Disabled Marylanders want federal government to step in on stalled appeals

MARYLAND (WBFF) — The Centers for Medicare and Medicaid Services is reviewing allegations that Maryland failed to process appeals for disability services within 90 days, which is a violation of federal rules.

That’s according to an email sent by a CMS employee to Jonathan Martinis, a lawyer representing Connor Feron, a Lutherville resident who has autism and other medical conditions.

Feron submitted an appeal in April to challenge the non-reimbursement of healthcare services for one of his staff, and the Maryland Developmental Disabilities Administration hasn’t yet scheduled a hearing — more than 180 days after he filed.

DDA receives around half of its $3.3 billion budget from the federal government. Martinis said that taxpayer money comes with a promise from DDA to operate an appeal system that hears and decides cases within 90 days.

“Connor’s case is now six months old. He doesn’t even have a case scheduled,” Martinis said.

“We hope that CMS is taking this seriously, and we hope that Maryland is being held accountable,” Martinis added.

Spotlight previously reported in September that the state failed to process more than 200 DDA appeals within the federal government’s 90-day deadline, according to a Maryland Public Information Act response.

A CMS employee told Martinis in a Sept. 8 email that while “CMS is not an investigative agency,” it “will thoroughly review your allegations against the State and proceed accordingly.”

“If we identify noncompliance with federal regulations, we can require a State to submit a corrective action plan (CAP),” the CMS email said.

The federal agency’s approval process for a corrective action plan requires a state to take specific steps to ensure compliance, including a detailed timeline for achieving compliance, according to the email.

Fair Hearing timeliness and backlogs are areas that corrective action plans commonly address, the CMS email said.

“Because our investigation can be lengthy, we forwarded your complaint to the State for immediate awareness and, hopefully, prompt action to address your concerns,” the CMS email to Martinis said.

On Oct. 5, the CMS employee told Martinis that the agency received the information from the MPIA but was “unable to share the status” of its investigation.

Martinis filed complaints with both CMS and Maryland’s Office of Inspector General for Health.

The OIGH told Martinis on Oct. 7 that it “has determined that the matter that you reported falls within the jurisdiction of the OIGH,” but didn’t say whether it would investigate.

“Allegations are screened and prioritized for investigation based on risk, significance, available resources, and other factors,” OIGH said to Martinis in an email. “Consequently, we cannot guarantee that any particular allegation will result in further investigative action. We are unable to provide updates of the status of particular allegations or cases.”

Krista Ennis filed a DDA services appeal in June for her son, Daniel Ennis, a Catonsville resident with autism. That appeal has also passed the 90-day deadline without a scheduled hearing. She said she hopes CMS will step in.

“I work in an industry that is very compliant to deadlines, and it just seems like DDA works at their own deadlines,” she said.

Ennis said she appealed unpaid benefits for a staff member. She said she’s having difficulty hiring new staff because she can’t promise the DDA will cover their benefits.

“They’re really wearing families down,” she said.

Feron’s mom, Tracie Feron, said she thinks the appeal process “has shown clearly how systemically broken this system is in Maryland to protect the most vulnerable,” adding that she hopes CMS “will step in so that Connor — his voice can be heard in a court of law.”

CMS did not respond to Spotlight on Maryland’s request for comment.

The Maryland Department of Health said it couldn’t respond to Spotlight’s questions within a 23-hour window.

Have a news tip? Contact Brooke Conrad at bjconrad@sbgtv.com or 443-578-2126, or contact the Spotlight team at SpotlightOnMaryland@sbgtv.com or 410-467-4670. Spotlight on Maryland is a joint venture by The Baltimore Sun, FOX45 News and WJLA in Washington, D.C.