Update: Accessing Home Nursing Services for Children on Medicaid

On June 26, 2012, federal judge Carl Barbier ruled that the Louisiana Department of Health and Hospitals is violating the settlement in Chisholm v. Greenstein, a class action brought in 1997 by the Advocacy Center in behalf of Medicaid-eligible children on the NOW waiver waiting list.  The Advocacy Center brought DHH back to court last fall, alleging that DHH was violating the settlement by reducing or denying home nursing services to children without proper notice regarding the reasons and without sufficient information about the child's needs.  Additionally, DHH's contractor often suggests personal care services instead of home nursing, without approving those services or informing parents and doctors about the limitations of the alternate services.

Judge Barbier ruled in favor of the Advocacy Center, and ordered the State to:

• In deciding whether to authorize nursing hours, consider the amount of services the child has received in the period immediately preceding the request, and whether the child's condition has improved or other circumstances make less care necessary;
• Approve hours prescribed by the child's physician, unless notices of denial explain evidence of improvement in the child's condition or other changed circumstances that make less care necessary;
• For requests submitted up to one year after June 26, 2012, approve the highest number of weekly hours the child has received from January 2010 to date, unless there is evidence the child's condition has improved or other circumstances make less care necessary;
• (If services are reduced or denied because personal care services can meet the need), include in its notices the number of hours of PCS that will be approved, based on information already submitted; specify whether an adult caretaker's presence is required; and state that the less costly service (PCS) will be approved if a prior authorization request is submitted and prescription is obtained.

The Department of Health and Hospitals cannot avoid these obligations by getting a statement from the child's treating physician that he or she now agrees to a reduced number of home nursing hours.

If you have any questions about this ruling, contact Nell Hahn at 1-800-960-7705, ext. 311.