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appeals

 
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srinne



Joined: 24 Oct 2005
Posts: 3

PostPosted: Wed Dec 21, 2005 6:53 pm    Post subject: appeals Reply with quote

I just received notification that 31 of our 63 appeals were denied. This information came via an email and included no information about the basis for the denial. What are others experiencing and what is the appeal of the appeal process? This did not come with the information either.
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Nancy Swaim



Joined: 26 Oct 2005
Posts: 17

PostPosted: Fri Dec 23, 2005 8:56 am    Post subject: appeals Reply with quote

It seems that only those requests that had 'place holder rates' are being altered.

Only providers are being notified of denials, case managers and the consumer are not aware of the denials.

I am aware of only 1 increase for a person living at home and the case seems no different than others who filed similar requests.

Many families filed appeals with the Office of Hearings and Appeals at FSSA. I have not heard of anyone having a response and I believe the deadline is past for a response.
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Nancy Swaim



Joined: 26 Oct 2005
Posts: 17

PostPosted: Fri Dec 23, 2005 9:03 am    Post subject: appeals Reply with quote

I should check my facts before I reply. I just re-read the appeal procedure and apparently there is no timeline for response from the Office of Hearings and Appeals. There is only a requirement that the person filing the appeal be notified of the hearing date at least 10 days prior to it being held.
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noplacelikehome



Joined: 22 Oct 2005
Posts: 45

PostPosted: Tue Jan 03, 2006 8:58 pm    Post subject: Reply with quote

Get this. In the case of people whose rate change is denied, the info goes in a mass email to the provider with no appeal rights info attached. On the other hand, if the rate appeal is approved, those people get a Notice of Action with appeal rights attached. OK, which one of these groups of people needs to know their appeal rights?!?! Sheesh!

It is very tempting to think that the state does not want those who have the need to appeal to know their rights...
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John Dickerson



Joined: 26 Oct 2005
Posts: 3

PostPosted: Fri Jan 06, 2006 12:00 pm    Post subject: appeals Reply with quote

From what we have learned from the state over 4,000 appeals were recieved. Of those, approximately 1/2 were resolved - that does not mean that the full amount requested was granted, but a higher amount was given. approximately 1/2 were denied. We do not know what the breakdown was on these approved/resolved or those denied on which waiver or for what amount. Individual stories support both low and high cost people in both categories.

We have worked with individual families that did get denied who contacted the Waiver Unit and they had one of the three reasons for an appeal and yet were denied. In several instances those were corrected as they were missed because of the volume of appeals.

We have asked the state for a process to let everyone know about their right to appeal any further decision and to give a clear process for what is going to happen. Everyone does have the right to appeal, but we need to make sure they know those rights and can do so.

Part of the volume of appeals is that some providers did appeal every amount that was below what the previous budget was regardless if it was just a few cents per day. Unfortunately this took attention away from the more significant cases that needed attention.

We have also seen a large number of people on the Support Services Waiver having their annual plan being reduced from $10 per day to $4 per day - this was not the stated goal of the plan and was supposed to not impact these people, we are seeking to address all of these as well.

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John Dickerson
The Arc of Indiana
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Provider1



Joined: 31 Oct 2005
Posts: 17

PostPosted: Wed Feb 08, 2006 2:43 pm    Post subject: Reply with quote

noplacelikehome wrote:
Get this. In the case of people whose rate change is denied, the info goes in a mass email to the provider with no appeal rights info attached. On the other hand, if the rate appeal is approved, those people get a Notice of Action with appeal rights attached. OK, which one of these groups of people needs to know their appeal rights?!?! Sheesh!

It is very tempting to think that the state does not want those who have the need to appeal to know their rights...


No Place,
I would suggest to families that the case manager make an appeal on behalf of the consumer. This is what I have asked families to do. We had maybe 6 letters like this...all the rest of our denials came in form of the NOA. I simply sent letters to families notifying them that they had rights of appeal and how to go about doing it if there was no NOA.

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Provider1...Crusading for what is right all the time!
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