Massachusetts Court of Appeals Rules MassHealth Must Review Payment Denial for Teenager's HIV-Related Surgery
February 21, 2008
A three-judge panel of the Massachusetts Court of Appeals on Tuesday ruled that MassHealth, the state's Medicaid provider, must review its decision to deny a claim filed in 2004 on behalf on a 15-year-old HIV-positive girl who underwent surgery to remove a growth on her neck caused by antiretroviral drugs, the Boston Globe reports (Ellement, Boston Globe, 2/20).
In addition, the court said the main issue in the case was not the time the request was made but whether the procedure was medically necessary and ordered MassHealth to decide the case on those grounds. Judge Elspeth Cypher in the opinion said the panel rejects MassHealth's "view that the review of Ashley's claim may be terminated because the procedure had been performed without authorization."
Jennifer Kritz, a spokesperson in Massachusetts' Executive Office of Health and Human Services, said MassHealth is reviewing the ruling and declined to comment further (Boston Globe, 2/20). Janson Wu -- an attorney with Gay & Lesbian Advocates & Defenders, which argued the case on behalf of the Shaws -- said the ruling is the "first time" a Massachusetts court "has ruled that MassHealth is misapplying their prior authorization regulation in this way," adding that the agency "ignore[d] the purpose" of the regulation in denying the original request (AP/Worcester Telegram, 2/19).
This article was provided by Henry J. Kaiser Family Foundation. It is a part of the publication Kaiser Daily HIV/AIDS Report. Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.