a handbook for parents of children with autism spectrum disorders

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APPENDIX F: COMPLAINT PROCESS What happens after I file a Second Level complaint? Community Care will send you a letter to let you know that your complaint was received. The letter will tell you about the Second Level complaint process. • You may ask Community Care to see any information it has about your complaint. You may also send information that may help with your complaint to Community Care. • You can come to a meeting of the Second Level complaint committee or be included by phone. Community Care will contact you to ask if you want to come to the meeting. You don’t have to attend if you do not want to. If you do not attend, it will not affect the decision. • The Second Level complaint review committee will have three or more people on it. At least one Community Care member will be on the committee. The members of the committee will not have been involved in the issue you filed your complaint about. • The committee will make a decision no more than 30 days from the date Community Care received your Second Level complaint. A letter will be mailed to you within five business days after the committee makes its decision. This letter will tell you the reason for the decision. It will also tell you how to ask for an external complaint review if you don’t like the decision. What to do to continue getting services: If your child has been receiving services that are being reduced, changed, or stopped because they are not covered services and you file a Second Level complaint that is hand-delivered or postmarked within 10 days of the date on the First Level complaint decision letter, the services will continue until a decision is made. What if I still don’t like the decision? External Complaint Review If you are not happy with the Second Level complaint decision, you may ask for a review of your complaint by the Department of Health or the Insurance Department. The Department of Health handles complaints that involve the way a provider gives care or services. The Insurance Department reviews complaints that involve Community Care’s policies and procedures. You must ask for an External complaint review within 15 days of the date you receive the Second Level complaint decision letter. If you ask, Community Care will help you put your complaint in writing. - Page 40 -
APPENDIX F: COMPLAINT PROCESS You must send your request for External review in writing to either: Pennsylvania Department of Health Pennsylvania Insurance Department Bureau of Managed Care OR Bureau of Consumer Services Health and Welfare Building, Room 912 1321 Strawberry Square 7th and Forster Streets Harrisburg, PA 17120 Harrisburg, PA 17120 Telephone Number: 1-877-881-6388 Telephone Number: 1-888-466-2787 Fax: 1-717-705-0947 Relay Service: 1-800-654-5984 If you send your request for an External complaint review to the wrong department, it will be sent to the correct department. The Department of Health or the Insurance Department will get your complaint information from Community Care. You may also send them any other information that may help with the external review of your complaint. An attorney, or another person of your choice, may represent you during the External complaint review. A decision letter will be sent to you after the decision is made. This letter will tell you the reason(s) for the decision and what you can do if you don’t like the decision. What to do to continue getting services: If your child has been receiving services that are being reduced, changed, or stopped because they are not covered services and you file a request for an External Complaint review that is handdelivered or postmarked within 10 days of the date on the Second Level complaint decision letter, the services will continue until a decision is made. - Page 41 -
Page 1 and 2: A HANDBOOK FOR PARENTS OF CHILDREN
Page 3 and 4: INTRODUCTION Developmental delays c
Page 5 and 6: What should I do first? Where do I
Page 7 and 8: How can my child qualify for Medica
Page 9 and 10: How does the verification process w
Page 11 and 12: As the parent of a child with Autis
Page 13 and 14: Which types of professionals delive
Page 15 and 16: As a parent, what is my role in the
Page 17 and 18: How might I approach my son or daug
Page 19 and 20: What happens if BHRS is recommended
Page 21 and 22: Who determines if my child will rec
Page 23 and 24: What happens after I file a First L
Page 25 and 26: What if I still don’t like the de
Page 27 and 28: Can I have someone else help me wit
Page 29 and 30: How do I ask for a Fair Hearing? Yo
Page 31 and 32: What happens if my child’s doctor
Page 33 and 34: APPENDIX B: DIAGNOSTIC CRITERIA - A
Page 35 and 36: APPENDIX D: GLOSSARY Autistic Spect
Page 37 and 38: APPENDIX D: GLOSSARY PT: Physical T
Page 39 and 40: APPENDIX E: LEVELS OF CARE/ TREATME
Page 41: APPENDIX F: COMPLAINT PROCESS If yo
Page 45 and 46: APPENDIX H: COMMUNITY CARE CONTACT
Page 48 and 49: Community Care Behavioral Health Or
Page 50 and 51: Laurel Creek 336 Chestnut Street Mi
Page 52 and 53: Laurel Behavioral Health 520 Ruah S
Page 54 and 55: BLaST IU 17 (Serving Bradford, Lyco
Page 56 and 57: Autism Connection, www.autism-conne
Page 58 and 59: National Autism Association, www.na
Page 60 and 61: Communication Assistance The Commun
Page 62 and 63: Early Intervention contact numbers,
Page 64 and 65: Incidental Teaching, http://www.spi
Page 66 and 67: Autism toolkit for physicians, http
Page 68 and 69: Heather Van Artsdalen Hoover, PHD G
Page 70 and 71: Safety Safety in the home, http://w
Page 72 and 73: State Departments/Agencies/Programs
Page 74 and 75: State Mental Health Agency Charles
Page 76 and 77: Sunbury Support Group Julia Robinso
Page 78 and 79: Religion and Autism http://www.auti
Page 80: Transitioning Transitions for you a

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