Please read the following message from Nebraska Appleseed below. If you or someone you know fits into one of these categories, please contact Nebraska Appleseed to offer your story. You can contact Nebraska Appleseed at (402)-438-8853 or 800-845-3746. This is relating to a denial from Medicaid / Megellan and not related to a denial from private healthcare providers.
On May 18, 2012, Nebraska Appleseed and the National Health Law Program (NHeLP) filed a class action lawsuit against Vivianne Chaumont and Kerry Winterer, in their official capacities as officers of the Nebraska Department of Health and Human Services (HHS). The lawsuit challenges Nebraska Medicaid policies that deny coverage for certain mental and behavioral health treatments for children with particular diagnoses and conditions, including developmental disabilities and autism. The lawsuit, if successful, would effectively strike down Nebraska’s Medicaid policies as in violation of federal law and would ensure that Medicaid eligible children would receive necessary early behavioral health interventions as recommended by their providers.
Appleseed would like to speak with parents/caregivers of children who may have been affected by these policies as well as attorneys and providers who have worked with children in this situation. The following is a more specific description of the types of people with whom we would like to speak. As this is a class action lawsuit, we are currently seeking children who may fit within our proposed class. We would appreciate any referrals should you come into contact with them in your work. Please note that there may be overlap among the denials described below, but we have provided a broad description in order to provide the most information possible.
Denials relating to diagnosis
· We would like to speak with any client or professional who has worked with a child with a developmental disability (e.g., Autism, Asperger’s Syndrome, Autism Spectrum Disorder, Pervasive Developmental Disorder) who has been denied medically necessary Medicaid coverage for treatment on the basis of their diagnosis.
o Example: Provider requested outpatient treatment to treat conditions related to a child’s developmental disability diagnosis and Magellan denied services entirely because developmental disabilities are “not covered.” Note that in this example the denial may simply say the service is not covered without saying anything about developmental disabilities.
Denials relating to type of service
· We would also like to speak with any client or professional who has worked with a child, for whom a provider has recommended behavioral-focused treatment, including but not limited to Applied Behavior Analysis (ABA), that has been denied medically necessary Medicaid coverage because the type of treatment or therapy is not covered.
o Example: Provider requests outpatient therapy for a child to focus on the child’s behaviors and Magellan denies services because:
1) The type of therapy is not considered a covered therapy;
2) The type of therapy is Applied Behavior Analysis and is not covered: OR
3) The type of therapy is considered “behavior management” or “focused on parent-child interaction.”
Denials relating to age
· We would also like to speak with any client or professional who has worked with a child under the age of 5, who has been denied medically necessary Medicaid coverage for behavioral health services on the basis of their age or, a perceived disability that the Department deems to be developmental.
o Example: Provider requested outpatient therapy for a child under five who has not yet been diagnosed with Autism Spectrum Disorder (but may have tendencies that are consistent with Autism Spectrum Disorder) and Magellan denied services because:
1) Developmental disabilities are “not covered,” OR
2) The type of therapy is considered “behavior management” or “focused on parent-child interaction.”
In addition, we are not seeking cases in which the denial occurred more than three years ago. It is not necessary that you confirm the exact date of the denial.
Finally, we are not seeking cases in which a private insurance carrier denied coverage for behavioral health services. Nor are we seeking cases where a Medicaid eligible adult (over 19 years of age) has been denied behavioral health services.
If in the course of your work you come into contact with anyone who fit the descriptions above, please have them call the Nebraska Appleseed intake line at (402)-438-8853 or 800-845-3746 and indicate they are calling about a Medicaid/Magellan denial. If you, as a provider or attorney, have information about this issue, have worked with children in this situation or simply have any questions, please contact Sarah Helvey at (402)-438-8853 x 106 or firstname.lastname@example.org.