Rosie D.
Reforming the Mental Health System in Massachusetts

A Timeline of the Case



October 30:  Rosie D. lawsuit is filed in the US District Court of Massachusetts against the Governor and various state officials of the Commonwealth.  The plaintiffs are represented by the Center for Public Representation, WilmerHale, and the Mental Health Legal Advisors Committee.



March 29: US District Court Judge Michael A. Ponsor denies the Commonwealth’s motion to dismiss the case and certifies the case as a class action lawsuit.  As a result, the nine named plaintiffs represent all Medicaid-eligible children in Massachusetts with psychiatric or emotional disabilities who would benefit from home-based services.


November 7: The United States Court of Appeals rejects the State’s appeal of its motion to dismiss and holds that children have an enforceable right under the Medicaid Act to medically necessary treatment.



January – March: The plaintiffs begin discovery, requesting documents from eight state agencies and five managed care companies, noticing 30 fact depositions, and assembling several expert teams.


April:  The Court rejects the defendants’ refusal to produce documents and respond to questions from managed care organizations and several state agencies.  The Court issues a broad protective order that allows discovery of confidential information from both class members and non-class members.


May: The plaintiffs’ first team of experts reviews existing mental health services and programs in Massachusetts.


August: Clinical experts review each of the named plaintiffs and recommend immediate actions to address their needs.



January – June:  Depositions continue, experts conduct additional reviews, and over 200,000 pages of documents are received, read, and indexed.


July: The plaintiffs’ Medicaid financing expert conducts a fiscal analysis of Massachusetts’ current spending on institutional care and develops a cost-effective model for providing home-based services.


September:    Another expert selects a random sample of 43 children with SED.  Five children’s mental health clinicians meet these children, their parents/guardians and therapists, and evaluate their need for home-based services.


September 30: Fact cut-off date for information to be presented at trial.


October-November: The plaintiffs submit twelve reports from their children’s mental health clinicians, program reviewers, Medicaid financing expert, EPSDT expert, and national researchers on home-based services.


December: The defendants submit reports from five experts.  The plaintiffs submit rebuttal reports from four additional experts.


One of the original nine plaintiffs withdraws from the case.  The lawsuit proceeds to trial with eight named plaintiffs representing a class of tens of thousands of Medicaid-eligible children with SED.



February:  The defendants’ motion for summary judgment is heard, and subsequently denied.


March: All of the defendants’ pre-trial motions are denied. 


April – June: Six-week trial before Judge Ponsor.  The parties present 45 witnesses and introduce more than 500 exhibits.


July: Plaintiffs and defendants file voluminous proposed findings of fact.


August:  Judge Ponsor hears closing arguments from both sides and takes the matter under advisement. 



January 26: Judge Ponsor issues landmark decision that finds the Commonwealth is violating the EPSDT provisions of the Medicaid Act by failing to provide necessary services to children with SED and failing to provide them promptly. Judge deplores the state’s “woefully inadequate” efforts to comply with federal law with disastrous consequences to vulnerable children.  He orders both sides to negotiate a remedial plan to address these violations and systemic deficiencies.


August: After six months of intensive negotiations that fail to produce agreement, each party submits its own proposed remedial plan.


October - November:  Each party files objections to the other’s proposed plan.  The plaintiffs submit 11 affidavits from experts critiquing the State’s plan.


December: Court hearing on remedial plans.











































February 22:  The Judge adopts the Commonwealth’s proposed remedial plan with four major modifications that reflect key provisions of the plaintiffs’ proposed plan.  The Judge’s order, approving the plan sets firm timetables: services must be in place by June 2009. 


May:  Following recommendations of the parties, the Court appoints Karen Snyder as Court Monitor.  Her role is to over see the implementation of the Plan, mediate disputes and ultimately determine compliance.


May:  The Commonwealth names Emily Sherwood as the Rosie D. State Coordinator.


July 16: The Court enters its final judgment, incorporating the revised Remedial Plan with an additional modification which ensures that all children with SED are entitled to medically necessary home-based services.


August: The parties begin designing the new children's mental health sytem


December 31: New screening for behavioral health issues begins by primary care clinicians



January: In response to the plaintiffs' motion to provide remedial services to children in all Medicaid expansion populations, the defendants agree to serve all Medicaid-eligible children, regardless of coverage categories.  


March: MassHealth submits State Plan Amendments for taregeted case management and EPSDT services to cover remedial services.


June - September: parties develop medical necessity criteria and program specifications for each remedial service.


November 30: Mental health evaluations using the CANS instrument required initiated for all Medicaid-eligible children referred for services.


December 2: CMS approves State Plan Amendment for targeted case management (Intensive Care Coordination) 


February: court allows modest extension of time to implement four of the seven remedial services;  requires full implementation of all services by December 1, 2009


March: new Community Service Agencies (CSAs) selected


April: new Emergency Service Providers selected; provider networks for other remedial services selected


May: Monitor issues recommendation on caseload limits for care coordinators; wraparound training of CSA staff


June 4: CMS approves EPSDT State Plan Amendment for other remedial services


June: state agency protocols released for DCF, DMH, and DYS; state agency staff trained; ulitization management procedures finalized; CSA Operations Manual issued


June 30: ICC, family partners, and mobile crisis services begin  





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