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County Management Plans for MH/DD Services
Policy and Procedures Manuals Best Practices Materials

  1. County Management Plan: Policy and Procedures Manual Checklist

  2. Introduction to the Policy and Procedures Manual

  3. Policy and Procedures Manual
    Section J. How Can I Be Sure My Privacy Will Be Respected?

  4. Policy and Procedures Manual
    Section K. What If I Have A Complaint, Or I Disagree With A Decision About Eligibility, Services or Funding?

  5. Notice of Decision Form (front page)

  6. Appeals Process Form (back page or reverse of Notice of Decision):
    This form involves decisions made by CPCAs which are appealed to the County Board of Supervisors.

  7. Appeals Process Form (back page or reverse of Notice of Decision):
    This form involves decisions made by CPCAs which are appealed directly to an Appeals Committee.

Letter of Explanation

The University of Iowa Clinical Law Program, in conjunction with the Iowa Program For Assistive Technology (IPAT), has for more than a year and a half been reviewing how each of the 99 counties in Iowa delivers mental health and developmental disability (MH/DD) services. We have focused on the decision-making and appeals process, to identify the procedural models and plan provisions that best serve consumers, and to develop "best practice" materials which can be adopted or freely adapted by each county.

This letter is to let you know that we have completed our final materials, to provide you with copies of these documents, and to suggest future actions that you might consider taking in response to our efforts, findings and work product. We are writing to you, to consumers and to other stakeholders who have been personally involved with our efforts, have expressed interest in reviewing and receiving the materials, and have worked to improve the services, supports and funding provided to persons with disabilities in your county.

Our goal is to improve the quality of information that consumers and others receive about how the system in each county works. Informed consumers, in our opinion, are better able to participate fully in developing and selecting services and supports that are tailored to their individual circumstances, priorities, abilities and capabilities. You, as a Central Point of Coordination Administrator (CPCA), play a pivotal role in shaping policy, drafting management plans, administering and overseeing related programs, and working at the county, state and federal levels to help restructure and refine Iowa’s MH/DD services delivery system. We trust that the enclosed checklist, sample plan sections on confidentiality and appeal rights, Notice of Decision and Appeals Process forms, and other materials will help you achieve these goals and, at the same time, empower consumers.

By way of background, these documents were created only after we, and our predecessor Student Legal Interns, working under Len Sandler’s supervision, conducted legal and factual research, interviewed stakeholders, and read and analyzed 86 county management plans. We compiled, compared and charted the different features of each county’s decision-making and appeals process.

To better understand the real world concerns of administrators, we met with CPCAs from the South Central SCAT region. We then shared our preliminary findings at an Iowa State Association of Counties (ISAC) meeting, and provided a county-specific chart to each CPCA who requested one. Moreover, we visited a number of counties, including Winneshiek, Allamakee, Howard and Washington counties, to meet with program administrators. These visits provided us with the opportunity to candidly discuss, review and critique their respective plans. The CPCAs returned the favor by evaluating our draft materials and exchanging insights regarding confidentiality, notices of decision, appeals and other plan provisions.

To ensure that all stakeholders contributed to the project, we interviewed individual consumers and their family members, and gathered more information at the 1998 and 1999 Systems Change Network (SCN) Congress meetings. The SCN is a grass roots education and advocacy organization that promotes changes in disability-related laws and policies. The professional advocate’s perspective was obtained by meeting with representatives of the Legal Services Corporation of Iowa, Iowa Protection & Advocacy Services, Inc., Centers for Independent Living, the Iowa Program For Assistive Technology, and by speaking with private attorneys.

Members of the Key Coalition, provider organizations, the State County Management Committee, the Governor’s DD Council, the Department of Human Services, and local planning councils also contributed to the project. In August 1999, draft copies of our best practices materials were mailed to more than 20 reviewers. Their comments were invited and evaluated. Many of their recommendations were incorporated into the final set of materials which accompany this letter.

When reviewing the materials, keep in mind that we have not attempted to do the impossible -- to create a Policy and Procedures Manual that is to be used by every county. From the start, we have acknowledged and respected each county’s right to devise a system which suits its population, tax base, resources and needs. No attempt has been made to impose any hard and fast rules or standards, either. Do not be put off by the sheer mass of the materials. We wrote them so that each county could pick and choose the documents, individual provisions, or forms that best serve the needs of all of its residents.

It is our distinct pleasure to provide you with the following materials:

1. County Management Plan: Policy and Procedures Manual Checklist, which is to be used to evaluate the completeness, effectiveness, and clarity of individual county management plans. The Table of Contents is organized in the Question and Answer format now used by Howard and Winneshiek counties.

2. Introduction to the Policy and Procedures Manual, which provides an overview of the MH/DD delivery system. It can be incorporated into the county plan or separately distributed as a consumer handbook.

3. Policy and Procedures Manual "Section J. How Can I Be Sure My Privacy Will Be Respected?" The section describes what happens to personal information and records provided by, for, and about consumers. It explains the general rules and the practical safeguards that apply to every stage of the application, service delivery and appeals processes. Also discussed are release of information forms, medical emergencies, and the state and federal laws that govern the disclosure of mental health, HIV/AIDS, substance abuse and other personal information.

4. Policy and Procedures Manual "Section K. What If I Have A Complaint, Or I Disagree With A Decision About Eligibility, Services or Funding?" This manual section details how MH/DD decisions are made and communicated, who the people are that make the decisions, and how decisions can be appealed. It is designed to walk people through each stage of the process. It is written for a county which uses three appeal stages. It is the most comprehensive and the most easily-edited segment because each appeal stage section repeats the general appeal rights, time lines and procedures set forth in previous sections.

