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Home My WebLink AboutMHIDD-305 Grievance Procedure - Individuals Right to Appeal1 FRANKLIN/FULTON COUNTY MENTAL HEALTH/INTELLECTUAL & DEVELOPMENTAL DISABILITIES/EARLY INTERVENTION 425 Franklin Farm Lane Chambersburg, PA 17202 (717) 264-5387 MH/IDD/EI PROCEDURE STATEMENT PROCEDURE SUBJECT: Grievance Procedure – Individual’s Right to Appeal PROCEDURE NUMBER: MHIDD-305 Effective Date: July 1, 2008 Date Revised: May 24, 2018 Reference: IDD Bulletin 00-08-05 (for the IDD portion only) INTRODUCTION: Individuals of the Franklin/Fulton MH/IDD/EI Program have the right to appeal the provision or denial of services, whether those services are provided directly by Franklin/Fulton MH/IDD/EI or by a contracted agency. Agencies that provide services under contract with the Franklin/Fulton MH/IDD/EI Program are required to maintain grievance/appeal procedures. It is expected that individuals will utilize the procedures of the provider agency first. Individuals who are not satisfied with the outcome of their grievance/appeals at the provider agency level may continue the appeal process using the appeals procedure of the Franklin/Fulton MH/IDD/EI Program. It is the responsibility of the Case Manager/Administrative Entity (AE) Program Specialist during intake to inform individuals of the appropriate grievance/appeal procedures. This procedure should be reviewed when the individual(s) enter services, as well as during the individual’s Service Plan reviews or anytime there is a change in services, such as denial/reduction or termination by the Case Manager/Supports Coordinator. All information relating to such grievance/appeal shall be kept strictly confidential in accordance with all HIPAA regulations. Consent forms must be used for all information shared with any outside person or agency. PROCEDURE: Step One: 2 It is the responsibility of the individual or their advocate to submit a formal grievance/appeal to Franklin/Fulton MH/IDD/EI program office if:  The grievance/appeal involves a contracted provider.  The grievance/appeal involves denial for eligibility, reduction, termination, and denial of Base funded services. The individual may choose to be assisted by an appropriate consumer advocacy organization or other advocate to help him/her in the grievance/appeal process. If the individual chooses to receive help from an advocate, the MH/IDD/EI Program must receive a signed Release of Information to include this advocate in any meetings or discussion. The MH/IDD/EI Program will make every effort to address and resolve the grievance/appeal by doing the following:  Within ten (10) business days of receipt of the grievance/appeal, the MH/IDD/EI Program Specialist will coordinate a meeting with the assigned Case Manager/Supports Coordinator, the individual, and the advocate (if appropriate) at a mutually agreed upon location to discuss the grievance/appeal. If the grievance/appeal involves a contracted provider, this provider will also be included in the meeting. If the grievance/appeal involves the individual’s Case Manager/Supports Coordinator, the Case Management Unit Director or designee will be included in the meeting. If the grievance/appeal involves IDD denial for eligibility, reduction, termination, and denial of Base funded services the meeting will be coordinated by the MH/IDD/EI Administrator or other appointed impartial reviewer.  After the meeting, written documentation will be completed by MH/IDD/EI Office to include the following information: 1. Individual’s name 2. Date appeal/grievance was received 3. Step number 4. A brief summary of what is being grieved/appealed 5. Action taken or to be taken 6. Record of all persons attending the meeting  A copy of this documentation will be given to the individual within ten (10) business days of the meeting. A copy will also be kept on file at the MH/IDD/EI Office. Within ten (10) business days of receiving the grievance/appeal decision, the individual may file a grievance appeal to move to Step Two. Step Two: In the second step, the MH/IDD/EI Administrator, in attempting to resolve the grievance/appeal, will conduct a hearing and may elect to involve the appropriate Regional Office Representative and/or the County Solicitor (depending on the nature of the grievance/appeal). In the MH/IDD/EI Administrator’s absence, he or she may also designate another individual as the primary contact person in working with the Regional Office of Mental Health and Substance Abuse Services (OMHSAS) or Office of Developmental Programs (ODP), or the County Solicitor, in resolving the appeal. 3 At this step, the MH/IDD/EI Administrator will review the results of the previous steps and within ten (10) business days the following actions will be taken:  The MH/IDD/EI Administrator will contact the individual and the advocate (if appropriate) to set up a hearing (this hearing may be recorded) at a mutually agreed upon location, to discuss the grievance/appeal. If the grievance/appeal involves a contracted provider, this provider will also be included in the meeting.  After the meeting, written documentation will be completed by the MH/IDD/EI office to include the following information: 1. Individual’s name 2. Date appeal/grievance was received 3. Step number 4. A brief summary of what is being grieved/appealed 5. Action taken or to be taken 6. Record of all persons attending the meeting  A copy of this documentation will be given to the individual and all parties in attendance within ten (10) business days of the meeting. A copy will also be kept on file at the MH/IDD/EI Office. Within ten (10) business days of receiving the grievance/appeal decision, the individual may file a grievance appeal to move to Step Three. The MH/IDD/EI Administrator will notify the Human Services Administrator and County Commissioners. Step Three: The third and final step of the grievance/appeal process will rest with the Human Services Administrator and County Commissioners. The decision made by these individuals shall be final. The only other step remaining for the individual would be to file a Civil Court Claim against the County. Note: If the grievance/appeal is resolved at any step, it should be noted under action taken. The MH/IDD/EI Office will retain one copy of this written summary of the individual’s Grievances/Appeal in Laserfiche. Individual’s Grievances/Appeals will be viewed as confidential information. Also, all applicable procedures relating to the management of confidential information will be followed. ATTACHMENT: Grievance/Appeal Form 4 FRANKLIN/FULTON MENTAL HEALTH/INTELLECTUAL & DEVELOPMENTAL DISABILITIES GRIEVANCE/APPEAL FORM TODAY’S DATE: _____________ NAME OF INDIVIDUAL: ____________________________________________________ ADDRESS: _________________________________________________________________ TELEPHONE: ______________________________________________________________ NAME OF SUPPORTS COORDINATOR/CASE MANAGER: ______________________ REASON(S) FOR GRIEVANCE/APPEAL (SHOULD INCLUDE BUT NOT BE LIMITED TO: RESOLUTION EXPECTATIONS; BACKGROUND INFORMATION ABOUT THE INDIVIDUAL; STEPS/ACTIONS TAKEN PRIOR TO FILING GRIEVANCE OR APPEAL, INCLUDE DATES IF KNOWN) - _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________