Page posted: 11/13/17

Page reviewed:

Page updated:

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

Overview

As a supplement to CBSM – Appeals, this page provides step-by-step information about the appeals process for both the person and the applicable county or tribal nation.

Process

The process for long-term services and supports (LTSS) includes the following steps, which generally happen in chronological order, but some may happen at the same time:

1. A county or tribal nation notifies a person about a change to their services and supports through a notice of action.

2. The person files an appeal in response to a notice of action.

3. The DHS Appeals Division requests an appeal summary from the responsible agency.

4. The county/tribal nation continues services at the prior level pending the appeal’s outcome (unless the appellant requests not to have a continuation of benefits).

5. The county/tribal nation and appellant may resolve the appeal before the fair hearing.

6. The county/tribal nation completes and submits the appeal summary.

7. The DHS Appeals Division schedules a hearing.

8. The DHS Appeals Division issues a decision.

9. The county/tribal nation implements the decision

10. The appellant or county/tribal nation may request reconsideration from the DHS Appeals Division.

The following sections describe these steps in detail.

Notice of action

When a county or tribal nation notifies the person of a change to services/supports, it sends a notice of action. That notice includes information about why the decision was made and how to file an appeal.

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

Person files an appeal in response to a notice of action

If the person does move ahead with an appeal, they must submit a written request to the county/tribal nation or to the DHS Appeals Division.

The person may use Appeal to State Agency, DHS-0033 to submit their appeal request.

If the person sends their request to the county/tribal nation, the county/tribal nation must forward the request to the DHS Appeals Division.

Time frame

A person must submit the written request within 30 calendar days of when they received the notice of action. A person may submit the request within 90 calendar days if they show a good reason for delay beyond the 30-day timeframe.

DHS Appeals Division requests an appeal summary from a county/tribal nation

When the person requests an appeal, the DHS Appeals Division will ask the agency whose action is being appealed to complete an appeal summary. This request acts as notice to the agency that a person filed an appeal.

When the appeal is related to an action taken by a case manager, the result of an assessment or another action taken by the county/tribal nation, the county/tribal nation is responsible to complete the appeal summary.

For instructions about how to complete and submit the appeal summary, refer to the “county/tribal nation completes and submits the appeal summary” section on this page.

If the county/tribal nation receives a request for an appeal summary in error

Follow this guidance if the county/tribal nation receives a request for an appeal summary from the DHS Appeals Division about either of the following:

1. Non-waiver home health services or home care nursing

For home health services (e.g., skilled nurse visits, home health aide visits) or home care nursing for an appellant who is not on a waiver, the county/tribal nation should notify both the Appeals Division at DHS.Appeals.Modification@state.mn.us and the human services judge that the Disability Services Division must complete the appeal summary. This also applies to appeals of reduction to personal care assistance (PCA) services due to an authorization for home care nursing.

2. MCOs

For service determinations made by a managed care organization (MCO), the county or tribal nation should notify both the Appeals Division at DHS.Appeals.Modification@state.mn.us and the human services judge that the MCO must complete the appeal summary.

Note

In these two situations, the DHS Appeals Division will resend the summary request to the appropriate entity.

County/tribal nation responsibility to continue services at prior level pending the appeal’s outcome

When the person requests an appeal, they have the right to keep their benefits the same as they were before the county/tribal nation’s notice of action. This is true until the human services judge makes a final decision.

The responsibility and required timeframes for continuing services differ depending on the action the person appeals.

Type B service agreements

If the person appeals an action related to PCA or home care services authorized on a Type B service agreement and does so within the required time frame in the “person files an appeal in response to notice of action” section, DHS automatically continues their services unless the appellant requests services to end. The county/tribal nation does not need to take action.

PCA services and waivers

If the person appeals an action related to PCA services authorized through a waiver or Alternative Care (AC) and does so within the required time frame in the “person files an appeal in response to notice of action” section, PCA services should continue at the previous level, unless the person requests their services to end. The county/tribal nation needs to take action to continue the person’s benefits at the previous level.

All other services

If the person appeals an action related to other services, they must request continuation of services within 10 days of receiving the notice of action. The county/tribal nation needs to take action to continue the person’s benefits at the previous level.

How to continue services

The county/tribal nation is responsible for continuation of all services authorized through waiver, AC or Essential Community Supports (ECS). For instructions, refer to Instructions for Completing and Entering the LTCC Screening Document and Service Agreement Into MMIS, DHS-4625 (PDF).