5. Notice of Decision Form (front page): This form was drafted to fully inform consumers about every aspect of their request for services and the decision-making and appeals process. It includes instructions on how to appeal any decision and where to get help.

6. Appeals Process Form (back page or reverse of Notice of Decision): This form involves decisions made by CPCAs which are appealed to the County Board of Supervisors. It was created to help consumers and their representatives understand what they must do, and by when, if they disagree with or question any decision.

7. Appeals Process Form (back page or reverse of Notice of Decision): This form involves decisions made by CPCAs which are appealed directly to an Appeals Committee. Several counties have intermediate appeal stages.

We recommend that you read the materials in sequence, keeping in mind the different perspectives, goals, needs and abilities of consumers, advocates, providers, administrators, decision-makers, agencies and lawmakers. Many of the words and segments have been highlighted to draw attention to provisions that require you to insert specific information, choose among various options or otherwise tailor the materials to your exact specifications. The county attorney should be consulted to review the provisions which describe the county’s obligations and the state and federal laws that apply to MH/DD issues.

Please share the materials with others in your community. Ideally, they will promote discussion and change. Plans are being made to post the documents on IPAT’s website and to electronically circulate them by other means, too. The DHS is including this letter in its regular CPCA mailing, a courtesy which will save us considerable time and expense. Your comments and suggestions are welcomed and invited. For more information, contact Len Sandler by calling 319-335-9023, faxing documents to 319-353-5445, or e-mailing messages to Contact us if you would like us to review your county plan and to meet with you to discuss it. Your continued efforts to improve the MH/DD system are appreciated.

Sincerely,

Sarah Barnes
Craig Cannon
Amy Lyons
Chris Pashler
Student Legal Interns

Leonard A. Sandler
Clinical Professor

1. County Management Plan:

Policy and Procedures Manual Checklist

I. The Policy and Procedures Manual should be organized, designed, formatted and written for consumers, providers, administrators and others interested in Mental Health and Developmental Disability (MH/DD) matters. We recommend that the Manual include:

An Introduction to the County MH/DD System and its Management Plan which provides an overview of how the county funds and delivers services and supports, highlights issues of importance, and refers readers to other sections for more information. It can be used and separately distributed as a consumer handbook (See attached model).
A Mission Statement.
The 24-hour crisis response hotline numbers, and the names of the persons and agencies to call in case of a medical or other emergency.
A Table Of Contents, with information organized and presented by topic, rather than by administrative code section, preferably in a Question and Answer format, one example of which reads:
  1. Where Do I Go To Get Services And Funding?
  2. How Do I Find Out If I Am Eligible For Services And Funding?
  3. How Are Decisions Made About My Services And Funding?
  4. What Types Of Services Are Available?
  5. Will I Have To Pay For My Services?
  6. What If I Am Approved To Receive Funding But There Is Not Enough Money?
  7. What Should I Expect From My Services?
  8. What Are My Rights And Responsibilities?
  9. Can The Person Making Decisions About My Funding Benefit Personally?
  10. How Can I Be Sure My Privacy Will Be Respected? (See attached model Section J)
  11. What If I Have A Complaint, Or I Disagree With A Decision About My Eligibility, Services Or Funding? (See Attached Model Section K)
Language that is easy-to-read and understand.
Updated and accurate citations to governing laws, rules and regulations.
The information and plan particulars required by 441 IAC 25 (Attached).
A list of advocates -- attorneys and others -- available to assist the consumer in understanding or appealing any decision.
Sample Forms: Application, Notice of Decision/Appeal Process, Request To Appeal, Release of Information, Complaint, and other forms used by the county (See attached model Notice of Decision/Appeals Process forms).
Information about how to obtain accommodations and copies of the County Management Plan, the Policy and Procedures Manual, Applications, Notices of Decision, and other materials in alternate formats.

II. Notices of Decision should be tailored to the individual consumer, provided to consumers, advocates and service providers, and contain a complete explanation of what happened, why it happened, and what is to happen next. We recommend that the Notice of Decision include:

The date of the decision and the date by which any appeal must be received. Central Point of Coordination (CPC) staff should compute the deadline day/date.
The name, address, telephone, e-mail and fax numbers of the decision maker.
The names, addresses, and telephone numbers of the consumer, consumer representatives, providers, and others that will receive a copy of the Notice.
A complete explanation of the decision, including:
The subject matter of each request -- eligibility, funding, appeal, etc.
The complete list of services and supports requested and the cost of each.
The precise action taken on the request, including the services approved, partially funded, or denied; the cost of each service, the effective date of the service funding, the consumer’s financial contribution, if any, and the services that will continue to be provided throughout the appeals process.
The records and information used to decide the request.
An explanation of what the consumer must do to appeal the decision, request information, obtain the decision in alternate formats or get help to understand or appeal the decision.
A complete description of the appeals process, including:
Deadlines for filing and receiving written appeals
The person(s) or entities that will hear and decide the appeal, and when and how they will meet to review the appeal.
A complete explanation of appeal rights, including the consumer’s right to hire a lawyer or have someone else represent them at their own expense; to present evidence and witnesses, personally appear at any hearing or review, inspect, in advance of any hearing, all records and information to be used by the person(s) deciding the claim, and to submit additional records or information.
The measures taken to safeguard personal information about the consumer.
The names, addresses and phone numbers of lawyers, organizations and advocates available to assist the consumer in appealing the decision.

