MassAbility Service Disputes

If you ever experience difficulties or challenges with one of our services, the MassAbility Ombudsperson is here to assist.

Conflict Resolution and the Appeals Process

We recognize that sometimes individuals receiving MassAbility services may experience challenges with their application or program services. Types of concerns may include:

• You have experienced unreasonable delays in services;
• You have been denied a service you expected to receive;
• You have been found ineligible for a MassAbility program and do not understand why;
• You are unsure of the next steps in your case; or
• You are having difficulty working or reaching your counselor or case manager.

If you experience challenges, there are steps and actions available to help address your concerns.

Step 1: Talk with a Supervisor or Area Office/Program Director

If you need assistance to address any of the above issues or other concerns you should first ask to speak to a Supervisor or Director within your office or program for assistance.  You can find office and program contact information here.

Step 2: Talk with the Ombudsperson

If you require further support, you may reach out to the MassAbility Ombudsperson for assistance. The Ombudsperson will work with you and your program team to address your concerns and offer solutions.

The quickest way to reach the MassAbility Ombudsperson is by email at [e-mail]. You may also reach them by calling [phone], or by sending a letter to:

MassAbility Ombudsperson

1785 Columbus Avenue

6th Floor

Boston, MA 02119

When you contact the Ombudsperson, please make sure to include the following information:

• Your name
• Program and Office you’re working with
• Staff person you’re working with
• Brief summary of the concern or dispute
• Best way of contacting you (i.e., email, phone – can include multiple methods of contact)

You have a right to have an advocate (family member, friend, medical provider, legal representative, etc.) communicate on your behalf if you feel uncomfortable reaching out directly. If you’d like the Ombudsperson to communicate with an advocate you must first provide MassAbility with signed release of information to allow MassAbility to discuss matters concerning your case with an individual of your choosing. 

Additionally, you have the right to access all or part of your case file. To do so, you must send a written request to the Area Office Director or Program Director explaining the part(s) of your record you are seeking and the reason(s) you are requesting access. Office and program contact information can be found here.

Step 3: Appeals Process

If the MassAbility Ombudsperson is unable to resolve your issue(s), the Appeals Process may help address your dispute. Because each MassAbility program is governed by its own respective rules and regulations (both state and federal), please refer to the appropriate program process below.

 All MassAbility program decision appeals require you to complete and return (via email or mail) an Appeals Form to the MassAbility Appeals Coordinator. To learn more about the appeals process and request an Appeals Form please email the Ombudsperson at [e-mail]. This is what starts the Appeals Process. All appeals must be initiated within 30 days of receipt of the program decision you’re seeking to appeal.

Career Services (Vocational Rehabilitation)

Governed by 34 CFR 361.57; 107 CMR 1.00 et seq.

Any Career Services applicant or participant who is dissatisfied with a determination made by MassAbility’s Career Services Division has the right to appeal. Appeal options include Administrative Review, Mediation, and Fair Hearings. While your appeal is pending, services under your approved Individualized Plan for Employment (IPE) will continue. If you disagree with a program decision within Career Services, you, your legal guardian, or your designated representative may file an appeal within thirty (30) days after receipt of the decision which is the subject of the appeal.

Because most issues can be resolved informally and most quickly through the Administrative Review process, most individuals select this option first.

Administrative Review

If you choose an Administrative Review, an Administrative Review Officer (ARO) will be assigned to your appeal. The ARO will schedule an informal meeting with you (and your advocate, if desired) and your Career Services team (i.e., counselor, supervisor, etc.) typically within two (2) weeks of receipt of your request. 

During this meeting, the ARO will review your case record, discuss with you and your Career Services team the issues that are the subject of your appeal, and work with all parties involved to resolve the disagreement. If an agreement is not reached during the scheduled meeting, the ARO will issue a written decision within thirty (30) days of the meeting. The ARO’s decision is based on the information presented, the defined issues, good professional rehabilitation practice, and the Commission’s regulations and policies.

If you do not agree with the ARO decision, you may request a Mediation or proceed to a Fair Hearing.

