Appeals, Grievances & Fair Hearings

Appeals – Call the Recipient Rights/Customer Services Department – 1-888-482-8269 or 989-895-2317 –  for help

An appeal is a request for a review of a decision BABHA or their contracted providers have made about your services that you do not like. (Terminate, reduce, suspend or deny). Anytime you disagree with BABHA or a contracted provider when they make a decision to deny, suspend, end or reduce your current services (or a service you have requested) you can file an appeal by contacting the Recipient Rights/Customer Services at 1-888-482-8269 or 989-895-2317. You have 45 calendar days from the date listed at the top of the Notice letter (which is sent to let you know about the decision to deny, suspend, end, or reduce treatment services) to file an appeal. The appeal process will not use anyone who was part of making the first decision.

You can ask for a quick appeal (expedited) if waiting 45 calendar days for a decision could cause you serious harm. The quick appeal will give you an answer within three business days. You can also ask for a medical second opinion if you are denied services.

Once you file an appeal you will receive an acknowledgement letter in the mail within five business days of filing a standard appeal. You will receive a letter telling you of the results of your appeal (called a disposition letter) within 45 calendar days of filing the appeal. During the appeal you can ask to see what information was used to make the decision and you can give us any information you think will help in making the best decision about your services. If you are not told of a decision within 45 calendar days you can file for a Medicaid State Fair Hearing.

Grievances

A grievance is an action you can file about a concern, question or complaint about services provided by your mental health or substance use disorder service provider. You can file a grievance at any time about anything. Someone else, such as a provider, can file a grievance for you as long as they have written consent to do so.

To file a grievance call the Recipient Rights/Customer Services Department at 1-888-482-8269 or 989-895-2317.

Once a grievance is filed, you will receive an acknowledgement letter within five business days. You will also receive a letter telling you the decision made about the grievance. This letter will be mailed within 60 calendar days.   If you receive Medicaid and get a Disposition letter after the 60 calendar days you will have the right to file for a State Medicaid hearing.

State Fair Hearings

A Medicaid State Fair Hearing (a type of trial) is provided by a state level administrative law judge if you ask for one when a decision has been made to deny, reduce or suspend services if you have Medicaid. BABHA’s Recipient Rights/Customer Services staff can help you. Call us at 1-888-482-8269 or 989-895-2317.

You must ask for this hearing in writing to the Michigan Administrative Hearing System (MAHS) within 90 calendar days of receiving a notice letter, a letter informing you of a reduction, suspension or termination of services.  The letter should be mailed to: 

MICHIGAN ADMINISTRATIVE HEARING SYSTEM (MAHS)
FOR THE DEPARTMENT OF COMMUNITY HEALTH
P.O. BOX 30763
LANSING, MI 48909

You can click on the link below for a copy of the Request for Hearing form:

http://www.michigan.gov/mdch/0,1607,7-132-2946_5093-16825–,00.html

You can click on the link below for more information on Medicaid Fair Hearings: Rights and Responsibilities:

http://www.michigan.gov/documents/ADMINISTRATIVEHEARINGS_81632_7.brochure.pdf

You can call Customer Services at 1-888-482-8269 or MAHS at 1-877-833-0870 to request a State Medicaid Fair Hearing Request form or to ask for help in completing the form.

Please note that before the actual hearing you may choose to have another person stand in for you or take part in the hearing. This person can be anyone you choose, including a service provider and/or an attorney. This person may request a hearing for you. You may have to give this person written permission to represent you. You have the right to give facts to support your case in a hearing. You may choose to have an attorney represent you at the hearing, but it is not necessary.

You can file for a Medicaid State Fair Hearing at the same time you file a local appeal. Or you can file an appeal only or a Medicaid State Fair Hearing only. You have many options.

If you need an answer right away and feel your situation could become worse by waiting too long, you can request a hearing to be conducted quickly by calling: 1-877-833-0870.

The hearing is conducted by an Administrative Law Judge from MAHS, a part of the State government. If you request a hearing before services are scheduled to be changed, your services may continue until a judge makes a decision on your case. In order to continue services, you must contact Customer Services by the date included on the letter you received to change (deny, suspend, terminate or reduce) your services. If the judge does not rule in your favor, you may be asked to pay for the services you used, up to your ability to pay.

Michigan Department of Health and Human Services (MDHHS) Alternative Dispute Resolution

This is available to people without Medicaid who are unhappy with the local appeal process. If you do not agree with an appeal decision made within BABHA’s local process. You have 10 days from when you get the written notice to file for an MDHHS Alternative Dispute Resolution.

You may contact the Recipient Rights/Customer Services Department at 1-888-482-8269 or 989-895-2317 or send a written request to:

Michigan Department of Health and Human Services
Division of Program Development, Consultation and Contracts
Bureau of Community Mental Health Services
ATTN: Request for DCH- Level Dispute Resolution
Lewis Cass Building – 5th Floor
320 S. Walnut St.
Lansing, MI 48913