III. Confidentiality and privacy practices and safeguards should detail what happens to information provided by, for, or about consumers. We recommend that this information be included in the Introduction, in a provision devoted exclusively to this topic, and in the appeal process provisions and forms. These provisions should delineate:

The broad range of medical, financial, employment and other information needed to evaluate and assess the consumer’s eligibility and suitability for services and supports and funding.
The general policies that apply to routine matters and those that apply to medical, psychological and other emergencies and crises.
The persons and organizations that can consent to the release of personal information on the consumer’s behalf, and the definition of each person or entity that can do so (legal guardian, authorized representative, legal representative, family member, custodian).
The persons and organizations that are entitled to receive or exchange information about the consumer and the extent to which they can share what they learn with others. This should cover the initial intake application through the last stages of any appeals process, up to and including the Board of Supervisors.
The day-to-day policies and office practices used by CPC staff, providers and others, in and out of their offices, including, but not limited to:
The use of release of information and other forms.
Guidelines for maintaining and protecting paper and computer records and using e-mail, cell phones and fax machines.
The use of confidentiality stamps, coded information, identifiers, deletions and other measures to protect documents that identify the consumer and contain personal information.
The protocols for interviewing consumers and conducting other business in private settings.
The federal, state, and local laws and regulations that apply to these matters.
The additional protections afforded HIV/AIDS, mental health and substance abuse information, and how they will be implemented.
Whether or not any personal information about the consumer will be made available to the public, by or through:
State Open Records Act requests (Iowa Code Chapter 22), or other freedom of information requests.
Board of Supervisors proceedings which are subject to the State Open Meetings Law (Iowa Code Chapter 21), through:
Agendas or Notices posted at the courthouse, printed in newspapers, or published elsewhere.
Persons or media representatives attending or broadcasting Board proceedings or deliberations, or learning of decisions announced at meetings.
Minutes of Board proceedings
Other Means
Training programs on confidentiality that are offered and actually provided to CPC staff, providers, experts and consultants, administrators, court and agency personnel, individuals involved in hearing and deciding claims and appeals, County Supervisors, and others involved in the delivery of services.
Release of Information Forms should:
Identify all persons and organizations that are free to share records and information.
List the nature and substance of the information to be shared and the purposes for which the information can be used.
Identify who consented to the release of information and by what authority they did so.
Specifically list and authorize (or not) the release of HIV/AIDS, substance abuse or mental health information, and have the consumer or representative sign or initial those additional disclosures.
Notify consumers that they may request a list of the persons and agencies that received the releases and shared information with anyone.
Note that consumers can revoke or withdraw their consent at any time.
Note for how long the consent is valid -- the time period when the consent is automatically revoked.
Note for how long the consent is valid -- the time period when the consent is automatically revoked.
Be signed by the consumer (or at the consumer’s direction) or by someone authorized to act on the consumer’s behalf.

IV. The Policy and Procedures Manual can be supplemented by materials created for consumers and advocates which explain the intake, enrollment and funding process, and advise them of their rights and responsibilities. These materials might complement, or be a substitute for, the Introduction/Overview.

Booklets and brochures created by or for your county.
Checklists and other forms which focus on a single subject or issue. For example, a checklist of time lines and events in the appeals process from the CPCA through the Board of Supervisors.
Newsletters, handbooks, checklists, manuals, and other materials created and distributed by other Central Point of Coordination Administrators (CPCAs), the Legal Services Corporation of Iowa, Iowa Program For Assistive Technology, University of Iowa Clinical Law Program, Iowa Protection & Advocacy Services, Inc., the Iowa State Association of Counties, the Department of Human Services, or others organizations.

V. The Policy and Procedures Manual should be reviewed and amended after asking and answering the following questions:

What is the plan’s purpose – Is it to educate consumers and others, to comply with governing laws and regulations and/or to provide a road map for persons using the system?
Who is the target audience – Consumers, providers, state or federal agencies, lawmakers or others?
What happens to information provided by, for, or about the consumer, and what safeguards are used to protect and preserve confidential information?
Who is told about and receives copies of Applications, Notices of Decision and other materials?
How or in what manner are decisions communicated to consumers or others?
How can consumers appeal any decision regarding eligibility, funding or services?
What happens at each stage of the decision-making and appeals process -- who makes decisions, what time lines are involved and what procedures are used?
How is the plan organized, formatted, designed and written to address the target audience and achieve the intended purposes?

These materials were developed and distributed by Student Legal Interns working under the supervision of Clinical Professor Len Sandler at the Clinical Law Programs, University of Iowa College of Law, Iowa City, Iowa, 52242-1113.

The Student Legal Interns who contributed to the project are: Dai Parker-Gwilliam, Andrea O'Malley, Lori Semke, Carl Wosmek, Cindy Kim, Ron Martin, Douglas Foster, Yasir Aleemuddin, Sara Scott, Marci Lowman, Paula Marshall, Jessica Roberts, Sung Hee Cho, Henry Kass, Brian Kinstler, Rumi Kuli, Sarah Barnes, Craig Cannon, Amy Lyons and Christopher Pashler.

This Clinical Law Systems Reform Project was sponsored by the Iowa Program for Assistive Technology.

For more information, or to request copies of the materials in alternate formats, contact the Clinical Law Programs -- Call 319-335-9023, fax documents to 319-353-5445, or send e-mail Professor Sandler.

