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Colorado Department of Health Care Policy and Financing – Judicial Review re: NEMT

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Citation

Taylor v. Colorado Department of Health Care Policy and Financing, 11-cv-58

Issues

Leslie Taylor and CCDC filed a second appeal against HCPF.  This appeal addresses HCPF’s failure to ensure necessary medical transportation.   Ms. Taylor uses a wheelchair and lives in rural Colorado. As a result of significant change in her condition she suddenly needed to go to numerous medical appointments.  Taylor, because of her disabilities, cannot drive herself.  Neither the Department nor the county where she lives provides any form of accessible NEMT.  Some appointments were as far as 100 miles from Taylor’s home.

Federal and state Medicaid regulations requires that the State “ensure transportation” which means HCPF must provide or fund transportation services so that Medicaid clients can access care.  HCPF offers mileage reimbursement for people who use their own vehicles, or pays providers such as taxi services or para-transit companies to transport clients who do not have a vehicle.  Because HCPF has failed to ensure accessible transportation in rural communities,  Taylor’s only means for traveling these long distances was to use her car and take her home health care attendants with her.  The attendants drive Ms. Taylor in her vehicle, assist her with getting in and out of the car, and help her during her appointments.  Clients like Taylor in this situation need to pay a driver in addition to mileage reimbursement.

After lengthy discussions with Ms. Taylor and Julie Reiskin, HCPF agreed to reimburse Ms. Taylor’s attendants for this travel time.  In December of 2009, in order to avoid going to an administrative hearing, the County issued Ms. Taylor a check intended to reimburse Ms. Taylor’s attendants.  Unfortunately, this check did not cover the actual number of hours the attendants traveled and had to be returned to the Department for clarification.

In an apparent fit of spite HCPF through its counsel, the Attorney General’s office, suddenly and without explanation refused to pay Taylor’s attendants.  Nevertheless, HCPF filed a second motion to dismiss telling the Court that “the attendants have been paid.”  The check apparently was a trap.  If Ms. Taylor had cashed it HCPF would have claimed she’d accepted this money as full compensation.

Because HCPF refused to address this issue CCDC proceeded to hearing at the Office of Administrative Courts.  The Administrative Law Judge sided with Taylor and CCDC, but HCPF, in an abuse of power, overturned the decision forcing us to pursue the case in the courts. After a three-day hearing in this case and the other appeal, ALJ Norwood ruled under NEMT rules, the Department was required to pay Ms. Taylor’s attendants for their time transporting her too and from medical appointments.

HCPF continues to litigate this case now in the Denver District Court.  HCPF is telling the Court that NEMT rules “prohibit” HCPF from paying attendants for travel time.  There is no such rule.  State and federal regulations simply require that Medicaid ensure transportation.

T rules “prohibit” HCPF from paying attendants for travel time.  There is no such rule.  State and federal regulations simply require that Medicaid ensure transportation.

Status

Ms. Taylor has filed motions for judicial review filed on administrative appeals regarding non-emergent medical transportation (“NEMT”) appeal and CDASS allocation amount appeal. Also, claim brought pursuant to Medicaid Act and ADA for failure to provide NEMT services or compensate drivers.

The complaints were filed January 4, 2011. A motion to consolidate the two cases into one case was denied.

Appellant filed her Opening Brief on June 13, 2011.

Available Document


Media Coverage


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