Complaint and Appeal Process

Complaint and Appeals Process

Customer Rights

NOTICE OF CUSTOMER RIGHTS

YOU have the right to be told about the services available at the ADRC.

YOU have the right to get information, referrals and assistance from the ADRC, in order to learn about area resources and enroll in the services and programs for which you qualify.

YOU have the right to have friends, family members or any others you choose to help in your contacts with the ADRC.

YOU have the right to dignity and respect, fair and equitable treatment and freedom from discrimination.

YOU have the right to confidentiality and privacy of information and to have access to such information.  Your records will not be released to individuals or agencies without your permission.

YOU have the right to special equipment or services to help you have an equal opportunity to benefit from the services of the ADRC. For example; an interpreter or taped material.

YOU have the right to a fair and equitable way to file and resolve complaints and the right to have someone help you with the process.  If you are dissatisfied ask any ADRC staff to explain how to exercise your right to file a complaint.

Complaint & Appeal Process

NOTICE OF COMPLAINT/APPEAL PROCESS

 WHAT IS A COMPLAINT/APPEAL?

If you are not happy with the service you received at the Aging and Disability Resource Center (ADRC) feel that you were treated unfairly or discriminated against or disagree with decisions made or actions taken you have the right to file a complaint or appeal.

 WHO DO I TELL?

  • Any staff person at the ADRC can assist you with filing a complaint/appeal.
  • A friend, relative, or anyone else can help you in filing and resolving a complaint/appeal.
  • The following advocacy agencies are also available to help file your complaint/appeal:
Any age: Under age 60: Over age 60:
Independent Living Resources Disability Rights Wisconsin Board on Aging & Long Term Care
149 E. Mill Street 131 W. Wilson Street Suite 700 1402 Pankrate Street Suite 111
Richland Center, WI  53581 Madison, WI 53798 Madison, WI 53704.4001
Phone: 608-647-8053 Toll free: 800-928-8778 Toll free:800-515-0015 fax:608-246-7001

 

OPTIONS TO RESOLVE COMPLAINT/APPEAL:

  1. Informal Internal Complaint.  This option is intended to promote understanding, bridge differences and identify and resolve problems on a less formal basis. If you choose this option, any ADRC staff can talk with you on the phone, or meet with you in person, to discuss and try to resolve the problem within ten business days.  You may include anyone at this meeting.
  2.  Formal Internal Appeal.   If you prefer a more formal process, or if you have tried the informal internal appeal process and are still dissatisfied, you can file a formal internal complaint/appeal. If you choose this option, the ADRC Office Manager will arrange to meet with you in person to discuss the problem within 15 business days to work towards a resolution.  You may include anyone at this meeting.  Following the meeting you will receive a letter that reviews your complaint/appeal and how it was resolved.
  1. Formal External Complaint.  At any time before, during or after the internal process described above, you can choose to file a formal external appeal with the Department of Health Services. They will acknowledge receiving your appeal within 5 days of its receipt; contact you; and try to make a decision no later than 20 business days after it was received.

ADRC Quality Assurance Specialist

Office for Resource Center Development /Division of Long Term Care

Wisconsin Department of Health Services

PO Box 7851

Madison, WI  53707-7851

Phone:  608-266-2536 Fax: 608-267-3203

E-Mail:  DHSRCT@wisconsin.gov (subject line:  ADRC Complaint)

  1. State Fair Hearing.  If your complaint/appeal relates to your application for Family Care or IRIS, you can file directly with the State Fair Hearing. This process is used if you have received a notice of decision, or there has been a failure to act regarding one of the following:
  • Determination of ineligibility for Family Care or IRIS;
  • Determination of cost sharing for Family Care or IRIS;
  • Determination that the person is eligible for but not entitled to Family Care or IRIS;
  • Determination in regard to divestment, treatment of trust amounts, and protection of income and resources of a couple for maintenance of the “community spouse”;
  • Failure of the Aging and Disability Resource Center to provide timely services/support.

Your complaint/appeal must be filed within 45 days of the receipt of notice or failure to act.

For matters other than those listed above, the formal external appeal process must be used, before using the State Fair Hearing Process.  To apply for a State Fair Hearing, contact:

Family Care Request for Fair Hearing

c/o DOA Division of Hearings & Appeals

PO Box 7875, Madison, WI  53707-7875

Phone: 608-266-3096 / TTY: 608-264-9853 / Fax: 608-264-9885

 

Download Complaint Form HERE

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