Medicaid Beneficiaries Under the Age of 21 in Managed Care: What you need to know about Alberto N., Fair Hearings, and Continued Services
Summary: Texas Medicaid lawsuit regarding Albert N.
HCSSA Topic(s) Addressed:
Faculty: Hofer, Peter & Anstee, Terry
Program Description: To best serve your pediatric clients in Medicaid Managed Care,
it is important to understand the requirements of the Court
orders in Alberto N., a Texas Medicaid lawsuit, as well as the Fair Hearing and Administrative Review process and timelines,
and your clients’ rights to continued services. This program will explain the Alberto N. lawsuit and the Court Orders
governing Texas Medicaid’s prior authorization process as it relates to requests for nursing services, and will also demystify
the fair-hearing and administrative review process. The presenters also discuss the process for requesting and receiving nursing services,
pending appeal. Presentation Date: 8.21.2014
Program Objectives: Upon completion of this program, the viewer will be able to:
About the Presenters:Peter Hofer, JD is a senior litigation attorney with
Disability Rights Texas, the federally-funded protection and advocacy organization charged with protecting the rights of persons with
disabilities in Texas. Peter was one of the plaintiffs’ attorneys who litigated the Alberto N. lawsuit concerning children’s Medicaid
services in Texas. Peter also litigated the Jonathan C. case, after which Texas Medicaid was required to provide continued services to
beneficiaries pending Medicaid fair hearings. Peter has also handled more than 175 individual appeals on behalf of children challenging
denials of Medicaid-funded services.
About the Presenters:Terry Anstee, RN, JD is a staff attorney at Disability
Rights Texas, the federally-funded protection and advocacy organization charged with protecting the rights of persons with disabilities in
Texas. In this role, Terry has represented many children in fair hearings on a variety of Medicaid issues, including Comprehensive Care
Program services and Medically Dependent Children Program services. His nursing experience helps him to understand client’s medical issues
and clinical records. He has dealt with Health and Human Services, Texas Medicaid and Health Partnership, and Medicaid Managed Care
organizations on the issue of continued services and their obligations under the law.