South Carolina Department of Health and Human Services Reviews
Jun 27, 2014
J.B. is a 79 year old, Medicaid eligible female who has been utilizing Non-Emergency Medical Transportation (NEMT) provided by the South Carolina Department of Health and Human Services (SCDHHS) through it's agent, LogistiCare Solutions, LLC (LogistiCare) to travel to medical appointments since 2009.
Because J.B. suffers from congestive heart failure, emphysema and dementia, J.B. has been escorted by her son and fulltime caregiver, G.L., to and from her medical appointments.
Since 2009, J.B. has experienced numerous missed appointments and failed transportation by LogistiCare as evidenced by numerous letters from SCDHHS and LogistiCare to G.L. in response to complaints from G.L. The letters acknowledged that J.B. suffered from catastrophic illnesses and assured that corrective action would be taken, that J.B.'s transportation would be monitored to ensure satisfactory service, and that a dedicated transportation provider would be assigned to J.B.
In April 2012, J.B. was declared by SCDHHS as an "Aged, Blind, Disabled" beneficiary. Amazingly, in December 2013, only six (6) days prior to J.B.'s cardiology appointment, while G.L. attempted to schedule transportation for J.B. by telephone, a customer service representative of LogistiCare informed G.L. that J.B. would be denied escorted transportation during any future trips pending LogistiCare's receipt of a letter of medical necessity from J.B.'s physician, notwithstanding the foregoing. A copy of SCDHHS's contract with LogistiCare, obtained from the South Carolina Budget and Control Board website, disclosed that no such letter of medical necessity was required; only a "medical certification statement" from the Medicaid beneficiary was required. Federal regulations, 42 CFR Sections 431.206, 431.210, 431.211 and 431.230 provides that Medicaid recipients are entitled to due process of law, which includes written notice 10 days prior to denial or suspension of their benefits and notice that their benefits may be continued during any appeal. 42 CFR Section 431.18(e) provides that the specific policy materials relevant to the adverse action taken must be made available to the beneficiary. No such written notices were provided to J.B.
In August 2013, G.L. appealed the actions of SCDHHS and LogistiCare with the SCDHHS Division of Appeals and Hearings. Subsequently, SCDHHS Hearing Officer, Betsy Schindler, and LogistiCare continued to deny J.B. escorted transportation for almost one year, during the pendency of her appeal, even after G.L. submitted a motion for reinstatement of J.B.'s escorted transportation, resulting in J.B. missing numerous critical medical appointments and exhaustion of her medication supply.
NEMT, provided by LogistiCare, was J.B.'s only mode of transportation to her medical appointments.
In early 2014, LogistiCare reinstated J.B.'s escorted transportation after G.L. threatened legal action. Both J.B. and G.L. have concluded that the malicious and tortious actions of SCDHHS and LogistiCare were the result of their numerous complaints against LogistiCare, which have caused them both Extreme Emotional Distress!
Perhaps a civil rights action would be the appropriate remedy for this situation.
South Carolina Department of Health and Human Services Reviews
J.B. is a 79 year old, Medicaid eligible female who has been utilizing Non-Emergency Medical Transportation (NEMT) provided by the South Carolina Department of Health and Human Services (SCDHHS) through it's agent, LogistiCare Solutions, LLC (LogistiCare) to travel to medical appointments since 2009.
Because J.B. suffers from congestive heart failure, emphysema and dementia, J.B. has been escorted by her son and fulltime caregiver, G.L., to and from her medical appointments.
Since 2009, J.B. has experienced numerous missed appointments and failed transportation by LogistiCare as evidenced by numerous letters from SCDHHS and LogistiCare to G.L. in response to complaints from G.L. The letters acknowledged that J.B. suffered from catastrophic illnesses and assured that corrective action would be taken, that J.B.'s transportation would be monitored to ensure satisfactory service, and that a dedicated transportation provider would be assigned to J.B.
In April 2012, J.B. was declared by SCDHHS as an "Aged, Blind, Disabled" beneficiary. Amazingly, in December 2013, only six (6) days prior to J.B.'s cardiology appointment, while G.L. attempted to schedule transportation for J.B. by telephone, a customer service representative of LogistiCare informed G.L. that J.B. would be denied escorted transportation during any future trips pending LogistiCare's receipt of a letter of medical necessity from J.B.'s physician, notwithstanding the foregoing. A copy of SCDHHS's contract with LogistiCare, obtained from the South Carolina Budget and Control Board website, disclosed that no such letter of medical necessity was required; only a "medical certification statement" from the Medicaid beneficiary was required. Federal regulations, 42 CFR Sections 431.206, 431.210, 431.211 and 431.230 provides that Medicaid recipients are entitled to due process of law, which includes written notice 10 days prior to denial or suspension of their benefits and notice that their benefits may be continued during any appeal. 42 CFR Section 431.18(e) provides that the specific policy materials relevant to the adverse action taken must be made available to the beneficiary. No such written notices were provided to J.B.
In August 2013, G.L. appealed the actions of SCDHHS and LogistiCare with the SCDHHS Division of Appeals and Hearings. Subsequently, SCDHHS Hearing Officer, Betsy Schindler, and LogistiCare continued to deny J.B. escorted transportation for almost one year, during the pendency of her appeal, even after G.L. submitted a motion for reinstatement of J.B.'s escorted transportation, resulting in J.B. missing numerous critical medical appointments and exhaustion of her medication supply.
NEMT, provided by LogistiCare, was J.B.'s only mode of transportation to her medical appointments.
In early 2014, LogistiCare reinstated J.B.'s escorted transportation after G.L. threatened legal action. Both J.B. and G.L. have concluded that the malicious and tortious actions of SCDHHS and LogistiCare were the result of their numerous complaints against LogistiCare, which have caused them both Extreme Emotional Distress!
Perhaps a civil rights action would be the appropriate remedy for this situation.