By Ben Solis
Gongwer News Service
A federal district court judge this week approved a settlement between the Department of Health and Human Services and a community health advocacy program after the case spent nearly a decade in court.
Waskul v. Washtenaw County Mental Health (USEDM Docket No. 16-10936) was filed in 2016 by several people who participate in the state's Community Living Supports program and the Washtenaw Association for Community Advocacy, a nonprofit organization that advocates for support services for people with intellectual and developmental disabilities.
The plaintiffs claimed the defendants, which include Washtenaw County Community Mental Health, DHHS and Director Elizabeth Hertel, violated state and federal law, as well as contracts shared among the defendants, by modifying the methodology by which the plaintiff's program budgets were calculated.
After nearly a decade in court, the parties engaged in settlement negotiations in 2023 and reached a pending settlement with the help of a mediator. The plaintiffs asked U.S. District Judge Linda Parker of the Eastern District of Michigan to approve the settlement, and a fairness hearing was held December 3, 2024.
Although there were numerous objections, Parker found the settlement to be fair, reasonable and in the public interest. An oral ruling was given from the bench, but Parker made it official with an opinion and order issued this week.
Details of the settlement include DHHS agreeing to a minimum fee provision through September 2029, which will provide all CLS recipients a $31 hourly rate for services and an approximately $21 hourly rate for overnight health, safety and support services subject to inflation.
The plaintiffs have been promised the increased rates as soon as possible after the settlement agreement is approved, but no later than 60 days after execution of the agreement.
The rates are to continue until the minimum fee provision take hold or, if failure to provide the rate occurs, until 60 days after a drop dead date of June 1 or any extension of that date.
The settlement agreement also aims to strengthen the administrative process, changing what a Community Mental Health Services Program or Prepaid Inpatient Health Plan must document when declining or rejecting services, and bolstering the administrative appeals process. The settlement provisions are intended to protect the due process rights of beneficiaries, Parker wrote, adding that they also confer more authority and power on administrative law judges to enforce a beneficiary's individual plan of service when the PIHP and/or CMHP decline or reject services.
An important contingency is for the execution of an amended contract between DHHS and Community Mental Health Partnership of Southeast Michigan, and for the Legislature to approve appropriations to fund the agreement.
Further, while the minimum fee schedules are not required if the contingencies do not occur, DHHS agrees in that instance to amend the Medicaid Provider Manual to reflect the 'costing out' procedure outlined in … the agreement," Parker wrote. "This procedure is designed to ensure that each component of a recipient's CLS budget (such as staff wages, community activities, transportation) is built up separately based on each beneficiary's (individual plan of service) to create a total, individualized … CLS rate. In other words, it is designed to assure that sufficient funding is budgeted to implement what is required in the (individual plan of service)."
The plaintiffs had also asked Parker for a declaration that the settlement be binding on the more local defendants, which Parker denied.
The judge also denied the defendants' request to strike the declarations submitted by two of the plaintiffs, which Parker said there was no reason to do.
Gongwer News Service
A federal district court judge this week approved a settlement between the Department of Health and Human Services and a community health advocacy program after the case spent nearly a decade in court.
Waskul v. Washtenaw County Mental Health (USEDM Docket No. 16-10936) was filed in 2016 by several people who participate in the state's Community Living Supports program and the Washtenaw Association for Community Advocacy, a nonprofit organization that advocates for support services for people with intellectual and developmental disabilities.
The plaintiffs claimed the defendants, which include Washtenaw County Community Mental Health, DHHS and Director Elizabeth Hertel, violated state and federal law, as well as contracts shared among the defendants, by modifying the methodology by which the plaintiff's program budgets were calculated.
After nearly a decade in court, the parties engaged in settlement negotiations in 2023 and reached a pending settlement with the help of a mediator. The plaintiffs asked U.S. District Judge Linda Parker of the Eastern District of Michigan to approve the settlement, and a fairness hearing was held December 3, 2024.
Although there were numerous objections, Parker found the settlement to be fair, reasonable and in the public interest. An oral ruling was given from the bench, but Parker made it official with an opinion and order issued this week.
Details of the settlement include DHHS agreeing to a minimum fee provision through September 2029, which will provide all CLS recipients a $31 hourly rate for services and an approximately $21 hourly rate for overnight health, safety and support services subject to inflation.
The plaintiffs have been promised the increased rates as soon as possible after the settlement agreement is approved, but no later than 60 days after execution of the agreement.
The rates are to continue until the minimum fee provision take hold or, if failure to provide the rate occurs, until 60 days after a drop dead date of June 1 or any extension of that date.
The settlement agreement also aims to strengthen the administrative process, changing what a Community Mental Health Services Program or Prepaid Inpatient Health Plan must document when declining or rejecting services, and bolstering the administrative appeals process. The settlement provisions are intended to protect the due process rights of beneficiaries, Parker wrote, adding that they also confer more authority and power on administrative law judges to enforce a beneficiary's individual plan of service when the PIHP and/or CMHP decline or reject services.
An important contingency is for the execution of an amended contract between DHHS and Community Mental Health Partnership of Southeast Michigan, and for the Legislature to approve appropriations to fund the agreement.
Further, while the minimum fee schedules are not required if the contingencies do not occur, DHHS agrees in that instance to amend the Medicaid Provider Manual to reflect the 'costing out' procedure outlined in … the agreement," Parker wrote. "This procedure is designed to ensure that each component of a recipient's CLS budget (such as staff wages, community activities, transportation) is built up separately based on each beneficiary's (individual plan of service) to create a total, individualized … CLS rate. In other words, it is designed to assure that sufficient funding is budgeted to implement what is required in the (individual plan of service)."
The plaintiffs had also asked Parker for a declaration that the settlement be binding on the more local defendants, which Parker denied.
The judge also denied the defendants' request to strike the declarations submitted by two of the plaintiffs, which Parker said there was no reason to do.
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