JAN 27 1995 The Honorable Barbara Boxer United States Senator 1700 Montgomery Street Suite 240 San

Francisco, California 94111 Dear Senator Boxer: This letter is in response to your inquiry on behalf of your constituents, XX XX have complained that their health care insurance provider, CIGNA, has discontinued coverage for the services of a home health care aide for XX . They inquire whether this violates the Americans with Disabilities Act (ADA). It appears from the correspondence that CIGNA generally does not provide coverage for home health care aides for any policyholders, although they provided such coverage to XX for a time just after his coverage was transferred to CIGNA from another company. The ADA prohibits discrimination on the basis of disability. It does not guarantee that persons with disabilities will be able to obtain insurance coverage for all the medical services that they need. Home health care services are presumably needed and used by persons without disabilities as well as persons with different types of disabilities than XX . An insurance company's decision not to cover home health services in these circumstances would not appear to violate the ADA. I hope this information will be helpful to you in responding to your constituents. Sincerely, Deval L. Patrick Assistant Attorney General Civil Rights Division 01-03590​ XX XX NORWALK, CALIFORNIA 90650

December 1, 1994 Honorable Barbara Boxer United States Senate 2250 E. Imperial, #545 El Segundo, California 90245 RE; Problems with Group Insurance for Insured, XX Dear Senator Boxer: My husband, XX , has been ill since February 2, 1992, when he contracted Guillain Barre Syndrome. This is a debilitating virus which paralyses it's victims, from one extreme to another. My husband had a very serious case. He was paralyzed completely for 5 weeks and has been in a recovery stage ever since. He is currently home after having spent nineteen months in the hospital and still is in a wheelchair. XX insurance company changed from Pacific Mutual to CIGNA last March 1st. At that time CIGNA stated that they do not cover Home Health Aides, which he did have under the Pacific Mutual program. I debated that issue with them successfully, and they have since provided an aide for six hours each weekday although they said that it was an extra-contractural benefit. Now they want to cancel the Home Health Aide for no good reason. There have been some personnel changes with their company and I suspect that someone wants to make points by cutting expenditures. I wrote to them, appealing their decision. My appeal was based on the fact that the situation which was the basis of the decision to provide the service has not changed, as outlined in the excerpt below. All of the criteria used to authorize this service still exist. * The Home Health Aide still helps XX with exercises. These are routine therapy exercises, not just passive, range of motion-type exercises. They are exercises which the therapists have prescribed, not just of a type which I or XX believe he needs in addition to therapy * The Home Health Aide still helps XX get into and out of his standing frame on days when he does not have therapy. * XX still cannot prepare his own lunch and cannot necessarily even feed himself his lunch, depending on what form it may take. * It still is not safe for XX to be left alone all day. I cannot stay home with him. My paycheck is three-fourths of our income and we cannot make our commitments without it. So far as family help is concerned; my parents are elderly and infirm, and my father has terminal cancer, so they are unable to help; I have no sisters and only one brother who lives in 01-03591​

RE: Leslie Wilkinson, 12/1/94 Page 2 Northern California, so he is unable to help; XX family all lives out of State and they are unable to help. * Since it is not safe for XX to be alone all day, it is entirely possible that his Physician would recommend that he go back into a care facility and THAT would COST you a great deal more than a Home Health Aide." In addition to all of the above, I want to bring to your attention an article recently published in "Money", (October 19, 1994). I don't know if it was "Money Magazine" or something else, I only received a photocopy and it is not clear who published it. The article states that a federal appeals court ruling could prohibit insurance companies from putting caps on benefits for people with disabilities. The article states that the insurance companies could be deemed as the insured's employer because they are a contracted agent of the employer. Therefore the insurance company would be subject to the Americans with Disabilities Act. In addition, insurance carriers could be classified as a public accommodation, also subject to the A.D.A. If true, this could apply not only to the present subject, but to the physical/occupational therapy limitation which CIGNA has of sixty days, as well. I am writing to you in the hope that you may be able to aid us in this matter. I am hoping that during this appeals process you would be able to bring pressure to bear on them to continue the Home Health Aide services. Their appeals procedure supposed takes 30 days and I mailed my appeal two days ago. CIGNA set a precedent by authorizing the benefit to begin with and now they want to cancel it. If you are able to write to them I would appreciate it. Their address for appeals is: CIGNA HealthCare of California Member Services Department 505 North Brand Blvd., Suite 200 Glendale, California 91203 I thank you for your time I reviewing this matter and for any efforts you may be able to make on our behalf. If you do write to them, please send us a copy. My day-time telephone number, should you need it, is XX . Sincerely, XX REPSINS.DOC 01-03592