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Appealing Wraparound Services in Health Choices

A Guide for Parents/Guardians and Advocates

Overview

This publication is intended to provide general legal information, not legal advice. Each person’s situation is different. If you have questions about how the law applies to your particular situation, please consult a lawyer.

This resource provides information on reasons for a Managed Care Organization denying, reducing, or ending your child’s wraparound services, as well as what you can do in this situation.

Section headings:

    • What if the MC Denies, Reduces, or Ends My Child’s Wraparound Services?
    • What are some common reasons for denial, reduction, or termination of wraparound services?
    • What is a Grievance?
    • What is a DPW Fair Hearing?
    • Should I File a Grievance or Request a Fair Hearing?
    • If I Loose at the Second Level Grievance, Should I Request a Fair Hearing or External Review?
    • How Can I Prepare for a Second Level Grievance or a Fair Hearing?
    • What if the Psychologist and I Agree that My Child’s Health is at Risk While Waiting for a Grievance or Fair Hearing Decision in the Usual Timeframes?

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This resource created by Pennsylvania Health Law Project