From Selfhelp Community Services, Inc. (4.29.11):
Medicaid Budget Cuts Triggering Illegal Cuts in Certified Home Health Services -- Know Your Client's Rights - Federal Court Suit Filed
A federal lawsuit has been filed challenging arbitrary cuts in Medicaid Certified Home Health Agency (CHHA) services, precipitated by changes in reimbursement enacted in the State budget , some of which were effective immediately - on April 1, 2011. Click here for the Press Release by the New York Legal Assistance Group describing the lawsuit and giving contact information for people affected by these cuts. Click here to see the Complaint.
The changes in reimbursement and other budget changes are described here Fundamental Changes to NYS Medicaid in 2011 State Budget. None of these changes requires or allows immediate reduction or termination of CHHA services.
Since April 1st, there have been numerous reports of some CHHAs sharply reducing hours of home health aide services, or of refusing to reinstate home health aide services after their patients were hospitalized or in short-term rehabilitation. CHHAs have misinformed patients and their families that Medicaid law no longer allows 24-hour care. These actions violate existing state law and regulations.
On April 8, 2011, the State Commissioner of Health sent all CHHA administrators a directive reminding them of some of the requirements under state law. See DOH Letter April 8, 2011.
On April 15, 2011, the Commissioner issued a second Dear Administrator Letter further fleshing out the existing due process protections of CHHA applicants and recipients. See DOH Letter April 15, 2011.
On April 21 , 2011, the New York Legal Assistance Group filed a lawsuit in federal court in the Eastern District of New York, challenging these cutbacks and seeking to restore home care services for individual clients. See news article , the complaint, and their press release.
The State letter confirms that these changes in reimbursement alone do not allow CHHAs to reduce home health aide services that were previously authorized. Similarly, if a CHHA client is hospitalized, or in temporary short-term rehabilitation, these changes do not allow the CHHA to abandon them -- the CHHA must reinstate the same home health services after the hospital or rehab stay is over, if the client continues to need the services as prescribed by his/her treating physician...
WHAT TO DO:
1. Make sure the treating physician provides the CHHA with a written statement of their professional opinion as to the medically necessary amount of home health aide services needed by their patients.
2. Request a Fair Hearing if hours are reduced or if services are not reinstated in the amount provided before a temporary hospital or rehab stay. Make sure to request AID CONTINUING. Provide the name and contact number of the CHHA and a copy of the treating physician's written statement if you have it. To request a hearing, go to this site http://projectfair.org/request_form.html (except note that in-person requests in NYC can no longer be filed at 330 W. 34th Street).
3. If you need legal advice or representation, call one of the following:
- New York Legal Assistance Group -- (212)-613-5000 (advice and representation)(NYLAG is counsel in the lawsuit challenging these cuts in CHHA servicess)
- Selfhelp Community Services - (212) 971-7658 (advice only)
- Legal Aid Society Health Law Unit (212) 577-3575 (advice only)
- Empire Justice Center (800) 635-0355 (technical assistance to professionals - outside of NYC)
4. In addition to (not instead of) requesting a fair hearing, file a complaint with the NYS Dept. of Health -
The New York State Department of Health, Division of Home and Community Based Care is responsible for investigating complaints and incidents for home care agencies and hospices in New York State. The federally mandated Home Health Hotline (1-800-628-5972) can be called 24 hours per day, seven days per week. The hotline is manned by Division of Home and Community Based Care staff from 10 a.m. to 4 p.m. Monday through Friday. Complaints and incidents may also be submitted by fax (518-408-1636) or by mail to:
Bureau of Home Care/Hospice Surveillance and Quality Indicators/Evaluation
161 Delaware Avenue
Delmar, New York 12054
Alternatively, you may send an e-mail to hmhscsurv@health.state.ny.us with the nature of the complaint. We also would appreciate if you would optionally provide us with your e-mail address, contact number, and name, so that we may contact you promptly regarding the complaint.
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