August 26, 2015
Ms. Tracie Drew, Bureau Chief
Bureau of Administrative Rules and Procedures
Department of Human Services
100 South Grand Avenue East
3rd Floor, Harris Building
Springfield IL 62762
Dear Ms. Drew:
Re:
Department of Human Services, Proposed Rules, 39 Illinois Register, pages 7301 est seq., May 29, 2015
As a Medicaid recipient of medical assistance and home services, I face a serious threat to my rights because the State of Illinois’ proposed hearing rules impose many overwhelming barriers for me to maintain my medical assistance benefits. I feel that the proposed rules would make it
difficult for me to appeal the Department of Human Services (DHS) decisions to terminate or deny my medical benefits, especially if I personally need to appeal a denial or termination of benefits.
Initially, I do not understand why
these proposed changes are necessary.
Secondly, because the hearing officer will impose the order of call of witnesses as she/he deems necessary, this two-hour hearing may be inadequate for me to fairly present my views in five minutes. I come here today to express my concerns.
Request for accommodation
To accommodate my disabilities, I request that DHS allow a 60-day appeal period, the historical time period, and that any delay caused by my medical condition may cause me medical and economic hardship. I suggest that a 30-days appeal period insufficient.
I request an accommodati
on for my disabilities that DHS offers me the option of an in-person hearing.
Benefits protection under federal law
The proposed rules are overwhelmingly complicated and confusing, and conflict with federal statutes and regulations that protect my eligibility rights for my Medicaid and Home Services benefits programs below noted.
Adequate notice
The proposed rules do not require adequate notices about termination or denial of my benefits. I suggest that DHS add language to the proposed rule to require a clear statement for the reason of its action. I suggest that the DHS does not delete the requirement that all written notices bear the same date as the date of their mailing and delivery.
DHS will not apprise me that I may request a hearing before a date of action (not the date of notice). I suggest that DHS gives me enough time to respond properly to my notice. I suggest that it offers me a means to comment.
In the past, DHS sent me a notice of termination that did not allow me to respond to my resident agency service office in a timely manner, i.e., the respondent office was not
my assigned office. I did not have enough time to acquire the information requested. This made me spend 6½ hours travel and waiting time, and three office visits to submit my missing documentation. I needed to leave one office due to my long wait in an office with permeating fecal smell. After a two-hour wait, I had to leave to avoid vomiting. I returned to a fresher office the next morning. There were 250 people waiting before me, so I had to wait again. The condition of the two offices that I entered I found filthy, bug-infested, moldy and unhygienic. My visit to 5050 N. Broadway caused me to have an asthma attack.
With the proposed deletion of the word “adequate” in notices suggests that DHS thinks that notices can be something less than adequate, yet still be legally sufficient. If I receive a vague notice and think that it does not affect my benefits, I will lose my benefits. By the time I understand that DHS terminated my benefits, my appeal time and benefit payment pending appeal may have expired. I will again lose my needed medical benefits while I reapply and appeal.
Hearing judges
At a minimum, due process requires that hearing officers must be impartial. I suggest that the DHS include qualifications for hearing officers for all hearings, and specifically that hearing officers be licensed attorneys. An impartial hearing officer holds appeal hearings to determine fairly the areas of agreement and disagreement. I strongly suggest that DHS replace the deletion of “unbiased” with “impartial” throughout the rules.
Free access to records
The proposed rules do not assure me free and timely access to my records for appeals. I suggest that DHS avail me of my full case record in the least burdensome manner.
I suggest that DHS not withhold my “confidential information” because that would restrict my review of my case record during an appeal process. DHS should not withhold anything in my case record for my review during the appeal process. Confidentiality is my choice, privilege, and not that of DHS.
Reasonable access to hearings
The proposed rules changed the hearing locations where I may not have reasonable access. I understand that long-term medical assistance, assigned to Chicago or Decatur, does not reimburse travel and associated costs. I could not afford to travel to Decatur.
The Bureau of Hearings (BOH) has the capability of taking appeals requests by telephone and has been doing so for many years. The proposed rules will not accept medical assistance appeals by telephone. This does not make any sense to me.
