Fall 2018
The Docket
What's Inside
  • HLA Welcomes Justin Lowe as New Legal Director

  • Championing Mental Health Parity

  • Client Profile: Jake

  • Statement on Judge Kavanaugh's Nomination

  • The 23rd Benefit Breakfast is Oct. 30th!
Dear Friends,

We hope you will add this edition of The Docket to your fall reading list.

HLA has had an extremely productive 2018 thus far and it has flown by. I can tell you our team is energized to continue the fight for health care justice for rest of the year and into 2019.

If you've been following our work, you know we're pouring our energy into protecting the rights of (in no particular order) - immigrants, transgender people and those with mental illness. Fortunately, we have capacity to do even more, such as advocating for children with disabilities, protecting families from medical bankruptcy and promoting access to oral health care.

So, grab your fleece, enjoy the cooler weather and read up on HLA's efforts to make sure everyone in our community can access the health care they need, regardless of financial resources.

Enjoy the fall!

Matt Selig
Executive Director
HLA Welcomes Justin Lowe as
Our New Legal Director
When thousands of mostly low-income students were bilked by a for-profit school in Massachusetts, Justin Lowe sat and listened to countless stories from the victims in his quest to bring them justice. At the time, Justin was a Massachusetts Assistant Attorney General in Attorney General Maura Healey's Consumer Protection Division.

After three years in court, Justin and his team prevailed when the "school," the American Career Institute (ACI), was forced to accept a $25 million judgement and admit its wrongdoing before a judge. The U.S. Department of Education then discharged $30 million the students had in federal loans, the only time the Department has cancelled all of a school's student loans because of fraud.

In December 2016, Justin received the Attorney General Elliot L. Richardson Award of Excellence for his work on behalf of consumers. This month, Justin joins HLA as our new Legal Director.

In his new role at HLA, Justin will lead the organization's litigation efforts to ensure vulnerable Massachusetts residents are not left behind by our health care system. He will also play a leadership role supervising attorneys leading several of HLA's key strategic initiatives. HLA, founded in 1996, is Massachusetts' only non-profit public interest law firm dedicated exclusively to promoting health care access. With its partner organization, Health Care For All, HLA combines legal expertise with grassroots organizing and policy reform to advance the statewide movement for universal health care access.

"Whether it be championing access to dental care for the poor, challenging the elimination of health benefits for immigrants, or defending the Affordable Care Act, HLA has led the way towards a future where health care is a right for everyone instead of a privilege reserved for the few. I am honored to join the passionate and dedicated attorneys at HLA in realizing their vision of health care justice in the Commonwealth," Attorney Lowe said.

Justin J. Lowe, a Southern California native, joins HLA after seven years as an Assistant Massachusetts Attorney General litigating matters in both the office's Consumer Protection and Medicaid Fraud divisions. Prior to moving to Massachusetts with his family, Justin was a Senior Litigation Associate in the Los Angeles office of Venable LLP, an Am Law 100 firm with over 700 attorneys nationwide.

"HLA has a rich history of bringing successful impact litigation to remove terribly unjust obstacles to health care for thousands of the most vulnerable residents of our community," said HLA's Executive Director Matt Selig. "There are a lot of people out there who rely on us to do this kind of work and we are thrilled that Justin has joined us to lead these efforts. His demonstrated talent speaks for itself and we welcome him warmly to our outstanding team."
Mental Health and Substance Use Parity

HLA remains vigilant guarding the landmark mental health rights created 10 years ago.
Ten years ago this October, President George W. Bush signed into law the Mental Health Parity and Addiction Equity Act written by Senator Ted Kennedy and Congressman Patrick Kennedy. The sweeping federal "Parity Law" banned health insurance coverage that discriminates against those with mental illness and substance use conditions. It added many additional protections on top of the Massachusetts Mental Health Parity Law of 2000.

HLA's Parity Initiative, under the leadership of Senior Staff Attorney Wells Wilkinson, uses the parity laws to ensure consumers can access the treatment they need. When we represent consumers in need of mental health care we ensure they cannot be denied coverage simply because the treatment they need is for a mental illness or substance use disorder. We promote more aggressive government enforcement of the federal and state parity laws so the civil rights of those with mental illness and/or addiction aren't devalued. And, HLA also educates the public on what the parity laws are and what to look out for to protect themselves from discrimination in the health care system. HLA's Mental Health Parity Toolkit is a great resource for consumers and others seeking information on our rights to coverage for mental health and addiction services.

Advocating for Policy Reform
In June, HLA and several allied organizations testified at the Massachusetts Division of Insurance (DOI) in support of proposed parity enforcement guidelines that mandate coverage for certain critical types of children's mental health care . The guidelines apply to commercially-sold health plans and mandate coverage for services such as in-home therapy intensive care coordination. This regulatory enforcement measure has been a longtime priority for HLA and we salute the DOI for publishing these guidelines.

HLA has also been advocating with the
DOI and working with a range of stakeholders, including Health Care For All, on regulations that will require health plans to ensure that their provider
directories accurately reflect the mental health clinicians that are in the plans' networks and are accepting new patients.
A recent DOI study revealed many
inaccuracies in provider directories.

Advocating for improvements to the DOI's parity complaint process for consumers and providers, and to the DOI's parity compliance self-reporting guidelines for insurers are also leading advocacy priorities for HLA. We appreciate the DOI's attentiveness to these issues and the progress we've made toward reforms in these areas.

