Fair Hearing Requests

Transcription

1 Fair Hearing

2 Fair Hearing Requests There are two ways to request a Fair Hearing from the Michigan Administrative Hearing System Completion of a Request for Hearing form or Submit the written request to: Michigan Administrative Hearing System for the Department of Community Health P.O. Box Lansing, MI A written request should contain: Name, address, and telephone number of the person for whom the request is being made and the same information for the person requesting the Fair Hearing (if different) Benefit or program involved Details of the decision being challenged

3 Fair Hearing Requests All completed Request for Hearing forms should be mailed to: Michigan Administrative Hearing System for the Department of Community Health P.O. Box Lansing, MI 48909

4 Timeframes Following a Notice of Action the beneficiary has 90 calendar days to request a Fair Hearing. Expedited Hearings are an option that MAHS may grant upon request.

5 Service Reinstatement and Continuity Services and supports must be reinstated during pendency of the Fair Hearing if: The Request is made within 12 calendar days of the date on the Notice of Action; and The beneficiary requests that they continue; and The appeal involves the termination, suspension, or reduction of a previously authorized service and The original period covered in the original authorization has not expired The services and supports must continue until one of the following occurs: The Administrative Law Judge orders a decision that is adverse to the beneficiary; The time period or services of the previously authorized service has been met.

6 Concurrent Processes A Local Appeal request does not need to be completed prior to a Request for Hearing The two processes can be concurrent

7 Authorized Representatives Beneficiaries may submit a Request for Hearing. An authorized representative may submit a Request for Hearing if they: They are over 18 years old and have written permission; or They are the guardian or conservator and submit a copy of the Court Order naming them

8 Fair Hearing Information Resources Brochures: Customer Services Appeals for Medicaid Beneficiaries Understanding the Grievances and Appeals Process for Medicaid Beneficiaries Agency Notice of Action format Agency Policies: Grievance Process Michigan Department of Community Health Medicaid Fair Hearings Local Appeals

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11 Local Appeal

12 Local Appeal Requests There are two ways to request a Local Appeal Completion of a Request for Local Appeal form (see form); or Make an Oral Request for a Local Appeal which will be treated as a Local Appeal to establish the earliest possible filing date for the Appeal. Following a Notice of Action the beneficiary has 45 calendar days to request a Local Appeal. Expedited Resolutions are an option that may be facilitated upon request.

13 System Navigation Reasonable assistance to complete forms and take other procedural steps must be provided to the individual or their representative. This may include: Reasonable opportunities to present evidence; Opportunities to examine the case file and documents considered during the Local Appeal process; Opportunities to include the beneficiary or their representative as a party to the Local Appeal; Information about the right to file a Fair Hearing and how to do so,

14 Notice of Disposition A written Notice of Disposition must be provided for each Local Appeal. Reasonable efforts must be made to provide an oral notice when an Expedited Resolution is requested. A Standard Resolution must be completed within 45 calendar days. An Expedited Resolution must be completed within three (3) working days. The Notice of Disposition must include: An explanation of the results of the resolution, and The date that the resolution was completed.

15 Notice of Disposition If the Local Appeal is not resolved wholly in favor of the individual the Notice of Disposition must also include: The right to request a Fair Hearing and how to do so; The right to request to receive benefits while the Fair Hearing is pending if : The Request is made within 12 calendar days of the date that the Notice of Disposition was mailed; It must include information identifying that the beneficiary may be held liable for the cost of benefits if the Fair Hearing decision upholds the Agency decision in the Local Appeal.

16 Service Reinstatement Services and supports must be reinstated during pendency of the for Local Appeal if: The Request is made within 12 calendar days of the date on the Notice of Disposition ; and The beneficiary requests that they continue.

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19 Grievance

20 Grievance Requests There are two different types of Grievances. Informal Grievances are filed with the Provider Formal Grievances are filed with the Agency s Customer Services Unit Grievances may be submitted orally or in writing

21 Contact Information Agency Customer Services: Phone: (888) Fax: (313) TDD: (866) Substance Abuse/Detroit Residents: Detroit Bureau of Substance Abuse Prevention, Treatment and Recovery Phone: (800) Substance Abuse/Out of County: SEMCA Phone: (734) (800)

22 Representatives Grievances may be submitted by the individual; or A Grievance may be filed on their behalf by: A Guardian or Parent of a minor child.

23 Resolution A Resolution Letter must contain: The results of the Grievance; The date the Grievance process was concluded; The right to access the Fair Hearing process if the Grievance process took over 60 calendar days.