Due process
The proposed rules do not provide me with due process. I am entitled to administrative hearing procedures that have integrity and are fundamentally fair. The proposed rules require that only I may personally file a medical assistance appeal. I suggest that DHS permit my Power of Attorney agent, guardian or an authorized representative, and/or legal counsel to file appeals on my behalf. I suggest that the appeal form request attachment of my Power of Attorney document or other authorization form.
There is no rule requiring DHS to make the written appeal form readily accessible, although it requires acceptance of only written medical assistance appeals. There is no rule requiring the department to make the written appeal form readily accessible. Presently, I can only find the appeal form online and I do not always have Internet access. I suggest that DHS enclose a blank appeal form with any notice that initiates my appeal rights.
The proposed rules say that if I “improperly” request an appeal, then the BOH will advise me of the proper appeal process. I do not understand what this means. What is an “improper” appeal? Do I lose time to file my appeal? May I bring witnesses, pursue any argument without undue interference, submit evidence to establish all pertinent facts and circumstances, and question or refute any testimony or evidence, and include the opportunity to confront and cross-examine adverse witnesses?
I commend DHS for proposing to make an electronic recording of the hearing proceedings available to me at no cost and if such recording is not available, to make a transcript available to me at no cost.
Confusing deadlines
The proposed rules require that I provide evidence to DHS at least 3 days ( business?) days in advance of my medical assistance appeal or the hearing officer may not consider that information. This worries me because I have limited access to email, fax and/or scanned required documents. Will DHS provide me with free legal representation? What happens if my correspondence or records are lost?
The rules do not consistently specify identify deadlines; whether due dates are counted in calendar days, business or working days. I suggest that time be consistently stated throughout the rules.
Benefit payments pending appeal process
Presently, I understand that a provision exists that I am entitled to continued benefits pending appeal if I appeal in a timely manner. I cannot locate it in the proposed rules.
Burden of proof
The proposed rules require me to prove that DHS’s action is wrong, rather than requiring DHS to identify why the action is right. Because of the above-mentioned lack of reassurance for me to access to my records for the appeal, I could be unable to provide proof. This seems distinctly unfair to me. Since DHS has full access to my records located in various agency data stores, warehouses, databases, prisons, telephone records, emails and at different agency locations, I think that DHS is in a better position to provide the burden of proof.
If an attorney does not represent me, I do not have the wherewithal to defend my position within the network of governmental agency policies and procedures. Given my limitations and the inaccessibility of DHS staff, it is unfair to place the burden of proof on me.
Task-based services
Now that DHS moved to task-based staffing and special processing units, my accessibility problems have increased. With the task-based system, trying to talk to someone about my case in my DHS agency office requires me to recapitulate my entire DHS history at every encounter; affords me with little or no timely availability of my records; and, completely loses consistency of my issues with a different task worker every time. I need a caseworker to follow my case, not a task worker.
While task-based staffing and special processing units provide efficiencies for DHS, in the appeal context, it has the potential to overwhelm me and force me to abandon my meritorious appeal rather than try to navigate the system. I feel so discouraged.
In summary, these proposed rules will cause wrongful termination of my entitled benefits that will cause serious threats to my health and economic security. I implore you to review these proposed rules and their due-process violations, barriers, and uncertainties, through my eyes, as an at-risk citizen. Accordingly, I suggest that DHS withdraw the proposed amendments and refile them with adequate descriptions and reasons for every proposed change, addition and deletion in the rules.
Sincerely,
Kathleen A. Powers, A.A.S.
Northside Action for Justice, Member of the Board
The Alliance for Community Services, Steering Committee Member
Medicaid Recipient082615 DHS Proposed Changes Testimony
KathyPowers1 
My testimony about the Department of Human Services (DHS) Proposed Changes on 08/26/15
August 28, 2015 Leave a comment
August 26, 2015
Ms. Tracie Drew, Bureau Chief
Bureau of Administrative Rules and Procedures
Department of Human Services
100 South Grand Avenue East
3rd Floor, Harris Building
Springfield IL 62762
Dear Ms. Drew:
Re:
Department of Human Services, Proposed Rules, 39 Illinois Register, pages 7301 est seq., May 29, 2015
As a Medicaid recipient of medical assistance and home services, I face a serious threat to my rights because the State of Illinois’ proposed hearing rules impose many overwhelming barriers for me to maintain my medical assistance benefits. I feel that the proposed rules would make it
difficult for me to appeal the Department of Human Services (DHS) decisions to terminate or deny my medical benefits, especially if I personally need to appeal a denial or termination of benefits.
