Free Trial Memo - District Court of Connecticut - Connecticut

Case 3:00-cv-01050-AVC Document 165-3 Filed 07/23/2007 Page 1 of 3 }
Joint Trial Memorandum Attachment B: Stipulations of Law 1
1. Plaintiffs’ seventh claim for relief asserts, with respect to the child subclass only, that "(t)he
defendant has failed to implement the requirement that Medicaid beneficiaries under age 21 be
effectively informed of the availability of early and periodic screening, diagnostic and treatment
services, including dental services, and of the benefits of preventive dental health care, in
. violation, 42 U.S.C. § 1396a(a)(43), 42 C.F.R. § 441.56(a) and 42 U.S.C. §l983.”
2. 42 U.S.C. § 1396a (a)(43)(A) addresses "EPSDT informing". It provides, in pertinent part
that: l
(a) A state plan for medical assistance shall-
(4.3) provide for-
(A) informing all persons in the State who are under the age of 21
and who have been determined to be eligible for medical assistance
of the availability of early and periodic screening, diagnostic,
and treatment services as described in section l396(r) of this title
and the need for age-appropriate immunizations against vaccine-
preventable diseases.
_ 3. 42 C.F.R. 441 .56(a) provides, in pertinent part, that:
(a) Informirzg. The agency must-
(1) Provide for a combination of written and oral health methods
designed to inform effectively all EPSDT eligible individuals (or
their families) about the EPSDT program.
" (2) Using clear and non technical language, provide information
(i) The benefits of` preventive health care;
(ii) The services available under the EPSDT
program and where and how to obtain those services;

Case 3:00-cv-01050-AVC Document 165-3 Filed 07/23/2007 Page 2 of 3
(iv) That necessary transportation and scheduling assistance
described in § 441.62 of this subpart is available to the EPSDT
individual upon request.
4. This Court, in its January 19, 2006 Ruling on Defendants’ Motion for Summary
Judgment at pp. 27-31, ruled that 42 U.S.C. § 1396a (a)(43)(A) creates an enforceable right in
members of the child subclass to be informed of the availability of EPSDT services.
J 5. P1aintiff`s’ eight claim for relief asserts, with respect to the child subclass only, that,
"The defendant has failed to provide or arrange for provision of periodic dental screens to assess
plaintiffs’ health; diagnostic dental services; and treatment identified during the dental screens,
in violation of 42 U.S.C. §§ l396a(a)(43)(B) and 1396d(r)(1)(A), 42 C.F.R. 441.56(b)(i)(vi) and
‘ 44l.56(c) and 42 U.S.C. § 1983."
6. 42 U.S.C. § 1396a(a)(43)(B) provides, in pertinent part, that:
A state plan for medical assistance shall- `
(43) provide for —
providing or arranging for the provision of such
screening services in all cases where they are requested.
7. 42 U.S.C. 1396gr)g1)A) is a definitional section which defines EPSDT "screening
services” as follows:
(r) Early and periodic screening, diagnostic, and treatment
services. The terms "early and periodic screening, diagnostic, and
treatment services means the following items and services:
(1) Screening services —
(A) which are provided- »
(i) at intervals which meet reasonable standards of medical and
dental practice ..., and “
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(ii) at such other intervals, indicated as medically necessary, to
determine the existence of certain physical or mental illnesses or
conditions.
8. Plaintiffs’ ninth claim for relief asserts, on behalf of the child subclass only, that the
defendant is violating 42 U.S.C. 1396a(a)(43), 1396d(a)(19), 42 C.F.R. § 441.62, and 42 U.S.C.
§ 1983 by not providing case management services, and transportation and scheduling assistance _
that is necessary to enable the plaintiff child subclass to obtain dental services.
i 9. 42 C.F.R. 441.62 provides as follows:
441.62 Transportation and scheduling assistance.
The agency must offer to the family or recipient, and provide if the
recipient requests-
(a) Necessary assistance with transportation as required under
§431.53 of this chapter; and
(b) 1\Iecessary assistance with scheduling appointments for
services.
10. This Court ruled in its January 19, 2006 ruling on defendant’s summary judgment
motion at pp 33, 34, that since "case management" is listed in § l396d(a) (at d(a)(19) ) as a
service that may be covered by a state plan, it "is plausibly included in ‘other measures’ and
consequently is one aspect of EPSDT services.”
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