2. Introduction to the Policy and Procedures Manual

COUNTY
CENTRAL POINT OF COORDINATION OFFICE
ADDRESS
CITY, STATE ZIP
TELEPHONE
EMERGENCY SERVICE NUMBER
TELEFACSIMILE NUMBER
E-MAIL ADDRESS

MENTAL HEALTH & DEVELOPMENTAL DISABILITY SERVICES
COUNTY MANAGEMENT PLAN
POLICY AND PROCEDURES MANUAL
CONSUMER HANDBOOK

INTRODUCTION

The purpose of this Introduction is to explain how we provide, fund and deliver mental health and developmental disability services in                  County. It is written as a guide for consumers, their families, friends and advocates. It is also a guide for service providers, administrators, and others interested in these important matters.

This introduction has been written to answer many of the basic questions and concerns you may have about how these programs work in                  County. The planning and funding of services is an ongoing process that has to adapt to the changing needs of consumers. Whether you are applying for the first time, or asking us to renew services and funding, we want to continue to work closely with you. Our goal is to ensure that services are cost effective and meet your particular strengths, abilities, priorities and needs. Regrettably, our resources and funding are limited. Because of this, we can not honor or fund every request for services or supports.

We encourage you to contact us if you need more information, help or referrals. This Introduction, the County Plan, the Policy and Procedures Manual, and other materials are also available to the public in alternate formats through our office.

IN EMERGENCIES: CALL OUR 24-HOUR HOTLINE ________________,
OR THE CRISIS MANAGEMENT PROVIDERS LISTED ON PAGE ____ OF THE PLAN.

HOW OUR SYSTEM WORKS

Consumer empowerment is our goal. It is essential that individuals have freedom of choice, and take an active role in deciding what services and supports they need and how those services are to be delivered.

Our office is called the Central Point of Coordination (CPC). We act as the gatekeeper to a countywide system of services and supports by taking applications, making eligibility decisions, evaluating the needs of individuals, and working to create and implement a service funding plan. We are part of the county’s Central Point of Coordination process, and we report to the Board of Supervisors.

We also cooperate and enter into contracts with other agencies, organizations and service providers. Providers are public and private companies, professionals and facilities that deliver a wide range of services. They might be businesses that operate transportation or para-transit systems; hospitals with rehabilitation, mental health, or long-term care facilities; practitioners such as counselors and therapists, home health care agencies, independent living centers, or job assistance coaches. Most providers in this county can assist you in filling out applications and forwarding them to our office. You can find a list of providers elsewhere or on Page __ in the policy and procedures manual.

The First Step: Intake, Eligibility and Enrollment:

You can receive services if you meet our four (4) eligibility requirements. The first requirement is that you have a diagnosed disability covered by the plan. We currently only cover persons with a diagnosis of:

The second requirement is that you meet our income and resource financial eligibility guidelines. The third requirement is that the requested service or support is covered by the plan. The fourth requirement is that                  County is required to pay for those services.

To start the process, a written application must be completed. You can do this at our offices, or at any one of the providers or access points listed in our plan. We can also mail an application directly to you. Staff members can help you fill out the applications. If you like, you can bring along a friend, family member or other person familiar with your personal matters.

You will be asked to provide information about disability, health, education, work history, income, benefits, insurance, and other matters. The application also requires us to gather information about others who live in your household or who are responsible for your support. We will also want to know where you have lived in the past, so we can determine if                  County has the responsibility to pay for the services and supports for which you qualify. A copy of our Application can be found elsewhere or in the Appendix in the policy and procedures manual.

We want to assure you that your privacy will be respected and protected both in and out of our offices. No personal information will be shared with others unless you give us written permission or we are required by law to do so. You will be asked to sign release forms that authorize us to talk with other persons and organizations and to freely exchange information and records about you.

In medical and psychological emergencies, however, you may be unable to give your consent to the release of information. When this happens, our first priority is to see that you receive emergency services. We will only release information that is necessary and required by law to address the crisis. We will keep track of the information. After the emergency ends, we will tell you who received the information and why they were entitled to receive the information. More information about our confidentiality and privacy policies and safeguards, and copies of our release forms, can be found in Section J of the Policy and Procedures Manual.

After we review the application information, we will decide whether or not you are eligible for county services and funding. If you meet our eligibility criteria, you are entitled to receive county funding. A written Notice of Decision will be sent to you which explains how and why we made that decision. If you are not eligible, you will receive a Notice of Decision which explains why we denied your request. You have the right to appeal any part of the decision. The appeals process is discussed later in this introduction and is more thoroughly explored in Section K of the Policy and Procedures Manual.

The Second Step: Service Planning and Funding:

Once we decide that you are eligible to receive services and supports, the next step is to develop a service plan individualized to your unique circumstances and priorities. To do that, we must learn more about you and assess your health care, treatment, employment, transportation, and other needs. A member of our staff will work with you and others to create a service plan tailored to your specific strengths, abilities and needs. If you agree, they may also speak with your family members, doctors, therapists, services providers, or other people involved in your day-to-day affairs.

When the plan is fully developed it will either be approved, adjusted, or denied. In any event, we will send you a written Notice of Decision which will set forth the services and supports you requested, the cost of each service, the actions we have taken on your request, and the reasons why we were able or unable to fund your service and funding requests. Many of the services are provided without cost to you. In some circumstances, depending on your income and resources, you will have to pay some of the costs. A list of funded services and supports can be found on Page ____ of the Policy and Procedures Manual.

It is possible that we will not have the funds to pay for all of the services that you need. If this happens, your name may be placed on a waiting list. While you are on the waiting list, we will refer you to other resources or agencies that might be able to help you or provide the services and funding that we cannot. You can appeal this or any other decision. An attorney can represent you during the appeals process, at your own expense.

The Third Step: Continued Service Coordination:

Even after you begin to receive services, we will keep working with you to make sure that your services and supports continue to meet your changing needs. Case reviews will also be conducted. We are always open to suggestions, and we welcome your comments on how we can better serve you and others in our community. Feel free to contact us if you have any questions, complaints or compliments about us, about your providers, or about anyone else involved in our county’s mental health and developmental disability service system.

