A complete set of claim forms, instructions and certification pages may be found here.  For notices and forms in languages other than English, please see the links below:

Если Вы желаете прочитать это извещение на русском языке, пожалуйста, посетите https://www.dshs.wa.gov/dda/mte.

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ប្រសិនបើអ្នកចង់អានសេចក្តីជូនដំណឹងនេះជាភាសាខ្មែរ សូមទៅកាន់ https://www.dshs.wa.gov/dda/mte

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What is M.T.E. et al., v. Wash. Dep’t of Soc. & Health Servs.?

This lawsuit was brought by two individuals who alleged that DSHS improperly applied WAC 388-106-0213, the Children’s Assessment Rule.  They alleged that the improper application of this Rule caused members of the Settlement Recipient Class to pay out of pocket for necessary personal care services.  They also alleged that the Rule improperly required members of the Settlement Provider Class to work without pay to meet the personal care needs of the child Medicaid recipients with whom they lived.  As a remedy, they alleged that pursuant to RCW 74.04.080 and RCW 34.05.574, the Settlement Recipient Class is entitled to past back benefits to the date that the Children’s Assessment Rule was first applied.  They also alleged that DSHS breached its contracts with the Settlement Provider Class by applying the invalid Rule, such that those providers are entitled to payment for unpaid work performed that would have been paid but for the application of the Rule.  DSHS denies all claims.

A copy of the Fourth Amended Complaint may be viewed here, and defendant's answer is here

 

Reason for Notice

In October 2015, the parties in M.T.E. reached a settlement.  DSHS has agreed to provide a $4,000,000 settlement fund, out of which claims will be paid for (1) out-of-pocket costs for MPC services that would have been covered but for the application of the Rule, and (2) unpaid work performed by individual providers who lived with their child Medicaid client that would have been covered but for the application of the Rule.

The motion for preliminary approval of the proposed Settlement Agreement is here.  The Order granting preliminary approval is here.

 

What is a class action, and who is involved?

In a class action lawsuit, one or more people (“Class Representatives”) sue on behalf of other people who have similar claims.  The people together are a “Class” or “Class Members.”  All of the Class Members are called the Plaintiffs.  One court resolves the issues for everyone in the Class, except for those people who choose to exclude themselves from the Class.  In this case, M.T.E., a child Medicaid recipient, and Sheryl Wagner, an individual provider, are the Class Representatives.  The Department of Social and Health Services is the Defendant.

 

Who are in the two Classes in this case?

There are two classes in this case.  They are defined as follows:

Settlement Recipient Class: All individuals who, during the Class Period:  (1) were recipients of Medicaid-funded personal care services; (2) had their Medicaid-funded personal care services determined by application of the former WAC 388-106-0213; and (3) who paid out of pocket for additional personal care services during any month in the Class Period.

Settlement Provider Class: All individuals who, during the Class Period:  (1) were authorized by DSHS to provide personal care services to individuals whose personal care service hours were determined by application of former WAC 388-106-0213; (2) lived with those individuals during that month; and (3) provided unpaid personal care services that exceeded the amount of personal care services authorized by DSHS during that month.

Class Period as used in this definition means July 1, 2005 through November 30, 2011.

 

What does the proposed Settlement Agreement provide?

The main points of the proposed Settlement Agreement are described below.  You can review the entire Agreement, which is available here.  The Agreement will only become effective if the Court approves the Agreement after the Final Hearing.

• $4,000,000 Settlement Fund

The Agreement provides for a $4,000,000 Settlement Fund to pay for claims submitted by Settlement Recipient Class Members and Settlement Provider Class Members, attorneys’ fees, litigation costs, payments for all potential disputed claims relating to the Collective Bargaining Agreements in effect during the Class Period, claims administration costs, and case contribution awards.

