{"id":3798,"date":"2023-03-08T14:10:58","date_gmt":"2023-03-08T21:10:58","guid":{"rendered":"https:\/\/yes.idaho.gov\/?page_id=3798"},"modified":"2024-12-18T14:28:07","modified_gmt":"2024-12-18T21:28:07","slug":"appeals","status":"publish","type":"page","link":"https:\/\/yes.idaho.gov\/appeals\/","title":{"rendered":"Appeals"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-1 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<figure class=\"wp-block-image size-full is-resized\"><img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"360\" src=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/05\/identifyingneeds-1.jpg\" alt=\"\" class=\"wp-image-2087\" style=\"width:712px;height:291px\" srcset=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/05\/identifyingneeds-1.jpg 800w, https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/05\/identifyingneeds-1-300x135.jpg 300w, https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/05\/identifyingneeds-1-768x346.jpg 768w, https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/05\/identifyingneeds-1-778x350.jpg 778w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><\/figure>\n\n\n\n<p>Youth and families may find there are times when they are not satisfied with a decision that is made about the YES services they requested or received. An appeal is a request to change a decision the state has made about your child\u2019s health care. Youth and families cannot be penalized or retaliated against for filing an appeal. This page includes information specific to appeals such as what can be appealed, how and when to file an appeal, frequently asked questions, and more.&nbsp;<\/p>\n\n\n\n<p>Youth and families may also find there are times they wish to file a complaint. To file a complaint or for more information, please see the <a href=\"https:\/\/yes.idaho.gov\/youth-empowerment-services\/about-yes\/contact-us\/?target=4\" target=\"_blank\" rel=\"noreferrer noopener\">Concerns\/Complaints section of the Contact Us page<\/a>.<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<h2 class=\"wp-block-heading has-text-align-left\">RESOURCES<\/h2>\n\n\n\n<p><img decoding=\"async\" width=\"50\" height=\"50\" src=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/Icons\/Icon_yesbluebird-e1619129661386.png\" alt=\"\"><a href=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2022\/04\/YES-DP-Protocol-2022-for-YES-Website.pdf\" target=\"_blank\" rel=\"noopener\">Due Process Protocol<\/a><br><img decoding=\"async\" width=\"50\" height=\"50\" src=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/Icons\/icon_contactus-1-e1619021717125.png\" alt=\"\"><a href=\"https:\/\/publicdocuments.dhw.idaho.gov\/WebLink\/Browse.aspx?id=17618&amp;dbid=0&amp;repo=PUBLIC-DOCUMENTS\" target=\"_blank\" rel=\"noopener\">Medicaid Services: Appeal Requests<\/a><br><img decoding=\"async\" width=\"50\" height=\"50\" src=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/Icons\/icon_contactus-1-e1619021717125.png\" alt=\"\"><a href=\"https:\/\/publicdocuments.dhw.idaho.gov\/WebLink\/Browse.aspx?id=3260&amp;dbid=0&amp;repo=PUBLIC-DOCUMENTS\" target=\"_blank\" rel=\"noopener\">Medicaid Eligibility and Other Welfare Benefits: Fair Hearings<\/a><br><img decoding=\"async\" width=\"50\" height=\"50\" src=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/Icons\/icon_contactus-1-e1619021717125.png\" alt=\"\"><a href=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2024\/06\/YES-Contacts.pdf\" target=\"_blank\" rel=\"noopener\">YES Contacts<\/a><br><img decoding=\"async\" width=\"50\" height=\"50\" src=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/Icons\/icon_contactus-1-e1619021717125.png\" alt=\"\"><a href=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2023\/02\/ServiciosdeEmpoderamientodelaJuventudProgramaYESCONTACTOS.pdf\" target=\"_blank\" rel=\"noopener\">Programa YES Contactos<\/a><br><img loading=\"lazy\" decoding=\"async\" width=\"50\" height=\"50\" src=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/Icons\/Icon_terms-e1619451823389.png\" alt=\"Terms Icon\"><a href=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/05\/ProjectTermstoKnowfinal051220.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">YES Project Terms to Know<\/a><br><img loading=\"lazy\" decoding=\"async\" width=\"50\" height=\"50\" src=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/Icons\/Icon_terms-e1619451823389.png\" alt=\"Terms Icon\"><a href=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/04\/TermstoKnowSystemofCare.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">YES System of Care Terms to Know<br><img loading=\"lazy\" decoding=\"async\" width=\"50\" height=\"50\" src=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2021\/Icons\/Icon_terms-e1619451823389.png\" alt=\"Terms Icon\"><\/a><a href=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2024\/12\/YESAppealsTrifold.