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, 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 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:

For more information, including which forms to use, refer to CBSM – Notice of Action.

Process

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

Documentation

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

The county/tribal nation also must retain a copy of all appeal paperwork. Appeal paperwork may include copies of:

Reimbursement for appeal preparation

A county/tribal nation can receive reimbursement for:

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 Aging and Adult Services and Disability Services divisions is 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 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 person must file an appeal within 90 days after the date of the conciliation conference.