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The Personal Assistance Services Council of Los Angeles County (PASC), an independent IHSS public authority serving 180,000 IHSS consumers and 140,000 IHSS providers respectively, submits the following motions for consideration:
PASC Motion January 7, 2013
The PASC Board supports the lawsuit filed by the Legal Aid Foundation of Los Angeles and the Western Center on Law and Poverty and the National Health Law Program, and urges the California Department of Health Care Services to remedy the violations set forth in the lawsuit. The Department must immediately:
- Cease to apply the “deleterious” standard when reviewing beneficiaries’ exemption requests from managed care;
- Restore to regular Medi-Cal those who were denied an exemption after the Department began to apply the deleterious standard on or about June 2011 in the two plan geographical counties, and initiate a new review of these cases using the standards set forth in 22 CCR section 53887 only unless the beneficiary declines such a review because s/he wants to remain in Medi-Cal managed care;
- Ensure that all beneficiaries – who apply for exemptions prospectively or are having their previous exemption denials reviewed again – remain in regular Medi-Cal until there is a final decision by an administrative law judge on the exemption;
- Cease sending inadequate and conclusionary form medical exemption denial notices; and
- Begin sending adequate medical exemption denial notices which indicate the individual facts and reasons which support the denial, and advise the beneficiaries of the circumstances under which they can remain in regular Medi-Cal while they appeal their exemption denials.
PASC Motion January 31, 2013
PASC is concerned that late instructions and budgets from the Department of Health Care Services to the managed care plans has resulted in disruptions in patient care during the Medi-Cal mandatory managed care and CBAS transitions, as well as the institution of mandatory criminal background investigations for providers that resulted in disruptions in patient care several years back. We resolved that the following emergency measures be taken to prevent these disruptions:
- The Department of Health Care Services issue instructions and budgets six months prior to managed care plans participating in the Dual Demonstration Pilots before any more seniors and persons with disabilities are enrolled in them.
- Establishment of robust independent ombudsman services, as were required by CMS in the Ohio Dual Demonstration Pilots, to assist clients in navigating anything preventing them from receiving medications, supplies, surgeries, procedures, treatments and physician consultations in a timely manner.
- The restoration of the DPSS or Other Special Circumstances Fund to provide patients with emergency medications and services in the event of delays.
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