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">YES Appeals \u2013 Trifold<\/a><\/p>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-2 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<table style=\"width: 100%;\">\n<colgroup>\n<col \/><\/colgroup>\n<tbody>\n<tr>\n<td style=\"text-align: center; color: #000000; font-size: 1.75em;\" bgcolor=\"#ffbf00\" height=\"38\">Appeals Contacts<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"accordion d-print-block\" id=\"accordian\"><div class=\"card bg-default\" id=\"-67b3dc323c5a6\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323c5a6\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323c5a6\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323c5a6\" class=\"btn btn-link\">Division of Medicaid <\/button><\/div>\n\t<div id=\"collapse--67b3dc323c5a6\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323c5a6\" data-parent=\"#heading--67b3dc323c5a6\"><div class=\"card-body\">\n<p><strong>Division of Medicaid\u00a0<\/strong><strong>(Independent Assessor<\/strong><strong> \u2013 Liberty<\/strong><strong>, <\/strong><strong>non-emergency medical transportation<\/strong><strong>, EPSDT<\/strong><strong>, inpatient behavioral health services, and other Medicaid benefits<\/strong><strong>)<\/strong><strong><br \/><\/strong><a href=\"mailto:MedicaidAppeals@dhw.idaho.gov\" target=\"_blank\" rel=\"noopener\">MedicaidAppeals@dhw.idaho.gov<\/a><br \/><strong>Phone:<\/strong> 208-334-5747 <span dir=\"ltr\" role=\"presentation\">or 877<\/span><span dir=\"ltr\" role=\"presentation\">&#8211;<\/span><span dir=\"ltr\" role=\"presentation\">200<\/span><span dir=\"ltr\" role=\"presentation\">&#8211;<\/span><span dir=\"ltr\" role=\"presentation\">5441<\/span>\u00a0<br \/><strong>Fax:<\/strong>\u00a0208-364-1811<br \/><strong>Mail:<\/strong>\u00a0Medicaid Appeals \u2013 IDHW, PO Box 83720, Boise, ID 83720-0009<br \/><strong>In Person:<\/strong>\u00a0Your Local Health &amp; Welfare Office<br \/><strong>Web link for processes:<\/strong>\u00a0<a href=\"https:\/\/publicdocuments.dhw.idaho.gov\/WebLink\/Browse.aspx?id=17618&amp;dbid=0&amp;repo=PUBLIC-DOCUMENTS\" target=\"_blank\" rel=\"noopener\">https:\/\/publicdocuments.dhw.idaho.gov\/WebLink\/Browse.aspx?id=17618&amp;dbid=0&amp;repo=PUBLIC-DOCUMENTS<\/a><\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323c63e\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323c63e\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323c63e\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323c63e\" class=\"btn btn-link\">Idaho Behavioral Health Governance Bureau<\/button><\/div>\n\t<div id=\"collapse--67b3dc323c63e\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323c63e\" data-parent=\"#heading--67b3dc323c63e\"><div class=\"card-body\">\n<p><strong>Idaho Behavioral Health Plan Governance Bureau<br \/><\/strong><strong>Email:<\/strong> <a href=\"mailto:IBHPAppeals@dhw.idaho.gov\" target=\"_blank\" rel=\"noopener\">IBHPAppeals@dhw.idaho.gov\u00a0<\/a><br \/><strong>Mail:<\/strong> IBHP Governance Bureau Appeals, IDHW, P.O. Box 83720, Boise, ID 83720-0009<br \/><strong>Fax:<\/strong> <span id=\"page248R_mcid63\" class=\"markedContent\"><span dir=\"ltr\" role=\"presentation\">208<\/span><span dir=\"ltr\" role=\"presentation\">&#8211;<\/span><span dir=\"ltr\" role=\"presentation\">364<\/span><span dir=\"ltr\" role=\"presentation\">&#8211;<\/span><span dir=\"ltr\" role=\"presentation\">1811<\/span><\/span><span id=\"page248R_mcid64\" class=\"markedContent\"><\/span><br \/>An appeal can be requested verbally by calling <span dir=\"ltr\" role=\"presentation\">866<\/span><span dir=\"ltr\" role=\"presentation\">&#8211;<\/span><span dir=\"ltr\" role=\"presentation\">681<\/span><span dir=\"ltr\" role=\"presentation\">&#8211;<\/span><span dir=\"ltr\" role=\"presentation\">7062<\/span> and must be followed up with a written request using one of the options listed above You can also e-mail <a href=\"mailto:YES@dhw.idaho.gov\" target=\"_blank\" rel=\"noopener\">YES@dhw.idaho.gov<\/a> for more information.<\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323c6c7\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323c6c7\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323c6c7\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323c6c7\" class=\"btn btn-link\">Idaho Behavioral Health Plan (IBHP) - Magellan Healthcare<\/button><\/div>\n\t<div id=\"collapse--67b3dc323c6c7\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323c6c7\" data-parent=\"#heading--67b3dc323c6c7\"><div class=\"card-body\">\n<p><strong>Idaho Behavioral Health Plan \u2013 Magellan Healthcare <\/strong><\/p>\n<p><strong>Phone:<\/strong> 1-855-202-0973 (TTY 711)<br \/><strong>Email:<\/strong> <a href=\"mailto:IDAC@magellanhealth.com\" target=\"_blank\" rel=\"noopener\">IDAC@magellanhealth.com<\/a><br \/><strong>Fax:<\/strong> 1-888-656-9795<br \/><strong>Mail:<br \/><\/strong>Magellan HealthCare, Inc.<br \/>Attn: Idaho Quality Department<br \/>P.O. Box 2188<br \/>Maryland Heights, MO 63043<\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323c724\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323c724\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323c724\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323c724\" class=\"btn btn-link\">Division of Welfare\/Self Reliance<\/button><\/div>\n\t<div id=\"collapse--67b3dc323c724\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323c724\" data-parent=\"#heading--67b3dc323c724\"><div class=\"card-body\">\n<p><strong>Division of Welfare\/Self-Reliance <\/strong><strong>(<\/strong><strong>Eligibility for <\/strong><strong>Medicaid and other benefi<\/strong><strong>ts<\/strong><strong>)<\/strong><br \/><a href=\"mailto:MyBenefits@dhw.idaho.gov\" target=\"_blank\" rel=\"noopener\">MyBenefits@dhw.idaho.gov<\/a><br \/><strong>Phone:<\/strong>\u00a0877-456-1233<br \/><strong>Fax:<\/strong>\u00a0866-434-8278<br \/><strong>Mail:<\/strong> Self-Reliance Programs, IDHW, PO Box 83720, Boise, ID 83720-0026<br \/><strong>In Person:<\/strong>\u00a0Your Local Health &amp; Welfare Office<br \/><strong>Web link for processes:<\/strong>\u00a0<a