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Minnesota Department of Human Services Community-Based Services Manual (CBSM)
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Appeals

Page posted: 10/1/03

Page reviewed: 11/13/17

Page updated: 11/13/17

Legal authority

42 C.F.R. 431.200 to 431.250, Minn. Stat. §256.045, Minn. Stat. §256.0451, Minn. Stat. §256B.0911, subd. 3(a), Minn. R. 9505.0125

Definition

Appeal: The process through which a human services judge reviews a decision made by either DHS or a county/tribal nation that affects the services a person receives or requests.

Appellant: The person who files the appeal.

Fair hearing: The meeting with the appellant, DHS, county/tribal nation and a human services judge to testify about the disputed decision. This meeting can be in person or via phone.

Overview

Federal and state law gives a person the right to a fair hearing when he/she disagrees with a decision made by the state, a county, tribal nation or health plan that impacts his/her public benefits, eligibility or payments. To request a fair hearing, the person files an appeal.

State, counties and tribal nations

If the person wants to appeal a decision made by the state, a county or tribal nation, the DHS Appeals Division will hold the fair hearing and make a decision. This page describes the process.

Managed care organizations (MCOs)

A person who receives services through a managed care organization (MCO) can request an appeal with either the DHS Appeals division or the MCO.

He/she should consult the health plan materials for these instructions.

New process as of Jan. 1, 2018

Effective Jan. 1, 2018, a person who receives services through an MCO must use the MCO’s appeal process before filing an appeal through the DHS Appeals Division.

For MCO contact information, see DHS – Health plan member services phone numbers.

County/tribal nation initial responsibilities

Provide information about appeal rights

The county/tribal nation must provide a person with his/her appeal rights during the assessment and support planning process. The county/tribal nation must document this action in the person’s record.

The county/tribal nation may use the following resources to assist with these requirements:

Notice of action

The county/tribal nation must send a notice of action to the person when it:

  • • Completes an assessment or reassessment
  • • Denies, terminates or reduces services.
  • • For more information, including which forms to use, see CBSM — Notice of Action.
  • Process

    The appeals process for long-term services and supports (LTSS) is detailed on the CBSM – Appeals processs page.

    Documentation

    During the appeal process, the county/tribal nation must send all appeal paperwork to the:

  • • Appellant
  • • DHS Appeals Division at DHS.AppealSummary@state.mn.us
  • • DHS Disability Services and the Aging and Adult Services divisions (depending on which one is applicable) via encrypted email to DHS.CCAappeals@state.mn.us.
  • The county/tribal nation also must retain a copy of all appeal paperwork. Appeal paperwork may include copies of:

  • • Appeal summary
  • • Notice of action
  • • The appellant’s written appeal request
  • • The appellant’s latest LTSS assessment or reassessment and other supplementary materials necessary to understand the action.
  • Reimbursement for appeal preparation

    A county/tribal nation can receive reimbursement for:

  • • The work the certified assessor does in preparation for an appeal
  • • Case management time for work the case manager does in assisting the person in appeals.
  • Certified assessors

    For certified assessor work, the lead agency receives reimbursement as an administrative activity under the time study reimbursement methodology.

    Case managers

    For case management time, appeal preparation not related to assisting the person is not billable as case management. It is considered an administrative activity.

    DHS assistance and involvement

    The role of the DHS Disability Services and the Aging and Adult Services divisions is to:

  • • Collect necessary data regarding appeals
  • • Provide technical assistance
  • • Monitor outcomes.
  • Divison staff can support counties and tribal nations during the appeal process by providing policy clarification or other technical assistance (e.g., reviewing assessment information, preparing the appeal summary, providing appropriate legal reference, implementing decisions, etc.). To receive assistance, email dhs.ccaappeals@state.mn.us.

    Case management conciliation conference

    A case management conciliation conference is another way to solve a grievance a person with a developmental disability or related condition has with his/her case management services.

    During a conciliation conference, the people involved try to resolve the conflict with a mediator in an informal setting.

    Following a conciliation conference, the person can file an appeal if:

  • • The county/tribal nation does not hold the conciliation conference within 30 days of his/her initial request
  • • The county/tribal nation does not issue the report to the person that outlines the outcome of the conciliation conference
  • • The person is unhappy with the outcome.
  • The person must file an appeal within 90 days after the date of the conciliation conference.

    Additional resources

    CBSM

    CBSM – Appeals process
    CBSM – Notice of action

    DHS policy/info

    DHS – Appeals Division
    DHS – Frequently asked questions about state appeal hearings

    eDocs/forms

    Your Appeal Rights, DHS-1941 (PDF)
    Instructions for Requesting an Appeal, DHS-0033 (PDF)

    Appeal Hearings Information, DHS-2811 (PDF)

    Information About Subpoenas For State Human Services Hearings, DHS-2935A (PDF)

    Ombudsman information

    Office of the Ombudsman for Long-Term Care
    Office of Ombudsman for Mental Health and Developmental Disabilities website (OMHDD)

    Office of Ombudsman for Long-Term Care fact sheet, DHS-4732 (PDF)

    Legal information

    Minnesota Judicial Branch – Civil appeal
    Minnesota Disability Law Center
    (legal aid)

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    © 2017 Minnesota Department of Human Services Updated: 11/13/17 12:24 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 11/13/17 12:24 AM