Appeal Process

(1) Right to Appeal to DALA. If the individual or their parent or guardian disputes the determination of the IRT, in whole or in part, such person may file an appeal with DALA, which conducts an adjudicatory proceeding in accordance with 801 CMR 1.01: Formal Rules and orders any necessary relief consistent with state or federal law. (2) Timeliness of Appeal. Any appeal to DALA must be filed within 30 days of receipt of the IRT’s written report, as applicable. (3) Grounds for Appeal. The permissible grounds for an appeal to DALA under 101 CMR 27.00 are (a) a dispute about the IRT’s determinations issued under 101 CMR 27.07(4)(a), subject to the limitations in 101 CMR 27.07(3); or (b) a dispute about the co-chairs’ determinations issued under 101 CMR 27.07(5), if the IRT is unable to reach consensus and the co-chairs issue a determination for the IRT review, subject to the limitations in 101 CMR 27.07(3). (4) Nonappealable Actions. The following actions do not constitute grounds for an appeal to DALA under 101 CMR 27.00: (a) the co-chair’s decision that a case is ineligible for IRT review; (b) any decision of the co-chairs, or the secretary of EOHHS, related to expenditures from the Interagency Services Reserve Fund; (c) a determination by a state agency of 1. ineligibility for services provided by a state agency; 2. unavailability of any service that the state agency is not required to provide under its applicable statutes or regulations; or 3. the applicability of agency policy and practices relating to eligibility for and delivery of services, including activities related to the maintenance of waiting lists; (d) appeals related to any MassHealth action. All such appeals must be made to the Office of Medicaid Board of Hearings pursuant to 130 CMR 610.000: MassHealth: Fair Hearing Rules. For an individual enrolled in a MassHealth managed care plan, such appeals must be made to the managed care plan directly, subject to review at the Office of Medicaid Board of Hearings in accordance with the provisions of 130 CMR 610.000: MassHealth: Fair Hearing Rules. A provider’s opinion or clinical determination that a service is not medically necessary does not constitute an action by the MassHealth agency and is not subject to appeal to the Office of Medicaid Board of Hearings or DALA; and (e) appeals related to a dispute concerning the free appropriate public education or special education services to which an individual is entitled under the IDEA and M.G.L. c. 71B. All such appeals must be made to the BSEA as provided in §1415 of the IDEA, M.G.L. c. 71B, and 603 CMR 28.08(3), or may be raised with DESE’s Problem Resolution System Office in accordance with 34 C.F.R. §§300.151 through 300.153 and 603 CMR 28.08(2).