href=\"https:\/\/healthandwelfare.idaho.gov\/appeals-and-fair-hearings\" target=\"_blank\" rel=\"noopener\">https:\/\/healthandwelfare.idaho.gov\/appeals-and-fair-hearings<\/a><\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323c784\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323c784\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323c784\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323c784\" class=\"btn btn-link\">Idaho Department of Education (IDE)<\/button><\/div>\n\t<div id=\"collapse--67b3dc323c784\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323c784\" data-parent=\"#heading--67b3dc323c784\"><div class=\"card-body\">\n<p><strong>Idaho Department of Education<br \/><\/strong><a href=\"mailto:info@sde.idaho.gov\" target=\"_blank\" rel=\"noopener\">info@sde.idaho.gov<\/a><br \/><strong>Mail:<\/strong> Special Education Dispute Resolution Idaho State Dept. of Education P.O. Box 83720\u00a0 Boise, ID 83720-0027<br \/><strong>Phone:<\/strong> (208) 332-6914 or (800) 432-4601<br \/><strong>TT:<\/strong>\u00a0 (800) 377-3529<br \/><strong>Fax:<\/strong> (208) 334-2228<br \/>Dispute Resolution Process: <a href=\"https:\/\/www.sde.idaho.gov\/sped\/dispute\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.sde.idaho.gov\/sped\/dispute\/<\/a><\/p>\n<\/div><\/div><\/div><\/p><\/div>\n<p><a name=\"parentfaq\"><\/a><\/p>\n<table style=\"width: 100%;\">\n<colgroup>\n<col \/><\/colgroup>\n<tbody>\n<tr>\n<td style=\"text-align: center; color: #000000; font-size: 1.75em;\" bgcolor=\"#ffbf00\" height=\"38\">Appeals FAQs<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"accordion d-print-block\" id=\"accordian\"><div class=\"card bg-default\" id=\"-67b3dc323db3d\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323db3d\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323db3d\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323db3d\" class=\"btn btn-link\">What is an appeal? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323db3d\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323db3d\" data-parent=\"#heading--67b3dc323db3d\"><div class=\"card-body\">\n<p>An appeal is a written or verbal request to the State or its contractors, such as Medicaid or the Idaho Behavioral Health Plan, to review and change a decision made about your youth\u2019s care.<\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323db89\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323db89\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323db89\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323db89\" class=\"btn btn-link\">What is an Adverse Benefit Determination (ABD) letter? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323db89\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323db89\" data-parent=\"#heading--67b3dc323db89\"><div class=\"card-body\">\n<p>An Adverse Benefit Determination (ABD) letter is sent by Magellan Healthcare when they:<\/p>\n<ul>\n<li>Denies (turns down) services or approves fewer services than you or your provider wanted<\/li>\n<li>Reduces, suspends, or terminates a previously approved service<\/li>\n<li>Denies part of or all of a payment to your provider<\/li>\n<\/ul>\n<p>The ABD letter also explains the decision that was made, your right to appeal, and your right receive information used in making the decision.<\/p>\n<p>An ABD letter may also be called a notice of decision or notice of action.<\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323dbf3\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323dbf3\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323dbf3\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323dbf3\" class=\"btn btn-link\">What can be appealed? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323dbf3\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323dbf3\" data-parent=\"#heading--67b3dc323dbf3\"><div class=\"card-body\">\n<ul>\n<li>A denial or termination of Medicaid eligibility<\/li>\n<li>A denial, reduction, or termination of Medicaid funded services or supports (including EPSDT determinations)<\/li>\n<li>A Medicaid benefit determination made by the Idaho Department of Health and Welfare or the independent assessment contractor, Liberty Healthcare, that a youth does not meet the following criteria for serious emotional disturbance (SED):<\/li>\n<\/ul>\n<p>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25e6 A functional impairment identified by the Child and Adolescent Needs and Strengths (CANS) assessment<\/p>\n<p>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u25e6 A mental health diagnosis identified by a Comprehensive Diagnostic Assessment (CDA)<\/p>\n<ul>\n<li>Failure to provide YES services or supports the youth is entitled to under Appendix C of the <em>Jeff D.<\/em> Settlement Agreement: <a href=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2022\/04\/Objective-C-IAP.pdf\">Objective-C-IAP.pdf (idaho.gov)<\/a><\/li>\n<li>When requests for eligibility or services are not acted upon with reasonable promptness<\/li>\n<\/ul>\n<p><span style=\"font-size: revert; color: initial;\"> \u00a0<\/span><\/p><\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323dc4d\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323dc4d\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323dc4d\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323dc4d\" class=\"btn btn-link\">Who can submit an appeal? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323dc4d\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323dc4d\" data-parent=\"#heading--67b3dc323dc4d\"><div class=\"card-body\">\n<p>Individuals who disagree or are not satisfied with a written notice of decision made by the Department of Health and Welfare or its contractors. If an individual has not received a written notice of decision following a verbal notice of decision within a reasonable time, an appeal can be submitted. The Department of Health and Welfare\u2019s contractors include the <a href=\"https:\/\/yes.idaho.gov\/youth-empowerment-services\/about-yes\/contact-us\/?target=5\">Idaho Behavioral Health Plan<\/a>, Liberty (Independent Assessments), and MTM (Non-Emergency Medical Transportation).<\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323dc89\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323dc89\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323dc89\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323dc89\" class=\"btn btn-link\">Can a provider or a friend appeal for me? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323dc89\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323dc89\" data-parent=\"#heading--67b3dc323dc89\"><div class=\"card-body\">\n<p>Yes, an attorney, community advocate, or any person you choose that has your permission may represent you at any point in an appeal. You are responsible for any fees charged by the person representing you.<\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323dcc2\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323dcc2\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323dcc2\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323dcc2\" class=\"btn btn-link\">What is an authorized representative? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323dcc2\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323dcc2\" data-parent=\"#heading--67b3dc323dcc2\"><div class=\"card-body\">\n<p>A family member, a provider, or someone else who has permission from the youth and\/or family to act on their behalf.<\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323dcfa\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323dcfa\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323dcfa\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323dcfa\" class=\"btn btn-link\">How do I submit an appeal? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323dcfa\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323dcfa\" data-parent=\"#heading--67b3dc323dcfa\"><div class=\"card-body\">\n<p>You can submit an appeal in person, via a website, fax, telephone, mail, or e-mail. Contact information for submitting an appeal can be found on your Notice of Decision or in the <a href=\"https:\/\/yes.idaho.gov\/appeals\/\">Appeals Contacts<\/a> section of the YES website appeals webpage. The appeal form can be found here: <a href=\"https:\/\/publicdocuments.dhw.idaho.gov\/WebLink\/Browse.aspx?id=3260&amp;dbid=0&amp;repo=PUBLIC-DOCUMENTS&amp;cr=1\">Fair Hearing Request (idaho.gov)<\/a><\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323dd37\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323dd37\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323dd37\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323dd37\" class=\"btn btn-link\">What are some documents needed for an appeal? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323dd37\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323dd37\" data-parent=\"#heading--67b3dc323dd37\"><div class=\"card-body\">\n<p>You can submit information to support why you think the decision should be changed. It is not required to submit this information. Examples include:<\/p>\n<ul>\n<li>A copy of the \u201cnotice of decision\u201d or \u201cadverse benefits determination\u201d letter &#8211; although it is not necessary or required for an appeal<\/li>\n<li>Medical\/behavioral health provider records and hospital records<\/li>\n<li>An explanation of why you disagree with the decision and what services you insist are medically necessary to address the needs of the youth<\/li>\n<li>Medical referrals<\/li>\n<li>Letters from the treating providers<\/li>\n<li>Emails<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323dd88\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323dd88\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323dd88\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323dd88\" class=\"btn btn-link\">How do I request records that I want to support the appeal? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323dd88\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323dd88\" data-parent=\"#heading--67b3dc323dd88\"><div class=\"card-body\">\n<p>Youth and their families have the right to request a copy of all documentation used in making decisions and\/or their entire record on file.<\/p>\n<ul>\n<li>You can request any records the Department of Health and Welfare\u2019s contractor used in making a decision by contacting them directly and requesting it. Contact information will be on the decision letter you received.<\/li>\n<li>You can also submit a public records request to the Department of Health and Welfare by emailing <a href=\"mailto:PRR@dhw.idaho.gov\">PRR@dhw.idaho.gov<\/a>. A youth that is 14 years old or older must sign the request in addition to their guardians. Please note, the Public Records Request unit tracks all requests for personal records, but they are not public records requests. More information about how to request records can be found at the Public Records Request webpage: <a href=\"https:\/\/healthandwelfare.idaho.gov\/news-notices\/public-records-requests\">https:\/\/healthandwelfare.idaho.gov\/news-notices\/public-records-requests<\/a>.