3. Policy and Procedures Manual

J. How Can I Be Sure My Privacy Will Be Respected?

Overview and General Principles: The purpose of this section is to describe what happens to personal information and records provided by, for and about consumers who apply for mental health and developmental disability services in our county. It explains the general rules and the practical safeguards that apply to each and every stage of the application, service delivery and appeals process. Also discussed are release of information forms, medical emergencies, and the state and federal laws that govern the disclosure of mental health, HIV/AIDS, substance abuse and other personal information.

We are committed to providing cost-effective services that match your unique strengths, circumstances, priorities, abilities and capabilities. To do so, and with your written permission, our staff must obtain and exchange records, information and impressions. Our written application asks for details about disability, health care, finances, employment, living arrangements, benefits and other personal matters. Developing a comprehensive service plan usually involves many individuals and organizations. Bringing people together is the best way we know to help you choose and begin receiving supports, referrals, case management and other services.

Confidentiality Safeguards: We are equally committed to respecting your privacy and keeping confidential the information, records, and files we compile, or that you share with us. In day-to-day terms, confidentiality means:

Release of Information Authorization Forms: When you apply for services, you will be asked to read, review, date and sign a release of information form. You can always change your mind at any time and revoke your consent to release information. Also, you can decide that only certain people or agencies can receive this information. Services will not be automatically denied if you refuse to sign the release. However, without supporting information, it will be difficult, if not impossible for us to act on or approve any request. If you are not able to sign the form or grant your consent, your legal guardian or can do so on your behalf.

A copy of the Release of Information form used by us can be found on page or in Appendix ___. It is included in our Application, which can be found on Page ___, or in Appendix ___.

The release identifies the persons and organizations that are free to share information and records about you. It also describes the types of information that can be released, the purposes for which the information can be used, and whether or not mental health, substance abuse or HIV/AIDS information can be released. It also notes that you have the right to withdraw or revoke your consent, request a list of the persons and agencies that received and used the releases, and inspect the materials that were disclosed. It must be signed and dated. You must sign and initial the form in two separate places to signify that you give us permission to release mental health, substance abuse or HIV/AIDS information or records.

Medical and Other Emergencies: In medical and other emergencies you may be unable to give your consent to the release of information. When this happens, our first priority is to see that you receive emergency services. We will only release information that is necessary and required by law to address and resolve the crisis. We will keep track of the information we shared or obtained. After the emergency ends, we will tell you who received the information and why they were entitled to receive the information.

The Right To Review Records: You or your authorized representative may review your mental health and developmental disability files and records. This can be done during office hours and for any reason. You have the right to review your files and records during the appeals process, which is discussed in Section K.

We ask that you call ###-###-#### to schedule an appointment to review the records. Please give us advance notice and time to gather the information. A representative of our office may be present while you review the files. There is no charge for reviewing or copying records. In very limited circumstances, family members and others can make a written request to review records classified by Iowa law as "mental health records." Special rules and protections apply to mental health, substance abuse and HIV/AIDS information, and are summarized below.

Overview of Confidentiality Laws and Where to Find More Information: A host of federal and state laws and regulations apply to the disclosure of personal information. They are far too numerous for us to mention or detail in this policy and procedures manual section. Some are detailed elsewhere in the manual. Each has its own set of definitions and terms. The Iowa Code contains the laws of Iowa, many of which touch upon these matters and set forth our duties and responsibilities.

All of these laws and regulations can be found in your public library and are available on the Internet. We are furnishing this list and summary of laws as a general guide and as a courtesy to you. It is not intended to provide you with legal counsel or advice and you should not consider this to be legal counsel or advice. Only a licensed and qualified attorney can provide you with legal counsel, advice or representation. The laws are discussed in the order they appear in the Iowa Code:

Our county supervisors meet in closed session -- unless you request that the public and media representatives be present -- when reviewing MH/DD cases. They do so because the cases involve medical, mental health and other records which are required or authorized by state or federal law to be kept confidential.

For more information or lawyer referrals, please contact us. The Legal Services Corporation of Iowa, the Iowa Volunteer Lawyers Project, Iowa Protection & Advocacy Services, Inc., the local Center For Independent Living and other advocacy organizations may also be able to provide you with general or legal advice. A complete list of the organizations can be found in Section K.

4. Policy and Procedures Manual

K. What If I Have A Complaint, or I Disagree With A Decision About Eligibility, Services, or Funding?

Overview of Decision-Making and Appeals: The purpose of this section is to describe in detail how MH/DD decisions are made and communicated, who the people are that make the decisions, and how decisions can be appealed. It is also provides information about the rights consumers enjoy and the help that is available to consumers during each and every stage of the appeals process.

We do our best to make sure that applications are completed and decisions are made as quickly as possible. Written notices of decision will be mailed and communicated in person to consumers and providers. Emergency services are to be provided immediately, with funding decisions to be made afterward. Appeals at the county level, which may involve as many as three different stages, should take no longer than one month from the time a written request for appeal is received by us. The process is designed to resolve disputes promptly and informally. Strict rules of evidence and procedures do not apply to the hearings and meetings used to decide appeals at the county level. Different people are involved, and slightly more formal procedures might be employed, as an appeal advances from one stage to another.

The first stage involves initial decisions, which are made by Central Point Of Coordination (CPC) staff. Any appeal or complaint regarding the CPC staff decision will be heard and decided by the Central Point of Coordination Administrator (CPCA), who supervises the delivery of services in our county.

