If you don’t agree with a decision you received about developmental disability services, one option is to file an “internal Managed Care Entity (MCE) appeal.” It is less formal than a Human Services Board Fair Hearing.
In an internal MCE appeal, the decision about your services will be reviewed by a staff member in the Vermont Department of Disabilities, Aging and Independent Living (DAIL) who was not involved in the decision to deny, reduce or stop your services.
1. Know the Deadline
You must file a request for an internal MCE appeal within 90 days from when the decision about your services was mailed to you.
2. Ask for the Appeal
You may ask for an appeal either by telling a staff person at your provider agency that you want to file an internal appeal, or by writing a letter to your provider agency and telling them you want to file an internal appeal. You may want to call your provider agency and ask if they have any forms to fill out to ask for an internal appeal. (Here’s a list of the agencies and their phone numbers.)
Be sure to describe the decision or action of the agency that you disagree with. If you need help in asking for or participating in an internal MCE appeal, your provider agency must help you.
3. Prepare for a Meeting
You should begin collecting information to help in your appeal as soon as you ask for the appeal. The Department of Disabilities, Aging and Independent Living will schedule a meeting to review the appeal. They must have the meeting and send you a written notice of their decision within 45 days of your request for an internal MCE appeal.
You have the right to participate in the meeting in person, by phone or by writing. You may bring someone with you to the meeting. This could be a friend, an advocate, or anyone who is familiar with the needs of the person applying for or receiving developmental disability services.
Before the meeting, ask the agency that made the decision you are appealing to provide you with all the information that was used to make the decision. The agency cannot make you pay for copies of the documents.
You may give information at the meeting that you think is important to your appeal. This could be school records or letters, incident reports, records or evaluations from medical providers and therapists familiar with the needs of the person appealing the decision. You should bring all information you think will help the DAIL staff person reviewing the decision understand the needs of the person applying for or receiving services.
The rules covering internal MCE appeals are found in Section 8.4 of the Vermont Developmental Disabilities Act Regulations.
We may be able to help you with your appeal. Call us at 1-800-889-2047 or fill out our form and someone from Vermont Law Help will call you.