Appeals and Grievances

General Information

The Michigan Mental Health Code has changed and so has the way public mental health services are provided. The departments of public health, substance abuse, mental health/ developmental disability, and services to the elderly are now part of one state department, the Michigan Department of Health and Human Services (MDHHS). MDHHS provides services through a managed care system of pre-paid inpatient health plans (PIHPs). Genesee Health System (GHS) contracts with the newly-formed Region 10 PIHP to provide such services in Genesee County.

In 1997, the Balanced Budget Act was written to protect the rights of Medicaid beneficiaries. This act gave beneficiaries a way to complain about their services and a way to dispute an action or a proposed action to be taken in regard to their services.

There are many ways to challenge a decision about mental health services provided by GHS. If you don’t agree with GHS or any of our providers about what services you may or may not get, you can file an appeal with GHS for review.

Appeals and Grievance Brochure
Appeals and Grievance Options

Listed below are basic grievance and dispute resolution options. These options can be used throughout our provider network in any directly-operated or contracted provider. This list does not include appeals and grievances you can make through the individual provider's accreditation, regulatory, or licensing agency.

Appeals

Appealing a Denial of Mental Health Services or Hospitalization
An individual has the right to request a second opinion from the Chief Executive Officer (CEO) of GHS. You may call the office at (810) 257-3707 to make a direct request. You may also put your request in writing and send it to:

Danis Russell, Chief Executive Officer
Genesee Health System
420 W. Fifth Avenue
Flint, MI 48503

Local Medicaid Appeal Process
If you have Medicaid, you can ask for a Local Appeal if there was an action taken or a proposed action was made about your services. If you disagree with the action, you need to make the request for appeal within 60 (calendar) days of the date of the notice. If you want your services to stay the same while the action is being appealed, you need to make the request within 10 (calendar) days of the notice. You may contact the GHS Customer Services Department at (810) 257-3705, Toll Free (877) 346-3648, or TTY (810) 257-1346.

State Level Appeal (State Fair Hearing)
If you have Medicaid and you disagree with a decision that was made about the services paid for by Medicaid, you can appeal the decision in the following situations (described as "actions"): 

    • Denial or limited authorization of a requested service, including the type or level of service, requirements for medical necessity, appropriateness, setting, or effectiveness of a covered benefit.
    • Reduction, suspension, or termination of a previously authorized service.
    • Denial, in whole or in part, of payment for a service.
    • Failure to make a standard authorization decision and provide notice about the decision within 14 calendar days from the date of receipt of a standard request for service authorization.
    • Failure to make an expedited authorization decision within 72 hours from the date of receipt of a request for expedited service authorization.
    • Failure to provide service within 14 calendar days of the start date agreed upon during the person‐centered planning and as authorized by the PIHP.
    • Failure of the PIHP to resolve standard appeals and provide notice within 30 calendar days from the date of a request for a standard appeal.
    • Failure of the PIHP to resolve expedited appeals and provide notice within 72 hours from the date of a request for an expedited appeal.
    • Failure of the PIHP/CMH to provide disposition and notice of a grievance/complaint within 90 calendar days of the date of the request.

You should receive a written notice telling you about one of the types of actions listed above. You have up to 120 (calendar) days from the date of the notice to file a Medicaid Fair Hearing. If you file the appeal before the date the services are scheduled to change, or within 10 (calendar) days of receiving the letter, services may stay the same if you request that they remain the same until the outcome of the hearing. To use this type of appeal, fill out the “Request for Hearing” form that came with your notice letter. You can contact the Administrative Tribunal at the Office of Administrative Hearings & Appeals for assistance at 1-(877) 833-0870. If you would like help from GHS, the Customer Services Department can be reached at (810) 257-3705, Toll Free (877) 346-3648, TTY (810) 257-1346.

Local Non-Medicaid Appeal
If you do not have Medicaid and an action is taken as described above, you can request a local appeal by calling Customer Services for assistance at one of the numbers above. If you are not satisfied with the way GHS settles the case, you can ask MDHHS to review the matter. This is called the "Alternative Dispute Resolution Process."

Grievances

An individual can complain about the services and supports he or she receives from GHS at any time. A grievance is an expression of dissatisfaction about any matter other than an action. A grievance can be filed by calling the Customer Services Department at (810) 257-3705, Toll Free (877) 346-3648, TTY (810) 257-1346).