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July 1, 2008: In a case of first impression, Federal Judge James L. Graham of the U.S. District Court for the Southern District of Ohio has issued a temporary restraining order against the Ohio Department of Job and Family Services and the Ohio Department of Mental Health preventing them from implementing proposed rules that would have eliminated Medicaid reimbursement for the medically necessary applied behavioral analysis (ABA) services to children with autism.
In a lawsuit filed by the Ohio Legal Rights Service on behalf of the Parents' League for Effective Autism Services (PLEAS), an association of parents and families who have received Medicaid services, Judge Graham issued the order late yesterday, just several hours before the rules would have gone into effect. Finding that the proposed rules were an effort to avoid having to pay for certain services under the federal Early Periodic Screening, Diagnosis and Treatment (EPSDT) requirement, Judge Graham held that the Defendants, including the federal Centers for Medicare and Medicaid (CMS) interpreted the federal Medicaid law too restrictively in denying Medicaid reimbursement.
The ruling followed a court hearing on Friday, June 27, during which parents of children with autism gave powerful testimony about the sometimes dangerous behavior their children displayed before they received the ABA services recommended by their physicians and psychologists. The parents and a psychologist told the court that without funding for ABA under Medicaid, the children had no other options for services and would likely immediately and substantially regress in their behavior and skills, posing a real threat of harm to the children and others.
In its ruling, the Court said that because the proposed administrative rules will effectively cut off funding for medically necessary services, and because the rules were more restrictive than federal law, Plaintiffs established a likelihood of success on the merits.
The Court also ruled that the Plaintiffs had established a claim under Section 1983 for violations of their federal constitutional rights under the federal Medicaid law. Earlier, the Court denied the Defendants' motion to dismiss, rejecting their argument that Plaintiff PLEAS did not have standing to bring the lawsuit.
The Plaintiffs are preparing for a trial on the merits of the case as the next step in this important litigation.
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Article posted July 1, 2008