NY DOH Wounds Rights of Brain Injured

Reliable sources say the New York State Department of Health has told TBI waiver staff that they must side with the DOH and against their clients when their clients appeal decisions made by the DOH in a Medicaid Fair Hearing.

A Fair Hearing affords people the chance to contest a DOH decision. As regular readers of this blog know, the DOH recently denied this writer’s request for white noise machines and a life alert.

Sources say the DOH Legal Department claims companies and individuals approved to provide waiver services are under contract with the state and therefore it would be a conflict of interest if they were to side with the brain injury survivors, the very people they are supposed to serve. Asked what options waiver staff have if they disagree with the DOH’s decision, sources say waiver staff can help survivors find community advocates to appear with them at the hearing.

The denial of my request came in the form of a letter from the Capitol Region’s Regional Resource Development Center (RRDC).

RRDCs are contract employees of the DOH who oversee those who provide and receive Traumatic Brain Injury Waiver services in their region. The TBI Waiver is an array of services that helps brain injury survivors live in the community. TBI Waiver Providers are companies and individuals who provide these services. Service Coordinators are providers who act as case managers and work with waiver participants in identifying  the services and developing the treatment plans that best serves waiver participants. Essentially, the Service Coordinator is the quarterback of the treatment team that works with and for the participant.

This legal directive was, according to sources, presented to RRDCs across the state in monthly conference calls facilitated by DOH employee Beth Gnozzio. Ms. Gnozzio has developed a reputation on several fronts for not responding to emails or phone calls.

The directive itself appears to violate the DOH’s TBI Waiver manual which reads, in part, that waiver participants must “Receive support and direction from the Service Coordinator to resolve (their) concerns and complaints about services and service providers” The directive’s rather apparent conflict with the manual does not stop there. The  TBI Waiver manual  says (bold is mine): “An individual has the right to seek a Medicaid Fair Hearing for many reasons including issues related to the …TBI waiver”. The manual also says brain injury survivors will “Have your service providers (to) help protect and promote your ability to exercise all your rights; identified in this document”, the document being the manual itself.

How on earth service providers, comprised of service coordinators and, for that matter, all waiver staff, can help protect and promote the survivors ability to exercise their rights, one of which is the right to a fair hearing, while at the same time they are being told they must stand against the survivors in a fair hearing is beyond me.

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One thought on “NY DOH Wounds Rights of Brain Injured

  1. The NBIF will be meeting this week when I plan to pursue gathering some testimony, whether it be completly anonymous or not, from members who recieve services under the DOH TBI waiver, as to how and if their needs (i.e. requests for assitive devices etc.) are being met and if they are met in a reasonably timely manner. To provide this information from recipients of DOH TBI Waiver Services throughout New York State to the KAC, who will present for review by DOH Deputy Commissioner Kissinger, may shed some light on where the waiver is failing to be the effective positive catalyst it could be in the lives of so many individuals living with brain injury. But when you present information such as in this blog, I am not so sure it will be revealed in the gathering of comments from DOH TBI Waiver consumers, that their MSC's have appealed on their behalf for a fair hearing and been told that the consumer's request could not be supported by waiver service providers!!!!….how is this legal at all??? Will this information be revealed by the consumer…are they even aware of it? It would be essential I think to gather testimony also from the Service Coordinators that are being prevented from DOING THEIR JOB in accordance with the DOH TBI Provider Manual. It is my hope that a strong effort will be made under the guidance of the KAC to bring these serious grievances to light, and that changes will result, or there seems no purpose or reason to encourage individual's to seek services from DOH.

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