Citation
CCDC, et al. v. Henneberry and Colorado Department of Health Care Policy and Financing, 2009CV11761Issues
Despite requiring CDASS Program Participants to stay within their monthly allocation budgets or be removed from the program, the Department reduced allocation amounts without notification. Plaintiffs allege violations of due process rights.
In recent filings with the Court, (see “Motion to Dismiss” and “Response to Motion to Dismiss”) the Department, through the state attorney general's office, has said the following about the CDASS program:
DEPARTMENT POSITION IS CDASS PROGRAM PARTICIPANTS ARE MEDICAID "PROVIDERS"
"In the sense that CDASS consumers direct and manage their care and are responsible for all aspects of service delivery, including payroll, these CDASS participants 'stand in the shoes' of a Medicaid provider. No Medicaid provider is permitted to dispute, on appeal, the reimbursement rate that Medicaid pays for covered services. Participation in the Medicaid program by providers is voluntary, as is participation in CDASS by Medicaid consumers. Just as providers dissatisfied with Medicaid rates have the option not to participate in the program, CDASS consumers may choose to opt out of the consumer directed care model and receive services from a Medicaid provider who accepts the reimbursement rates."
DEPARTMENT POSITION REGARDING IMPACT OF ALLOCATION REDUCTIONS:
"Indeed, the allocation reductions break down to such a small increase [sic EDITOR’S NOTE: THE DEPARTMENT INCORRECTLY USES THE WORD “INCREASE” INSTEAD OF “DECREASE IN”] funds actually available to pay attendants that a CDASS recipient with even the barest amount of competence should have experienced only the most negligible of effects."
DEPARTMENT’S RESPONSE TO ERRORS IN AMOUNT OF ALLOCATION REDUCTIONS:
"Plaintiffs state that individual recipients have received comparatively disparate reductions and that some CDASS recipients saw changes in their allocation amounts that exceeded 3.56%. This is explained by the fact that, in September, 2009, when the 1% provider rate cut was implemented, (reducing rates for all services, including those utilized by CDASS participants), the Department forwarded an electronic worksheet to case managers to use to adjust each of their client's allocations. Unfortunately, there was a defect in the embedded formula that was part of the worksheet. Errors in the electronic worksheet resulted in erroneous adjustments statewide to some allocations. To correct these allocations, the Department is auditing allocations and recalculating those that were incorrectly adjusted."
“Errors in the electronic worksheet resulted in erroneous adjustments statewide to some allocations. To correct these allocations, the Department is auditing allocations and recalculating those that were incorrectly adjusted. The Department will complete its audit and communicate the results of the approximately 1,035 audited client allocations that were reported within the next couple of weeks.”
Status
The Class Action Complaint was filed in Denver District Court on December 22, 2009.
The Department's Motion to Dismiss was denied.
