Fair Hearing & Appeal Process

Fair Hearing & Appeal Process An applicant or recipient has the right to request a Hearing or Appeal if they are dissatisfied with the denial, delay, cancellation, or any adverse decision related to your application for services. A. Types of Hearings 1) Appeal (Agency Level) i. Basis for an Appeal • Incorrect bill submitted • Information provided is insufficient to determine eligibility • Requested additional information not returned within ten (10) calendar days • Non-compliance with CSBG Case Management Plan • Threatening behavior toward staff • Your claim for assistance was not acted upon with reasonable promptness If a client submits a Fair Hearing request for any of the above-mentioned reasons their request will be automatically denied. ii. The client must submit a request for an appeal within thirty (30) calendar days of the denial or adverse action. The request must be submitted on https://virtualroma.mdhs.ms.gov/ and include all of the following: Name of Community Service Agency Full Name and Address Date of Denial or Adverse Action Notice Stated Reason(s) for Denial or Action Reason(s) for Appeal Request The client’s request will be submitted to the Executive Director and Board Chair. The Executive Director and Board Chair will have 15 calendar days to contact the client to schedule an appeal. After scheduling and hearing the grievance, the Executive Director and Board Chair will then have 15 calendar days to make a final determination in regard to the appeal. 2) Fair Hearing (MDHS Level) i. Basis for a Fair Hearing • If the client was denied at the agency-level appeal process and has met all the criteria for a complete application, but still feels they are eligible for services for the following reasons: o Disagreement with the appeal denial itself o Incorrect information or assessment o Procedural error o Discrimination o Failure to make a timely decision o Changes in circumstances o Other _________________ Clients must first exhaust the agency-level appeal process before requesting a Fair Hearing with the Mississippi Department of Human Services (MDHS). ii. Requesting a Fair Hearing The client can request a fair hearing by calling 601-359-4921 or by completing a MDHS Programmatic Appeal Request form at (https://www.mdhs.ms.gov/wp-content/uploads/2023/12/MDHS-OIG-200- Programmatic-Appeal-Request-Form.pdf) iii. Submitting a Fair Hearing Request The client can submit a MDHS Programmatic Appeal Request form by: Email: admin.hearings@mdhs.ms.gov Fax: 601-359-5047 Mail: Mississippi Department of Human Services Office of the Inspector General Administrative Hearings P.O. Box 352 Jackson, MS 39201 iv. After submitting a Fair Hearing Request The client will receive a notice letting them know a date and time for their fair hearing. Usually, fair hearings are conducted over the phone. During the hearing, the client will be given the opportunity to present their position fully and explain why they believe that the decision made by Agency was wrong. The client may bring any evidence that they believe supports their position. MDHS may also present information about why the agency believes the decision was correct. After hearing from both sides, the hearing officer will make a decision about whether the agency’s decision was wrong and should be changed or the agency’s decision was correct and should not be changed. Important Information If at any point during the appeals process, the initial denial or adverse action is reversed, appropriate corrective actions, including processing payments or reinstating services, will be taken by the Community Service Agency in a timely manner. Please note: Lack of available funding in your county is not subject to a Fair Hearing. In such cases, subgrantees should: 1) Refer applicants to other service providers, 2) Utilize non-federal funds where possible, 3) Maintain a waitlist of applicants to prioritize once funds become available. Contact Information If the client has questions about this notice or the appeals process, please have them to contact the local Community Service Agency/Human Resource Agency or the Mississippi Department of Human Services at admin.hearings@mdhs.ms.gov. *A copy of the Fair Hearing & Appeal Process must be posted at each agency and county office for clients to view.