From: Summer Harrison <summer@aloha.

net>
Subject: email
Date: July 5, 2010 10:55:24 AM HST
To: summer@childrensdisabilityrights.org

Alston, Hunt, and Floyd filed a lawsuit on behalf of the Hawai'i Disability Rights Center in the First Circuit
Court State of Hawai'i asking for injunctive relief on June 22, 2010.

The defendant in this case is the Department of Health (DOH) Adult Mental Health Division (AMHD)
which claims are based on cuts to services to clients who are severely mentally ill.

In further research of the issue Alston, Hunt, and Floyd failed to discover that the contract for these services
are held by the Department of Human Services (DHS) with the Federal Government and oversight of DOH-
AMHD is solely the responsibility of DHS not DOH.
(See Exhibit A)

The ultimate responsibility lays in the hands of Department of Human Services for this lawsuit for two
reasons.
(1) The draw down for AMHD is through Department of Human Services who remains contractually
responsible for these services.
(2) There is a Memorandum of Agreement between DOH and DHS which sets the parameters for DOH-
AMHD services.

MEMORANDUM OF
AGREEMENTS
(MOA): BRANCH/OFFICE CONTACT
Dept of Health/Adult Start Extension
Mental Health Div date Potential
(AMHD) HCSB/Patti Bazin CFO/Brian Higgins 7/01 06/30
Dept of Health /Child HCSB/Patti Bazin
& Adoles Mental Hlth
Div (CAMHD) Chief/Dr Stanton Michels
Dept of Health/Early HCSB/Patti Bazin Extension
Intervention Section Potential
(EIS) Chief/Sue Brown 06/30/11
HCSB/Patti Bazin

Dept of Public Safety Deborah Stampfle

HCSB/Patti Bazin Start
date End date
Dept of Education Eric Rolseth 7/01/07 6/30/10
PACE (Program for HCSB/Patti Bazin
All-Inclusive Care for Hale Makua & Kaiser
the Elderly (Maui)

There is also a conflict of interest that Alston, Hunt, and Floyd must disclose to Court as they represent
Evercare in their QExA contract which would also be a co-defendant in this case as the issues brought by the
plaintiffs surrounding lack of access as well as co-pays will expose the lack of coordination between QExA
Healthplans (Evercare and 'Ohana) and DOH.

Under the 1115 Waiver for the State of Hawai'i between the Federal Government and DHS the provision
reads. (See Exhibit 1115 Waiver)

"g) Behavioral Health Benefits. All QEx and QExA plans will provide a full array of basic behavioral
health benefits to members who may need such services. In addition, some members may opt to receive
additional, specialized behavioral health services that are not available through the capitated managed care
program as described below. Expenditures for beneficiaries who exercise this option will be paid fee for
service by the State. By November 1, 2008 the State is required to provide a protocol that provides the
following:
(i) Services provided by the DOH Child and Adolescent Mental Health Division (CAMHD) to children with
serious emotional behavioral disorders (SEBD).
(ii) Services provided by the DOH Adult Mental Health Division (AMHD) to adults with serious mental
illness (SMI).
(iii)Behavioral health and substance abuse services provided fee-for-service to individuals who are SEBD or
SMI but who are not receiving services through AMHD or CAMHD.
(iv)A memorandum of agreement (MOA) that reflects the current interagency agreement for behavioral
health services provided by the DOH to demonstration eligibles.
(v) The process and protocol used for referral between MCOs and the DOH, as well as the DOH and
MCOs."

To date there has been no protocol established and the QExA healthplans remain liable until such protocol is
established.

This lawsuit will expose DHS as a payer and holder of applicable contracts with oversight responsibilities for
DOH-AMHD. Ultimately the Plaintiffs are suing the State of Hawai'i specifically in this order: DHS
(contractually obligated to the Federal Government for oversight), DOH (agreement with DHS), Evercare
(coordination and responsibility of managing services for a number of AMHD clients), 'Ohana (coordination
and responsibility of managing services for a number of AMHD clients).

Under the 1115 Waiver for the State of Hawai'i between the Federal Government and DHS the provision
reads.

"33. Service Coordination Model. After a recipient selects a health plan, the health plan will assign a
licensed or qualified professional as the beneficiaries’ service coordinator. The following are required to
ensure QExA program integrity.
a) Service Coordinator Responsibilities...
iv. Coordinating services with other providers such as physician specialists, Medicare fee-for-service and/or
Medicare Advantage health plans and their providers, mental health providers at DOH, and MR/DD
providers;"

Alston, Hunt, and Floyd should have followed the money before filing, let's see what happens next.

All monies for services are drawn down by DHS.

ARRA FMAP - 66.13% As of 3/24/09

FY 09 FY 10 FY 11 Total

FMAP for MQD 92,970,381 131,760,951 50,028,369 274,759,701

AMHD 1,861,500 2,531,764 870,311 5,263,575
CAMHD 1,979,666 3,042,537 1,045,893 6,068,096
DDD 9,813,478 14,473,221 4,975,266 29,261,965
DOE 173,154 189,284 65,067 427,505

Grand Total 106,798,179 151,997,757 56,984,906 315,780,842

FMAP for DOH 13,654,644 20,047,522 6,891,470 40,593,636