Initially, I do not understand why
these proposed changes are necessary.
Secondly, because the hearing officer will impose the order of call of witnesses as she/he deems necessary, this two-hour hearing may be inadequate for me to fairly present my views in five minutes. I come here today to express my concerns.
Request for accommodation
To accommodate my disabilities, I request that DHS allow a 60-day appeal period, the historical time period, and that any delay caused by my medical condition may cause me medical and economic hardship. I suggest that a 30-days appeal period insufficient.
I request an accommodati
on for my disabilities that DHS offers me the option of an in-person hearing.
Benefits protection under federal law
The proposed rules are overwhelmingly complicated and confusing, and conflict with federal statutes and regulations that protect my eligibility rights for my Medicaid and Home Services benefits programs below noted.
Adequate notice
The proposed rules do not require adequate notices about termination or denial of my benefits. I suggest that DHS add language to the proposed rule to require a clear statement for the reason of its action. I suggest that the DHS does not delete the requirement that all written notices bear the same date as the date of their mailing and delivery.
DHS will not apprise me that I may request a hearing before a date of action (not the date of notice). I suggest that DHS gives me enough time to respond properly to my notice. I suggest that it offers me a means to comment.
In the past, DHS sent me a notice of termination that did not allow me to respond to my resident agency service office in a timely manner, i.e., the respondent office was not
my assigned office. I did not have enough time to acquire the information requested. This made me spend 6½ hours travel and waiting time, and three office visits to submit my missing documentation. I needed to leave one office due to my long wait in an office with permeating fecal smell. After a two-hour wait, I had to leave to avoid vomiting. I returned to a fresher office the next morning. There were 250 people waiting before me, so I had to wait again. The condition of the two offices that I entered I found filthy, bug-infested, moldy and unhygienic. My visit to 5050 N. Broadway caused me to have an asthma attack.
With the proposed deletion of the word “adequate” in notices suggests that DHS thinks that notices can be something less than adequate, yet still be legally sufficient. If I receive a vague notice and think that it does not affect my benefits, I will lose my benefits. By the time I understand that DHS terminated my benefits, my appeal time and benefit payment pending appeal may have expired. I will again lose my needed medical benefits while I reapply and appeal.
Hearing judges
At a minimum, due process requires that hearing officers must be impartial. I suggest that the DHS include qualifications for hearing officers for all hearings, and specifically that hearing officers be licensed attorneys. An impartial hearing officer holds appeal hearings to determine fairly the areas of agreement and disagreement. I strongly suggest that DHS replace the deletion of “unbiased” with “impartial” throughout the rules.
Free access to records
The proposed rules do not assure me free and timely access to my records for appeals. I suggest that DHS avail me of my full case record in the least burdensome manner.
I suggest that DHS not withhold my “confidential information” because that would restrict my review of my case record during an appeal process. DHS should not withhold anything in my case record for my review during the appeal process. Confidentiality is my choice, privilege, and not that of DHS.
Reasonable access to hearings
The proposed rules changed the hearing locations where I may not have reasonable access. I understand that long-term medical assistance, assigned to Chicago or Decatur, does not reimburse travel and associated costs. I could not afford to travel to Decatur.
The Bureau of Hearings (BOH) has the capability of taking appeals requests by telephone and has been doing so for many years. The proposed rules will not accept medical assistance appeals by telephone. This does not make any sense to me.
Due process
The proposed rules do not provide me with due process. I am entitled to administrative hearing procedures that have integrity and are fundamentally fair. The proposed rules require that only I may personally file a medical assistance appeal. I suggest that DHS permit my Power of Attorney agent, guardian or an authorized representative, and/or legal counsel to file appeals on my behalf. I suggest that the appeal form request attachment of my Power of Attorney document or other authorization form.
There is no rule requiring DHS to make the written appeal form readily accessible, although it requires acceptance of only written medical assistance appeals. There is no rule requiring the department to make the written appeal form readily accessible. Presently, I can only find the appeal form online and I do not always have Internet access. I suggest that DHS enclose a blank appeal form with any notice that initiates my appeal rights.