Engaging the Community
Our recent travels around the state to promote mental health parity took us to Taunton recently, where Attorney Wilkinson spoke to members of the Dept. of Mental Health Citizen Advisory Board, and to Watertown, where Wells met with members of SEIU Local 509's Clinicians UNITED. The more that consumers know about their rights, the better their chances of receiving the care they need when they need it.

P roviding Legal Services
HLA Parity Initiative recently won a legal victory on behalf of a 22-year-old male from south of Boston who has autism. Our client's health care providers determined that he needs Applied Behavioral Analysis therapy, but his health insurer denied coverage for all of the dozens of hours of services requested. Our appeal to the health plan was denied. Wells then appealed to the state's independent Office of Patient Protection which overturned the denial and ordered coverage for 23 hours per week of ABA therapy. Wells pushed further and argued for the OPP to consider approving additional coverage based on the parity laws and other consumer protections. The OPP agreed and awarded an additional five hours of weekly coverage for our client.
Client Spotlight: Jake
Keeping Him Out of the Juvenile Court
"Jake" is a 9-year-old boy with a history of psychiatric screenings and hospitalizations. He has been diagnosed with bipolar disorder with psychotic features, as well as ADHD, anxiety, and trauma. Lisa Morrow, HLA's Mental Health Advocacy Program for Kids' (MHAP for Kids) Senior Attorney, started working with Jake and his mother in November 2017. At the time, Jake had several community-based mental health support services in place, including an intensive care coordinator, a family partner for his mother, and an in-home therapist. Additionally, the school district was providing Jake with special education services in their small, substantially separate therapeutic classroom for children with emotional disabilities.

Despite the array of supports in place, Jake continued to struggle. Over the next six months, he had seven psychiatric hospitalizations/Community Based Acute Treatment placements. Both Jake's community-based clinicians and clinicians at the various psychiatric placements agreed that Jake needed long-term therapeutic residential treatment. In Massachusetts, this often requires the child's school district and a state agency like the Department of Mental Health (DMH) or the Department of Children and Families (DCF) to share the cost of such a program. Multiple treatment providers told Jake's parent to file a complaint in juvenile court on his behalf as a means to get DCF involved. This would have exposed Jake to the juvenile court system and require him, as a 9-year-old with severe anxiety and trauma, to go in front of a judge. MHAP for Kids advocates zealously to avoid juvenile court involvement for children with mental health issues, so Lisa prepared to ensure Jake was found eligible for DMH.

One of Jake's community-based treatment providers had to set up a neuropsychological evaluation for him, because in the past DMH found him ineligible based on a previous evaluation suggesting Jake falls somewhere on the autism spectrum. This treatment provider told the rest of Jake's treatment team that his DMH application would be complete once the new evaluation was finished. Unfortunately, this was not the case. Lisa discussed Jake's case with DMH and learned that the family needed to submit a new application. She worked with Jake's mother to complete the application, and submitted it to DMH along with numerous school and medical records. DMH's eligibility determination team was short-staffed, but due to Lisa's advocacy, Jake was found eligible within 30 days rather than the usual 90-day eligibility period.

DMH came on board and recognized Jake's need for a longer-term placement. Initially, they proposed a group home placement with wrap-around services, but the program they spoke with knew Jake well, and felt they would be better able to meet his needs in their full residential program. Jake's team reconvened with the school district. After reviewing testing and discussing Jake's needs, Lisa and the school district's attorney wrote an agreement stating that the district would share the cost of the residential placement with DMH for the 2018-2019 school year, beginning immediately.

Lisa recently attended Jake's "30-day" meeting at his new residential program. His clinician and teacher have both seen improvements in his frustration tolerance, which has been a big challenge for him. Jake's mother reports that Jake now says he loves school, and he has been able to attend school daily with minimal incidents for the first time this school year. His treatment team is being thoughtful and deliberate in planning for visits home as well as engaging both his mother and father in therapy sessions. Jake has not needed to be screened for a mental health crisis or hospitalized since his admission to the therapeutic residential program in May.

Learn more about how MHAP for Kids is advocating for young people here .
Judge Kavanaugh, An Unacceptable Choice for the Supreme Court
In the decades to come, the U.S. Supreme Court will have a profound impact on the ability of Americans to access quality health care, particularly those who are at risk due to factors such as race, gender, immigration status, disability, age or geographic location. Right now, challenges to the Affordable Care Act (“ACA”), reproductive freedom and the authority of regulators to protect our most vulnerable citizens are among the most critical legal issues making their way through the lower courts. How the court acts on these issues could impact access to health care in our country for generations.

As an organization dedicated to assisting people overcome obstacles to accessing or paying for needed medical services, Health Law Advocates (“HLA”) believes that the next justice confirmed to the Supreme Court who will consider these and other health-related legal issues, must share our commitment to legal principles that will enable our society to have a health care system that works for everyone - not just those of or with a certain age, race, gender, citizenship, medical history or financial status.

“We are gravely concerned that throughout his time on the bench, Judge Kavanaugh has repeatedly adopted positions that undermine, or simply block, access to health care for consumers,” said HLA’s Executive Director Matt Selig. “His hostility toward the ACA, opinions on reproductive rights and intolerance for government regulation of business place him far outside the mainstream of our country. The Senate should reject his nomination to the Court.”
Based on Judge Kavanaugh’s record as a jurist in matters concerning health care access, HLA strongly opposes his nomination to the U.S. Supreme Court.

Read the full statement here .
Health Law Advocates
One Federal Street | Boston, MA 02110 | 617.338.5241 | www.healthlawadvocates.org