Appeals and Grievances

Appeals

What is an appeal and when can I file an appeal?

An appeal is when you disagree with a decision to terminate, reduce, suspend or deny treatment or services to you. Anytime you disagree with the AAM Access Center or a provider when they make a decision to deny, suspend, terminate or reduce your current services or a service you have requested you can file an appeal by contacting Customer Services at 1-888-482-8269. You have 45 days to file an appeal. The appeal process will not involve anyone who was involved in making the initial decision.

You can request a quick appeal if waiting 45 days for a decision could cause you serious harm. 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 within five 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 days of filing the appeal. If you are not informed of a decision within 45 days you can file for a state hearing.

If, at any point in the process you have questions or concerns you may contact Customer Services at 1-888-482-8269.

Grievances

What is a grievance and when should I file a grievance?

A grievance is an action a consumer can file regarding a concern, question or complaint about services provided by their mental health or substance abuse service provider. A person can file a grievance at anytime about any matter. Someone else, such as a provider can file a grievance on behalf of a consumer as long as they have written consent from the consumer.

To file a grievance call AAM Customer Service at 1-888-482-8269.

Once a grievance is filed the consumer will receive an acknowledgement letter within 5 days and a letter telling you the outcome of your grievance in no more than 60 days. An individual can request an expedited (fast) resolution if they believe waiting the standard 60 days would cause serious harm. Any person who receives Medicaid and receives a Disposition letter past the 60 days will have the right to file for a State hearing as noted below.

State Fair Hearing

What is a State Fair Hearing?

A hearing provided by a state level administrative law judge when a decision has been made to deny, reduce, suspend or terminate services for a person who has Medicaid.

How do I request a State Fair Hearing?

You must make all requests in writing to the Administrative Tribunal within 90 days of receiving a notice letter, a letter informing you of a reduction, suspension or termination of services.

Administrative Tribunal
Michigan Department of Community Health
P.O. Box 30195
Lansing, MI 48909

Is there a special form that I need to complete when filing for a state hearing?

You can call AAM Customer Service at 1-888-482-8269 or Department of Community Health 1-877-833-0870 to request a Fair Hearing Request form or to ask for assistance in completing the form.

Do I need an attorney if I request a hearing?

Please note that prior to the actual hearing you may choose to have another person represent you or participate 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 present 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.

What if I have already filed for a local appeal?

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

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

How do I know the process is going to be fair?

The hearing is conducted by an Administrative Law Judge from the Administrative Tribunal, a branch of the State government.

If I am already receiving services, what happens with my services during the local appeal or state hearing process?

If you request a hearing before services are scheduled to be changed, your services may continue until a judge makes a ruling on your case.

In order to continue services, you must contact AAM Customer Service by the date included on the letter you received to 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 received.

What is the Michigan Department of Community Health (MDCH) Alternative Dispute Resolution?

This process is available for persons without Medicaid that are unhappy with the local appeal process.

If you do not agree with an appeal decision made at the local dispute level. (You have 10 days from receiving the written notice to file for an MDCH Alternative Dispute Resolution.)

If you do not receive an Appeal Disposition letter within 45 days of filing an Appeal.

You do not receive a Grievance Disposition letter within 60 days of filing a grievance. (You have five days to file after receiving the disposition letter).

You may contact AAM at 1-800-448-5498 or send a written request to:

Michigan Department of Community Health
Division of Program Development, Consultation and Contracts
Bureau of Community Mental Health Services
ATTN: Request for DCH Level Dispute Resolution
Lewis Cass Building-6th FL
Lansing, MI 48913