Ch. 45, § 21. Complaint Process

(a) A provider or provider employee who has a reasonable suspicion that a participant's health or safety is in jeopardy shall immediately contact the Division, Protection & Advocacy Systems, Inc., and other governmental agencies, such as law enforcement or DFS to report incidents or concerns. (b) A provider shall have policies and procedures for handling complaints, including: (i) How it will attempt to resolve the complaint; (ii) How it will document actions, follow-up, and resolution of the complaint; (iii) How and when information shall be shared with the complainant, legally authorized representative, and the case manager; and (iv) How the complainant will be informed of the process to file a formal complaint with the Division. (c) Complaints may be filed with the Division in writing or verbally. If a provider files a complaint, the complaint shall be submitted in writing unless the complaint involves a participant whose health or safety is in jeopardy. Upon receipt of a complaint from any person, the Division shall: (i) Send written notification to the complainant, within fifteen (15) business days, that the complaint has been received. The notification shall address: (A) Anticipated timeframes for completing the follow-up and resolution of a complaint; and (B) The authority for taking actions. (ii) Send written notification to the provider, within fifteen (15) business days, when a complaint involving that provider is received, unless the complaint involves significant health, safety, or rights concerns, which require an unannounced on-site visit. In these cases, the Division shall provide written documentation to the provider at the time of the on-site visit that indicates a complaint has been received, the nature of the complaint, and that complaint follow-up is being conducted. (iii) Within fifteen (15) business days of complaint resolution, send written notification to the complainant that the complaint has been resolved. (iv) Within fifteen (15) business days of the complaint resolution, submit a written report to the provider(s) that are the subject of the complaint summarizing the results of the complaint findings. The report may include findings, recommendations, and timeframes to address the recommendations through corrective action. If the complaint involves a specific participant, the report will also be sent to the participant and legally authorized representative. (d) Accredited providers shall adhere to the current accreditation requirements for complaints or grievances. (e) A provider's failure to submit and successfully implement an approved corrective action plan, as outlined in Section 29 of this Chapter, may result in sanctions per Section 30 of this Chapter.