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Appeals Archive

As part of our commitment to transparency, we make DHS appeals decisions available to the public in this appeals archive.

Results 1 - 10 of 1182
The issue raised in this appeal is: 1. Whether the agency correctly terminated appellant’s CADI waiver as of November 30, 2018. PROCEDURAL HISTORY 1. On November 6, 2018, County (agency) sent (appellant) a written Notice of Action informing appellant that his annual assessment was due before November 30, 2018 and failure to complete the annual assessment would result in a termination of current services. Exhibit 3. On December 27, 2018, the agency sent appellant a written Notice of Action informing his Community Access for Disability Inclusion (CADI) waiver was terminating November 30, 2018 because participation requirements were not followed. Exhibit 1. On January 8, 2019, the appellant filed an appeal. Id. 2. A hearing was scheduled for February 19, 2019, but was continued at the request of the appellant. On March 27, 2019, the Human Services Judge held an evidentiary hearing on the matter by telephone. On March 27, 2019, the record closed consisting of the hearing testimony and seven exhibits. 2 3. In order to obtain additional information, the record was reopened and a new hearing date was set for April 25, 2019. Because neither of the parties was available on that date, the hearing was reset. 4. Appellant called the appeals division and provided his phone number for the reset hearing. On the date of the reset hearing, May 8, 2019, two attempts were made to contact the appellant and a voice message was left requesting that he contact the appeals division immediately. The appellant did not contact the appeals division. The hearing proceeded and additional testimony was taken from the agency. One additional exhibit was submitted. 3
Date: May 17, 2019
Docket: 217509
Examiner: Joan G. Hallock
related to the MnCHOICES Assessment Behavior Domains. Judge Lomheim sent the request to Disability Services Compliance Consultant. Judge Lomheim asked that Ms. provide the DSD Comment by February 11, 2019. Judge Lomheim gave the County until February 25, 2019, to respond to DSD comment and gave Mr. until March 11, 2019, to respond to DSD comment. 7. On February 6, 2019, Ms. requested an extension to February 18, 2019. Judge Lomheim granted Ms. request and extended the County’s response to March 4, 2019, and Appellant’s response to March 18, 2019. 8. On February 15, 2019, the County indicated they had mailed a closing statement on November 11, 2018, but it was not received. Judge Lomheim accepted the closing and notified Appellant that it had been received, and there was a mailing error. 9. On February 19, 2019, Ms. submitted DSD comment to Judge Lomheim, the County, and Mr. Judge Lomheim accepted it into the record. 5 10. On March 8, 2019, the County indicated they did not have any additional information to add to DSD comment. 11. On March 11, 2019, Mr. submitted a response to DSD comment. Judge Lomheim accepted into the record. 6 12. On March 18, 2019, Judge Lomheim closed the record.
Date: May 13, 2019
Docket: 213198
Examiner: Jamie L. Lomheim
Date: May 13, 2019
Docket: 219634
Examiner: John Freeman
The issue raised in this appeal is: Whether the Agency correctly denied Appellant’s request for prior authorization for dental implants. Recommended Decision: Yes. PROCEDURAL HISTORY 1. On January 29, 2019, South Country Health Alliance (Agency) denied (Appellant’s) prior authorization request for dental implants. Exhibit 2. On February 25, 2019, Appellant requested that the Agency conduct an internal appeal. Id. On February 28, 2019, the Agency completed an internal review process and affirmed the original determination. Exhibit 3. On March 8, 2019, the Appellant filed an appeal. Exhibit 1. 2. On April 11, 2019, the Human Services Judge held an evidentiary hearing on the matter by telephone conference. At the hearing, two exhibits were accepted into evidence. 2 The record was held open until April 19, 2019 to receive an additional exhibit. 3 The record, consisting of the sworn testimony and three exhibits, was closed on April 19, 2019.