The proposed rules say that if I “improperly” request an appeal, then the BOH will advise me of the proper appeal process. I do not understand what this means. What is an “improper” appeal? Do I lose time to file my appeal? May I bring witnesses, pursue any argument without undue interference, submit evidence to establish all pertinent facts and circumstances, and question or refute any testimony or evidence, and include the opportunity to confront and cross-examine adverse witnesses?
I commend DHS for proposing to make an electronic recording of the hearing proceedings available to me at no cost and if such recording is not available, to make a transcript available to me at no cost.
Confusing deadlines
The proposed rules require that I provide evidence to DHS at least 3 days ( business?) days in advance of my medical assistance appeal or the hearing officer may not consider that information. This worries me because I have limited access to email, fax and/or scanned required documents. Will DHS provide me with free legal representation? What happens if my correspondence or records are lost?
The rules do not consistently specify identify deadlines; whether due dates are counted in calendar days, business or working days. I suggest that time be consistently stated throughout the rules.
Benefit payments pending appeal process
Presently, I understand that a provision exists that I am entitled to continued benefits pending appeal if I appeal in a timely manner. I cannot locate it in the proposed rules.
Burden of proof
The proposed rules require me to prove that DHS’s action is wrong, rather than requiring DHS to identify why the action is right. Because of the above-mentioned lack of reassurance for me to access to my records for the appeal, I could be unable to provide proof. This seems distinctly unfair to me. Since DHS has full access to my records located in various agency data stores, warehouses, databases, prisons, telephone records, emails and at different agency locations, I think that DHS is in a better position to provide the burden of proof.
If an attorney does not represent me, I do not have the wherewithal to defend my position within the network of governmental agency policies and procedures. Given my limitations and the inaccessibility of DHS staff, it is unfair to place the burden of proof on me.
Task-based services
Now that DHS moved to task-based staffing and special processing units, my accessibility problems have increased. With the task-based system, trying to talk to someone about my case in my DHS agency office requires me to recapitulate my entire DHS history at every encounter; affords me with little or no timely availability of my records; and, completely loses consistency of my issues with a different task worker every time. I need a caseworker to follow my case, not a task worker.
While task-based staffing and special processing units provide efficiencies for DHS, in the appeal context, it has the potential to overwhelm me and force me to abandon my meritorious appeal rather than try to navigate the system. I feel so discouraged.
In summary, these proposed rules will cause wrongful termination of my entitled benefits that will cause serious threats to my health and economic security. I implore you to review these proposed rules and their due-process violations, barriers, and uncertainties, through my eyes, as an at-risk citizen. Accordingly, I suggest that DHS withdraw the proposed amendments and refile them with adequate descriptions and reasons for every proposed change, addition and deletion in the rules.
Sincerely,
Kathleen A. Powers, A.A.S.
Northside Action for Justice, Member of the Board
The Alliance for Community Services, Steering Committee Member
Medicaid Recipient082615 DHS Proposed Changes Testimony
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Filed under Advocacy, Alliance for Community Services, Commentaries, Department of Human and Family Services (DHFS), Northside Action for Justice Tagged with 39 Illinois Register, abandonment of meritorius appeals, access to medical care, accommodation for disabilities, ADA, Advocacy, Alliance for Community Services, appeals process, barriers, bias of hearing judges, care coordination, civil rights violations, communication strategies, community resources, confusing deadlines, continued benefits payments during appeal process, date notice received, denial of benefits, deplorable agency office conditions, DHS case records availability, DHS office cuts, Disabilities, disability, dual eligibility, due dates inconsistencies, due process, economy, electronic recording of hearing, eligibility, federal statutes, Funding, improper appeals, inadequate descriptions, inadequate time to present views, inefficiences of task-based process, lack of clearity, mailing date, Medicaid, notices requirements, proposed changes, proposed changes in appeals regulations, records lost, right to due process, right to representation, State of Illinois, suggested withdrawal of proposed rules, task-based process unfair to beneficiaries, termination of benefits, transcript of hearing, uncertainties, unwieldy system navigation, violations, who may file an appeal, wrongful termination