Your Rights

Handbook Content

Terms and Meanings

Some terms that we use in this chapter may not be familiar. These terms and their meanings are listed below.

  • Appeal: Asking for Medicaid to review a decision they made about a service you want covered.
  • Assistance: Help.
  • Complaint: You are letting Medicaid know that you are not happy with some part of your coverage or treatment from HHS staff.
  • Facility: A health care building or practice.
  • Fraud: Lying to get Medicaid coverage.
  • Liability: When you are responsible for payment or another action.
  • Provider: A doctor, nurse, therapist, or another qualified health care professional.
  • Request: To ask for something.
  • Require: Must have.
  • Services: Care, treatments, testing, checkups, equipment, supplies, and other ways your health care providers help you stay healthy.
  • TTY: The number you can call to connect with someone when you have a hearing impairment.

APPEALS

Medicaid may deny, change, or end your coverage. This can happen for different reasons. An appeal is when you ask Medicaid to take a closer look at the decision that has been made.

Appeals can be made for different Medicaid actions. You or your provider may be responsible for filing an appeal depending on the type of denial that was issued by Medicaid. Providers can file appeals for payment denial, reduction, recoupment, or adjustment. Members can file appeals for eligibility or denial, reduction, or termination. 

Medicaid actions that cannot be appealed include mass coverage changes that apply to all members and services being discontinued due to program ending or lack of funding.

Examples of an appealable decision include denial of your Medicaid application, out-of-state medical care, denial of medications, and denial of specific services.

So, what do you do when your coverage is denied, changed, or terminated, but you still feel you need it? You can file your appeal to Medicaid. Eligibility staff at our Customer Support Center can help you file your appeal. You can ask a team member in your local human service zone office to help you file your appeal. Your provider may file your appeal with a release and an authorization form. Our Legal department can help you understand the appeals process but cannot offer legal guidance. You have up to thirty (30) days to file your appeal starting from the mailing date of the letter telling you about the change to coverage or denied service. You can file an appeal by:  

  • Visiting our File an Appeal webpage
  • Call to ask for an appeal or ask a question:
  • Phone: (701) 328-2311
  • Toll-Free: (800) 472-2622
  • TTY: 711
  • Send a written request for an appeal:
  • Email: dhslau@nd.gov
  • Mail: Appeals Supervisor
    Department of Health and Human Services
    600 E. Boulevard Ave., Dept. 325
    Bismarck, ND 58505-0250
  • FAX: (701) 328-2173

HEALTH INFORMATION PRIVACY 

Medicaid is required by law to maintain the privacy of your confidential health information, known as protected health information (PHI), and to provide you with notice of its legal duties, privacy practices, and your rights with respect to your PHI.

Protected health information (PHI) is health information created, or received by Medicaid that:

  • Relates to your past, present, or future physical or mental health or condition.
  • Shares how your health care was provided.
  • Refers to past, present, or future payments for your health care.
  • Could identify you, including your demographic information.

State law and federal regulations require Medicaid to keep your PHI private. Medicaid receives PHI:

  • From you when you apply for Medicaid; and
  • When your health care provider sends your health information to Medicaid to request approval and/or payment for your health care. 

State law and federal regulations require that Medicaid give you a copy of its Notice of Privacy Practices (NPP). The NPP informs you of Medicaid’s legal duties and privacy practices about your PHI, how your PHI may be used and disclosed, and your rights about your PHI. 

You may view and download a copy of the Notice of HIPAA Privacy Practices from our website. You can also request a paper copy of the NPP, ask questions, or request more information by contacting the HIPPA Privacy Officer:

  • Toll-Free: 1-800-472-2622
  • TTY: 1-800-366-6888
  • Mail: HIPPA Privacy Officer 
    North Dakota Department of Human Services 
    State Capitol, 600 East Boulevard Ave. Dept. 325
    Bismarck, ND 58505-250

NONDISCRIMINATION

Discrimination is treating someone differently based on race, color, sex, age, disability, national origin or religion. In North Dakota, we also include status with respect to marriage or public assistance as a protected class. 

North Dakota Health and Human Services (ND HHS) is prohibited from discriminating based on race, color, sex, age, disability, national origin, religion, or status with respect to marriage or public assistance. In accordance with the U.S. Department of Agriculture (USDA), ND HHS is also prohibited from discriminating against political beliefs or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by the USDA.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, languages other than English, etc.) should contact their local human services zone office for assistance. 

The U.S. Department of Health and Human Services (HHS) complies with applicable federal civil rights laws and does not discriminate based on race, color, national origin, age, disability, religion, or sex. HHS does not exclude people or treat them differently because of race, color, national origin, age, disability, religion, or sex. 

This means that HHS does not discriminate and makes all services and assistance available to all North Dakotans. These laws must be followed by persons who contract with or receive funds to provide services for HHS, including the state's eight regional Human Service Centers, the State Hospital, the Life Skills and Transition Center, and the human service zone offices.

The policies of HHS also require that you be given the chance to apply for assistance or services, or both. The same eligibility standards apply to you as apply to others in similar situations.

HHS provides:

  • Free aid and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages

You can contact HHS if you need these services:

  • Call: 1-877-696-6775.

You can find more information on nondiscrimination on our Nondiscrimination Policy webpage.

How to Report Discrimination

You may file a written complaint if you believe you have been discriminated against. You should fill out the Civil Rights Complaint Form SFN 143 or write a letter and provide the following information:

  • Name
  • Address
  • Program Name
  • Details of complaint including the date it occurred

The complaint must be filed within 180 days of the incident. Include the nature of the discrimination, where and when it took place, who discriminated against you, and all other important facts. Date the form and sign your name. 

Your Local Human Service Zone Office:

  • See our list of human service zone offices
  • Department of Health and Human Services:
    • Email: dhslau@nd.gov
    • Mail: Legal Division
      Department of Health and Human Services
      600 E. Boulevard Ave, Dept 325
      Bismarck, ND 58505-0250
    • Phone: 701-328-2311 or 1-800-472-2622
    • TTY: 711
    • Fax: 701-328-2173
  • U.S. Department of Health & Human Services: Main Office
    • Online: Program Complaint Portal Assistant
    • Email: ocrcomplaint@hhs.gov
    • Mail: Centralized Case Management Operations
      U.S. Department of Health & Human Services
      200 Independence Avenue SW
      Room 509-F HHH Bldg.
      Washington, DC 20201
    • Phone: 1-800-368-1019
    • TTY: 1-800-537-7697
    • Fax: 1-202-619-3437
  • U.S. Department of Agriculture Food and Nutrition Services
    • Online: Program Complaint Online Portal
    • Email: fnscivilrightscomplaints@usda.gov
    • Mail: Food and Nutrition Service, USDA
      1320 Braddock Place, Room 334
      Alexandria, VA 22314
    • Phone: 1-866-632-9992
    • TTY: 711 or 1-202-720-2600
    • Voice and TDD: 1-202-260-1026 or 1-202-690-0443
    • Fax: 1-202-690-7442
  • U.S. Department of Agriculture   
    • Online: Program Complaint Online Portal
    • Email: program.intake@usda.gov
    • Mail: Office of the Assistant Secretary for Civil Rights
      1400 Independence Ave. SW
      Mail Stop 9410 
      Washington, DC 20250-9410
    • Phone: 1-866-632-9992
    • TTY: 711 or 1-202-720-2600
    • Fax: 1-202-690-7442

Contact Information Mentioned in this Chapter:
 

Order
23