•  Claims Process for Recipient Class Members

A Settlement Recipient Class Member, on his or her own behalf or through his or her parents and/or legal guardian, will be eligible for payment from the Settlement Fund by submitting a claim form (here, with instructions here) that attests to the following four items:

  1. The Recipient received Medicaid-funded personal care services and was under the age of 18 when the services were provided;

  2. The  Recipient received personal care services in excess of the amount DSHS authorized during the Class Period (July 1, 2005 through November 30, 2011);

  3. The name of the provider(s) of personal care services and the amount and date of the personal care services (month/year); and

  4. The out-of-pocket costs associated with those personal care services.

    The claims must also be documented with some evidence of payment(s) or obligation, such as (but not limited to) cancelled checks, credit card account statements, checking account statements, provider ledgers or signed letters from the provider or the provider’s employer documenting the amount paid or due (so long as the letter clearly connects payments with the personal care service dates by at least the month/year).  The Recipient must also authorize the Claims Administrator to obtain any necessity information from DSHS and/or the identified personal care provider to confirm the Recipient’s attestation and documentation. Note: Reimbursement is available only for payments made to cover the difference between authorized hours and the claimant’s base hours at the time of payment.  See WAC 388-106-0125 for an explanation of base hours and classification groups.

•  Claims Process for Provider Class Members

A Settlement Provider Class Member will be eligible for payment from the Settlement Fund by submitting a claim form (here, with instructions here) that attests to the following four items:

  1. The Provider was a qualified Individual Provider who was living with, and provided services to, a recipient of Medicaid-funded personal care services who was under the age of 18 when the services were provided;

  2. The  Provider provided personal care services in excess of the amount authorized by DSHS during the Class Period (July 1, 2005 through November 30, 2011);

  3. The date (month/year) that personal care services in excess of the authorized amount were provided; and

  4. The Provider was not paid for those services.

    The Provider must also authorize the Claims Administrator to obtain any necessity information from DSHS and/or the relevant Medicaid-funded personal care recipient to confirm the Provider’s attestation.  All valid provider claims will be compensated at a per-month “proxy” amount of $450 per month, unless there are insufficient funds to pay each claim at 100%. 

    A Claims Administrator will review the claims to confirm that the four requisite items are present in the relevant claim forms and that the submitted documentation supports the claimed amounts.  The Claims Administrator will also confirm that the Provider was on the list provided by DSHS of potential Settlement Class Members during the time of the claim, and that claimed sums are not duplicative. 

    The Claims Administrator must provide a Claimant with a deficient claim form an opportunity to fix any problems.  Class Counsel can assist the Claimant with fixing any problems with her/his claim.   

•  Collective Bargaining Agreement Settlement Amount

The proposed Settlement Agreement includes an Appendix A, available here, which contains a separate agreement between Defendant, Service Employees International Union (“SEIU”) 775, SEIU Healthcare NW Health Benefits Trust (“HBT”) and SEIU Healthcare NW Training Partnership (“TP”), referred to as the “CBA Settlement.”  Under the CBA Settlement, SEIU 775 shall receive $115,000, HBT shall receive $30,000, and TP shall receive $5,000 from the Settlement Fund, in exchange for a release of some  potential claims against Defendant. 

•  Attorneys’ fees, Litigation Costs, and Costs of Claims Administration

Under the proposed Settlement Agreement, Class Counsel will apply for their attorneys’ fees from the Settlement Fund, based upon their normal hourly rates and the hours spent on the litigation.  In addition, litigation costs (money Class Counsel paid out of pocket on behalf of the Classes) and costs for claims administration will be requested to be paid from the Settlement Fund.  Class Counsel’s attorneys’ fees, litigation costs, and claims administration costs are subject to review and must be approved by the Court.  Class counsel's motion for fees and costs is available here, along with a supporting declaration here.

•  Case Contribution Awards

Case contribution awards of up to $25,000 for each Class Representative (M.T.E. and Sheryl Wagner Houlihan) for a total of no more than $50,000 will be requested from the Settlement Fund.  The Court must approve the case contribution awards. 

