Appealing Choices:
Your Grievance and Appeal Options
In Michigan, the Department of Community Health (DCH) is in charge of substance abuse, mental health services, and developmental disability services. DCH provides services through a managed care system or an HMO (Health Maintenance Organization).
If you do not agree with a decision about what services you will or will not get, there are many ways to challenge the decision. There is usually more than one way to appeal, so if one way doesn't work, you can try another. In some cases, you may file several different appeals at the same time.
If you not agree with the services services you will or will not get, it is a good idea to talk with the person who made the decision. If that does not solve the problem, go to the supervisor. If you still want to appeal, send your request in writing and keep a copy for yourself.
(Remember to keep a copy of any appeal, complaint or grievance that you file).
This brochure tells you about your appeal rights. It does not include appeals you can make through the agency's regulatory or licensing agency.
- Recipient Rights Complaints
- Appealing A Denial of Service or a Denial for Hospitalization
- Medicaid Appeal
- Delays In Service
- Appealing Your Person-Centered-Plan
- Grievances About the Services You Receive
- Complaints about Substance Abuse Services
- For Answers To Questions
Recipient Rights Complaints
You may file a Recipient Rights complaint for any action (or lack of action) by Community Support and Treatment Services (CSTS) or Washtenaw Community Health Organization (WCHO) staff that you think violates rights. Your rights include: the right to be free from abuse, the right to confidentiality, and the right to be treated with dignity and respect.
Rights complaints can be made by phone or by filling out a form. It may be better to fill out a form, so you can keep a copy for your records.
Appealing A Denial of Services or a Denial for Hospitalization
You can ask for a second opinion from the director of the agency that refused to give you services. A CSTS or WCHO employee or a Rights Officer can answer your questions about the second opinion process. appeal.
Medicaid Appeal
If you have Medicaid, you can ask for a Medicaid Fair Hearing if services paid for by Medicaid are denied, reduced or stopped. You should receive a letter telling you that your Medicaid covered services are denied or changing. You have up to 90 days from the date of the letter to appeal.
You have to receive an Advance Notice if a service that is being stopped or changed is one you already receive. If you appeal before the date your services are suppose to stop or change, your services can stay the same until after a hearing is held.
To ask for a Medicaid Fair Hearing, you need to a Request for Hearing form from the agency.
Delays In Service
Federal Medicaid regulations allow you to ask for a Medicaid Fair Hearing if CSTS or WCHO does not act with "reasonable promptness." You can also file a Recipient Rights complaint or use the CSTS/WCHO local appeal process.
"Reasonable promptness" means that the agency usually has 14 days to tell you if you will or will not get a service you asked for. If it is an emergency, the agency must tell you in 3 days.
The agency also has to begin implementing your Person Centered Plan within 14 days of the date you signed it, unless you agree to a later start date.
Appealing Your Person-Centered-Plan
Your Individualized Plan of Service should be written using a person centered planning process. If this did not happen (you weren't invited to participate), or you do not agree with the final plan, you may appeal. Once you file an appeal, the agency has 30 days to review the plan, so this might not be a useful approach in an emergency situation.
Grievances About the Services You Receive
A "grievance" is a concern you have that is not a Rights violation, and does not involve the amount of services you get, the timeliness of those services, or a denial of services. If you have a grievance, you can ask for a meeting of the Local Dispute Resolution Committee. To do this, just call the local hearings officer and ask for a Grievance meeting or a Local Dispute meeting.
Complaints about Substance Abuse Services
A Rights complaint related to substance abuse services is a little different from the usual Recipient Rights complaint process. The forms are different, and the complaint is started with the agency that provides direct services.
The second level of appeal is to the WCHO (the Coordinating Agency for substance abuse services). If the problem is not resolved at that level, you can appeal to the Department of Consumer and Industry Services.
Remember: Sometimes you can use more than one kind of appeal at the same time. If you have questions about the appeal process, please call:
