Health care law win. Client’s family were attempting to obtain benefits so their aunt could enter an assisted living shelter. The State denied the application. The family turned to the lawyers at Kenny, Burns & McGill for assistance. The family was faced with an unfamiliar and complicated appeal process. Appeal process is in part below:
Medical Assistance (MA)
Client
You do not qualify for Medical Assistance because :
– the value of your resources is too high If you do not agree with this decision, fill out the enclosed Fair Hearing form and mail or give it to your caseworker. It must be postmarked or received on or before September 27, 2019.
Your countable resources are over the resource limit. This is the law we used to make this decision: 55 Pa. Code§ 178.1
Long Term Care (LTC)
You do not qualify for payment towards services in a Long Term Care (LTC) facility because: – you do not qualify for MA If you do not agree with this decision, fill out the enclosed Fair Hearing form and mail or give it to your caseworker by September 27, 2019. If the form is postmarked or received on or before September 12, 2019, you will continue to receive your benefits while you wait for the Fair Hearing decision.
Your countable resources are over the resource limit. You can find out more information about benefit options by contacting PA Link at www.aging.pa.gov/local-resources/pa- link/Pages/default.aspx or 1-800-753-8827.
If you are denied benefits or your benefits are being closed, you may not need to complete a new application.
There may be other services available if you live in a long term care facility or if you receive or need supports and services to help you live in your home or community, or if you have very high medical bills. If you have any of these special health care needs and want to know if you qualify, you can contact us.
If you need to contact us, you can contact the Statewide Customer Service Center or your County Assistance Office (CAO) Monday through Friday between 8 a.m. and 5 p.m.
Statewide Customer Service Center: 1-877-395-8930 County Assistance Office
Phone: 1-215-781-3300
Fax: 1-215-781-3438
If you have a disability and need this letter in large print or another format, please call our helpline at 1-800-692-7462. TDD Services are available at 1-800-451-5886.
To learn more about how we calculated and determined your benefits, see the eligibility handbooks at http://www.dhs.pa.gov/publications/policyhandbooksandmanualsl.id you know the Department of Human Services developed a mobile app called myCOMPASS PA?
Save time by sending your verification documents right from your smart phone using the myCOMPASS PA mobile app. Download the app today to:
- Upload documents
- Check Application and Benefit Status
- Retrieve username and password
- Report Changes
The Pennsylvania Department of Human Services (OHS) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. OHS does not exclude people or treat them differently because of race, color, national origin, age, disability, creed, religious affiliation, ancestry, gender, gender identity or expression, or sexual orientation.
OHS PROVIDES:
Free aids and services to people with disabilities to communicate effectively with us, such as:
Qualified sign language interpreters
Written information in other formats (large print, audio, accessible electronic formats, other formats)
Free language services to people whose primary language is not English, such as:
Qualified interpreters
Information written in other languages
If you need these services, contact your local county assistance office.
If you believe that OHS has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: The Bureau of Equal Opportunity, Room 223, Health and Welfare Building, P.O. Box 2675, Harrisburg, PA 17105-2675, (717) 787-1127, PA Relay Services 711, Fax (717) 772-4366, or Email – [email protected]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Bureau of Equal Opportunity is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services 200 Independence Avenue, SW
Room 509F, HHH Building Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at https://www.hhs.gov/ocr/office/file/index.html.
Your Right to Appeal and to a Fair Hearing
You can contact us if you have any questions about this notice…
You can call us:
You can call the Statewide Customer Service Center at 1-877-395-8930. In Philadelphia, call 1-215-560-7226.
The call is free. Call Monday through Friday between 8 a.m. and 5 p.m.
Or call the county assistance office (CAO) using the contact information listed in the CAO section of this notice.
You can talk to us before the hearing.
You will get a letter from the CAO asking if you want to meet before the fair hearing takes place. This meeting can be in person or on the telephone. A meeting before the hearing is called a pre-hearing conference. This meeting will not delay or replace your fair hearing. You can use this meeting to tell us if you have information that you think might change our decision. You can have someone speak on your behalf if you want to.
