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Abdul-Akbar v. Dhss Hearing Office and Health Options

Superior Court of Delaware

September 11, 2018

DEBRO ABDUL-AKBAR, Appellant
v.
DHSS HEARING OFFICE AND HEALTH OPTIONS, Appellee

          Submitted: August 1, 2018

          On Appellant Debro Abdul-Akbar's Appeal of Delaware Department of Health and Social Services Fair Hearing Decision. APPEAL DISMISSED.

          Debro Abdul-Akbar, Wilmington, Delaware, Appellant, pro se

          Geoffrey G. Grivner, Esquire, Buchanan, Ingersoll & Rooney, P.C., Wilmington, Delaware, Attorney for Appellee, Health Options.

          MEMORANDUM OPINION

          Richard R. Cooch, R.J.

         I. INTRODUCTION

         Before the Court is Appellant Debro Abdul-Akbar's Appeal of the Decision of the Fair Hearing Officer ("FHO") on behalf of the Delaware Department of Health and Social Services ("DHSS"). The FHO upheld a denial of Appellant's request of 60 hours per week of Self-Directed Attendant Care ("SDAC"). Highmark Health Options ("Health Options/Appellee") is the contracted provider and servicer of DHSS's Medicaid program.[1] Health Options originally set Appellant's SDAC needs at 28 hours per week. On July 25, 2017, Health Options denied Appellant's request to increase SDAC to 60 hours per week.[2] Appellant's appeal stems from this initial denial.

         The threshold issue at this stage is whether Appellant has met his burden under 31 Del. C. §520 to establish that his appeal to this Court was timely filed.[3] The Court finds that Appellant's appeal was not timely. The appeal is dismissed.

         II. FACTS AND PROCEDURAL HISTORY

         The record indicates that Appellant is a 58-year-old man diagnosed with several medical conditions including diabetes, hypertension, heart disease, asthma, cyclical vomiting syndrome, Hepatitis C, celiac disease, and liver disease. Despite numerous medical conditions, Appellant is occasionally able to function on his own, [4] but often requires assistance with daily activities such as bathing, cooking, cleaning, and laundry. Appellant's wife handles much of his care when he is unable to function solely on his own. Appellant also receives care under the SDAC program, a DHSS Medicaid program intended to assist disabled patients with ambulation, assistive devices, wound dressing, bathing, etc.

         As of July 2017, Appellant received 28 hours per week of SDAC. Appellant apparently believed more hours should be ordered to help him with numerous daily activities. Through his physician Dr. Karlo Magat, Appellant requested an increase in SDAC to 60 hours per week; a 32-hour increase. On July 25, 2017, Health Options denied Appellant's request as "not medically necessary."[5] ("July Denial") Appellant requested an appeal of the July Denial on July 31, 2017. Health Options held an internal appeal on August 23, 2017 which upheld the July Denial. Appellant requested a State Fair Hearing on September 12, 2017. The Fair Hearing began on October 12, 2017. On January 8, 2018, after a continuance to gather more medical records, the FHO upheld the July Denial. Appellant filed the present appeal on February 12, 2018.

         III. PARTIES' CONTENTIONS

         A. Appellant Mr. Abdul-Akbar 's Contentions

         Appellant first contends he has "suffered gross negligence" from the "hearings parties thus far[.]"[6] Second, Appellant asserts Health Options committed "gross medical malpractice" by permitting a nurse to "essentially prescribe treatment."[7] Lastly, Appellant contends the FHO ignored claims of discrimination. Appellant asserts the July Denial "was made due to racial and ...


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