Rosie D. v. Romney Class Action Suit

## Overview

Rosie D. v. Romney is a class action lawsuit against the Commonwealth of Massachusetts resulting from a complaint filed in 2001 on behalf of 8 named plaintiffs as representatives for 30,000 additional children identified as having “Serious Emotional Disturbances,” seeking to resolve systemic mental healthcare breakdowns and the state’s failure to provide these children with the services they are entitled to under the federal Medicaid Act.

The case was tried in 2005, and a decision from the court was reached on January 6, 2006. The court found in favor of the plaintiffs and concurred that the Commonwealth of Massachusetts had violated certain provisions of the Medicaid Act related to not providing the home and community-based services to which the eligible children are entitled by law. This decision had profound and widespread implications for how the Commonwealth needed to restructure the established systems for purveying mental health services to children across the state. The findings of this case have had lasting effects and are largely responsible for the restructuring the infrastructure of children’s mental healthcare in Massachusetts. One major development resulting from the legal precedent set by Rosie D. v. Romney was establishing the Children’s Behavioral Health Initiative (CBHI).

## Background

The Rosie D. complaint was a response to what was described as a children’s mental health crisis that was being seen nationwide in the early 2000s. Many children with significant emotional and behavioral illnesses and disabilities were not receiving mental health care, and those who did receive care were often cycling through acute care, hospitalizations, or residential settings without improved prognosis. Concern was growing in Massachusetts regarding whether or not these children were able to access appropriate mental healthcare in a largely fragmented healthcare delivery system, resulting in many children stuck in institutions and unable to be supported to remain at home. Additionally, this lack of sufficient mental healthcare was determined to be contributing to the overuse juvenile justice and child welfare systems in the Commonwealth.

The Federal Medicaid program, authorized under Title XIX of the Social Security Act, 42 U.S.C § 139a, is a health insurance program operated jointly by federal and state governments to provide insurance access to low-income people. One of the provisions of the law is “Early Periodic Screening, Diagnosis, and Treatment (EPSDT).” 42 C.F.R. §441.50 states, “This subpart implements sections 1902(a)(43) and 1905(a)(4)(B) of the Social Security Act, by prescribing State plan requirements for providing early and periodic screening and diagnosis of eligible Medicaid beneficiaries under age 21 to ascertain physical and mental defects, and providing treatment to correct or ameliorate defects and chronic conditions found.”

## Case Litigation

The class action lawsuit was filed in the US District Court of Massachusetts on October 30, 2001. The Plaintiffs included Rosie D., Tyriek H., Joshua D., Sheena M., Devin E., Anton B., Nathan F., Shaun E., and Jerry N., Medicaid eligible children in Massachusetts between the ages of 6 to 15 who had been diagnosed with behavioral, emotional, or psychiatric illnesses or disabilities that put them at risk of hospitalization due to lack of appropriate home-based services. The class represented in the class action suit was the tens of thousands of other Medicaid eligible children in the state with similar illnesses and disabilities. The defendants included the then governor of the Commonwealth of Massachusetts Mitt Romney and other state officials responsible for overseeing the state’s Medicaid program, specifically related to the provision of mental healthcare services.

The complaint alleged that the Commonwealth was in violation of provisions of the Federal Medicaid by failing to provide medically necessary mental health screenings and comprehensive community-based mental health services.

The trial was held in 2005, lasting 6 weeks at the United States District Court, Western Massachusetts Division with Judge Michael A. Ponsor presiding. On January 26, 2006, Judge Ponsor passed down a ruling in favor of the plaintiffs, determining that the Commonwealth was in violation of the EPSDT provisions outlined in the complaint by failing to provide the necessary home-based assessment and intervention of eligible children of the state.

This judgement compelled the parties into negotiations for purposes of developing a remedial plan, but they were unable to agree. The plaintiffs and defendants submitted separate proposals for remedial action to be taken by the state, and on February 22, 2007 the court approved the defendants’ plan with modifications to accommodate concerns raised by the plaintiff’s plan.

The remedial plan sought to focus on coordination of the incongruent parts of the mental health care system that often function in silo in order to integrate existing systems with the added services necessary to meet the level of care dictated by federal law. To achieve this, they outlined that the Commonwealth must do all of the following:

1. Improve awareness and access to Early and Periodic Screening, Diagnosis, and Treatment for MassHealth eligible children and families.
2. Require primary care providers and pediatricians to conduct EPSDT. This screening must be conducted as standard practice in their healthcare delivery to children with appropriate evidence-based and standardized screening instruments. They must also provide referrals for all positive screenings. Similarly, state agencies will refer children to their primary healthcare providers for these screenings as needed.
3. Implement the Child and Adolescent Needs and Strengths (CANS) survey for facilitation of appropriate and accurate diagnoses for children with “serious emotional disturbance” as defined by the legislation. These diagnoses would then trigger appropriate referrals to Intensive Care Coordination (ICC) as appropriate.
4. Establish a collaborative and systematically established care management and treatment planning system for children with SED. This is important because a major failure point in previous system structure was lack of support for the many providers who are often involved in these high needs cases.
5. Develop intensive community and in-home behavioral, therapy, and mentoring services functioning in a collaborative and wrap-around model with the ICC.
6. Establish Community Service Agencies (CSAs) through collaboration with MassHealth and the Department of Mental Health to improve care coordination and accessibility in a state-wide network of service delivery.
7. Improve comprehensive data collection and monitoring to reduce the number of children falling through the cracks and not receiving or prematurely losing access to appropriate services and intervention.

1. ↑ 1.0 1.1 https://clearinghouse.net/case/11227/
2. ↑ http://www.rosied.org/page-89308
3. ↑ 3.0 3.1 Rosie-D\_Issue-Brief-WEB.pdf (bluecrossmafoundation.org)
4. ↑ Children's Behavioral Health Initiative (CBHI) | Mass.gov
5. ↑ Center for Public Representation - Goals and Objectives (rosied.org)
6. ↑ https://casetext.com/regulation/code-of-federal-regulations/title-42-public-health/chapter-iv-centers-for-medicare-medicaid-services-department-of-health-and-human-services/subchapter-c-medical-assistance-programs/part-441-services-requirements-and-limits-applicable-to-specific-services/subpart-b-early-and-periodic-screening-diagnosis-and-treatment-epsdt-of-individuals-under-age-21/section-44150-basis-and-purpose
7. ↑ 7.0 7.1 CPY Document (masslegalservices.org)
8. ↑ Center for Public Representation - About Rosie D.