(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.
