Page posted: 10/1/03

Page reviewed: 11/12/26

Page updated: 11/12/26

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

Definitions

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.

Lead agency: County, Tribal Nation or managed care organization (MCO).

Fair hearing: The meeting with the appellant and a human services judge, DHS or a county/Tribal Nation to testify about the disputed decision. This meeting happens via telephone unless there is an accommodation request.

Overview

Federal and state law gives a person the right to a fair hearing when they disagree with a decision made by the state or a lead agency that affects their public benefits, eligibility or payments. The person must file an appeal to request a fair hearing.

State, county and Tribal Nation decisions

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

MCO decisions

If the person receives services through an MCO, they must use the MCO’s appeal process before filing an appeal through the DHS Appeals Division. The person should consult the MCO’s materials for instructions. For MCO contact information, refer to DHS – Health plan member services phone numbers.

County/Tribal Nation initial responsibilities

Provide information about appeal rights

The county/Tribal Nation must provide the person with their appeal rights during the assessment and support planning process. The county/Tribal Nation must document this action in the person’s record. For more information, refer to:

Send a notice of action

The county/Tribal Nation must send a notice of action to the person when:

For more information, refer to CBSM – Notice of Action.

Process

CBSM – Appeals process explains the appeals process for LTSS in detail.

Documentation

During the appeal process, the county/Tribal Nation must send all appeal paperwork to:

For instructions to encrypt emails, refer to CBSM – How to exchange private and protected information with DHS.

The county/Tribal Nation must retain a copy of all appeal paperwork, which may include copies of:

Reimbursement for appeal preparation

The county/Tribal Nation can receive reimbursement for completing certain activities.

Certified assessors

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

Case managers

Case managers can bill case management units for time spent helping the person file an appeal or other activities that directly benefit the person. Appeal preparation not related to helping the person is not billable as case management.

DHS assistance and involvement

DHS Aging and Adult Services and Disability Services divisions are responsible to:

Division 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 request assistance, email DHS.CCAappeals@state.mn.us.

Case management conciliation conference

A case management conciliation conference is another way to solve a dispute about services for people with developmental disabilities or related conditions. During a conciliation conference, the people involved try to resolve the conflict with a mediator in an informal setting.

The person can file an appeal if:

The person must file an appeal within 90 days after the date of the conciliation conference.

For more information, refer to CBSM – Rule 185 case management.