The Department of Medical Assistance Services (DMAS) oversees the Elderly or Disabled with Consumer Direction (EDCD) Waiver Program. Therefore, DMAS decides how many hours of attendant care each consumer receives. (They also oversee respite, supervisory, and all other types of care hours).
DMAS rules provide that you have the right to appeal the amount of hours that you are granted. We as SEIU Virginia 512, have received several inquiries as to how to go about successfully appealing hours. We recommend the following:
1. Contact your union immediately once you are believe that you were given too few hours.
DMAS only provides a limited amount of time (about 10 days from when you receive the notice from DMAS) for you to request an appeal by writing to their Richmond office. If you put in a request after this deadline, you may be denied a hearing. Accordingly, it is important that you communicate with your union to ensure that you are including the necessary information in the request for appeal.
Once you receive a hearing date, you will need to decide whether you will be represented in the hearing. Being that the hearing is a legal proceeding, we recommend that you seek representation through the union. They will present your side (including referring to the applicable evidence and law) throughout the hearing. DMAS hearings are held over the phone and typically run about 1 hour—but can be as long as 2.5 hours or as quick as 30 minutes.
2. Keep regular contact with your service facilitator.
Your service facilitator will be a key part of your appeal of hours. As the individuals that submitted the paperwork requesting the hours on your behalf, they have firsthand knowledge of the information at issue. Therefore, you will need their assistance in compiling the necessary paperwork in preparing for the appeal. Moreover, if they are available, you may need them to testify as part of the phone hearing. Be sure to work with the union to determine the appropriate level of involvement by your service facilitator on the actual day of the hearing.
3. If you are not successful in the appeal, work with your union and service facilitator to see how you may be able to obtain more hours in the future.
DMAS regulations are difficult to overcome and, therefore, there is always the chance that you might not be successful in your appeal. In the event that you are not successful, your union and service facilitator can work with you to see how the request might be better resubmitted in the future. If we are able to successfully show that a consumer needs more care, there is likely a way that we can garner the hours in the future.
For more information on the appeal process, contact the SEIU Virginia 512 office at (571) 432-0209. You can also refer to the DMAS appeals pamphlet: http://www.dmas.virginia.gov/Content_atchs/appls/app-pmphlt_eng.pdf.
Many times in life, situations arise that impact our overall well being, whether physical, mental, or both. The law provides that you cannot be treated differently simply because you have a disability. As a union, we have seen an increase in questions regarding how Loudoun County should handle disabilities. The key to receiving fair treatment with regard to a disability is to know your rights and keep in contact with your union to make sure that they are protected. Below are some frequently asked questions regarding the federal and county policy regarding the law that protects disabilities, the Americans with Disabilities Act (ADA) of 1990
1. What is a disability under the ADA?
Not all conditions or health situations are considered disabilities under the ADA. The law defines disabilities as conditions that substantially limit one or more major life activities. Major life activities include functions such as caring for oneself, breathing, learning, and working.
Therefore, a condition might be a disability if it limits your ability to perform a major life activity. The law compares your abilities to those of an average person in the general population. An example of disability might be diabetes, if it decreases your ability to learn or work. In the alternative, if you have diabetes but only have a few temporary side effects that do not impact your ability to learn or work, you likely would not be deemed to have a disability.
2. What should I do if I find out that I have a disability?
The first course of action once you are diagnosed with a disabling condition is to seek medical treatment. Next, contact your union and seek assistance to discuss whether a reasonable accommodation might be appropriate for your disability.
3. What is a reasonable accommodation and how do I ask for one?
A reasonable accommodation is a tool that assists a disabled employee with doing the essential functions of their job. Under the law, the reasonable accommodation is only required to be granted if the employee can do their job with or without the reasonable accommodation. Examples include a larger size computer monitor, breaks from work, or recording devices.
To apply for a reasonable accommodation in Loudoun County, a Human Resources form must be filled out which identifies what your disability is and what reasonable accommodation is being requested. To ensure that this form is filled out in a way that best protects your rights, contact the union office. After we assist you with submitting the form, we can work with you and management to ensure that they engage in their obligation to have a discussion regarding the reasonable accommodation. As a union, we want to ensure that your rights are protected.
Service Facilitators play a key role in the administration of your Elderly or Consumer Direction Waiver Services Waiver (EDCD). Service Facilitators not only serve as advocates for consumers and Personal Care Assistants (PCAs) but also must provide clear information to the Department of Medical Assistance Services (DMAS) that affects the care of a consumer and a PCA’s pay. Below are a series of frequently asked questions on the role of a Service Facilitator that SEIU Virginia 512 often receives in assisting members.
Examples of paperwork and communications that a Service Facilitator is responsible for transmitting to and from DMAS include: initiating care with a particular PCA, requests for an increase in attendant care/respite/supervision hours, and annual authorizations. A good Facilitator will make sure that all paperwork is quickly communicated to DMAS and that a family and their PCA are aware of any possible changes in the waiver.