DRP Successfully Assists York County Woman with Restoration of her Personal Assistance Services Under the Community HealthChoices Waiver

After a fair hearing before DHS’s Bureau of Hearings and Appeals, a 53-year-old York County woman with multiple sclerosis and mental health disabilities had her personal assistance services (“PAS”) hours under the Community HealthChoices waiver restored to 98 per week.  The woman’s managed care organization (“MCO”) had reduced her hours to 70 and then increased them to 82 per week.  DRP represented the woman at her fair hearing and successfully argued that the MCO’s service reduction did not accurately capture the woman’s needs, particularly given that her husband was unable to provide informal support as the MCO assumed since he worked and cared for their three minor children.  The Administrative Law Judge (“ALJ”) recognized that there was no improvement in the woman’s condition justifying the reduction.  The ALJ also found that the MCO’s calculation of PAS hours was based on outdated information and could not be deemed to accurately reflect the woman’s needs and that the woman was not notified of her reassessment, which denied her the opportunity to have her husband or caretaker participate to provide input about her needs.