Bristol v. Rhode Island Dep’t of Human Services

Nos. 95-6605 (R.I. Super. Ct. Jan. 30, 1997). ; Clearinghouse Number: 51599

Description

Agency’s Exclusion of Medical Assistance Coverage for Incontinence Supplies Prescribed by Physician Is Reversed

Abstract

The court has reversed the Rhode Island Department of Health and Human Services (DHS) decisions denying Medical Assistance coverage of adult diapers needed by incontinent plaintiffs and prescribed by their physicians. DHS regulations explicitly excluded coverage of adult diapers under the "durable medical equipment" category. The court ruled that the supplies fell within the category "rehabilitation services" included under the federal definition of "optional categories of service" under 42 U.S.C. § 1396d(a)(13). The court noted that the blanket exclusion of adult diapers was an unreasonable standard and therefore contrary to 42 U.S.C. § 1396(a)(17) and held that blanket exclusion was arbitrary and capricious in that it excluded coverage of services without regard to medical need and without due deference to treating physician opinions.

Additional Information

Attorney Information
Plaintiffs represented by Gretchen Bath, Rhode Island Legal Services, Inc., 56 Pine St., 4th Floor, Providence, RI 02903-2835; (401) 274-2652; (800) 662-5034.
Docket Date
1997-01-30 00:00:00+00:00

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