On Feb. 9, 2021, the Missouri Court of Appeals Eastern District handed down a ruling granting Kennedy Hunt P.C. its attorney’s fees for a case the firm has been fighting since 2012.
Our client is a 33-year-old woman with several medical, behavioral, mental, and developmental disorders and disabilities. For 15 years prior to 2012, our client received medically-necessary support services through the Missouri Department of Mental Health. Specifically, our client was a participant in the Comprehensive Medicaid Home and Community-Based Services Waiver program and received Orientation and Mobility Services and Blindness Services (OMS/BS). In 2009, the Missouri Department of Mental Health approved our client for an in-home Independent Support Living plan, which provided her and her family with assistance in caring for our client’s complex medical and behavioral needs.
From 2009 through September 2012, our client received these services without issue. But in October 2012, the Missouri Department of Mental Health denied our client’s Independent Support Living plan, including her Orientation and Mobility Services and Blindness Services.
Additionally, The Missouri Department of Mental Health re-coded our client’s OMS/BS supports as Community Specialist services (billed at a rate of $40/hour) as opposed to the Positive Behavior Supports/Person Centered Strategies Consultation services (billed at a rate of $67/hour).
In effect, the Missouri Department of Mental Health denied our client medically necessary services. On October 23, 2012, a member of our client’s medical team told the director of the Missouri Department of Mental Health that “neither he, nor any other COMS/CBP provider in the St. Louis area would be able to provide M.F. with OMS/BS services if they were billed at that reduced rate.”
Still, though, the Missouri Department of Mental Health denied our client’s appeals. This is where a years-long fight for our client to receive medically-necessary support services began.
In 2017, the Missouri Court of Appeals Eastern District ruled in favor of our client and reversed the lower courts’ rulings that denied our client’s appeals. In effect, the appellate court found that “DMH’s justifications for denying M.F. the medically-necessary OMS/BS service were not supported by substantial and competent evidence.”
Shortly after, our client filed an application for attorney’s costs and fees, which was denied in the lower court. Our client appealed that decision, which was reversed in the Circuit Court of St. Louis County and affirmed in the Missouri Court of Appeals Eastern District on Feb. 9, 2021.
This case is ongoing. For further information, please contact attorney Sarah Jane Hunt at (314) 872-9041 or firstname.lastname@example.org. If you or someone you know has been a victim of denied Medicaid services, our skilled attorneys at Kennedy Hunt, P.C. may be able to help you. Fill out a questionnaire so we can understand your claim.