Waiver Service Provider's Internal Complaint Procedure

Each waiver service provider must develop and implement a process for responding to complaints made by participants or other(s) on his/her behalf (e.g. guardian, family members or advocates). This process must be clearly written, easy to navigate and provided to the participant.

The complaint policy must include:

  1. A description of how to register a verbal or written complaint, that registering a complaint in no way jeopardizes his/her right to receive services, who is responsible to receive and respond to the complaint, and a time frame for making initial contact with the participant (within seventy-two (72) hours) upon receipt of complaint;
  2. A time frame for completing a complaint investigation and providing a written response to the complainant (maximum of thirty (30) calendar days from receipt of initial complaint);
  3. An appeals process, including timeframes, if the person who registered the complaint is not satisfied with the response (to be completed in no more than fifteen (15) calendar days from notice from the complaint);
  4. Additional appeals process, in which the complaint is forwarded to the provider agency's governing authority for review and recommendations (to be completed in no more than fifteen (15) calendar days from receipt of the information); and
  5. Notification to the participant of his/her right to contact the RRDS if not satisfied with the outcome of the agency's response.

The RRDS may utilize the QMS for technical assistance as needed. If the RRDS is not able to resolve the difficulties, the RRDS forwards the matter to the DOH WMS for review and final resolution.

Note: At any time, the participant has the right to notify his/her SC regarding registering of a complaint with a provider agency. The participant may request that the SC act as advocate for the participant assisting him/her through the complaint process with the provider agency. The SC and/or participant may contact the RRDS for assistance when the appeals process does not lead to a satisfactory resolution.

There may be times when a complaint must be converted to a Serious Reportable or Recordable Incident report. A provider must inform the individual filing the complaint that this has occurred, the reason for converting the complaint, and documents the incident review process.

Information regarding complaints must be made available to DOH WMS upon request and to DOH during survey of the agency.