Community Mental Health for Central Michigan ADMINISTRATIVE GUIDELINE SERVICES ADMINISTRATION – CHAPTER 2 CONCERNS, COMPLAINTS, DISPUTES, GRIEVANCES, AND APPEALS – SECTION 100 REQUESTS FOR STATE LEVEL HEARINGS – SUBJECT 002A Page 1 of 1

ADMINISTRATIVE GUIDELINE

It is important for staff to know that no one may limit or interfere with an applicant or consumer’s freedom to make a request for a hearing. This includes situations when staff feel certain that they are not eligible to have a hearing. The Administrative Law Judge is the only one that is able to decide if the person is eligible for a hearing.

The request for hearing must be in writing. A DCH Request for an Administrative Hearing form (DCH 0092) and return envelope must be given/sent with every Medicaid notice of action (adequate and advance). Consumers who are non-Medicaid cannot request a state level hearing (called the MDCH Alternative Dispute Resolution process) until they have exhausted the local appeal process.

The request for a state fair hearing (Medicaid) must not exceed 90 days from the date the notice of action is mailed. Again, CMH employees are not to deter an individual from requesting a hearing even though the 90 days has past. The Administrative Law Judge will make the determination.

Upon receipt of a hearing notice, Customer Services staff will contact the consumer to offer assistance in the process and if not previously utilized, to offer the local appeals process, without coercion, to attempt to offer resolution prior to the hearing. The Customer Service Coordinator will serve as coordinator for appeals and grievances as well as dispute resolution options and maintain applicable logs. The Customer Service Coordinator shall have a working knowledge of CMHCM service delivery system and benefits.

At CMHCM the Provider Network Manager, (back up, Contract Manager) will represent the agency during the hearing process, notify appropriate service staff and Customer Service/Recipient Rights; and communicate with the Administrative Tribunal.

Appropriate Service staff will be asked to assist in the preparation of the Hearing Response Form, and may be called as witnesses during the hearing. Service staff will be mailed additional information regarding hearings at the time of notice by the Provider Network Manager.

Appeal and grievance notification of right to appeal shall be available in the Customer Service Handbook, on posters and pamphlets identifying Customer Service and Recipient Rights as available to offer assistance with the complaint/grievance/appeal processes.

Approved by the Executive Leadership Team: 3/22/02 Revised: 9/18/06 Revised: 4/23/09