Supreme Court Slams the Doors on Justice in Armstrong case

The following press release from the National Health Law Program describes the Supreme Court’s cruel and abusive ruling today to prevent providers of treatment services from being advocates for the children they are treating.  According to the Court, treatment providers are not allowed to challenge State Medicaid Agencies and their contracted Managed Care Organizations when they misbehave and impose excessive restrictions, limitations and other impediments to access to EPSDT treatment funding.

This ruling affirms that the only avenue available to providers of EPSDT (Medicaid) funded services like Behavioral Health Rehabilitation Services (BHRS, still mistakenly called “wraparound services” in Pennsylvania), when children are prevented from accessing them due to the maintenance of low payment rates (payment rates in Pennsylvania haven’t been raised in 23 years)  and excessively restrictive service delivery requirements set by Managed Care Organizations (both of which effectively drive providers of BHRS from the field) is the Office for Civil Rights.  A ruling on the Civil Rights complaints filed in December of 2012 is expected relatively soon and will hopefully provide more justice than the Supreme Court could muster….


WASHINGTON–Today, the National Health Law Program (NHeLP) released the following statement reacting to the ruling by the U.S. Supreme Court in Armstrong v. Exceptional Child. The Court ruled that the Supremacy Clause of the Constitution does not confer a private right of action for health care providers to sue for an injunction to enforce § 30(A) of the Medicaid Act, a provision that requires states to ensure Medicaid-participating providers are adequately paid.

“Today’s decision ignores hundreds of Supreme Court cases, dating from the early 1800s, which have recognized the ability of private parties to bring Supremacy Clause suits in federal court to stop state officials from implementing state laws that violate a federal law or the Constitution,” said Jane Perkins, NHeLP legal director.

“The ruling immediately affects Medicaid providers, but it will be interesting to see whether this Court will find a way to limit the ruling to Medicaid and similar programs for low-income Americans, while continuing to allow banks, railroads, airlines and telecommunications companies to bring Supremacy Clause actions.”

In Armstrong, Medicaid providers sued Idaho to enjoin state policies (provider reimbursement rates) that they argued are inconsistent with the federal Medicaid statute. The Ninth Circuit affirmed a lower court ruling that the Supremacy Clause gave providers a private right of action to sue to enforce the federal Medicaid law. Today, the Supreme Court reversed the Ninth Circuit in a 5-4 decision. Justice Breyer voted with the majority and Justice Kennedy voted with the dissent. “The Medicaid Act contains provisions that set forth protections and obligations,” said Elizabeth G. Taylor, NHeLP executive director. “The ability to enforce those provisions in court has been a critical hallmark. Today, the Supreme Court has shamefully interfered.”

NHeLP filed an extensive amicus brief, joined by 19 of the nation’s leading consumer organizations, defending the ability of health care providers to enforce Medicaid law when states do not comply.

The Medical Review – a new show hosted by William Shatner retreats from Autism controversy

Of the approximately $217 million dollars that the National Institutes of Health (NIH) invested in autism research in 2010 (the most recent year for which data is available), only a meager 2.45% went towards improving the quality of services and supports available to Autistic people and their families.  Only 1.5% went towards research that addresses the needs of Autistic adults.

When compared to research on questions of causation, etiology and biology and diagnosis, the percentage of the autism research agenda focused on the actual needs of Autistic people in order to improve their quality of life is miniscule.

It was initially planned that this new television series would help to raise awareness that Autism symptoms can be treated successfully, and that Behavioral Health Rehabilitation Services (BHRS, still unaccountably referred to in Pennsylvania as “wraparound services”) are unquestionably “the treatment of choice” for children with Autism Spectrum Disorder symptoms.  When “applied behavior analysis” principles are incorporated into BHRS treatment plans for children, and the treatment process is infused with the “wraparound” philosophy, Effective Treatment in a Wraparound Cup® results.  I developed that treatment model 20 years ago and have been refining and improving it ever since.  It works.  It’s funded 100% by Medicaid.  In 36 states, it’s available regardless of family income.  It’s “the greatest treatment funding secret ever concealed.”  You can learn where and how to ask for it by contacting me.  A visit to the www.ibc-pa.org website is a good place to start.

Unfortunately, the producers of the show have apparently changed their minds.  There is no mention of Autism on their website and they are not returning calls (after expressing a high level of interest in the treatment of Autism that I described to them when they spoke with me a few months ago).  So much for “cutting edge television.”

Steve

A new resource for parents, advocates, providers and attorneys

As the Executive Director of the Institute for Behavior Change, I have been involved in the planning and delivery of Behavioral Health Rehabilitation Services (BHRS, still mistakenly referred to in Pennsylvania as “wraparound services”) since 1996.  I and my staff have been extremely successful in obtaining and keeping EPSDT funding for treatment programs involving 20, 30 and more hours of intensive, individualized treatment for children between the ages of 1 and 21 years with Autism spectrum disorders, ADHD and other conditions.  This funding is available in all 50 states to children with disabilities who are enrolled in Medicaid; it is a Civil Right, in fact.   Click here for in-depth information about BHRS funded through EPSDT

In 36 states, children with disabilities can enroll in Medicaid regardless of family income and are entitled to EPSDT funding for the treatment of their disability.  This is “the greatest treatment funding secret ever concealed.”  You can learn more about it, and the success we’ve had with it, here; I have been producing videos about EPSDT funding since 2007.

Now, I am offering a new means of supporting parents in their quest for quality treatment for their children.  I will be providing 2 hours of training, consultation, demonstration and assistance to parents so that their advocates, service providers and attorneys can do their work more effectively at Fair Hearings and other meetings where denials of EPSDT funding can be challenged successfully.  The cost for these training sessions is $200 per family.  Many people have told me that my consultations have been among the most useful and informative that they’ve ever had.  In this new forum, they will receive personalized recommendations about how to get and keep the funding necessary for their child’s treatment services to be delivered in their home and the child’s school or community at no cost to them whatsoever, through the EPSDT mandate of the Medicaid Act.

Training groups are limited in size to four families at a time in the Southeastern PA region. On-line sessions via Skype or other media sharing methods are available at the same hourly rate also.  Please send e-mail inquiries about this to employment@ibc-pa.org.

Governor acts to protect Direct Service Workers – a good start

We can only hope that PA Governor Tom Wolf recognizes the comparable need to raise protections for funding Therapeutic Staff Support (TSS) and other professional mental health treatment providers under the EPSDT program who have been similarly faced with grossly inadequate, outdated State funding limits (TSS, BSC and MT pay rates have never been increased — since 1992) which contributes to the extremely high turnover in their ranks as well.

Here is the text of Governor Tom Wolf’s Executive Order on behalf of Direct Service Workers who receive compensation via the Office of Long Term Living.  The same text could be applied to workers who receive compensation via the EPSDT program for the delivery of Behavioral Health Rehabilitation Services (BHRS, still widely misunderstood to mean “wraparound” services in Pennsylvania).

Remember:  Wraparound is a philosophy and an approach to the management of treatment services; BHRS are treatment services that are funded under the EPSDT mandate of Medicaid that disabled children in Pennsylvania are entitled to when they are prescribed correctly by a psychologist or a psychiatrist in this state.

Steve