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2nd Opinion and Appeal Rights

We want to work with you to make sure that your experiences with MCCMH are effective, satisfying, and problem-free. From time to time, concerns about your services may arise.  You have the right, at any time, to tell us if you are dissatisfied with anything about your services or about your experience with MCCMH.  You may do so in a number of ways:

· Informal Resolution:  If you are unhappy with something about your services or your experience with MCCMH, we encourage you to tell us.  Talk to your therapist, case manager or supports coordinator, or their supervisors, to see if your concern can be resolved right in the clinic.  If this does not resolve your concern, or you aren't comfortable doing this by yourself, the MCCMH Ombudsman can help you.

· If you are receiving MCCMH services and you are dissatisfied with something, you may file a grievance.  A grievance is a formal expression of dissatisfaction with something about your service delivery or your experience with one of our staff, contractors, or service sites.  You may file a grievance verbally or in writing. When you file a grievance, MCCMH must acknowledge your concern in writing and must work with you to resolve it within 60 days.  The Ombudsman can help you with a grievance, or may be able to resolve the issue on your behalf.

· If you are requesting MCCMH services for the first time, or you are requesting hospitalization, and your request is denied, you may request a Second Opinion.  A second opinion is a review of the decision made.  Usually, a second opinion is provided by the Executive Director,  or by his  designee.  If you request a second opinion, we must review the decision promptly. You must request a second opinion in writing. The Ombudsman will help you with a request for a second opinion.

· Anyone who uses MCCMH services  may request a Local Appeal.  An Appeal is a formal request for a review of an action made by MCCMH. You may file an Appeal if you do not agree with our decision to reduce, suspend, or terminate your services, or if you don’t agree with the contents of your person-centered plan (your plan of service), or if you don’t agree with certain other decisions we have made about your services.   Your appeal will be heard by someone in Macomb County who was not involved in the original decision. You must request an appeal in writing.  If you have Medicaid or Healthy Michigan coverage, you have 45 days from the date of the action to request an appeal; if you have other coverage or no coverage, you have 20 days to request an appeal. 

· If you receive Medicaid, you may request a Medicaid Fair Hearing. A Medicaid Fair Hearing is a state level review of a decision we have made to deny, reduce, terminate or suspend your Medicaid-covered services.  An Administrative Law Judge who is independent of both the Department of Community Health and MCCMH will hear the review.  You must request a Medicaid Fair Hearing in writing, within 90 days of the action.  If you receive Medicaid, you may file a grievance, request a Local Appeal and request a Fair Hearing all at the same time.

You have many other specific rights and options related to grievances, second opinions, appeals, and Medicaid Fair Hearings.  The MCCMH Ombudsman is available to help you with these options.  Call the Ombudsman at 586-469-7795 for help with your concerns.  You may call any MCCMH office “Collect,” or, if you prefer, we will call you back at any number you give us.  Our offices are also equipped with telephone interpreter services for those who best use a language other than  English.