Whether you provide home and community-based services (HCBS), personal care assistance (PCA) and community-first services and support (CFSS), early intensive developmental and behavioral intervention (EIDBI) services, substance use disorder (SUD) treatment, or any of the other services licensed or reimbursed by the Minnesota Department of Human Services (DHS), few things are more unsettling than receiving a notice of an adverse action. DHS has significant oversight authority and numerous tools at its disposal when it has concerns that a provider is not complaint with state law. Fortunately, organizations enrolled with DHS to provide services to Minnesota Health Care Programs (MHCP) enrollees have options to respond to an adverse action notice, but it is important to act quickly. 

Types of DHS Sanctions

There are multiple ways DHS may seek to sanction a human services provider, including:

1. Terminating its enrollment in MHCP
2. Immediately withholding MHCP payments pending an investigation
3. Seeking repayment of an alleged overpayment and/or imposing conditions on a provider’s MHCP enrollment
4. Imposing a conditional license
5. Revoking a provider’s license entirely

Tips for Handling a DHS Notice

Each sanction comes with different appeal or reconsideration rights, and therefore it is important to begin addressing the notice as soon as you receive it. Here are five tips when faced with a notice from DHS:

1. Identify the kind of adverse action being taken, including the kind of appeal available and the timeline for the appeal. Timelines vary and quality appeals can take time to prepare. Act quickly; do not ignore a notice from DHS. 
2. Quickly determine whether the notice was a result of a mistake or miscommunication or whether you need to take corrective action to become compliant.  
3. Compile all documentation related to the alleged violation and speak with any staff who may have engaged with DHS regarding the portion of your program in question. 
4. Prepare a draft response, including a narrative, which addresses the issue raised in the notice and provide attachments or exhibits that either clear up the mistake or correct the issue as effectively as possible. 
5. Consult legal counsel as to how to best respond to the notice. Filings can be complicated, and you want to make sure to frame any response within the parameters of the appeal or review. Administrative law appeals and requests for reconsideration are very different and should be approached differently. An attorney is a valuable resource during this process. 

While experienced legal counsel can be important in these situations, providers can improve their chances of success and reduce their legal fees by following the steps above and taking prompt action to respond to notices of sanctions.