Released September 29, 2006
Appeals for Communication Device Carrying
Cases under Medical Assistance
A Fact Sheet from the
This fact sheet is an introduction to the
rights of people with disabilities to appeal denials for communication device
carrying cases under the Minnesota Medical Assistance program. The information
in this fact sheet is not legal advice. Every case is different and the laws
change all the time. This fact sheet concerns only
communication devices. If the Medical Assistance
program denies funding for a carrying case for a communication device, you have
the right to appeal that decision at a hearing before a Human Services Judge
with the Department of Human Services. This fact sheet describes how to appeal
the denial.
1. How do I appeal?
Write a simple letter stating that you appeal
the decision of the Department
of Human Services to deny a carrying case
for your communication device.
Sign and date the letter. You should attach
a copy of the denial notice you
received from the Department of Human Services. Keep
a copy of
what you send in. If you want a sample appeal letter,
contact the
2. When do I appeal?
Your appeal must be received by the state
within thirty days of the date you
received the denial notice or, if you have good cause for delay,
within 90
days of that date.
3. Where should I send the appeal?
Send your letter, along with a copy of the
denial notice to:
MN Department of Human Services
Appeals Office
Metro: 651-431-3600
Outstate: 800-657-3510
TTY/TDD: 800-627-3529
FAX: 651-431-7523
4. Where will the appeal be?
Ordinarily appeal hearings are held at the
county social service office in the
county where you live. The human services judge
may want to schedule a
telephone appeal where the hearing is done over the
telephone. You do not
have to agree to have a telephone appeal. You
have the right to have
the hearing held in person.
Our advice is that you should not agree
to a telephone appeal unless
there are special circumstances which require
it for your convenience. If
you need a very prompt decision, the judge’s
schedule may require a
telephone appeal. If you have difficulty getting
out of your home or
apartment for an appeal, you may want to have a
telephone appeal from
your own place.
5. Who can help me with the appeal?
You may have a lawyer, an advocate, or
anyone you want come to help you
with the appeal. The
everyone for whom the Department of Human Services
denies carrying
cases. You should seek the help of your speech therapist
who recommended the carrying case. Ask your speech therapist to go to the hearing
with you or to testify by telephone. If your speech therapist is not willing to
help you, you should consider getting another speech therapist.
6. What information do I need for the
appeal?
The Human Services Judge will look at six
criteria to decide if Medical
Assistance should pay for the carrying case.
At the hearing, you have to
prove that the carry case is:
·
medically
necessary;
·
appropriate
and effective to your medical needs;
·
timely,
meaning it is right for your medical condition at this time;
·
furnished
by a provider with appropriate credentials;
·
the
least expensive appropriate alternative health service available; and
·
an
effective and appropriate use of program funds.
You an show that the carrying case meets
these criteria by using letters and testimony from you, your doctor, speech
therapist, and the device manufacturer.
7. When is a carrying case medically
necessary?
A carrying case for a communication device
is not always medically
necessary. However, a carrying case is medically
necessary if your doctor
or therapist thinks anyone with the same
condition would need it. Some
examples of when a carrying case may be medically
necessary include:
·
If
you cannot use your communication device because you are not able to carry the device
or get it in and out of another bag easily, like a back pack, due to your
disability; or
·
If
you use the device outdoors a lot when it is raining or snowing;
·
If,
because of your disability, it is hard for you to determine when the device
needs to be protected from the weather; or
·
If
you have difficulty with your vision or ability to walk and you bump into walls
or furniture easily; or
·
If
you have difficulty carrying things or drop them easily because of your
disability; or
·
If
you have excessive oral secretions that may come into contact with the device
or if it is difficult for you to keep the device clean; or
·
If
you have a compromised immune system and need added protection from the transmission
of bacteria; or
·
If
your communication device is showing excessive signs of wear and tear,
especially on the screen; or
·
If
parts of the communication device have been replaced due to damage.
There may be other reasons that you need a
carrying case for your
communication device that are not mentioned in this
fact sheet. You
should discuss these reasons with your speech
therapist or doctor who
can help you determine if the reasons meet
the “medically necessary”
standard.
8. Have other appeals for carrying cases
been successful?
Yes. Other people have appealed denials
for carrying cases and won. You can request copies of decisions from the Chief
Human Services Judge
to use at your hearing. One specific decision
you can request is the Department of Human Services Decision #90774. If that
case is similar to the reasons you need a carrying case, the Department must treat
you in the same way and pay for a carrying case. You should give the Human
Services Judge a copy of any helpful decision at the hearing.
9. What is the appeal hearing like?
The appeal is held by a Human Services
Judge of the Department of
Human Services. Ordinarily the appeal is held in a
conference room
with the participants sitting around a table.
The judge records the hearing
on a tape recorder. Sometimes appeals follow
the question and answer process similar to a trial; often the judge asks each
person to talk in turn.
You have a right to ask questions of
witnesses, including anybody present from the state. However, in most cases the
Department sends a letter explaining its denial to the judge for
its "evidence" and typically no one from the Department comes to the
hearing. You may present your own testimony and the testimony of anyone else
with knowledge about your disability or need for a carrying case. Your witnesses
can testify by telephone.
Let the Human Services Judge know and
schedule a specific time to call
the witness. You can also require people to
come to the hearing by asking for a subpoena. If you have questions about
requiring someone to testify, call the
10. When will the appeal be decided?
The Human Services Judge makes a recommended
decision after the hearing, usually in about 30 – 60 days. This recommended
decision is
reviewed by the Chief Human Services Judge, who
may approve or
change it. If the decision is going to be
changed, you will be given time to
respond.
11. What if I lose?
You have 30 days from the date of the decision
in which to request reconsideration from the Chief Human Services Judge or to
appeal
the decision to the state district court for
the county in which you live. A request for reconsideration is simply a letter
to the Chief Human Services
Judge saying why you believe the Decision
should be changed. If you ask for reconsideration, the time in which you may
appeal to state district court is extended. If reconsideration is denied, you
will get another 30 days to appeal to court. There is no filing fee
for an appeal to state district court. The
How do I contact the
You may write to us at the address below
or call our Client Intake line. We cannot represent everybody who is denied a
carrying case. In those cases in which we do not represent a person, we will
try to provide advice over the telephone to help in the appeal. We may also
have additional resources on the appeal process that we can send to you.
New Client Intake Numbers:
612-334-5970 (Twin
Cities metro area)
1-800-292-4150 (Greater
612-332-4668 (TDD)
Email: mndlc@midmnlegal.org
Website: www.mndlc.org
This Fact Sheet may be reproduced in its
entirety with credit given to the