CCF Family Handbook > Grievances and Appeals

Grievances and Appeals

GRIEVANCES & APPEALS Children Come First wants your family to get the best care possible. If you are not happy with the care you are getting, we would like you to let us know. You will not get in trouble for telling us your concerns. Knowing your concerns can help us give you better care.

Informal Grievances If you are unhappy with your care, you can let the person you are working with know you are not happy. He or she can try to help work it out. If you don’t want to tell this person, you can call his/her Supervisor.

Formal Grievance If you are not happy with the response from the person you are working with, or their supervisor you can file a formal Grievance. You can also do this right away if you want. To do this, contact the following people:

For Community Partnerships:
Quality Improvement Manager
1334 Dewey Court
Madison, WI 53703
608) 250-6634, ext. 110

For ARTT:
CYF Mental Health Manager
1202 Northport Dr.
Madison, WI 53704
(608) 242-6404

If you would like, you may use this form to file your grievance Click here for a Grievance Initiation form

If you need help to file or write your Grievance you can call Wisconsin Family Ties at (608) 267-6888.

If your formal Grievance is about a decision to decrease or deny a covered service, you must file within 45 days of that decision. This also applies:

  1. If you were not getting the service before the decision CCF does not need to provide the service during this process.
  2. If you weregetting the service before the decision CCF will provide the same level of service during this process. If the decision does not change you may have to pay for these services.

This is how Children Come First will respond to your formal grievance:

  1. The Quality Improvement Manager (for Community Partnerships) or the CYF Mental Health Manager (for ARTT) will send you a letter within 10 business days. This is to let you know we received your grievance. We will look into your concerns. The Manager will mail you a decision letter within 30 calendar days from the day you filed your grievance. You will also get information on what to do if you do not like this decision.
  2. If the Quality Improvement Manager (for Community Partnerships) or the CYF Mental Health Manager (for ARTT) needs more time to make a decision, their time period may be increased by 14 calendar days. If this happens, we will notify you in writing. We will explain why we need more time. We will also tell you when we will have a decision for you. The total time for Children Come First to make a decision will not be more than 45 calendar days from when you filed.
  3. If you do not like the CCF Manager’s decision, you can ask for it to be reviewed by the CCF Grievance Committee. You have 14 days from the day you receive the Manager’s decision letter to ask for this review. You can ask for this review by contacting the following person:

    CYF Mental Health Manager
    1202 Northport Dr.
    Madison, WI 53704
    (608) 242-6404

    You will get a letter telling you when and where the Grievance Committee will meet. You will get this letter at least 7 days before the meeting. You have a right to be at the meeting. You have a right to present your information in writing or orally. You can bring whoever you want to the meeting. This can be a family member, a friend, or a provider.

Expedited Review If you think your grievance is urgent you can ask for an Expedited Review. This means we will decide very quickly. This is for when you need a response right away to prevent serious harm. We will look over your concerns and decide within 2 business days. You can ask for an Expedited Review from the person you are working with, or their Supervisor. You will not be penalized for asking for this. Also, your providers will not be penalized for asking for this.

If we do not think this is urgent, we may not speed up your decision. If that happens, we will tell you right away. We will also mail you a letter within 2 calendar days. We will then respond to your grievance in our regular timeframes.

Grievance Rights
You have the right to:

Appealing a Decision

Please note: You can go to any part of this grievance process at any time. You can file directly with the State if you want to.

You have 14 days from the date you get the CCF Grievance Committee decision to ask for a State level review.

Appealing to the Department of Health and Family Services
You can appeal a grievance decision to the State of Wisconsin, Department of Health and Family Services. You can do this by contacting:

Medicaid Managed Care Ombuds
P.O. Box 6470
Madison, WI 53716
Phone: 1-800-760-0001

The Department will review your grievance. They will provide a final response within 30 days from the date the Department has all the information they need to make a decision.

State Fair Hearing Request
You can appeal a grievance decision by asking for a hearing with the State’s Department of Hearings and Appeals (DHA). You can do this by writing to:

Division of Hearings and Appeals
P.O. Box 7875
Madison, WI 53703-7875

In your letter you will need to include the enrollee’s name and social security number, your mailing address, a brief description of the problem, and your signature. The hearing request date will be the date they receive your letter.

If your Appeal is about a decrease or denial of a covered service this applies:

  1. If you were not getting the service before the decision CCF does not need to provide the service during this process.
  2. If you were getting the service before the decision CCF will provide the same level of service during this process. If the decision does not change you may have to pay for these services.

If you need help asking for a State Fair Hearing, you can call the Medicaid Managed Care Ombudsman at 1-800-760-0001.



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