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Settlement with EOHHS Regarding Treatment of Trusts and Administrative Appeal Timelines

Date: 
09/13/2021
Author: 
MISC
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This settlement with the Executive Office of Health and Human Services (EOHHS) arises out of several consolidated cases brought in Suffolk Superior Court. Congratulations to Nicholas Kaltsas of Elder & Disability Law Advocates, John Welch of Life Care Planning Law Group, and John Ford of the Northeast Justice Center for their impressive advocacy and for obtaining such an impactful settlement agreement. The settlement addresses promptness of fair hearing decisions and responses to requests for rehearing, as well as procedures to promote MassHealth’s consistent treatment of trusts when determining financial eligibility for long-term care. The court did not retain jurisdiction to enforce the agreement, but by the terms of the agreement,  non-parties may seek specific performance of the  requirement for timely Board of Hearings decisions.  A copy of the Oct 14, 2021 final judgement on the joint motion  dismissing the litigation as well as the Sept 13, 2021 settlement agreement is attached.  Some highlights are:

 

Promptness of fair hearing decisions: the settlement reinforces 42 C.F.R § 431.244(f)’s requirement that the Board of Hearings make a final decision within 90 days of the request for fair hearing. It requires MassHealth to create an email address that appellants awaiting a fair hearing decision may email within 14 days of the 90 day deadline. If the board then fails to issue a timely decision, the appellant may bring an action in superior court seeking specific performance of the agreement's requirement of timely decisions. 

 

Promptness of Response to Requests for Rehearing: Prior to this settlement, there was no specific timeline for the Medicaid Director to act on a request for rehearing. This settlement sets a 45 day timeline; the request is deemed denied if the Medicaid Director doesn’t act on it in 45 days, unless the appellant opts out of this timeline in writing. This allows the appellant to get a timely decision on their request for rehearing before filing a 30A request for judicial review. 

 

Consistent Treatment of Trusts: This settlement defines “good cause” for the Medicaid Director to grant a rehearing request as when the fair hearing decision is inconsistent with a previously issued hearing decision or an appellate court decision construing the same trust language or law. To assist with this, the settlement also requires the Board of Hearings to make its best effort to make fair hearing decisions available online by September, 2023.

 

Stay tuned for amended regulations and subregulatory guidance from MassHealth implementing the new procedures established by this settlement.

 

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