Solving Your Appeal With Medicaid
The Global Commitment to Health, or “Global Commitment” is an 1115(a) Medicaid Demonstration waiver program under which the federal government waives certain Medicaid coverage and eligibility requirements found in Title 19 of the Social Security Act. The Department of Vermont Health Access (DVHA), which operates using a managed care delivery model, and is therefore required under 42 C.F.R. Part 438, Subpart F, to have an internal grievance and appeal process for resolving service disagreements between members and the Medicaid Program, representatives of the Medicaid Program, and state designated agencies, including Designated Agencies (DAs) and Specialized Service Agencies (SSAs) for mental health services.
The Medicaid Program and any part of the Medicaid Program receiving funds for the provision of services under Global Commitment shall be responsible for resolving grievances and appeals initiated under 42 C.F.R. Part 438, Subpart F.
Ensuring Fairness and Equity
The overall goal of the grievance and appeal process is to resolve disputes fairly, to enhance member and public confidence in the equity and integrity of the service system, to ensure members access to medically necessary, covered, benefits, and to allow for the independent review of Medicaid Program staff decisions concerning appealable actions. Members initiating or pursuing a grievance or appeal will be free from retaliation.
NKHS takes all complaints seriously. If you wish to pursue a grievance, filling out a grievance form will help us understand what happened and any areas we might need to work on. As a business serving the community for almost 60 years, we take our reputation and our ability to provide quality service seriously.