Friday, July 27, 2007

Medicaid consumers have no Due Process Rights re: defunding of Community Support Services: WHAT GIVES?

When DHHS began outlining Community Support, how did they speak about it?:
FROM: Allen Dobson, MD Mike Moseley SUBJECT: Enhanced Services Implementation January 19, 2006 MEMORANDUM These new services become effective Monday, March 20, 2006. ".....Medicaid eligible consumers are entitled to due process rights. Medicaid eligible consumers must receive a formal notification, including notification of their appeal rights, for any services that Medicaid continues to cover that are removed from the plan through this procedure. See the discussion of due process notices later in this document.] ... Subjects for Future Updates: Due Process Issues As noted earlier in this correspondence, many Medicaid eligible consumers will need to receive formal notification of service changes and their associated appeal rights as a result of implementation of the new services. We will distribute to LMEs and providers in the next few weeks a standardized letter to be used in those required notices. "
http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servdefupdates/
servdefimplementation1-19-06dmadmh-memo.pdf
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Just how was Community Support envisioned in May, 2007 as per document from DHHS? (bold is mine)
http://www.ncdhhs.gov/mhddsas/servicedefinitions/commsupports/csservdef-referencesheets5-07.doc
"Community Support – Children/Adolescents (MH/SA)Key Elements
Service Definition and Required Components
rehabilitative, and recovery goals.
psychoeducational and supportive in nature .
consists of a variety of interventions: Education and training of caregivers
Preventive and therapeutic interventions
Assist with skill enhancement or acquisition, and support ongoing treatment and functional gains.
Assist the recipient in accessing benefits and services.
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And so can someone tell me how DHHS and by proxy, the LME's, gotten away with limiting ---across the board------Community Support to 12 hours/ week/ consumer WITHOUT advising Medicaid consumers of Due Process Rights?
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Medicaid Appeal cases: http://www.nls.org/conf/dueprocess.htm
MEDICAIDDUE PROCESS ISSUES - NOTICE AND HEARINGS
III. Case Law Concerning Medicaid Fair Hearing
A. Denial, Suspensions, Terminations & Reductions, i.e. Changes in Care
C. Across-the-Board Changes (Sole Issue of Federal or State Law)
Eder v. Beal, 609 F.2d 695 (3d Cir. 1979), cert. Denied, 444 U.S. 950 (1979). Notice required to implement various across-the-board reductions in Medicaid benefits.
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FACT SHEET
MEDICAID’S AMOUNT, DURATION AND SCOPE REQUIREMENT:
CHALLENGING CUTS TO SERVICES FOR ADULTS
Prepared by:
Sarah Somers, Staff Attorney
National Health Law Program
March 31, 2004
"...Beneficiaries have challenged the sufficiency of Medicaid services numerous times over the past thirty years, however, no concrete rule has emerged as to what constitutes a sufficient amount of services.....“the Medicaid agency may not arbitrarily deny or reduce the amount, duration or scope of a required service under §§ 440.210 and 440.220 to an otherwise eligible recipient solely because of the diagnosis, type of illness or condition.”36"

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