The second stage involves decisions made by the Central Point Of Coordination Administrator (CPCA) regarding eligibility, funding or services. Any appeal or complaint regarding the CPCA decision will be heard and decided by the Appeals Committee, which is comprised of county residents interested in mental health and developmental disability issues.

The third stage involves decisions made by the Appeals Committee. Any appeal or complaint regarding the Appeals Committee decision will be heard and decided by the County Board of Supervisors. The next stage involves appealing the decision of the Board of Supervisors to the District Court of Iowa or other courts, depending on the actions taken or the relief that is requested.

Appeals rights and protocols are explained in greater detail later in this section. Be assured that your personal information will be protected during each and every stage of the process. Staff members, committee members and supervisors receive training on the legal and practical safeguards that apply to personal, mental health and other information and records.

The State of Iowa, rather than our county, must sometimes pay for MH/DD services provided to county residents. Many consumers also participate in Title XIX Medical Assistance and food stamp programs run by the Department of Human Services (DHS). Appeals about these "state cases" and DHS program eligibility decisions are governed by administrative agency rules and by the Iowa Administrative Procedures Act, Iowa Code Chapter 17A. More information about these appeals will be provided to consumers by the Department of Human Services.

Notices of Decision and Appeal Rights: Every decision regarding eligibility, services or funding will be issued in writing using a Notice of Decision form. We will also try our best to personally notify consumers about the decision. A copy of the Notice of Decision form we use can be found on page ____ or in Appendix ___. The first page (front) of the Notice of Decision will explain the:

The second page (reverse side) of the Notice of Decision summarizes the Appeals Process that is explained in greater detail in this section. We recommend that you review the Notice of Decision the day you receive it. Read both sides of the document carefully, word by word and line by line. Call our office at the number listed later in this section with any questions or concerns. It is important that you act quickly to preserve your right to challenge the decision. A complete description of each stage of the appeals process follows, in the order they must be pursued.

FIRST APPEAL STAGE: This stage involves initial decisions which are made by Central Point Of Coordination (CPC) staff. Any appeal or complaint regarding that decision will be heard and decided by the Central Point of Coordination Administrator (CPCA), who oversees the delivery of services in our county.

If you disagree for any reason with the initial service, funding, or eligibility decision made by the CPC staff, you may appeal that decision to the CPC Administrator. To do so, you must notify us in writing by the deadline date printed on the first page of the Notice of Decision, which is ten (10) working days from the date of decision. You may mail, hand-deliver, or fax the written appeal request. We do not use a standard form. Any letter that questions or disputes the decision will be considered an appeal request. We will use the postmark date to determine if the appeal was received by us on time. You may also call us to appeal the decision, but the call must be received by the deadline date and it must be noted in your case files. You can then visit our office or provide us with a written request within the next (five) days. All appeals must be directed to the office which is listed on the Notice of Decision, which is:( insert the name, address, title of the office which receives appeal requests).

If your appeal is not received by the appeal deadline date listed on the Notice of Decision, it will be denied, and the initial decision regarding your service, eligibility, or funding will be considered final.

The appeal should state that you do not agree with the decision, and explain why you believe the decision is incorrect. It should also describe the action you would like us to take. If you are unable to notify us on your own that you wish to appeal, a parent, guardian, provider, family member, lawyer, other advocate or authorized person may do so for you.

After we receive your timely-filed appeal, a meeting (hearing) will be scheduled to review the initial decision. You will receive a written notice that states the date, time and place the appeal will be heard. This document will be mailed to you to by certified mail and by first class mail, postage prepaid, no later than five (5) working days after we receive your appeal. We will also give you this information in person or by phone.

Our goal is to resolve disputes quickly and informally using only the procedures which are listed in this section. The appeal will be held in private. You have the right to have an attorney or other advocate accompany and represent you, but at your own expense. You may qualify for free legal assistance through the Legal Services Corporation of Iowa, the Iowa Volunteer Lawyers Project, Iowa Protection & Advocacy Services, Inc., or other organizations. A list of legal service and advocacy organizations appears on the Notice of Decision and later in this section. Consumers and their representatives also have the right to:

The CPC Administrator will consider all the information that is presented during the appeal. Appeals should rarely, if ever, involve the consumer’s entire clinical, medical or mental health history or records. The CPC Administrator should only consider and review information and records that are needed to address the particular and limited issue being decided. Mental health information, as defined by Iowa Code Chapter 228, can only be shared with the persons identified in that law. As a result, certain people attending the hearing or deciding the appeal may not be able to obtain this information. Additional information about privacy safeguards can be found in Section J.

A written Notice of Decision will be mailed to you no later than ten (10) working days after the appeal is heard. The Notice of Decision will be sent to you and to your legal or other authorized representative by certified mail, and by first class mail, postage prepaid, to make certain that you receive it. The Notice of Decision will completely explain the Administrator’s decision and detail what is to happen next regarding your services and supports.

SECOND APPEAL STAGE: This stage involves decisions made by the Central Point of Coordination Administrator (CPCA) regarding eligibility, funding or services. Any appeal or complaint regarding the CPCA decision will be heard and decided by the Appeals Committee.

If you disagree for any reason with the decision made by the CPC Administrator, you may appeal that decision to the Appeals Committee. To do so, you must notify us in writing by the deadline date printed on the first page of the Notice of Decision, which is ten (10) working days from the date of decision. You may mail, hand-deliver, or fax the written appeal request. We do not use a standard form. Any letter that questions or disputes the decision will be considered an appeal request. We will use the postmark date to determine if the appeal was received by us on time. You may also call us to appeal the decision, but the call must be received by the deadline date and it must be noted in your case files. You can then visit our office or provide us with a written request within the next (five) days. All appeals must be directed to the office which is listed on the Notice of Decision, which is:( insert the name, address, title of the office which receives appeal requests).

