N. v. Hawkins

No. 6:99CV459 (E.D. Tex. filed October 11, 2005) ; Clearinghouse Number: 52964

Description

Settlement Reached in Challenge to Texas’ Failure to Provide In-Home Health Care Services to EPSDT-Eligible Children

Abstract

The parties reached a settlement in this class action challenging Texas officials’ policies and practices that resulted in the systematic denial of medically necessary in-home health services to Medicaid-eligible children and young adults with disabilities and chronic health conditions. Plaintiffs claimed that they were entitled to these services under the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). Under the terms of the settlement, the Texas Health and Human Services Commission will timely authorize all medically necessary benefits. Medically necessary services and durable medical equipment will not be denied or reduced based solely on a recipient’s diagnosis, type of illness, condition, or functional limitations. Quantities of durable medical equipment—whether new or replacement items—will not be subject to an absolute cap based on amount or frequency of replacement. Commission will authorize all medically necessary nursing services that correct or ameliorate a child’s disability, physical or mental illness, or condition. Commission will not apply a cap on the amount of medically necessary nursing services available to children. Commission will implement a new personal care services benefit by September 1, 2006, for children who require assistance on activities of daily living. The personal care service policies and procedures will promote the health, safety, and well-being of children in the context of their family and the community by taking into consideration the parents’ or guardians’ need to sleep, work, attend to their own medical needs, meet the needs of other dependents, and ability to perform the task. Commission will train appropriate state agency staff, providers, contractors, and managed care organizations on the requirements of the settlement agreement and the new policies developed from the agreement. Commission will convene a work group to help create new service plan forms to request authorization for nursing and personal care services.

Additional Information

Attorney Information
Plaintiffs represented by Peter Hofer, Steven Elliot, Advocacy Inc., 7800 Shoal Creek, Suite 171-E, Austin, TX 78757 (512.454.4816); Maureen O'Connell, Maryann Overath, Southern Disability Law Center, 1307 Payne Ave., Austin, TX 78757 (512.458.5800).
Docket Date
2005-10-11 00:00:00+00:00
Attorney Email
phofer@advocacyinc.org