Medicaid Notice

Re: Motorized and Customized Mobility Devices

July 30, 1999

IMPORTANT VICTORY for
INDIVIDUALS WITH DISABILITIES!!!

Attention all individuals with disabilities, parents, guardians, representatives, doctors, physical therapists, other medical personnel, advocates, advocacy groups, disability organizations and other interested or affected parties.

A victorious class action litigation set an important case precedent for individuals with disabilities on Medicaid. The Advocacy Center for Persons with Disabilities Inc.’s Technology Assistance Program (TAP) is pleased to report that U.S. District Judge Donald L. Graham issued a precedent setting Final Order on June 14, 1999 (see attached), which prohibits the Agency for Health Care Administration’s Medicaid program from denying medically necessary motorized and customized mobility devices (MCMDs) under prescription as durable medical equipment (including J motorized wheelchairs and other customized motorized mobility devices) for individuals who qualify for Medicaid. Further, this Order prevents Medicaid from using a list of predetermined covered items as an exclusive list of medical equipment Medicaid covers as durable medical equipment. Important information for doctors, medical professionals, individuals with disabilities and their representatives who seek to receive Medicaid’s approval for MCMDs. Doctors and other health care professionals should review the attached Order before writing a prescription and must be aware that MCMDs, as durable medical equipment, are required to be verified as medically necessary. Prescriptions should clearly detail all the reasons a MCMD is medically necessary, in accordance with the attached Order, incorporating exact specs, proper seating and positioning, including a physical therapist evaluation with a prescription.

Judge Graham’s June 14th Final Order granted a judgment in favor of our 14 named individual plaintiffs, insuring that they and, most importantly, the classes of individuals with disabilities they represent will get the MCMDs they need.

This class action litigation was filed by the Advocacy Center’s TAP program because of illegal provisions in Florida’s Medicaid plan that previously capped coverage for wheelchairs and other mobility devices for adults at $582. That limitation had the effect of preventing adults from obtaining MCMDs even when those devices were certified as medically necessary. This, in turn, directly impacted the ability of individuals with severe disabilities to be mobile and excluded them from being able to fully participate in major life activities.

This class action litigation, brought by the Advocacy Center’s TAP program, will help insure that all Floridians who qualify for Medicaid will finally be able to get MCMDs under prescription that are medically necessary. Please be aware that this Final Order also includes an extremely important provision for the repair of MCMDs.

Thank you in advance for circulating this important notice and attached Final Order to individuals with disabilities, guardians, representatives, doctors, physical therapists, other medical personnel, advocates, your staff, constituents, grassroots advocacy groups, disability organizations and all other interested or affected parties.

Steve Howells, Director

Technology Assistance Program

UNITED STATES DISTRICT COURT, SOUTHERN DISTRICT OF FLORIDA

Case No. 97-2830-CIV-GRAHAM

MANUEL ESTEBAN, et al.,

Plaintiffs,

Vs.

DOUG COOK, et al.,

Defendants

FINAL SUMMARY JUDGEMENT

THIS ACTION came before the court on Plaintiffs’ Motion for Summary Judgment (D.E. # 33) and

Plaintiffs’ Motion for Class Certification (D.E. # 11).

THE COURT has considered the Motion and the pertinent portions of the record, and in accordance with the Amended Order granting Summary Judgment (D.E. # 84) and Amended Order Certifying Class (D.E. # 83), and being otherwise fully advised in the premises, it is

ORDERED AND ADJUDGED that Final Summary Judgment is hereby entered in favor of Plaintiffs against Defendants. Plaintiffs’ Motion for Class Certification (D.E. # 11) is GRANTED. The certified class is defined as:

All Florida Medicaid and Medicaid eligible individuals who have been diagnosed with severe mobility impairments and are over age 21 and who need or will need motorized and customized devices and services as prescribed by their treating professionals.

ORDERED AND ADJUDGED that Defendants are hereby enjoined from using the list of covered items as the exclusive determinant of Medicaid coverage for Durable Medical Equipment. It is further

ORDERED AND ADJUDGED that Defendants are DIRECTED to reprocess Plaintiffs’ requests for coverage in compliance with the Court’s Amended Memorandum Opinion (D.E. # 84) within 30 days from the date of that Opinion. In addition, costs and attorneys fees in this action may be taxed at a later date upon the appropriate motion.

DONE AND ORDERED in Chambers at Miami, Florida, this 14th day of June, 1999.

Donald L. Graham
United States District Judge

cc: Thomas Falkinburg, Esq.

Ellen Saideman, Esq.,

Peter Nimkoff, Esq.

Judy Gallagher, Esq.

Medicaid Notice

IMPORTANT VICTORY for INDIVIDUALS WITH DISABILITIES!!!

UNITED STATES DISTRICT COURT, SOUTHERN DISTRICT OF FLORIDA

IMPORTANT VICTORY for
INDIVIDUALS WITH DISABILITIES!!!