If your appeal is not received by the appeal deadline date listed on the Notice of Decision, it will be denied, and the CPC Administrator’s decision regarding your service, eligibility, or funding will be considered final.

The appeal should state that you do not agree with the decision, and explain why you believe the decision is incorrect. It should also describe the action you would like us to take. If you are unable to notify us on your own that you wish to appeal, a parent, guardian, provider, family member, lawyer, other advocate or authorized person may do so for you.

After we receive your timely-filed appeal, a meeting (hearing) will be scheduled to review the CPCA’s decision. You will receive a written notice that states the date, time and place the appeal will be conducted. This document will be mailed to you to by certified mail and by first class mail, postage prepaid, no later than five (5) working days after we receive your appeal. We will also give you this information in person or by phone.

An Appeals Committee will be appointed to hear and decide your appeal. Three (3) people from the community who are interested in mental health and disability issues, and who do not have a personal interest in your case, will be randomly selected to hear your appeal. You will be provided with the names of the people who will serve on the Appeals Committee, before the hearing.

Our goal is to resolve disputes quickly and informally using only the procedures which are listed in this section. The appeal will be held in private. You have the right to have an attorney or other advocate accompany and represent you, but at your own expense. You may qualify for free legal services through the Legal Services Corporation of Iowa, the Iowa Volunteer Lawyers Project, Iowa Protection & Advocacy Services, Inc., or other organizations. A list of legal service and advocacy organizations appears on the Notice of Decision and later in this section. Consumers and their representatives also have the right to:

The Appeals Committee will consider all the information that is presented during the appeal. Appeals should rarely, if ever, involve the consumer’s entire clinical, medical or mental health history or records. The Appeals Committee should only consider and review information and records that are needed to address the particular and limited issue being decided. Mental health information, as defined by Iowa Code Chapter 228, can only be shared with the persons identified in that law. As a result, certain people attending the hearing or deciding the appeal may not be able to obtain this information. Additional information about privacy safeguards can be found in Section J.

A written Notice of Decision will be mailed to you no later than ten (10) working days after the appeal is heard. The Notice of Decision will be sent to you and to your legal or other authorized representative by certified mail, and by first class mail, postage prepaid, to make certain that you receive it. The Notice of Decision will completely explain the Appeals Committee’s decision and detail what is to happen next regarding your services and supports.

THIRD STAGE APPEAL: This stage involves decisions made by the Appeals Committee. Any appeal or complaint regarding the Appeals Committee decision will be heard by the County Board of Supervisors.

If you disagree for any reason with the decision made by the Appeals Committee, you may appeal that decision to the County Board of Supervisors. To do so, you must notify us in writing by the deadline date printed on the first page of the Notice of Decision, which is ten (10) working days from the date of decision. You may mail, hand-deliver, or fax the written appeal request. We do not use a standard form. Any letter that questions or disputes the decision will be considered an appeal request. We will use the postmark date to determine if the appeal was received by us on time. You may also call us to appeal the decision, but the call must be received by the deadline date and it must be noted in your case files. You can then visit our office or provide us with a written request within the next (five) days. All appeals must be directed to the office which is listed on the Notice of Decision, which is:( insert the name, address, title of the office which receives appeal requests).

If your appeal is not received by the appeal deadline date listed on the Notice of Decision, it will be denied, and the Appeals Committee’s decision regarding your service, eligibility, or funding will be considered final.

The appeal should state that you do not agree with the decision, and explain why you believe the decision is incorrect. It should also describe the action you would like us to take. If you are unable to notify us on your own that you wish to appeal, a parent, guardian, provider, family member, lawyer, other advocate or authorized person may do so for you.

After we receive your timely-filed appeal, an appeal hearing will be scheduled. If possible, the Board of Supervisors will hear the appeal at its next regularly-scheduled meeting. You will receive a written notice that states the date, time and place the appeal will be heard and the names of the Supervisors. This document will be mailed to you by certified mail and by first class mail, postage prepaid, no later than ten (10) working days after we receive your appeal. We will also give you this information in person or by phone. At times, the Board of Supervisors must consult with experts to help them better understand the mental health and other complex issues involved in disability matters. You will be told, in advance of the hearing, the names and credentials of the people who will participate in the hearing, provide information to the Board of Supervisors, or represent the county at the hearing.

Our goal is to resolve disputes quickly and informally. However, the Board of Supervisors must follow the Iowa Open Meetings Law, Chapter 21 of the Iowa Code when hearing MH/DD appeals. The general rule is that all matters must be discussed in open session, with members of the public, the press and other media allowed to be present. You may request that your hearing be closed to protect your confidentiality and privacy.

In our county, the Board of Supervisors meets in closed session – unless you request that the public and media be present – to review and decide MH/DD matters. They do so because the appeals involve medical, mental health and other records which are required or authorized by state or federal law to be kept confidential. Your name will not appear on the agenda, in the minutes, or in other materials which are posted published or publicly broadcast. The proceedings will not be televised or broadcast without your written permission. Privacy and confidentiality policies are addressed in more detail in Section J.

