Appeals and Complaints Branch

​​​​​​​​​​​​​​​​​​​​​​​​​The Appeals and Complaints Branch uses monitoring and oversight techniques to ensure members have access to quality services. This approach involves the Department for Medicaid Services, managed care organizations, providers and members. The Disease and Case Management Branch staff is responsible for the following:

  • Monitoring the Early and Periodic Screening, Diagnostic and Treatment benefits that are available to Medicaid members younger than 21
  • Coordinating fair hearing requests for the denial of Medicaid services.

CMS health care quality core set chart packs

Each year the Centers for Medicare and Medicaid Services publishes core measures of the quality-of-care and health outcomes for adults participating in Medicaid and children enrolled in the Medicaid Children’s Health Insurance Program.  Please view the:

Additional Information