Hooper v. Division of Medical Assistance Programs

356 P.3d 666, 273 Or. App. 73, 2015 Ore. App. LEXIS 995
CourtCourt of Appeals of Oregon
DecidedAugust 19, 2015
DocketA154410
StatusPublished
Cited by2 cases

This text of 356 P.3d 666 (Hooper v. Division of Medical Assistance Programs) is published on Counsel Stack Legal Research, covering Court of Appeals of Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hooper v. Division of Medical Assistance Programs, 356 P.3d 666, 273 Or. App. 73, 2015 Ore. App. LEXIS 995 (Or. Ct. App. 2015).

Opinion

NAKAMOTO, J.

Petitioner seeks judicial review of a final order of respondent Division of Medical Assistance Programs (DMAP), a division of the Oregon Health Authority, denying his request for a hearing after a provider refused to transport him for a medical appointment. As permitted by DMAP, petitioner sought reconsideration and requested referral of the factual issues concerning the timeliness of his hearing request to the Office of Administrative Hearings. DMAP denied reconsideration and denied petitioner’s request for referral of the issues for hearing, which petitioner also challenges on judicial review. Before filing its answering brief, DMAP moved for dismissal, contending that this matter is now moot, given that petitioner no longer has a need for medical transportation to that appointment. In light of the Oregon Supreme Court’s recent decision in Couey v. Atkins, 357 Or 460, 355 P3d 866 (2015), holding that the legislature acted within its authority in enacting ORS 14.175, we conclude that this case is justiciable under ORS 14.175 and choose to exercise our authority to issue a determination on the merits of petitioner’s challenge. We reverse and remand because DMAP’s order lacked substantial reason, and we do not reach the question whether DMAP must refer the timeliness issue for a hearing.

I. FACTS

Before we relate the procedural history, we briefly describe the nature of the dispute underlying petitioner’s request for a hearing concerning medical transportation services, as petitioner has described it, for context. Petitioner is paralyzed and must use wheelchairs for mobility. He has health care coverage through the Oregon Health Plan. Two wheelchairs were stolen from his home in southwest Oregon, for which he sought a replacement. Under his health plan, he needed a physician’s order to obtain the replacement wheelchair. His regular physician, in petitioner’s local area, was unable to see him urgently and so recommended an appointment with another in-network physician who could see him immediately. Petitioner arranged such an appointment with a doctor whose offices were located farther away at Curry General Hospital and sought transportation [76]*76from TransLink, which provides transportation for eligible Oregon Health Plan clients traveling to receive medical care. TransLink initially told him by phone that it was going to deny his request.

Petitioner then sought to challenge TransLink’s response. TransLink issued petitioner a “Notice of Action” dated October 30, 2012, but petitioner did not immediately receive that notice because TransLink had sent it to an incorrect address. The copy of the notice in the record contains petitioner’s street address, not his post office box, which was his correct mailing address. Eventually, he received the notice from TransLink, which stated the basis for its denial of services. Petitioner submitted a written request for a contested case hearing, which DMAP’s hearings unit received on December 19, 2012.

Although a hearing was scheduled for February 2013, a hearing representative for DMAP sent petitioner a letter dated December 21, 2012, stating that “clients must submit a hearing request within 45 days from the date of the notice” and that his request came 69 days from the date of the TransLink notice. She requested that petitioner provide her with “a written statement explaining any factors or circumstances that prevented [him] from completing [his] hearing request on time.”

Petitioner submitted a written statement to DMAP’s hearing representative, which the hearings unit received a week later. His statement contained the following explanation for the timing of his hearing request, which focused on TransLink’s late delivery of its written notice denying services, his limited mobility, and his interim doctor appointments:

“Well, initially, it took me awhile to get a straight answer from TransLink. I had to be a liaison between my doctor’s office and them, to get everyone on the same page. I gave my notice to appeal to TransLink via telephone. I then contacted my DHS caseworker and requested the appeal form; number 443, I believe. The caseworker stated that had to come from TransLink. After a week or so, I had not heard anything. I telephoned the quality assurance person at TransLink * * *, and she stated they had mailed it twice [77]*77to an incorrect address. They confused my mailing address with the physical address. After clarifying the correct mailing address, I reviewed the materials and researched the alleged relevant OAR’s. I submitted the appeal form shortly thereafter.
“As a note, I still have no replacement wheelchair. I have been impeded by my using an ill-fitted, inappropriate, uncomfortable wheelchair, as interim mobility. Further, I have had several doctors’ appointments and a wheelchair assessment during this time, which may have delay [ed] response time.”

DMAP then issued an order in early January 2013 denying petitioner an opportunity to challenge TransLink’s action. DMAP’s “Late Filing” order acknowledged petitioner’s written statement but informed him that “your letter did not describe circumstances beyond your control. Therefore, your hearing request is untimely and will be dismissed.” DMAP’s order did not provide any factual findings or any reasoning. The order stated that the February hearing was cancelled and provided petitioner with an opportunity to seek reconsideration of the decision within 60 days.

Petitioner obtained DMAP’s acknowledgment that the hearing request had been received 50 days, not 69 days, after the date of the notice, i.e., it was five days late. He then requested reconsideration on February 21, 2013. Petitioner informed the hearing representative that he had attempted to procure information from TransLink to corroborate that TransLink was at fault during the notification process, enclosing his letter to TransLink stating that an employee had admitted to him that TransLink had used the wrong address to send out the notice “at least twice.” He requested a hearing on the factual issue of timeliness and asserted that his hearing request was either timely under DMAP’s administrative rules or that there was good cause for any delay.

On May 13, 2013, more than 60 days after petitioner’s request for reconsideration, DMAP issued its “Final Order on Reconsideration.” That order purported to dismiss petitioner’s request for reconsideration and stated that,

“[bjecause the issue for which [petitioner] requested an Administrative Hearing cannot be provided (cannot go back [78]*78and provide transportation) and did not involve reimbursement, the DMAP Hearing Representative and [petitioner] agreed that although his reconsideration request would be denied, a conversation with TransLink and response to his questions in his February 14, 2013 letter will be addressed separately. The request for reconsideration submitted by [petitioner] is dismissed.”

(Emphasis added.) However, by operation of law, petitioner’s request for reconsideration had already been denied in April, pursuant to ORS 183.482(1).1

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Cite This Page — Counsel Stack

Bluebook (online)
356 P.3d 666, 273 Or. App. 73, 2015 Ore. App. LEXIS 995, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hooper-v-division-of-medical-assistance-programs-orctapp-2015.