’s delays and errors in processing Medicaid eligibility applications and renewals. 

First, the District must grant provisional eligibility to all individuals who inform the government that more than 45 days have elapsed without a determination on their non-disability application for Medicaid benefits. The District must grant provisional eligibility to such individual applicants until it makes an eligibility determination on the application and provides them written notice of the decision.

Read more . . .

Thursday, May 26, 2016

District Court Issues Injunction Requiring Improvements to the District’s Provision of Special Education and Related Services for Preschoolers in the District

In DL v. District of Columbia, on May 18, 2016, the district court found the District of Columbia liable for violating children’s rights under the Individuals with Disabilities Education Act (IDEA) and District law through November 12, 2015, and the Rehabilitation Act until March 22, 2010, and issued a sweeping injunction.  The district court enjoined the District of Columbia from further violations of the IDEA and District law, and ordered specific corrective actions, including that the District ensure that (1) at least 8.5 percent of children between the ages of three and five who reside in the District or are wards of the District receive necessary special education and related services, (2) at least 95 percent of all children between the ages of three and five referred for special education services receive a timely eligibility determination, and (3) at least 95 percent of all children receiving Part C services (early intervention services for children up to three years of age) that are found eligible for Part B services (special education and related services for children ages three and older) receive a smooth and effective transition to those Part B services by their third birthdays.

Read more . . .

Thursday, March 13, 2014

Passive Medicaid Recertification for Some D.C. Medicaid Beneficiaries to Begin on July 1, 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

Court Orders D.C. to Publicize and Allow an Extension of Time for Certain Medicaid Reimbursement Claims

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, 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.

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