I don't like the idea of a rigid rules based system for this because there will be many cases in both directions where rigid application of those rules produces results which just don't make sense for the intent of the rule. Plus a lot of the criteria involve very subjective judgment or a person's attestation which you have to accept at face value. As a doctor, I often have to fill out paperwork for someone to the best of my ability which asks very specific information e.g. duration of impairment, frequency of follow-up care needed, whether something will be permanent, is someone safe to do XYZ activity. All those questions sound reasonable, but are often can only be answered with a best guess, and sometimes you are placed in some trap by answering which makes you more liable, but for the most part unless you give a concrete specific answer, you might as well not have done it at all.
What does make sense, though, would be a very rigid and concrete initial review process that is done expediently and a subsequent appeals process that allows subjectivity to be judged.
But my biggest concern still holds and that is inequity. Someone with lower resources, no legal representation, trying to get records on behalf of a loved one to document their severe illness when their loved one has Medicaid, has faced transient homelessness, etc. is going to have a very hard time and no ally who knows the system to assist. Hell, in the hospital we often struggle to get necessary treatment records for our inpatients even knowing how to do it. Really, having a lawyer on your side who has actual time for you is the best thing, but they're also going to do the best job for your goal. As we have seen, even when it appears inappropriate, they're usually able to win which totally devalues the process and further exacerbates the inequity problem.