•  Insufficient Funds or Excess Funds

If, after payment of the Collective Bargaining Agreement Settlement Amount, attorneys’ fees, case contribution awards, litigation costs, and claims administration costs, there are insufficient funds to pay 100% of all valid claims then all valid claims, including both Recipient and Provider claims, shall be paid on a pro rata (percentage) distribution of their approved claim amount. 

After payment of the Collective Bargaining Settlement Amount, attorneys’ fees, case contribution awards, litigation costs, claims administration costs, and all valid claims at 100%, if there are excess funds in the Settlement Trust Fund, then those excess funds shall be returned to the State of Washington.

 

When will the Settlement Funds be available?

The Court must finally approve the proposed Settlement Agreement, and if any Class Members appeal, a final adjudication of any appeal(s) must be made before the funds are available.

 

How do I respond to the proposed Settlement Agreement?

•  You May Submit a Claim

As described above, you may submit claims if you are a member of either the Settlement Recipient Class or the Settlement Provider Class.  Claims must be received by the Claims Administrator by April 20, 2016.  The Settlement Recipient Class claim form is here, the certification page is here, with instructions here.  The Settlement Provider Class claim form is here, with instructions here.

•  You May Exclude Yourself or Your Dependent (Opt Out)

If you wish to exclude yourself or your dependent from the Class, you must write a letter stating that you wish to be excluded or send in the enclosed Exclusion or “Opt-Out” Form.  An opt-out form may be found on the last page of the notice, which is attached here. Your letter or form must be postmarked by April 20, 2016 and sent to:

M.T.E. v. DSHS
Claims Administrator
P.O. Box 3266
Portland, OR 97208-3266

If you opt out of one of the Classes, you will not be entitled to make a claim or receive a payment if the proposed Settlement Agreement is approved.  You will, however, retain any rights you may have to pursue an individual claim for back benefits or breach of contract damages against DSHS regarding its application of WAC 388-106-0213, the Children’s Assessment Rule.  If you believe that you have such claims, you may wish to consult with an attorney.  You should confer with the attorney about the relevant statute of limitations.

•  You May Comment on, Object to, or Support the Proposed Settlement Agreement

The Court will hold a final hearing on the proposed Settlement Agreement on May 20, 2016, 2015 at 9:00 a.m., Thurston County Courthouse, 2000 Lakeridge Drive SW, Room 204, Olympia, WA 98502.

You are not required to attend the hearing, and you are not required to be present to submit comments for consideration.  All comments on the proposed Settlement Agreement, however, must be submitted in advance and in writing to the Court.

You may attend the hearing, and you may bring a legal representative if you wish at your own expense.  You must tell the Court in advance and in writing that you plan to come to the hearing to object to, comment on, or formally support the proposed Settlement Agreement or the Class Representatives’ request for payment of attorneys’ fees, litigation costs, costs of claims administration, or case contribution awards.

If you choose to submit written comments or appear at the Court hearing, you letter must be received no later than April 20, 2016 and must be mailed to:

Richard E. Spoonemore and Eleanor Hamburger, Class Counsel
Sirianni Youtz Spoonemore Hamburger
999 Third Avenue, Suite 3650
Seattle, WA 98104

John K. McIlhenny, Jr., William McGinty and
   Martin Wyckoff
Office of the Attorney General
P.O. Box 40124
Olympia, WA 98504-0124

 

Where I can get more information?

For information, you may contact DSHS at (360) 725-3449. If you are an individual provider, you can also call the SEIU 775 Member Resource Center at 1 (866) 371-3200.  You may also call or write Class Counsel to request copies of any of the documents in this matter:

Richard E. Spoonemore and Eleanor Hamburger, Class Counsel
Sirianni Youtz Spoonemore Hamburger
999 Third Avenue, Suite 3650, Seattle, WA  98104
Tel. (206) 838-3210
Email:  ehamburger@sylaw.com or rspoonemore@sylaw.com