Mediation

Mediation is a voluntary option for all parties. It is conducted by a qualified and impartial mediator who is trained in effective mediation techniques. The Mediator opens up a discussion between you and your provider and creates a written settlement agreement that serves both parties. If no settlement can be created, you can request a Fair Hearing. 

Fair Hearing

A fair hearing includes you, your advocate(s) of choice, MassAbility staff with knowledge of your case, and an impartial Fair Hearing Officer (FHO). At the hearing, the FHO will hear from you and the agency as each side presents their case. The FHO will allow you or your representative to ask witnesses questions. Witnesses may include agency staff. The FHO will review case information, listen to testimonies from both parties, and issue a final decision within thirty (30) days of the close of the hearing. If you disagree with the decision, you can appeal the decision to the appropriate superior court in the Commonwealth within thirty (30) days of your receipt of the final decision.

Massachusetts Office on Disability Client Assistance Program

Career Services applicants and participants can also access an advocate through the Client Assistance Program (CAP) of the Massachusetts Office on Disability to help you understand your rights during the appeals process. To learn more about CAP and how they can help you, please visit their website at: https://www.mass.gov/news/mods-client-assistance-program. You can also reach out directly via email at [e-mail] or by phone at 617-727-7440. 

Statewide Head Injury Program

Governed by: 107 CMR 12.09; 801 CMR 1.02

If you disagree with the finding that you are ineligible for the SHIP program or with a denial, suspension, reduction, or termination of any of your SHIP services, you, your legal guardian, or your designated representative may file an appeal within thirty (30) days after receipt of the decision which is the subject of the appeal. While your appeal is pending informal review and/or final decision, the services which are the subject of your appeal will not be suspended, reduced, or terminated until the appeal is resolved.

The SHIP Director or their designee will conduct an Informal Review of the matter within thirty (30) days of receiving the appeal. Following the Informal Review, the SHIP Director will notify you in writing of their decision concerning your appeal.

If you are unsatisfied with the SHIP Director’s decision, you may file an appeal for a Fair Hearing within sixty (60) days of receiving the decision. 

A Fair Hearing includes you, your advocate(s) of choice, MassAbility staff with knowledge of your case, and an impartial Fair Hearing Officer (FHO). At the hearing, the FHO will hear from you and the agency as each side presents their case. The FHO will allow you or your representative to ask witnesses questions. Witnesses may include agency staff. The FHO will review case information, listen to testimonies from both parties, and issue a final decision within thirty (30) days of the close of the hearing. If you disagree with the decision, you can appeal the final decision to the appropriate superior court in the Commonwealth within thirty (30) days of your receipt of the final decision.

Home Care Assistance Program

Authority: 107 CMR 11.00 et seq.; 801 CMR 1.02

If you disagree with the agency’s decision that finds you ineligible for Home Care Assistance Program services, closes your case, or reduces or terminates any of your services, you may request an Administrative Review within thirty (30) days of the decision. The service that is the subject of the appeal will continue unless doing so would pose a risk to your physical safety or that of agency staff or a homecare worker. All other services may continue except for very specific reasons.

The Home Care Director or their designee, after reviewing your HCAP case file, will issue a written decision to you within thirty (30) days of acknowledging your appeal.

If you are unsatisfied with the Home Care Director’s decision, you or your authorized representative may request a Fair Hearing within thirty (30) days of the Administrative Review decision. A Fair Hearing will be held no later than sixty (60) days after the agency receives your appeal request. 

A Fair Hearing includes you, your advocate(s) of choice, MassAbility staff with knowledge of your case, and an impartial Fair Hearing Officer (FHO). At the hearing, the FHO will hear from you and the agency as each side presents their case. The FHO will allow you, or your representative, to ask witnesses questions. Witnesses may include agency staff. The FHO will review case information, listen to testimonies from both parties, and issue a final decision within forty-five (45) days of the close of the hearing. If you disagree with the decision, you can appeal the final decision to the appropriate superior court in the Commonwealth.