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Advocacy Center News |
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Chisholm v. Hood: A Fact Sheet What is Chisholm v. Hood? A class action lawsuit filed by the Advocacy Center in 1997 to make Louisiana Department of Health and Hospitals (DHH) live up to its obligation to arrange for necessary services under regular Medicaid to children on the MR/DD Waiver waiting list. Reported decisions in the case are: Chisholm v. Hood, 133 F.Supp.2d 894 (E.D.La., 2001) (holding that Louisiana's Medicaid program did not adequately provide community-based behavioral and psychological services to class members diagnosed with autism); 110 F.Supp.2d 499 (E.D.La., 2000) (holding that state must make available medically necessary occupational, speech and audiological services to children confined to their homes, and may not limit providers to school boards or early intervention centers); 1998 WL 92272 (E.D.La., 1998) (class certification). There are also three settlement stipulations and a contempt order. Who are members of the Chisholm class? Persons under age 21 who currently receive or are eligible for Medicaid, and who are now on the MR/DD Waiver waiting list, or not on the list now, but have been on it at some point since October 20, 1997. What are all children under age 21 entitled to under Medicaid? All Medicaid services that are necessary to treat a mental or physical condition or make it better, whether or not these services are provided to adults in this state. "EPSDT" stands for Early and Periodic Screening, Diagnostic, and Treatment." EPSDT means the same thing as Medicaid for people under age 21. What are class members entitled to under Court orders in the Chisholm case?
Chisholm v. Hood: A Chronology The following is a summary (as of 12/31/02) of how Chisholm v. Hood has progressed through the court system and the results that that have led to critical health services for Medicaid eligible children under the age of 21.
On February 16, 2000, a partial settlement was approved. This assured that case management would be available to all class members. This settlement also provided for additional information to be given out about Medicaid services for children on the MR/DD waiver waiting list, and for training and monitoring of case managers. On August 30, 2000, another partial judgment was issued that dealt with audiology services, occupational therapy, psychological evaluations and therapy, and speech therapy. These are services that are usually provided through schools and early intervention centers. The judgment required schools and early intervention centers to notify parents that the services could be obtained through other providers, as well as schools. Also, this judgment ordered DHH to allow home health agencies and rehabilitation centers to provide speech therapy, audiology, and occupational therapy in the home if this is medically necessary. On October 16, 2000, another partial settlement was approved. It dealt with interperiodic screens (checkups in between the scheduled checkups that are required). It also required DHH to find a personal care service provider or an extended home nursing provider within 10 days, if recipients can't find one. It also dealt with situations in which the Medicaid Prior Authorization Unit denied items or services because cheaper items or services would supposedly work. It said that, in those cases, the cheaper items or services had to be identified and provided, while the recipient could still appeal for the requested items. In October, 2000, there was a trial on the issue of services to children with autism and other pervasive developmental disorders. In February of 2001, the judge entered an opinion that DHH was violating the Medicaid Act by failing to provide psychological and behavioral services for children with autism. The parties agreed upon a remedy, and on June 27, 2001, the Court ordered the Department of Health and Hospitals to provide 15 teams of psychologists, social workers, and behavioral specialists throughout the state to provide these services to children who needed them (including some children who did not have autism or pervasive development disorders, but did have a need for similar services). Unfortunately, DHH was not able to get the teams to perform these services as planned. Plaintiff's attorneys agreed to a delay until June of 2001 for them to provide the services, but it still did not happen. Plaintiff's attorneys then asked DHH to be held in contempt, and required to allow any qualified, licensed psychologist to enroll in Medicaid to provide services to class members. This was ordered by the Court in June of 2002. Since then, class members and psychologists have been notified that these services can be provided. DHH has appealed this order, however, and the appeal is pending. In the meantime, plaintiff's attorneys are continuing to discuss the situation with DHH, and hopefully will reach a new agreement on these services soon. Finally, in July of 2002, there was a final settlement order dealing with Medicaid's prior authorization process Case managers now have the responsibility for tracking services that require prior authorization and assuring that all steps are followed to get the class member the necessary services. In addition, a Prior Authorization Liaison position was added to provide class members, case managers and service providers a person to call when they have questions or are having difficulty receiving an approved prior authorization for a service. Notices will be simplified, and the prior authorization process will be improved in a number of other ways that will make it easier for people who need services to get them.
Update on the Chisholm lawsuit - 4/16/07 The Advocacy Center represents a class of Medicaid-eligible persons under the age of 21 who are on the NOW request for services registry, and obtained orders that DHH had to provide case management or “support coordination” services, assistance with the prior authorization process, psychological and behavioral services, and assistance in locating home nursing and personal care services. On March 16, the Advocacy Center filed a motion to enforce parts of these orders that require DHH to effectively monitor support coordinators, and to assist class members or support coordinators to locate home nursing and personal care service providers if necessary. The Department of Health and Hospitals has filed a motion asking the Court to release it from all obligations under the Chisholm orders. Hearings on these motions are currently set for May 2 in federal court in New Orleans. |
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The Protection and Advocacy System for Louisiana ~ Serving People with Disabilities and Senior Citizens Advocacy Center |
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