You can get a copy of any information we used to make our decision.
You can ask for a copy of all the documents that will be used at the hearing.
You can bring anyone to the hearing.
You can bring witnesses who might have information. You can speak for yourself or bring someone to speak for you who knows more about the rules of the program.
You can get help if you speak another language, are deaf, or have another disability.
You can ask for an interpreter to be at the fair hearing, or other assistance, on the attached Fair Hearing Form . This is a free service. You may bring a friend or relative to help you at the hearing but the department will provide the official interpreter.
Your rights
You have a right to appeal.
This means that you have the right to ask us to review our decision if you think we made a mistake. You can ask a judge to review the CAO’s decision at a fair hearing.
You have a right to a fair hearing.
A fair hearing is a formal meeting where you, the CAO, and a judge can talk about your appeal. The judge will follow the law and the department’s policies in making a decision. You should be prepared for the meeting. If you want to present any evidence that supports your claim that the decision was not correct, bring that evidence with you.
You have a right to appeal and to have an expedited Fair Hearing for Medical Assistance.
An expedited Fair Hearing may be granted when it’s determined that the normal time for review of an appeal would jeopardize your life, health, or ability to attain, maintain, or regain maximum function.
Your choices
You can ask for a fair hearing by:
Calling the Statewide Customer Service Center or the CAO to ask for a fair hearing, or
Mailing or hand delivering the completed, attached Fair Hearing Form to the CAO.
You can choose the kind of fair hearing you want:
A telephone hearing at a place you choose. Tell us which phone number to use, such as your own, or a friend or relative’s phone number. If you choose this kind of hearing, make sure we can reach you at this phone number.
The judge will call you, your witnesses, anyone helping you, and the CAO.
A telephone hearing at the CAO. You will go to the CAO for your hearing.
The judge will call you there in the office, and call your witnesses and anyone helping you.
A face-to-face hearing with you and the people you bring in the hearing room with a judge and CAO staff on the phone.
Your witnesses and anyone helping you will be in the hearing room with a judge. The CAO staff will be on the phone.
You must travel to the assigned Bureau of Hearings and Appeals office for a face-to-face hearing. The location will be assigned to you based on where you live.
A face-to-face hearing with you and the people you bring in the hearing room with a judge and the CAO staff in the hearing room.
The judge, you, CAO staff, witnesses, and anyone helping you will be in the room.
You must travel to the assigned Bureau of Hearings and Appeals office for a face-to-face hearing. The location will be assigned to you based on where you live.
You may continue to receive your benefits while you wait for your fair hearing if:
This letter tells you that your benefits will stop or be reduced and:
This letter provides you a date to request an appeal and continue your benefits while you wait for the Fair Hearing Decision, and
Your request for appeal is received or postmarked by that date and you do not waive continuation of benefits;
OR
This letter tells you that your benefits will stop or be reduced, and:
The reason for this change is because of information you provided on a semiannual reporting form, and
Your request for appeal is received or postmarked within 10 days of the mailing date on this letter and you do not waive continuation of benefits.
The judge will send you the decision within 90 days (within 60 days for SNAP) of the day you asked for the hearing. If the judge decides that the CAO made the right decision, your benefits will change or stop. You may have to pay back some or all of the benefits you got while waiting for your hearing.
During the hearing
You will have time to tell the judge your side of the case at the hearing.
Someone can speak for you (if you want), and your witnesses can speak. You may show documents to the judge.
You can appeal again if you do not agree with the judge’s decision.
The judge’s decision letter will tell you how to appeal.
Following appeal, Kenny, Burns & McGill was victorious and was happy to help another client. Health care law win.
For more about health care law win and other results please see our webpage.
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By
Kenny, Burns & McGill
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Published
June 10, 2020
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Posted in
Civil Litigation
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