Below is the letter that we sent today, 05.26.15, to DSS and the health department. We attached a few documents to the letter. The denial letter has already been posted in a previous post, as well as our list of concerns my husband and I constructed before we received the denial letter.
As I have stated before, this exact situation has happened many times in the past, however no one knows how to prove them wrong. I have reached out to five of my friends who are attorneys. Not one of them knew of a for sure attorney that handles these cases. Two main reasons-
1. Most want attorneys to represent pro bono given that income is an issue.
2. The risk outweighs the benefits in representing a big case that has the potential of falling through. No professional wants to risk having their reputation blown when they have to earn money to support their family. I don’t blame them.
I have however been directed to contact the Attorney General’s office, which I have. I will continue to contact them daily until I reach someone who will listen. Since it’s regarding an agency not following state and federal law, then the state will have to be the ones to hold them accountable.
As I’ve stated before, I am not doing this because I feel I have been “wronged” or that I want to win a case. I am perusing this because the special needs community needs to be heard. This case will represent ALL prior wrongful screenings and denials not just for the parents but for All special needs children. These children don’t have a voice but we do! The screening agencies have discriminated against innocent special needs children, saying the EDCD waiver is for the elderly- another lie. But more than discrimination, they have made a mockery of the law that has already been set?! I’m not fighting that a right may potentially have been broken, I am fighting because the law HAS been broken! I will not stop. Please continue to read the letter below. This is only a small fraction of the letters, calls, emails, etc. that we have done in the last week.
I’d like to take an opportunity to follow-up with ______’s case. Here is a breakdown of what has occurred since his screening (please note that I will be attaching documents provided during the screening for your reference):
We received a phone call from Jennifer _____, a few days after our son’s screening. She apologized for statements made by Susan _______, during our screening – specifically that our son would not qualify for waiver services; “he was denied before and he will be denied again” Susan stated multiple times.
We received a phone call from Susan _____, to let us know that her insurance is through Blue Cross / Blue Shield and that she has coverage for ABA Therapy.
We provided the attached letter stating that we were concerned that our son would not receive a complete evaluation based on the events and statements of our screening.
We received the attached letter indicating denial of waiver services for our son.
We received a phone call from you where you let us know that you believed that our son’s screening was conducted appropriately. We indicated that we had a hard time believing this based on what had transpired to date. We also indicated that the letter of denial of services made statements that a change of avialable supports was not indicated and attending physician / medical professional documentation was not provided. We clearly indicated a change in available supports during our sons’s screening and provided the attached letters from our son’s attending physician and Board of Medicine certified BCBA. We requested further written explanation of the basis of our son’s denial in light of the provided documentation and have not yet received anything. We are owed this information should we need to proceed through the appeal process.
We have received subsequent phone calls from you where you have made further inquiries about Our son’s case and did acknowledge that Susan_____, should not have made a statement about our son not meeting the criteria for services during the screening prior to reviewing all documentation provided with the entire screening team. We also indicated that we believed that State and Federal Laws governing the pre-admission screening and approval/denial process were not followed in our son’s case. We asked if DSS had someone in their office making sure that the screenings are conducted to legal requirements and you indicated that there was someone in the city that DSS uses occasionally, but not recently.
Just for your reference:
You had stated during our phone conversation on 05.22.15 that the team bases their decision on the evaluation of need for a nursing facility, and that our son did not seem to meet the level of care that a nursing facility would provide. The partial code you read to me was of 42CFR441.302 which states “evaluation of need” is the assurance that the agency will provide for an initial evaluation. The evaluation was not completed.
To be specific, the sole purpose for denying our son was based on an excerpt taken from Virginia Code12VAC 30-60-312 stated in the denial letter. If you claim that the team conducted a complete evaluation, and more so that you reviewed the case yourself, as well as other superiors, then you would easily see that we provided the team with a physician letter (documentation attached) whom stated his needs are not being met. You would also see a letter from his therapist who is certified by the Virginia Board of Medicine (reported findings from medical) stating (among other things) that his needs are not being met, and also documentation provided during the screening of his “change in available support” as he has been “cared for in the home prior to the assessment”. This includes his ten in-home care hours that he was provided before the assessment and is offered no longer. The state code does not specify the type of care. To state that his care was “behavioral” as stated by Susan ______, would be adding to the state code in which no party is able to do. All of this information was provided to you during the screening, but the denial letter states (attached) that there has been no change in his available support system, and that there also is “no evidence available” demonstrating that his needs are not being met. The reason for the denial is false. Our son has been wrongfully denied. Not only was he wrongfully denied, but the screening team as well as those whom reviewed our son’s case have seemed to miss some very important information. This is extremely troublesome and we need answers as to why.
Please let us know when we may expect further information regarding the exact basis for our son’s denial along with the State and Federal Code support of the decision. You had stated you could provide us with this information by 05.22.15, but none has been received as of 05.26.15.