Professional Case Management’s lawsuit FAQ
What is the lawsuit about?
This lawsuit is about making sure that the hard-working men and women who built this nation’s nuclear defense and got sick as a result of exposure to radiation and other toxins, have access to the medical care they have earned, in a timely manner.
Congress created a program to ensure these workers, many of whom are now in their 70s and 80s, received the medical care they need. Now, the Department of Labor is preparing to change the rules for the program in a way that would create significant delays in the time it takes to get approved for home health care, up to 60 days or more, time that many of our patients may not have. We want to stop the rule changes from being implemented and work with the DOL on updating the program in ways that don’t harm the American people.
Who is affected by the rule changes?
The people hurt by these rule changes are American workers who sacrificed their health to protect our country during World War II, through the Cold War to today. They now have severe and debilitating illnesses caused from being unknowingly exposed to radiation and other toxins while building our country’s nuclear defense. They helped defend the United States and now we need to fight for them.
What are you seeking in the lawsuit?
The lawsuit seeks to prevent implementation of the rule changes governing the Energy Employees Occupational Illness Compensation Program from taking effect on April 9. The EEOICP was established by Congress to ensure that workers who sacrificed their health to protect the country would receive the medical care they need in an efficient and timely manner.
Instead, we are asking the DOL to work collaboratively with stakeholders in good faith to establish appropriate regulations to ensure that seriously ill workers receive the medical treatment without unnecessary and life-threatening delays.
What are your specific concerns about the rule changes?
We have many concerns, but they all boil down to one thing, which is that these changes could prevent thousands of elderly, sick and dying workers from receiving the medical care they need in an efficient and timely manner. Today, when a doctor orders home health care for a patient in this program, care can be provided almost immediately. If the rules are changed as proposed, it could take 60 days or more to preauthorize care.
One of our specific concerns is a new 36-step process to obtain preauthorization and preclusion of health care professionals to assist in the process. Sadly, some could die waiting for this new pre-authorization process to run its course. For them, health care delayed is truly health care denied. They deserve so much better.
Why are you filing the lawsuit?
We didn’t want to resort to a lawsuit, but we felt we had no choice, given that the DOL ignored not only our concerns about its rule changes, but ignored virtually all of the concerns that were raised during the public comment period. We are fighting on behalf of our patients who depend on us to take care of them and the countless others who have worked in support of our nation’s defense.
When did you first start voicing concerns to the DOL regarding the proposed rule changes?
We have been making our concerns known since the rule changes were first proposed. We submitted our concerns and recommendations to the DOL more than three years ago. And we weren’t alone. Nearly 500 comments were submitted by claimants, worker advocates, physicians, and the Advisory Board on Toxic Substance and Worker Health, which was established by Congress specifically to advise the DOL on these topics. The majority of the comments objected to the proposed rule changes but the DOL largely ignored them. That is why we felt we had no choice but to file this lawsuit.
What other concerns do you have about the rule changes?
The changes make it harder for people to get the home health care they need, and that has been prescribed by their doctor, in a timely manner.
The rule changes would prevent health care professionals from helping their patients navigate the process, fill out the forms, access employment records and ensure medical and regulatory accuracy. Under the current rules, patients can have help from their health care provider to get all of this done.
The industry standard for the time to complete an initial home health care assessment is 48 hours. With the proposed 36-step preauthorization process for home health services which could take 60 days or more to complete, health care providers will not be able to do their initial assessment in a timely manner. And, the patient might not live long enough to get the preauthorization for home health care.
The rules include vague language about potential changes to the payment system. This obtuse language leaves providers and patients not knowing what to expect, what the changes might be, or how the changes might affect them.
Why are you specifically concerned about the new preauthorization requirements?
Under the existing stringent rules, the patients we care for already require an independent physician to assess the patient, order the care, and refer to a home health care provider. Preauthorization, as prescribed in the rule changes, only dramatically delays the process. And, the onerous 36-step process proposed would take upwards of 60 days to complete. The length of time needed under the rule changes to get preauthorization could be longer than the patient has left to live.
Is anyone else filing a lawsuit?
We can’t speak on behalf of any other organizations, but we do know that there is a tremendous amount of concern in the Cold War Patriots community about the impact these rules will have on the lives of the patients and their families. We’ve been talking with a number of other organizations about our shared concerns and there is potential for additional lawsuits and amicus briefs to be filed.
What else besides the lawsuit are you doing to help these people?
We hold regular town hall meetings in communities across the country so that we can connect nuclear and uranium workers with resources, information and a sense of community. We provide information through Coldwarpatriots.org about how to access benefits. And, we’re encouraging everyone who cares about what happens to these people – their neighbors, family members, strangers who helped defend our country – to speak up and ask the Department of Labor to postpone the proposed changes and work with us and others in our community on regulations that don’t create unnecessary delays in care.
How many people would be adversely affected by these changes?
There are about 20,000 workers who qualify for the benefits today, living with chronic illnesses caused by their exposure to nuclear radiation, uranium and other toxins. And, hundreds of thousands more can be eligible.
Delays in care not only will affect the health of the people seeking care, but it could impact their finances, their families’ finances and ultimately, leave people mourning the loss of their loved ones.
What does this mean for your business?
The proposed rule changes will make it harder for the people we serve to receive the care they need in a timely manner. When you work in this industry, and you hear the stories of the people who worked for the government building our nuclear defense, who were not told of the dangers they face in just doing their job, you know fighting for them is the right thing to do.
We are ready and willing to work with the Department of Labor to collaboratively change rules to help them improve the program and help the workers get the medical care they need as quickly as possible.
What is PCM? What is Cold War Patriots?
Professional Case Management (PCM) specializes in providing in-home health care for people suffering from chronic illnesses contracted in the course of their employment at nuclear facilities and uranium mines. Our mission is to deliver quality care that helps patients in the privacy and comfort of their own homes.
Cold War Patriots, a division of PCM, is a community resource organization committed to supporting nuclear defense and uranium workers, many of whom worked on behalf of the United States during the Cold War. We help connect them to benefits and services they are eligible for and advocate for their rights.