Date: May 13, 2019
Docket: 220222
Examiner: Nicole Kralik
The issues raised in this appeal are: Whether the Agency correctly determined that Appellant’s MinnesotaCare coverage became effective on April 1, 2019. Recommended Decision: Yes. PROCEDURAL HISTORY 1. On March 12, 2019, Appellant filed an appeal request of the Agency’s determination to begin his MinnesotaCare coverage effective April 1, 2019. Exhibit 1. 2. On April 16, 2019, the Human Services Judge held an evidentiary hearing on the matter by telephone conference. At the end of the hearing, the record closed consisting of the hearing testimony and two exhibits. 2
Date: May 13, 2019
Docket: 220394
Examiner: Nicole Kralik
Date: May 03, 2019
Docket: 219377
Examiner: John Freeman
The issue raised in this appeal is: Whether the Agency correctly denied the request to increase the direct care staff wage of Appellants’ parents to $27, under Appellants’ Consumer-Directed Community Supports budget for the Developmental Disabilities waiver. Recommended Decision: AFFIRM (see “Analysis and Conclusion” below) PROCEDURAL HISTORY 1. Notice and Appeal. On March 8, 2019, County (“Agency”) sent and (“Appellants”) written notices of action, informing Appellants that their request for a direct care wage increase for their parents was denied. Agency Exhibit 1; Appellant Exhibit A. In response, Appellants’ mother and legal guardian, (“Ms. ”), filed appeal requests for each Appellant, which were received by the Appeals Office on March 25, 2019. Appellant Exhibit A. 2. Consolidation. Evidentiary hearings on the appeals were set to take place consecutively, but separately, on April 24, 2019. However, both parties expressed a preference for and consented to the hearings being consolidated into one. While Appellants each have their own Consumer-Directed Community Supports budgets, the request applies to both budgets. Therefore, Human Services Judge John Freeman granted the joint consolidation request as a matter of efficiency. 3. Hearing and Appeal Record. On April 24, 2019, Judge Freeman held an evidentiary hearing on the matter by telephone conference, attended by Ms. two Agency representatives, and one Agency observer. The Judge accepted into the record one exhibit from Ms. and one exhibit from the Agency. At the end of the hearing, the record was closed consisting of the testimony of the parties and two exhibits. 2
Date: April 26, 2019
Docket: 220884
Examiner: John Freeman
The issue raised in this appeal is: Whether the Agency correctly determined the effective date of Appellant’s eligibility for Medical Assistance as February 1, 2019. Recommended Decision: REVERSE (see “Analysis and Conclusion” below) PROCEDURAL HISTORY 1. Notice and Appeal. On February 27, 2019, Minnesota Department of Human Services (“Agency”) sent (“Appellant”) a written notice of action, informing Appellant that she was approved for Medical Assistance effective February 1, 2019. Agency Exhibit 1. Because Appellant sought an earlier effective date, she filed an appeal request that was received by the Appeals Office on March 15, 2019. Appellant Exhibit A. 2. Hearing and Appeal Record. On April 15, 2019, Human Services Judge John Freeman held an evidentiary hearing on the matter by telephone conference, attended by Appellant and her partner. The Judge accepted into the record one exhibit from Appellant and one exhibit from the Agency, and held the record open to receive additional evidence from Appellant and an optional reply from the Agency. At the end of the day on April 18, 2019, the record was closed consisting of the testimony of Appellant and her witness and six exhibits. 2
Date: April 22, 2019
Docket: 220555
Examiner: John Freeman
The issues raised in this appeal are: Whether the Agency correctly determined that Appellant’s 2018 MinnesotaCare coverage terminated on December 31, 2018 due to non-renewal; and Whether the Agency correctly determined that Appellant’s MinnesotaCare coverage became effective on February 1, 2019. Recommended Decision: Yes. PROCEDURAL HISTORY 1. On December 3, 2018, DHS (Agency) sent (Appellant) a notice that her MinnesotaCare coverage will end on December 31, 2018 due to non-renewal. Exhibit 2. On March 8, 2019, Appellant filed an appeal request. Exhibit 1. 2. On April 18, 2019, the Human Services Judge held an evidentiary hearing on the matter by telephone conference. At the end of the hearing, the record closed consisting of the hearing testimony and two exhibits. 2
Date: April 22, 2019
Docket: 220283
Examiner: Nicole Kralik
The issue raised in this appeal is: Whether the Agency properly determined that Appellant was not eligible for Medical Assistance (MA) at the time of redetermination. Recommended Decision: The human services judge recommends affirming the Agency’s decision. PROCEDURAL HISTORY 1. On February 14, 2019, the Minnesota Department of Human Services (“the Agency”) sent (“Appellant”) a written notice of action informing Appellant that he no longer qualified for MA and that his MA coverage would stop at the end of the day on February 28, 2019. Exhibit 2 . Appellant contested this determination by filing an appeal, which the Appeals Office received on February 21, 2019. Exhibit 1 . 2. On March 25, 2019, the human services judge held an evidentiary hearing on the matter by telephone conference. The human services judge closed the record at the conclusion of the hearing. The record consists of the hearing testimony and two exhibits. 2
Date: April 22, 2019
Docket: 219705
Examiner: Randall Shimpach
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Disclaimer: As part of its commitment to transparency, DHS makes publicly available this library of appeals decisions. Consistent with the requirements of applicable state and federal laws, protected information is removed from the decisions in this library. This library is not intended to give legal advice. You should not interpret these decisions as binding on anyone except the parties to the decision. The decisions are not precedent for any dispute between parties in the future. The laws affecting these programs may change frequently and information provided in this library of decisions may not reflect the current state of the law. The decisions also may be subject to further review. Therefore, please consult with a knowledgeable expert before you take action in reliance on any information provided here.
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