County/tribal nation and appellant may resolve the appeal before fair hearing

Before the fair hearing, the county/tribal nation may contact the appellant to discuss the dispute they raised in the appeal request. In some cases, the county/tribal nation and appellant may resolve the dispute with additional communication.

If the county/tribal nation and the appellant are able to resolve the dispute before the fair hearing, the county/tribal nation should advise the appellant to contact the DHS Appeals Division to withdraw their appeal. If the county/tribal nation does not receive a decision from the judge that the appeal was withdrawn, the county/tribal nation completes the appeal summary to inform the appellant and the human services judge of the resolution.

County/tribal nation completes and submits the appeal summary

The person who took the action on behalf of the county/tribal nation (e.g., certified assessor, case manager) is responsible to complete the appeal summary.

Purpose

The purpose of the appeal summary is to:

The audience of the appeal summary is the appellant and the human services judge.

How to complete

The county/tribal nation may complete the appeal summary using either State Agency Appeals Summary, DHS-0035 (PDF) or a narrative format.

While completing the appeal summary, consider the following:

If the county/tribal nation has questions about what to include in the appeal summary or needs technical assistance, email DHS.CCAappeals@state.mn.us.

Submit

The county/tribal nation must send the completed appeal summary at least three days before the hearing to the:

The county/tribal nation should notify the human services judge of their intent to participate in the hearing. If participating by phone, they should provide a contact phone number.

DHS Appeals Division schedules a hearing

The DHS Appeals Division will schedule the fair hearing in a way that permits easy access (typically via phone or videoconference). It will notify the county/tribal nation and appellant of the hearing date, time and location.

The hearing date, time and location is subject to change to permit flexibility.

Time frame

The DHS Appeals Division will send the notice of hearing within 30 business days of receiving the appeal request.

What to expect at the hearing

The hearing is a semi-formal process in which rules of testimony and evidence are in place. All of the participants are sworn in, and the human services judge will direct the participants when to respond.

The DHS Appeals Division:

DHS Appeals Division issues a decision

Following the hearing, the human services judge sends the recommended decision to the chief appeals judge. The human services judge’s recommended decision typically will do one of the following:

As required by federal law, the chief human services judge must issue the final decision within 90 days of the appeal request.

The DHS Appeals Division will send the final decision to the appellant (and their representative[s], if applicable) and all other involved parties, who may include applicable:

County/tribal nation implements the decision

The county/tribal nation must follow the final decision or request a reconsideration as soon as possible, but within 30 days of the decision. If requesting a reconsideration, the county/tribal nation should delay implementing the final decision until the Appeals Division makes a final determination.

Changing the service agreement

If changes to the person’s service agreement are necessary to implement the final decision:

1. DHS will enter changes for home care and PCA service agreements (Type B).
2. The county/tribal nation should enter changes for all other service agreements (waiver, AC, and ECS). On the comment screen in MMIS, the county/lead agency should indicate that the change is a result of the appeal decision. Next, the county/tribal nation should document the appeal results in the person’s support plan.

Technical assistance

Contact DHS.CCAAppeals@state.mn.us via encrypted email for technical assistance implementing decisions regarding assessment results, consumer directed community supports (CDCS) budget changes or any difficulties making the necessary changes to a service agreement.

Reconsideration of final appeal decision

If the appellant or county/tribal nation disagrees with the chief human services judge’s final decision, either may request reconsideration from the DHS Appeals Division. The appellant may appeal the final decision in district court.

Time frame

The appellant or county/tribal nation must request reconsideration within 30 calendar days of when the chief appeals judge issues the final decision. The Appeals Division will make a determination to grant or deny reconsideration within 30 calendar days.

If the DHS Appeals Division chooses to reconsider the decision, it will provide each party an opportunity to submit additional information relevant to the reconsideration. This information must be submitted within 10 business days of the request. The Appeals Division will make the final determination to review the request within 30 calendar days of receiving additional information.

Process

To request reconsideration, send a written request to the Appeals Division director. Include in the request why you are requesting reconsideration.

The county/tribal nation should consult DHS.CCAAppeals@state.mn.us for technical assistance for formal reconsideration requests.

As the appellant or county/tribal nation decide if they want to request reconsideration, consider the that the Appeals Division director: