Ladd v. Thomas

No. 3:94cv1184(JBA) (D. Conn. Jan. 8, 1997). ; Clearinghouse Number: 51567

Description

Agency’s Failure to Notify Medicaid Recipients of Decisions on Their Requests for Prior Approval of Durable Medical Equipment Violates Federal Law

Abstract

The district court has granted plaintiff Medicaid recipients declaratory relief in this class action alleging that the Connecticut Department of Social Services (DSS) procedures for prior approval of Medicaid coverage of durable medical equipment violate due process requirements of federal Medicaid law. The court held that DSS’s failure to send notices of denials to recipients when vendors fail to respond to "pink-slip" requests for further information violated the Medicaid Act’s requirement that requests for medical assistance be acted on with reasonable promptness. Pink slips are sent only to vendors; when a vendor fails to respond to a pink slip, DSS simply never acts on the prior authorization request and never gives notice of hearing rights. The court ordered further discovery and a hearing on the issue of what constitutes "reasonable promptness." The court also held that DSS’s failure to notify recipients that a request for prior approval had been approved in modified form (i.e., regarding the type of equipment or the time period) and to notify recipients of the denial of oral requests by vendors for prior authorization violated the Medicaid Act’s due process requirements. However, the court held that DSS was not required to give notice of its approval of coverage for durable medical equipment. It also rejected plaintiffs’ claim that they should have the option of submitting a request for prior authorization to DSS without going through a vendor.

Additional Information

Attorney Information
Plaintiffs represented by Shelley White, New Haven Legal Assistance Association, Inc. 426 State St., New Haven, CT 06510-2018 ((203) 946-4811); Sheldon Toubman, Greater Hartford Legal Assistance, 80 Jefferson St., New Haven, CT 06106 ((860) 541 5000).
Docket Date
1997-01-08 00:00:00+00:00