Frequently Asked Questions
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If you have a problem, contact your Supports Coordinator (SC) first. Make sure you have clearly identified the problem and thought about how you would like it resolved. Speak frankly about the problem. If it is still not resolved, you can ask to discuss the issue with the Supports Coordinator Supervisor. If that doesn't resolve the issue, you can go up the chain of command to the County Program Supervisor in the Mental Health/Mental Retardation (MH/MR) office.
If you are not sure your SC or Administrative Entity (AE)/County Program are following the rules, you can call the Office of Developmental Programs (ODP) customer service line (1-888-565-9435) for information and answers to questions about state policies and processes.
You have the right to appeal under the Local Agency Law (see below) when services through the County Program are denied, reduced or terminated. Each County Program must have a clearly defined, written policy and procedure for this appeals process. The process includes an administrative review procedure and will result in a written decision. You can ask your County for a copy of the policy and procedure.
This means that if you apply for Mental Retardation services in your county and are told you are not eligible, you have the opportunity to disagree with this decision. If you are denied eligibility for MR services, you will get a written notice explaining why you were denied.
The appeals process steps are as follows:
If you had been receiving services through Base-funding (Family-Driven Support, Family Support Services, etc.) and they are reduced or terminated, you can have a meeting with the County Program representatives, the Supports Coordination Organization and the provider, if appropriate, to attempt to resolve the issue.
If that doesn't resolve the problem, each County has written procedures that explain how to appeal the denial or termination of services and supports. The local appeals process is the same as outlined in the previous section (LOCAL AGENCY LAW) for denial of services. When you receive written notice from the County that your services will be ending, you should also get information about the appeals process.
If you have been told over the phone or in a meeting that your supports are being reduced or terminated, you should request that in writing. The County is required to give written notice.
Unlike waiver recipients, the County Program and/or provider can discontinue services due to lack of money, and you are not entitled to have the services remain in place while you appeal the decision through the county process. However, you should argue and request that services remain until resolution.
Within 30 days of the hearing date, you will receive written notice of the decision. If you are not happy with the results, you can go on to the Court of Common Pleas.
If you request and are denied Base services, you also have appeal rights through Local Agency Law as described above.
People receiving supports through the Person/Family Directed Support (P/FDS) and the Consolidated waivers have a right to fair hearing and appeal before the Department of Public Welfare Bureau of Hearing and Appeals (BHA). You will get information about the fair hearing and appeals process when:
There are several basic reasons or decisions that you can appeal.
Complete the Fair Hearing Request Form, DP 458, and submit it to your AE/County. Because there are timelines for filing an appeal, the postmark on your form is important. You can also submit the form to your Supports Coordinator, who will submit the form to the AE/County on your behalf. You can ask for a form from your Supports Coordinator or get one on the Office of Developmental Programs website. If you need help completing the form, your Supports Coordinator can assist you with filing a Fair Hearing Request.
Yes. In order for your services to remain in place while you are waiting for your appeal to be heard, you must file within 10 days of the written notice. The 10-day clock starts as soon as the AE/County mails the letter to you. If you file the appeal within the 10-day window, services that are on-going will continue. One-time services or services that have not started do not need to be provided during the appeal process.
If you miss the 10-day window, the change will take effect, but you can still appeal any decision within 30 days.
Your AE/County will forward your appeal to the Bureau of Hearings and Appeals and will send a copy to the Office of Developmental Programs Regional Office for review. If your appeal is eligible for a Service Review, the Regional Office will review your case and make a recommendation to the AE/County.
Service Review is a quick process in which the Regional Office reviews your appeal and makes a decision as to whether the AE/County acted in accordance with ODP policies. Immediately after you submit your Request for Fair Hearing, the AE/County will forward your paperwork to the Regional Office for review. Within 15 days, the Regional Office will make a decision regarding the disputed issue. During this time, you may be contacted by the Regional Office for additional information or clarification.
If the result of the Service Review is not in your favor, you still have the right to a fair hearing. The Hearing Officer at the Bureau of Hearings and Appeals (BHA), also called an Administrative Law Judge, will have a copy of the Service Review decision to review when judging your case.
The Appeal Hearing should take place within 90 days of the date you filed your Request for Fair Hearing. The decision will be sent in writing to you within this 90-day period.
If you appeal within 10 days of the notice to reduce or terminate services, your service will remain in place until the Hearing Officer decides your case. It is very important to appeal any reduction or termination quickly to ensure you keep your services while you are waiting for the hearing.
An impartial Hearing Officer (also called an Administrative Law Judge) will have written information from the AE/County and from you regarding the issue at hand. You can offer testimony on your behalf and have experts testify on your behalf. You can also have someone represent you (for example, a family member or surrogate). The AE/County will have the opportunity to present evidence and testimony as well. The Hearing Officer may ask questions of both parties. It is recommended that you consult or use an advocate during the process. Advocates should be knowledgeable about the MR system, the rules that govern Waiver participation and administration and state policy.
Keep accurate records of the supports and services you receive through the Office of Developmental Programs (ODP). Also collect and organize your phone log and correspondence related to the issue you are disputing. You should contact advocacy organizations in your area for advice and assistance.
The consequence of the AE/County's action will take effect. This means that if the AE/County said your services would be terminated, the services will stop. If they said your services needed to be reduced, then your services will be reduced.
You have two options for further appeal:
The Hearing Officer's decision will instruct the AE/County as to the appropriate restoration or action that must be taken by the AE/County Program. The AE/County Program can also request a Reconsideration by the Secretary of the Department of Public Welfare.
ODP Bulletin 00-08-05: Due Process and Fair Hearing Procedures for Individuals with Mental Retardation, www.temple.edu/thetrainingpartnership/resources/mrBulletins/gd/00-08-05.pdf
THE STATE OFFICE OF DEVELOPMENTAL PROGRAMS HAS A TOLL FREE PHONE NUMBER FOR YOU TO CALL IF YOU HAVE QUESTIONS. Additionally, The Partnership and its participating agencies can answer questions and offer assistance to individuals or their families.
Office of Developmental Programs
ODP Regional Point People:
(as of April 2009)
Phone: 717-772- 6507
Toll free: 1-888-272-7229
Mentors for Self Determination
Self-Advocates United as 1
Eastern 215-923-3349 x132
Vision for Equality
Phone: Philadelphia 215-923-3349
Phone: Harrisburg 717-233-2424
Institute on Disabilities at Temple University
Toll free: 1-866-865-6170
THE PARTNERSHIP—The Pennsylvania Training Partnership for People with Disabilities and Families
The Partnership is funded by the Office of Developmental Programs, Department of Public Welfare.
This information is available in alternate formats, upon request.
Para información en español: 215-204-9348 o por correo electrónico al: firstname.lastname@example.org.