Court Opinion

ID: 9364947
Source: CourtListenerOpinion
Date Created: 2023-01-20 19:00:30.62983+00
Date Added: 2024-06-11T17:15:41.503061
License: Public Domain

Case: 21-30580        Document: 00516617806             Page: 1      Date Filed: 01/20/2023

             United States Court of Appeals
                  for the Fifth Circuit
                                                                                United States Court of Appeals
                                                                                         Fifth Circuit

                                                                                       FILED
                                                                                January 20, 2023
                                       No. 21-30580                                  Lyle W. Cayce
                                                                                          Clerk

   A. A., by and through his mother, P.A.; B. B., by and
   through her mother, P.B.; C. C., by and through her
   mother, P.C.; D. D., by and through his mother, P.D.; E.
   E., by and through his mother, P.E.; F. F., by and
   through her mother, P.F.,

                                                                   Plaintiffs—Appellees,

                                            versus

   Courtney N. Phillips, Dr., in her official capacity as
   the Secretary of the Louisiana Department of Health;
   Louisiana Department of Health,

                                                               Defendants—Appellants.

                     Appeal from the United States District Court
                         for the Middle District of Louisiana
                               USDC No. 3:19-CV-770

   Before Higginbotham, Duncan, and Engelhardt, Circuit Judges.
   Per Curiam:*

         *
             This opinion is not designated for publication. See 5th Cir. R. 47.5.
Case: 21-30580        Document: 00516617806             Page: 2      Date Filed: 01/20/2023

                                        No. 21-30580

           Medicaid-eligible children living in Louisiana allege that the Louisiana
   Department of Health (the “Department”) fails to provide them and
   similarly situated children with intensive home- and community-based
   services (“IHCBS”) needed to treat their diagnosed mental health or
   behavioral health conditions, as required by Medicaid’s Early and Periodic
   Screening, Diagnostic, and Treatment (“EPSDT”) mandate. Plaintiffs on
   behalf of themselves and a putative class of similarly situated Medicaid-
   eligible children sued the Department and its Secretary for violating
   Plaintiffs’ rights to necessary treatment under EPSDT and to treatment in
   the least restrictive setting under the ADA and Rehabilitation Act. The
   district court certified the class, which Defendants appeal. We VACATE
   the class certification and REMAND the case for further proceedings
   consistent with this opinion.
                                              I.
           Plaintiffs are six Medicaid-eligible children residing across Louisiana
   who have been diagnosed with mental health or behavioral health conditions.
   Plaintiffs allege that the Department fails to provide Plaintiffs and similarly
   situated children across Louisiana with the IHCBS needed to treat their
   conditions, as required by Medicaid’s EPSDT mandate. Under the EPSDT
   mandate, Medicaid-administering agencies like the Department must
   provide or arrange for all “necessary health care, diagnostic services,
   treatment, and other measures described in subsection (a),” which
   encompasses all services identified as medically necessary by a health
   professional. 1

           1
             42 U.S.C. §§ 136d(a)(13), 1396d(r)(5). Congress amended the EPSDT provision
   in 1989 to impose “a mandatory duty upon participating states to provide EPSDT-eligible
   children with all . . . treatments and other measures described in § 1396d(a) of the Act,

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Case: 21-30580           Document: 00516617806             Page: 3   Date Filed: 01/20/2023

                                            No. 21-30580

           Plaintiffs’ core allegation is that the Department maintains a policy of
   not providing IHCBS, which the district court defined as “intensive care
   coordination, crisis services, and intensive behavioral services and supports
   that are necessary to correct or ameliorate [Plaintiffs’] mental illnesses or
   conditions.” Plaintiffs allege that the Department instead only provides basic
   mental health interventions such as medication management and infrequent
   counseling. As a result, Medicaid-eligible children requiring intensive mental
   health care are untreated and, when they inevitably experience mental health
   crises, are forced to seek emergency care or psychiatric institutionalization.
           In 2019, Plaintiffs, on behalf of themselves and a putative class of
   similarly situated Medicaid-eligible children in Louisiana, sued the
   Department and its Secretary, Dr. Courtney Phillips, in her official capacity,
   (collectively “LDH”) contending that LDH’s failure to provide IHCBS
   violates their right to medically necessary treatment under Title XIX of the
   Social Security Act (the “Medicaid Act”) 2 and violates their right to
   treatment in the least restrictive setting under Title II of the ADA 3 and the
   Rehabilitation Act. 4 The district court certified a class under Rules 23(a) and
   (b)(2) consisting of:
           All Medicaid-eligible youth under the age of 21 in the State of
           Louisiana (1) who have been diagnosed with a mental health or
           behavioral disorder, not attributable to an intellectual or
           developmental disability, and (2) for whom a licensed
           practitioner of the healing arts has recommended intensive

   when necessary to correct or ameliorate health problems discovered by screening . . . .”
   S.D. ex rel. Dickson v. Hood, 391 F.3d 581, 589–90 (5th Cir. 2004) (emphasis added).
           2
               42 U.S.C. § 1396(a)(13).
           3
               42 U.S.C. § 12132, et seq.
           4
               29 U.S.C. § 701, et. seq.

