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Wells v. Kliebert

United States District Court, M.D. Louisiana

February 20, 2018

MONICA WELLS, on behalf of M.W., a minor, and others similarly situated
v.
KATHY KLIEBERT, Secretary of Louisiana Department of Health and Hospitals, and the LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

          RULING

          BRIAN A. JACKSON, CHIEF JUDGE UNITED STATES DISTRICT COURT.

         Before the Court is Plaintiffs' Motion to Alter or Amend Judgment and Alternatively for New Trial.[1] Defendants, the Louisiana Department of Health and Hospitals ("Department") and Dr. Rebekah Gee, in her official capacity as Secretary of the Department, have filed an Opposition to which the Plaintiffs have filed a Reply.[2] For the following reasons, the Plaintiffs' Motion shall be DENIED.

         I. RELEVANT PROCEDURAL BACKGROUND

         The factual background of this case is set forth in detail in the Court's Ruling denying Plaintiffs' Second Supplemental Motion to Enforce Stipulation and Order, and it is incorporated by reference herein.[3] The relevant procedural history is set forth below.

         On October 24, 2014, the Court entered an Order of Class Certification and Partial Dismissal.[4] In its Order, the Court also approved the parties' Stipulation and Order of Dismissal[5] and directed the parties to comply with the terms set forth therein. The Court explained that it would retain jurisdiction of the action to ensure that the Stipulation was implemented and enforced, and to resolve "any disputes that [might] arise in the future regarding the Stipulation and orders, their terms, or the enforcement thereof."[6]

         On July 31, 2017, the Court entered a Ruling denying Plaintiffs' Second Supplemental Motion to Enforce Stipulation and Order.[7] In its Ruling, the Court found that the Defendants had not violated the Stipulation by not issuing notices of denial during the first two stages of the screening process for service delivery through the Coordinated System of Care ("CSoC").[8] After reviewing the Brief Child and Adolescent Needs and Strengths ("CANS") manual for Louisiana and the CANS Comprehensive form, the Court also found that the Department was not in violation of the Stipulation for using the CANS measurement terms without offering an additional definition or explanation for said terms.[9] Finally, the Court found that the Department was not in violation for instructing Molina, its contractor that issues prior authorizations, not to issue notices of denial to recipients when the reasons for denial are (1) the requested procedure is specialty restricted (Code 237); (2) when the requested services are the responsibility of a nursing home or Intermediate Care Facility ("ICF/DD") (Code 988); (3) when the procedure does not require prior authorization (Code 025); and (4) when an invalid procedure code was used to request the item or service (Code 057).[10]

         Within 28 days of the Court's Ruling, the Plaintiffs filed a Motion to Alter or Amend Judgment and Alternatively for New Trial.[11]Plaintiffs argue that the Court's July 31, 2017 Ruling is "based on clear error and is manifestly unjust" on the following three grounds: the Court's "1) misidentificat[ion of] the timeframe upon which Plaintiffs filed their First Motion to Enforce; 2) err[or] in ruling that services are not denied during the 'initial screening' stages of the CSoC waiver, because services are available during the 'presumptive eligibility' stage; and 3) err[or] in ruling that there are no further definitions of the terms 'mild, ' 'moderate, ' and 'severe' in the Child and Adolescent Needs and Strengths (CANS) tool used in Stage 3 of [the] CSoC eligibility process."[12] The Defendants disagree with the Plaintiffs on each point.

         II. LAW

         Plaintiffs seek the entry of an order pursuant to Rule 59 of the Federal Rules of Civil Procedure to alter or amend the Court's July 31, 2017 Ruling.[13]A Rule 59(e) motion to alter or amend a judgment "calls into question the correctness of a judgment."[14] District courts have "considerable discretion in deciding whether to grant or deny a motion to alter a judgment."[15] Nevertheless, a motion for reconsideration of a judgment under Rule 59(e) is "an extraordinary remedy that should be used sparingly."[16] Amending a judgment under Rule 59(e) is appropriate: "(1) where there has been an intervening change in the controlling law; (2) where the movant presents newly discovered evidence that was previously unavailable; or (3) to correct a manifest error of law or fact."[17] A Rule 59(e) motion may not be used to re-litigate matters that have been resolved to the movant's dissatisfaction.[18] Nor is a Rule 59(e) motion a "proper vehicle for rehashing evidence, legal theories, or arguments that could have been offered or raised before entry of judgment."[19]

         In the alternative, Plaintiffs seek a Motion for New Trial. Rule 59(a)(1)(B) of the Federal Rules of Civil Procedure permits the granting of new non-jury trials (e.g., bench trials). However, because there has been no trial in this matter, the Court shall analyze Plaintiffs' alternative Motion for New Trial under the same standard applicable to Rule 59(e) motions to alter or amend judgments.