<\/li>\n<li>You may also request records from your providers. If you are having difficulty requesting this information, the Department or its Contractors may be able to help you.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323dddc\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323dddc\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323dddc\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323dddc\" class=\"btn btn-link\">Can I receive the services that I am appealing during the appeal process? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323dddc\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323dddc\" data-parent=\"#heading--67b3dc323dddc\"><div class=\"card-body\">\n<ul>\n<li>If you are on Medicaid and are already receiving services that have been reduced or denied, you may request to continue to receive these services while you are waiting for an appeal decision. This is called \u201cContinuation of Benefits.\u201d<\/li>\n<li>You must submit an expedited or urgent appeal within <strong>10 days <\/strong>from the date on the notice of decision. If the denial you are appealing is upheld, you may be responsible for the cost of the services.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323de28\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323de28\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323de28\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323de28\" class=\"btn btn-link\">What are the timelines for filing a Standard appeal for a decision made by Magellan Healthcare (the Idaho Behavioral Health Plan?) <\/button><\/div>\n\t<div id=\"collapse--67b3dc323de28\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323de28\" data-parent=\"#heading--67b3dc323de28\"><div class=\"card-body\">\n<ul>\n<li>You have<strong> 60 days<\/strong> from the date Magellan Healthcare makes a decision on a requested service to submit an appeal to them.<\/li>\n<li>If you are not satisfied with Magellan\u2019s appeal decision, you have <strong>120 days<\/strong> from the date Magellan Healthcare makes an appeal decision to submit an appeal to the Department of Health and Welfare.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323de8b\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323de8b\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323de8b\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323de8b\" class=\"btn btn-link\">What is the timeline for filing a Standard appeal for a decision made by the Department of Health and Welfare or on of the other State Contractors, such as Medicaid, Liberty Healthcare, or MTM? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323de8b\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323de8b\" data-parent=\"#heading--67b3dc323de8b\"><div class=\"card-body\">\n<ul>\n<li>You have <strong>28 days<\/strong> from the postmark date of the notice of decision to submit an appeal for denial of medical services and supports, transportation, independent assessment, hospital or residential behavioral health care, pharmacy, and any other medical decisions.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323defb\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323defb\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323defb\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323defb\" class=\"btn btn-link\">What is the timeline for filing a Standard appeal for denial of Medicaid Eligibility? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323defb\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323defb\" data-parent=\"#heading--67b3dc323defb\"><div class=\"card-body\">\n<ul>\n<li>You have <strong>30 days<\/strong> from the postmarked date of the notice of decision to submit an appeal for a denial for or change to your youth\u2019s Medicaid eligibility (for example, losing Medicaid coverage).<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323df49\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323df49\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323df49\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323df49\" class=\"btn btn-link\">How do I file an Expedited\/Urgent appeal with Magellan Healthcare? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323df49\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323df49\" data-parent=\"#heading--67b3dc323df49\"><div class=\"card-body\">\n<ul>\n<li>You can request an Expedited or Urgent appeal with Magellan Healthcare if you feel that waiting up to 30 days for an appeal decision could jeopardize the youth\u2019s life, health, or ability to regain maximum functioning. Magellan Healthcare will decide if your appeal meets urgent criteria. If your provider supports the urgent request Magellan Healthcare will automatically grant the urgent appeal. If the urgent appeal is not granted, Magellan Healthcare will notify you and give you a decision within 30 calendar days.<\/li>\n<li>You can submit letters from treating providers and other information to establish the need for an Expedited or Urgent appeal.<\/li>\n<li>When you submit your expedited\/urgent appeal use the contact information on the notice of decision letter.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323df92\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323df92\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323df92\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323df92\" class=\"btn btn-link\">How do I file an Expedited\/Urgent appeal for a decision made by the Department of Health and Welfare or one of the other State Contractors, such as Medicaid, Liberty Healthcare, or MTM? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323df92\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323df92\" data-parent=\"#heading--67b3dc323df92\"><div class=\"card-body\">\n<ul>\n<li>You can use the Medicaid Appeal Request Form in the Resources section of this page, check the box in Section 3 to indicate that you are requesting an expedited appeal. If you are submitting your appeal in any other way, be clear that you are asking for an expedited, urgent, or fast appeal.<\/li>\n<li>When you submit your expedited\/urgent appeal follow the instructions on the Medicaid Appeal Request Form.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e014\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e014\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e014\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e014\" class=\"btn btn-link\">When can I expect a decision on my appeal? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e014\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e014\" data-parent=\"#heading--67b3dc323e014\"><div class=\"card-body\">\n<ul>\n<li>For a standard appeal submitted to Magellan Healthcare, a decision will be made within 30 calendar days.<\/li>\n<li>For an expedited\/urgent (fast) appeal, a decision will be made within 72 hours.<\/li>\n<li>If you submitted a standard appeal to the Department and the appeal goes to a State Fair Hearing, the time to make a decision may be longer. Once the hearing is held, the Hearing Officer will make a decision within 30 calendar days for a standard appeal and as soon as possible for an expedited appeal.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e05a\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e05a\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e05a\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e05a\" class=\"btn btn-link\">What happens after I submit my appeal? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e05a\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e05a\" data-parent=\"#heading--67b3dc323e05a\"><div class=\"card-body\">\n<ul>\n<li>For an appeal submitted to a contractor, the contractor will review the documents submitted to support your appeal, all documents in your case that were used to make the decision that you are appealing, and criteria for the service that was requested. A different person than the one who made the original decision will conduct this review. The contractor will communicate the outcome to you in writing within 30 days. If you disagree with the outcome of this appeal, you can follow instructions on your appeal resolution letter to submit an appeal to the Department and request a State Fair Hearing.<\/li>\n<li>For an appeal submitted to the Department, the Department will first conduct an internal review (sometimes called an \u201cinformal review\u201d) of the appeal. The internal review includes reviewing all the documents submitted to support your appeal, all documents in your case file that were used to make the decision you are appealing, and criteria for the service that was requested. A different person than the one who made the original decision will conduct this review. The Department will communicate with you about the preliminary outcome of the internal review within the 30 days.<strong style=\"font-size: revert; color: initial;\">\u00a0<\/strong><\/li>\n<li>If you disagree with the Department\u2019s internal review, a State Fair Hearing will be scheduled with the Office of Administrative Hearings (OAH) at the earliest available date. State Fair Hearings are all telephonic (over the phone). The date of the hearing is selected by the Hearing Officer and sent to you via mail or email with a date, time, and call-in information. If the date or time do not work for you, please follow the instructions on your Notice of Scheduling to request a new date. The Notice of Scheduling will also include information on how to submit supporting documentation (called \u2018exhibits\u2019) and how to have people to support you at the hearing (called \u2018witnesses\u2019).<\/li>\n<li>At the hearing you will have the right to present witnesses and documents to support your appeal and to ask the Department\u2019s witness questions about the decision. After the hearing, the Hearing Officer will issue a decision in no more than 30 calendar days. More information on the hearing process is available in the <a style=\"font-size: revert;\" href=\"https:\/\/yes.idaho.gov\/youth-empowerment-services\/tools\/understanding-yes\/guide-to-yes\/\" target=\"_blank\" rel=\"noopener\">YES Practice Manual Guide to YES: A Practice Manual<\/a><span style=\"font-size: revert; color: initial;\">.<\/span><\/li>\n<li>If you would like copies of any of the information and documentation used in the internal review or used in making the decision, you may request them from the Department or the contractor. Please see the Frequently Asked Question titled, \u201cHow do I request records used in making the decision that I want to appeal?\u201d<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e0b0\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e0b0\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e0b0\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e0b0\" class=\"btn btn-link\">What do I do if 30 days have lapsed since I filed a Standard appeal and I have not received an appeal outcome? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e0b0\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e0b0\" data-parent=\"#heading--67b3dc323e0b0\"><div class=\"card-body\">\n<ul>\n<li>If you submitted an appeal to Magellan Healthcare and you have not received a notice of decision on your appeal within 30 days, you may submit an appeal to the Department without waiting for a decision from Magellan Healthcare.<\/li>\n<li>If you submitted an appeal to the Department or another contractor (Liberty, MTM, etc.), please reach out directly to the contact you filed your appeal with to inquire about the status of your appeal. Contact information can be found on your notice of decision letter or in the <a href=\"https:\/\/yes.idaho.gov\/appeals\/\"><strong>Appeals Contacts<\/strong><\/a> section this webpage.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e106\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e106\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e106\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e106\" class=\"btn btn-link\">What do I do if 72 hours have lapsed since I filed an Expedited\/Urgent appeal and I have not received an appeal outcome? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e106\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e106\" data-parent=\"#heading--67b3dc323e106\"><div class=\"card-body\">\n<p>Please reach out directly to the contact you filed your appeal with and inquire about the status of your appeal. Contact information can be found on your Notice of Decision or in the <a href=\"https:\/\/yes.idaho.gov\/appeals\/\"><strong>Appeals Contacts<\/strong> <\/a>section of this webpage.<\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e15a\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e15a\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e15a\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e15a\" class=\"btn btn-link\">What do I do if my provider(s) does not submit requested paperwork before the appeal deadline and\/or before a State Fair Hearing? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e15a\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e15a\" data-parent=\"#heading--67b3dc323e15a\"><div class=\"card-body\">\n<ul>\n<li>If the deadline for submitting for an appeal is coming up and you do not have information you requested from your provider, you can file your appeal without it. The documentation can be submitted after you request an appeal.<\/li>\n<li>If you are having trouble getting the supporting documents you requested from your provider, notify the Department of Health and Welfare and they can request that documentation for you.<\/li>\n<li>\n<p>If the date for a State Fair Hearing is coming up and you do not have the paperwork or documentation you need to submit to support you during the hearing, contact the Office of Administrative Hearings (OAH) by emailing them at: <a href=\"mailto:health.filings@oah.idaho.gov\">health.filings@oah.idaho.gov<\/a> or call them at: (208) 690-2242. They may suggest you work with the Department of Health and Welfare to reschedule the hearing to a later date. When rescheduling a hearing, the Office of Administrative Hearings (OAH) will request you and the Department of Health and Welfare submit three dates and times that you agree work for both of you. They will select one time out of those and reschedule the hearing.<\/p>\n<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e1b9\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e1b9\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e1b9\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e1b9\" class=\"btn btn-link\">How long should I wait after I filed my appeal before I reach out to the agency that I filed my appeal with? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e1b9\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e1b9\" data-parent=\"#heading--67b3dc323e1b9\"><div class=\"card-body\">\n<ul>\n<li>To ensure your standard appeal request was received, please wait five (5) business days to allow the agency you filed the appeal with to document and begin the appeal process.<\/li>\n<li>To ensure your expedited appeal request was received, please contact the agency you filed the appeal with the next business day.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e208\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e208\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e208\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e208\" class=\"btn btn-link\">My youth\/child needs or was recommended a service that we cannot find or access. Does this qualify for an appeal? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e208\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e208\" data-parent=\"#heading--67b3dc323e208\"><div class=\"card-body\">\n<ul>\n<li>No. An appeal cannot be submitted due to inability to locate a provider for services.<\/li>\n<li>If you can\u2019t find a provider or access a recommended service, please contact <a href=\"https:\/\/magellanofIdaho.com\" target=\"_blank\" rel=\"noopener\">Magellan Healthcare<\/a> to help you locate a service provider or alternative service.<\/li>\n<li>If Magellan Healthcare cannot find you a provider or alternative service, you can file a complaint with Medicaid using the form on the YES website at <a href=\"https:\/\/app.keysurvey.com\/f\/1391131\/5d8d\/\">Youth Empowerment Services Concern and Complaint Form (keysurvey.com)<\/a> or by emailing <a href=\"mailto:YES@dhw.idaho.gov\">YES@dhw.idaho.gov<\/a>. \u00a0<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e263\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e263\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e263\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e263\" class=\"btn btn-link\">What do I do if I want to file a complaint about an appeal decision or the appeals process? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e263\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e263\" data-parent=\"#heading--67b3dc323e263\"><div class=\"card-body\">\n<ul>\n<li>If you feel you are being retaliated against or if you have any other concerns, you are free to submit your questions or file a complaint directly by using this link: <a href=\"https:\/\/app.keysurvey.com\/f\/1391131\/5d8d\/\">Youth Empowerment Services Concern and Complaint Form (keysurvey.com)<\/a> or by emailing <a href=\"mailto:YES@dhw.idaho.gov\">YES@dhw.idaho.gov<\/a>. You can submit your questions or complaint anonymously.<\/li>\n<li>You can also reach out to Families and Youth of Idaho (FYIdaho) for support in filing a complaint or navigating the appeals process by emailing them at: <a href=\"mailto:support@FYIdaho.org\">support@FYIdaho.org<\/a>.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e2b7\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e2b7\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e2b7\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e2b7\" class=\"btn btn-link\">Who can help me understand the appeal process? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e2b7\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e2b7\" data-parent=\"#heading--67b3dc323e2b7\"><div class=\"card-body\">\n<ul>\n<li>Any of the contacts in the <a href=\"https:\/\/yes.idaho.gov\/appeals\/\"><strong>Appeals Contacts<\/strong><\/a> section of this webpage.<\/li>\n<li>These contacts include the Department of Health and Welfare\u2019s divisions of Medicaid, Behavioral Health, and Welfare\/Self-Reliance, and Magellan Healthcare.<\/li>\n<li>You may also contact Families and Youth of Idaho (FYIdaho) for support in filing an appeal or understanding the appeals process by emailing them at: <a href=\"mailto:support@FYIdaho.org\">support@FYIdaho.org<\/a><\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e2fe\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e2fe\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e2fe\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e2fe\" class=\"btn btn-link\">Where can I find the appeal and fair hearing process? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e2fe\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e2fe\" data-parent=\"#heading--67b3dc323e2fe\"><div class=\"card-body\">\n<p>The complete appeal and fair hearing process can be found in the YES Practice Manual\u00a0<a href=\"https:\/\/yes.idaho.gov\/youth-empowerment-services\/tools\/understanding-yes\/guide-to-yes\/\">Guide to YES: A Practice Manual | YOUTH EMPOWERMENT SERVICES (idaho.gov)<\/a><\/p>\n<\/div><\/div><\/div><div class=\"card bg-default\" id=\"-67b3dc323e33a\">\n\t<div class=\"card-header\" role=\"tab\" id=\"heading--67b3dc323e33a\"><button data-toggle=\"collapse\" data-target=\"#collapse--67b3dc323e33a\" aria-expanded=\"false\" aria-controls=\"collapse--67b3dc323e33a\" class=\"btn btn-link\">What are the Rules, Regulations, and Due Process Protocol that govern the appeal and fair hearing process and procedures? <\/button><\/div>\n\t<div id=\"collapse--67b3dc323e33a\" class=\"collapse \" aria-labelledby=\"heading--67b3dc323e33a\" data-parent=\"#heading--67b3dc323e33a\"><div class=\"card-body\">\n<ul>\n<li>The Department of Health and Welfare \u2018s Contested Case Rules: IDAPA 16.05.03<\/li>\n<\/ul>\n<p><a href=\"https:\/\/adminrules.idaho.gov\/rules\/current\/16\/160503.pdf\" target=\"_blank\" rel=\"noopener\">IDAPA 62 &#8211; Office of Administrative Hearings<\/a><\/p>\n<ul>\n<li>The federal Managed Care Organization grievances &amp; Appeals: <a href=\"https:\/\/www.ecfr.gov\/current\/title-42\/chapter-IV\/subchapter-C\/part-438\/subpart-F\">eCFR :: 42 CFR Part 438 Subpart F &#8212; Grievance and Appeal System<\/a><\/li>\n<li>The federal Medicaid Regulations: 42 U.S.C. section 431.200 Fair Hearings<\/li>\n<\/ul>\n<p>\u00a0<a href=\"https:\/\/www.ecfr.gov\/current\/title-42\/chapter-IV\/subchapter-C\/part-431\/subpart-E\/subject-group-ECFR14123c518724401\/section-431.200\">eCFR :: 42 CFR 431.200 &#8212; Basis and scope.<\/a>\u00a0<\/p>\n<ul>\n<li>The <em>Jeff D<\/em> YES Due Process Protocol: <a href=\"https:\/\/yes.idaho.gov\/wp-content\/uploads\/2022\/04\/YES-DP-Protocol-2022-for-YES-Website.pdf\">YES Due Process Protocol (idaho.gov)<\/a><\/li>\n<\/ul>\n<\/div><\/div><\/div><\/p><\/div>\n<\/div>\n<\/div>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-3 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Youth and families may find there are times when they are not satisfied with a decision that is made about the YES services they requested or received. An appeal is [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-3798","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\r\n<title>Appeals - YOUTH EMPOWERMENT SERVICES<\/title>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" href=\"https:\/\/yes.idaho.gov\/appeals\/\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Appeals - YOUTH EMPOWERMENT SERVICES\" \/>\r\n<meta property=\"og:description\" content=\"Youth and families may find there are times when they are not satisfied with a decision that is made about the YES services they requested or received. 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