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                                            No. 21-30580

           home- and community- based services to correct or ameliorate
           their disorders.
   LDH appeals the class certification, arguing that the class is not
   ascertainable, the district court abused its discretion in certifying the class,
   and the district court failed to conduct a rigorous analysis.
                                                  II.
           We review a district court’s decision to certify a class for abuse of
   discretion. 5 A district court “maintains great discretion in certifying and
   managing a class action.” 6 We will reverse a class certification if a district
   court “abuses its discretion when its ruling is based on an erroneous view of
   the law or a clearly erroneous assessment of the evidence.” 7 “Implicit in this
   deferential standard is a recognition of the essentially factual basis of the
   certification inquiry and of the district court’s inherent power to manage and
   control pending litigation.” 8 “Whether the district court applied the correct
   legal standard in reaching its decision on class certification, however, is a legal
   question that we review de novo.” 9

           5
               M.D. ex rel. Stukenberg v. Perry, 675 F.3d 832, 836 (5th Cir. 2012).
           6
            Berger v. Compaq Comput. Corp., 257 F.3d 475, 478 (5th Cir. 2001) (quoting Mullen
   v. Treasure Chest Casino, LLC, 186 F.3d 620, 624 (5th Cir. 1999)).
           7
              Yates v. Collier, 868 F.3d 354, 359 (5th Cir. 2017) (quoting Bocanegra v. Vicmar
   Servs., Inc., 320 F.3d 581, 584 (5th Cir. 2003)).
           8
             Stukenberg, 675 F.3d at 836 (quoting Maldonado v. Ochsner Clinic Found., 493 F.3d
   521, 523 (5th Cir. 2007)).
           9
             Berger, 257 F.3d at 479 (quoting Allison v. Citgo Petroleum Corp., 151 F.2d 402, 408
   (5th Cir. 1998)).

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                                          No. 21-30580

                                              III.
           For class certification to succeed under Rule 23, the class “must be
   adequately defined and clearly ascertainable.” 10 To be ascertainable, the
   class must be susceptible to a precise definition to properly identify “those
   entitled to relief, those bound by the judgment, and those entitled to
   notice.” 11 The district court “need not know the identity of each class
   member before certification[,]” but it needs to “be able to identify class
   members at some stage of the proceeding.” 12 “The order defining the class
   should avoid subjective standards (e.g., a plaintiff’s state of mind) or terms
   that depend on resolution of the merits (e.g., persons who were discriminated
   against).” 13 “There can be no class action if the proposed class is
   ‘amorphous’ or ‘imprecise.’” 14 “[T]he possibility that some [claimants]
   may fail to prevail on their individual claims will not defeat class

           10
              DeBremaecker v. Short, 433 F.2d 733, 734 (5th Cir. 1970); see also John v. Nat'l
   Sec. Fire & Cas. Co., 501 F.3d 443, 445 (5th Cir. 2007) (“The existence of an ascertainable
   class of persons to be represented by the proposed class representative is an implied
   prerequisite of Federal Rule of Civil Procedure 23.” (footnote omitted)).
           11
           In re Monumental Life Ins. Co., 365 F.3d 408, 413 (5th Cir. 2004) (quoting 5 JAMES
   W. MOORE ET AL., MOORE’S FEDERAL PRACTICE § 23.21[6] (Matthew Bender 3d ed.
   1997)).
           12
               Seeligson v. Devon Energy Prod. Co., L.P., 753 F. App’x 225, 230 (5th Cir. 2018)
   (unpublished per curiam) (quoting Frey v. First Nat’l Bank Sw., 602 F. App’x 164, 168 (5th
   Cir. 2015) (unpublished per curiam)). The ascertainability standard is less burdensome in
   this circuit than in others, which require that the class be readily ascertainable at
   certification. See id. at 230 (discussing the Third Circuit’s requirements).
           13
             Plaza 22, LLC v. Waste Mgmt. of La., LLC, No. CIV.A. 13-618-SDD, 2015 WL
   1120320, at *3 (M.D. La. Mar. 12, 2015) (quoting MANUAL FOR COMPLEX LITIGATION §
   21.222 at *1 (4th ed. 2004)).
           14
           John, 501 F.3d at 445 n.3 (quoting 5 JAMES W. MOORE ET AL., MOORE’S
   FEDERAL PRACTICE § 23.21[1] (Matthew Bender 3d ed. 1997)).

