Pashby v. Cansler

279 F.R.D. 347, 2011 U.S. Dist. LEXIS 141497, 2011 WL 6130819
CourtDistrict Court, E.D. North Carolina
DecidedDecember 8, 2011
DocketNo. 5:11-CV-273-BO
StatusPublished
Cited by8 cases

This text of 279 F.R.D. 347 (Pashby v. Cansler) is published on Counsel Stack Legal Research, covering District Court, E.D. North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pashby v. Cansler, 279 F.R.D. 347, 2011 U.S. Dist. LEXIS 141497, 2011 WL 6130819 (E.D.N.C. 2011).

Opinion

ORDER

TERRENCE WILLIAM BOYLE, District Judge.

This matter is before the Court on Plaintiffs’ Motion to Certify Class and Motion for Preliminary Injunction. A hearing was held on these matters before the undersigned on November 17, 2011, at Raleigh, North Carolina. For the reasons discussed below, Plaintiffs’ Motions to Certify Class and for Preliminary Injunction are granted.

BACKGROUND

Plaintiffs filed this action on May 31, 2011, challenging the legality of Defendant’s new rule regarding the provision of Medicaid-covered Personal Care Services for adults over twenty-one years of age. The new rule went into effect on June 1, 2011. Plaintiffs seek a preliminary injunction that would enjoin Defendant from implementing this rule, specifically the provisions of the In Home Care for Adults Clinical Policy 3E (Policy [350]*3503E) that would terminate eligibility for in-home care for Medicaid recipients that were eligible for such care prior to the implementation of Policy 3E. Plaintiffs challenge the legality of Policy 3E, alleging that it violates the comparability requirement of the Medicaid Act, 42 U.S.C. § 1396a(a)(10)(B); Title II of the Americans with Disabilities Act, 42 U.S.C. § 12312; section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794; and the due process clause.

Medicaid

Medicaid is a cooperative program between the federal government and the states that seeks to enable each state to “furnish (1) medical assistance on behalf of families with dependent children and of aged, blind, or disabled individuals, whose income and resources are insufficient to meet the costs of necessary medical services, and (2) rehabilitation and other services to help such families and individuals attain or retain capability for independence or self care.” 42 U.S.C. § 1396-1. Participation by the states in the Medicaid program is voluntary, and all participating states must comply with federally mandated standards. 42 U.S.C. § 1396(a); Antrican v. Odom, 290 F.3d 178, 183 n. 2 (4th Cir.2002). North Carolina has chosen to participate in the Medicaid program, and North Carolina’s Medicaid program is administered by Defendant. N.C. Gen.Stat. 108A-56; 108A-54.

Personal Care Services

Medicaid-participating states are required to include some types of benefits in their Medicaid plans and may elect to include other, optional benefits. Personal care services (PCS) are an optional benefit that provide for assistance with activities of daily living, including toileting, dressing, bathing, and eating. North Carolina has elected to provide coverage for PCS for qualifying Medicaid recipients. Prior to the implementation of Policy 3E, PCS were provided to individuals who, after referral by a physician and assessment by an independent entity, were determined to need assistance with at least two of the following qualifying activities of daily living (ADLs): bathing, dressing, toileting, mobility, and eating. If qualified, a recipient could receive no more than eighty hours of PCS per month or no more than 3.5 hours of PCS per day. See DMA Clinical Coverage Policy No. 3C, 2010 version.

Pursuant to Session Law 2010-31, Defendant revised its plan for providing PCS to eligible recipients and created two new services: In-Home Care for Adults (IHCA) and In-Home Care for Children (IHCC). Defendant developed an amended plan for providing in-home PCS under the IHCA, about which it solicited comment pursuant to N.C. Gen.Stat. 108A-54.2, and which it submitted to the Center for Medicaid and Medicare (CMS), the federal agency responsible for Medicaid, for approval. CMS approved the amended plan on April 18, 2011, and made the plan effective as of June 1, 2011. IHCA Policy 3E, developed as part of the implementation process for the new plan, details the eligibility and coverage criteria for in-home PCS which were specified by the North Carolina state legislature. N.C. Session Law 2010-31, Section 10.35. Specifically, N.C. Session Law 2010-31 and Policy 3E provide that in-home PCS will be provided to qualifying adults who need limited assistance with three qualifying ADLs or extensive assistance with two ADLs. A recipient’s treating physician must attest that PCS are medically necessary, the need for in-home PCS must be directly linked to a documented medical condition, and the recipient must approved by a designee of the Division of Medical Assistance (DMA), currently Carolinas Center for Medical Excellence (CCME), before he will be deemed eligible for in-home PCS under IHCA.

PCS are also provided to Medicaid recipients who reside in institutional settings or adult care homes (ACHs). A person residing in an ACH may receive PCS associated with bathing, dressing, personal hygiene, ambulation or locomotion, transferring, toileting, and eating. There is no prior approval process by a designee of the DMA required for an ACH resident to receive PCS, but a physician must certify that the resident has a medical condition with associated mental or physical limitations. All residents who receive Special Assistance funding from the State of North Carolina, which requires cer[351]*351tification by a physician of the need for care in an adult home, are automatically eligible for Medicaid and associated ACH PCS.

I. Motion to Certify Class

Rule 23 provides the requirements that plaintiffs must satisfy in order be permitted to represent a class. Fed. R. Civ. Pro. 23(a). First, a plaintiff must show that “(1) the class is so numerous that joinder of all members is impracticable; (2) there are questions of law or fact common to the class; (3) the claims or defenses of the representative parties are typical of the claims or defenses of the class; and (4) the representative parties will fairly and adequately protect the interests of the class.” Id. Additionally, plaintiffs seeking class certification must also satisfy one of the requirements of Rule 23(b). Plaintiffs bear the burden of proving the requirements of Rule 23, Thorn v. Jefferson-Pilot Life Ins. Co., 445 F.3d 311, 317 (4th Cir.2006) (internal citations omitted), and only one named Plaintiff must have standing with respect to each claim. Village of Arlington Heights v. Metropolitan Hous. Dev. Corp., 429 U.S. 252, 264, 97 S.Ct. 555, 50 L.Ed.2d 450 (1977).

Here, Plaintiffs contend they have satisfied both the requirements of Rule 23(a) and Rule 23(b)(2), which provides that class certification is appropriate where “the party opposing the class has acted or refused to act on grounds that apply generally to the class, so that final injunctive relief or corresponding declaratory relief is appropriate respecting the class as a whole.” Fed.R.Civ.P. 23(b)(2).

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Cite This Page — Counsel Stack

Bluebook (online)
279 F.R.D. 347, 2011 U.S. Dist. LEXIS 141497, 2011 WL 6130819, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pashby-v-cansler-nced-2011.