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PostPosted: Sat Oct 22, 2005 6:55 pm    Post subject: APPEALS Reply with quote

Some reductions in the dollars noted on the Notice of Action that a waiver recipient receives may not affect the person's services. However if the reduction is substantial and your provider is changing your services by reducing the number of hours or by reducing the pay to direct support staff or making other chages that alter the services your son or daughter receives, then write an appeal and mail as soon as possible.

These reductions are to take place November 1. If an appeal is filed prior to the changes taking effect, the current Plan of Care stays in place until the appeal is heard.

Use this format:

Your Name
Phone Number

Regarding: Waiver recipients Name

This letter serves notice as an appeal to the attached Notice of Action.

I wish to appeal the reduction in services brought about by the significant reduction in dollars available to

__________. This reduction does not allow _________________ to purchase necessary services to assure his
insert name

health and safety, or to make progress on active treatment goals.

The reduction in dollars was made without the knowledge or permission of _____________________, or of his

parent or guardian. We were not given any appeal rights. We have been told that we may not choose a

different provider than the one who is holding our contract for services.

Please advise me of any remedies as soon as possible as I am very worried about _________________:



Attach copy of the Notice of Action with a serial number ending in RT2 to the letter. Mail in stamped envelope with your return address on the outside. If you wish you may send by certified mail.

Mail to: MS04
Indiana Family and Social Service Administration
Office of Hearings and Appeals
Room W392
402 W. Washington St.
Indianapolis, IN 46204

The letter without the Notice of Action attached should also be mailed to:
Indiana Civil Liberties Union
Price Building
1031 E. Washington St.
Indianapolis, IN 46202

And, without the Notice of Action, mailed to:
Indiana Protection and Advocacy Services
Tom Gallagher, Executive Director
4701 N. Keystone Ave.
Suite 2222
Indianapolis, IN 46205
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