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                                         No. 21-30580

   membership’ on the basis of the ascertainability requirement.” 15 Ultimately,
   “the touchstone of ascertainability is whether the class is ‘sufficiently
   definite so that it is administratively feasible for the court to determine
   whether a particular individual is a member.’” 16
           LDH argues that the class definition is not ascertainable because it is
   not clear which services are included in the term “IHCBS” and which are
   not. We agree. The district court defined IHCBS as “intensive care
   coordination, crisis services, and intensive behavioral services and supports
   that are necessary to correct or ameliorate [class members’] mental illness or
   conditions.” These three terms are not defined, nor are they specific, billable
   behavioral health services ordered by a doctor or licensed mental health
   professional. Billable specialized behavioral health services include things
   like psychosocial rehabilitation or community psychiatric support and
   treatment. Here, it is not clear which care coordination services and
   behavioral services are “intensive,” falling within the IHCBS definition, and
   which are not. Knowing which services IHCBS encompasses is essential to
   evaluating whether an individual is a class member.
           The district court found that the class definition was ascertainable in
   large part because IHCBS is the “functional equivalent” to specialized
   behavioral health (“SBH”) services that Louisiana state law mandates. 17

           15
              In re Deepwater Horizon, 739 F.3d 790, 821 (5th Cir. 2014) (quoting In re
   Rodriguez, 695 F.3d 360, 370 (5th Cir. 2012)); see also McKeage v. TMBC, LLC, 847 F.3d
   992, 999 (8th Cir. 2017) (holding that manual review does not preclude ascertainability).
           16
           Brecher v. Republic of Argentina, 806 F.3d 22, 24 (2d Cir. 2015) (quoting 7A
   CHARLES ALAN WRIGHT & ARTHUR R. MILLER ET AL., FEDERAL PRACTICE &
   PROCEDURE § 1760 (3d ed. 1998)).
           17
             See La. Admin. Code tit. 50, Pt. XXXIII, § 2101 (2021) (“The specialized
   behavioral health services rendered to children with emotional or behavioral disorders are

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                                           No. 21-30580

   Because the Louisiana Legislative Auditor reports on SBH services available
   to Louisiana’s Medicaid recipients and LDH has responded to those
   findings, the district court reasoned that LDH must understand what
   services are included in SBH, and thus understand what services are included
   in its “functional[ly] equivalent” IHCBS. But “functional equivalent” does
   not mean that SBH services are identical to IHCBS. For example, while some
   SBH services, like inpatient care and long-term residential care, 18 are
   presumably not included in IHCBS, it is not clear if other SBH services, like
   group therapy, functional family therapy, and homebuilders services, 19 are
   encompassed in IHCBS. Accordingly, we are not convinced that LDH’s use
   of the term SBH services indicates an understanding of what services are
   included in IHCBS. 20

   those services necessary to reduce the disability resulting from the illness and to restore the
   individual to his/her best possible functioning level in the community.”).
           18
             LOUISIANA LEGISLATIVE AUDITOR, ACCESS TO COMPREHENSIVE AND
   APPROPRIATE SPECIALIZED BEHAVIORAL HEALTH SERVICES IN LOUISIANA, LA. DEP’T
   HEALTH                  1                (Feb.          14,             2018),
   https://www.lla.la.gov/PublicReports.nsf/B99F834BF8F4AB908625823400758F9B/$F
   ILE/000179B4.pdf.
           19
              Id. at 6, 14. Functional family therapy “[t]argets youth primarily demonstrating
   externalizing behaviors or at risk for developing more severe behaviors which affect family
   functioning.” Id. at 6. Homebuilders services “[t]argets families with children at imminent
   risk of out-of-home placement or being reunified from placement.” Id. It is not clear to us
   whether these services would be considered “intensive care coordination, crisis services,
   and intensive behavioral services and supports that are necessary to correct or ameliorate
   [class members’] mental illness or conditions.”
           20
               We recognize that an Illinois district court approved a class with an identical
   definition. N.B. v. Hamos, 26 F. Supp. 3d 756, 762 (N.D. Ill. 2014). However, the defendant
   in that case did not object to the use of the term “IHCBS.”

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                                    No. 21-30580

          We hold that the term IHCBS, as defined by the district court, is too
   vague to identify class members, and that the class—as currently defined—
   is unascertainable.
                                        IV.
          We VACATE the class certification and REMAND the case to the
   district court for further proceedings consistent with this opinion to clarify
   which services are included in the term IHCBS. Because further proceedings
   may impact the Defendants’ remaining claims that the district court abused
   its discretion certifying the class under Rules 23(a)(1)–(4) and (b)(2) and
   failed to conduct a rigorous analysis, we do not address those claims now.

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