You have the right to have an attorney or other advocate accompany and represent you, but at your own expense. You may qualify for free legal assistance through the Legal Services Corporation of Iowa, the Iowa Volunteer Lawyers Project, Iowa Protection & Advocacy Services, Inc., or other organizations. A list of legal services and advocacy organizations appears on the Notice of Decision and later in this section. Consumers and their representatives also have the right to:

The Board of Supervisors will consider all the information that is presented during the appeal. Appeals should rarely, if ever, involve the consumer’s entire clinical, medical or mental health history or records. The Board of Supervisors should only consider and review information and records that are required to address the particular issue being decided. Mental health information, as defined by Iowa Code Chapter 228, can only be shared with persons identified in that law. As a result, certain people attending the hearing or deciding the appeal, including individual Supervisors, may not be able to obtain this information. Additional information about privacy safeguards can be found in Section J.

A written decision will be mailed to you no later than ten (10) working days after the appeal is heard. The decision will be sent to you and to your legal or other authorized representative by certified mail, and by first class mail, postage prepaid, to make certain that you receive it. It will completely explain the Board of Supervisors’ findings, conclusions and ultimate decision, and will detail what is to happen next regarding your services and supports.

JUDICIAL AND OTHER APPEALS: This stage involves decisions made by the Board of Supervisors regarding services, supports and funding. These Board of Supervisor decisions must be appealed to a court of law.

The Board of Supervisors makes the final administrative decision at the county level, except for "state cases" and DHS program matters. If you disagree with the Board of Supervisors’ decision regarding services, supports or funding, you can appeal to the Iowa District Court In and For County. This is generally done using a procedure known as a Writ of Certiorari. There are very strict time limits and procedural rules for filing these appeals. If you do not act immediately, you may lose all your rights to challenge the Board of Supervisors’ decision.

You may have additional appeal rights and avenues, depending on your particular case and circumstances. We strongly urge you to consult with a lawyer as soon as possible if you disagree with the Board of Supervisors’ decision. The County does not provide you with a lawyer or pay for your attorney fees except in cases involving commitment hearings. You may qualify for no-cost or low-cost legal services. For information, referrals and representation, contact the:

5. Notice of Decision Form (front page)

DATE OF DECISION: _ (date)__                  APPEAL DEADLINE: _ (date 14 days later)__

FROM: Insert Your CPC OFFICE or Other Decision-Maker and Address

TO: CONSUMER and Designated Representative(s) and Address
        PROVIDER and Address

REQUEST:

Eligibility determination
Funding/services request
Review or appeal of previous decision
Other __________________________

DECISION:

Eligible
Not Eligible
Funding Approved
Funding Denied
Partial Funding
Waiting List
No Action Taken
Other ____________

EXPLANATION OF DECISION: You requested that we determine your eligibility and/or fund the following services, supports and costs:________________________________.

(Choose, complete fully, and insert one of these options:)

  1. We approved your request in full, effective _ (date)__ through _ (date)__, and your financial contribution is _$##.00_.
  2. We were only able to approve your request in part, for the following reasons:
    We will fund the following services:
    Your financial contribution is $00.00:
  3. We denied your request, for the following reasons: :
    The following services will continue to be provided to you during any appeal proceedings:
  4. We could not act on your request because: Call our office when you receive this Notice.
  5. Your application was approved but you have been placed on a waiting list for the following services ; estimated length of time on the waiting list is :

In reaching our decision, we used records and information from:_____________________.

If you have any questions, want more information, or disagree in any respect with our decision, call us at _###-###-####_ when you receive this notice. You have the right to appeal any part of this decision. The appeal must be in writing and must be received by our office on or before __(date)__. The names, addresses and phone numbers of persons and organizations who can assist you in any appeal are listed on the other side of this page and in the Policy and Procedures Manual.

SEE REVERSE SIDE FOR
APPEALS PROCESS RIGHTS

6. Appeals Process Form (back page or reverse of Notice of Decision):
This form involves decisions made by CPCAs which are appealed to the County Board of Supervisors. Appeals Process (to County Board of Supervisors)

If you disagree at all with the Central Point of Coordination Administrator’s (CPCA’s) decision, you have the right to appeal. The County Board of Supervisors will hear and decide your case. You can have a lawyer, friend or someone else assist you in the appeals, at your expense.

It is very important that you follow the directions and meet the deadlines listed below. Failure to do so will result in the immediate denial of your appeal. When we refer to "days" we mean working days. Working days are Monday through Friday and do not include Saturdays, Sundays or holidays.

WHAT YOU SHOULD DO IMMEDIATELY IF YOU WANT TO APPEAL:

WHAT HAPPENS NEXT:

YOU HAVE THE RIGHT TO:

See Section K of the Policy and Procedures Manual for detailed information about the appeals process.

7. Appeals Process Form (back page or reverse of Notice of Decision):
This form involves decisions made by CPCAs which are appealed directly to an Appeals Committee.

If you disagree at all with the Central Point Of Coordination Administrator’s (CPCA’s) decision, you have the right to appeal. A panel of three (3) community members interested in mental health and developmental disability issues will hear and decide the appeal. You can have a lawyer, friend or someone else assist you in the appeal, at your expense.

It is very important that you follow the directions and meet the deadlines listed below. Failure to do so will result in the immediate denial of your appeal. When we refer to "days" we mean working days. Working days are Monday through Friday and do not include Saturdays, Sundays or holidays.

WHAT YOU SHOULD DO IMMEDIATELY IF YOU WANT TO APPEAL:

WHAT HAPPENS NEXT:

YOU HAVE THE RIGHT TO:

See Section K of the Policy and Procedures Manual for detailed information about the appeals process.

IPAT is supported by the National Institute on Disability and Rehabilitation Research, United States Department of Education (NIDRR/ED). This material does not necessarily reflect the views of NIDRR/ED or indicate official endorsement of their contents.

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