         III. ANALYSIS

         A. Factual Error

         Plaintiffs argue that a factual error made by the Court in its Ruling "is significant and merits correction as it incorrectly implies that Plaintiffs have been overly litigious or hasty in their action to seek judicial enforcement."[20] In its Ruling, the Court erroneously stated that the Plaintiffs had filed their Motion to Enforce Stipulation "less than one month" from the date the Court entered an Order of Class Certification and Partial Dismissal. The relevant portion of the Ruling states as follows:

On October 24, 2014, the Court entered an Order of Class Certification and Partial Dismissal ... In its Order, the Court also approved the parties' Stipulation and Order of Dismissal and directed the parties to comply with the terms set forth therein. The Court explained that it would retain jurisdiction of the action to ensure that the Stipulation was implemented and enforced, and to resolve "any disputes that [might] arise in the future regarding the Stipulation and orders, their terms, or the enforcement thereof."
Less than a month later, on November 17, 2015, the Plaintiffs filed a Motion to Enforce Stipulation, which was opposed.[21]

         Although the Court incorrectly described the filing of Plaintiffs' first Motion to Enforce Stipulation as being less than a month from the October 24, 2014 Order, it is clear that the November 17, 2015 date upon which this Motion was filed and was accurately captured in the Court's Ruling, occurred more than one year later.

         Even more importantly, this misprint played no part in the Court's analysis or reasoning of its July 31, 2017 Ruling. Initially, the Court points out that Plaintiffs' first Motion to Enforce Stipulation was not the subject of the Court's Ruling; rather, it was the Plaintiffs' Second Supplemental Motion to Enforce Stipulation and Order, which was filed on November 22, 2016.[22] Furthermore, the Court stated in its Ruling that its analysis would "focus on the issuance and substance of notices of denial during the CSoC process and the [Department's] decision not to require Molina to issue denial notices under all circumstances."[23] Based on the foregoing, the Court finds that its misprint does not amount to manifest error.

         B. Issuance of Notices of Denial During Initial Stages of CSOC Screening Process

         Plaintiffs argue that the Court's Ruling is factually and legally erroneous in finding that the notices of denial do not need to be issued during the two initial stages of the screening process for service delivery through the CSoC. Plaintiffs contend that a denial of eligibility during stages 1 and 2 of the CSoC screening process amounts to a "denial of prior authorized services and falls squarely within the definition of denial articulated in the Consent Decree."[24] Plaintiffs also argue that the Court ignored the record demonstrating that services are available during the presumptive eligibility period.[25] The Court disagrees.

         Rule 59(e) does not exist to give the Plaintiffs a "second bite at the apple."[26] In its prior Ruling, the Court addressed the very argument Plaintiffs present here: whether the first two stages of the screening process for the CSoC services fall within the scope of the Stipulation, thereby requiring written notices of denial.[27] In its reasoning, the Court relied upon the specific definitions of "denial" and "partial denial" as set forth in the Stipulation.[28] Contrary to Plaintiffs' position otherwise, the Court also devoted much discussion to the CSoC process and, in doing so, relied upon the Standard Operating Procedures manual for Louisiana CSoC.[29] In finding that denial notices were not required after the initial stages of the screening process (Stage 1, preliminary screening by managed care organization ("MCO"); Stage 2, Brief Child and Adolescent Needs and Strengths Tool ("CANS")), the Court stated as follows:

[T]he Court finds that the Plaintiffs' interpretation of the terms of denial and partial denial [within the Stipulation] is too broad. During the first two stages of the screening process, there have been no requests for prior approval of services made by a Medicaid provider on behalf of the child through Louisiana Medicaid in relation to service delivery through CSoC. As the Court interprets the CSoC process, the first two stages simply operate to determine who will be eligible to make such prior approval requests for those services that the MCO is unable to provide. Because there ...

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