OAR 411-318-0015
Complaints
(1)
The Department and local programs must address all complaints in accordance with their policies and procedures and these rules.(2)
An individual or the representative of the individual may file a complaint at any time. A complaint may include, but is not limited to:(a)
An expression of dissatisfaction with a developmental disability service; or(b)
An allegation of circumstances or events that are contrary to law, rule, policy, or otherwise adverse to the interests of an individual.(3)
The complaint process described in this rule does not apply to a complaint in the following situations:(a)
The complaint is filed anonymously. Anonymous complaints are reviewed by the Governor’s Advocacy Office;(b)
The merits of the complaint have been, or are going to be, decided by a judge or a juvenile court ruling;(c)
The subject matter of the complaint is not related to a developmental disability service or a provider; or(d)
The subject matter of the complaint is subject to review under the following:(A)
ORS 419B.005 (Definitions) to 419B.050 (Authority of health care provider to disclose information) for child abuse reports;(B)
OAR chapter 309, division 118 for state institutions operated by the Oregon Health Authority;(C)
OAR 407-005-0025 (Requesting a Reasonable Modification) and 407-005-0030 (Report of Discrimination and Other Remedies Available for Alleged Discrimination) for discrimination against people with disabilities;(D)
OAR 407-005-0100 (Purpose and Scope) to 407-005-0120 (Retaliation Prohibited) for conduct of Department personnel;(E)
OAR chapter 411, division 020 for adult protective services;(F)
OAR 410-141-0260 to 410-141-0266 for Oregon Health Plan, Prepaid Health Plans;(G)
OAR 413-010-0420 (Right to Review) for Department child welfare decisions;(H)
OAR 413-010-0700 (Purpose) to 413-010-0750 (Revising Founded Abuse Dispositions in the Department’s Electronic Information System) for child protective services dispositions;(I)
OAR 413-120-0060 (Review of the Adoption Placement Selection) for adoption placement selections; and(J)
OAR chapter 582, division 020 for vocational rehabilitation service determinations.(4)
If a complaint alleges circumstances that meet the criteria for an investigation of abuse, the allegation must be immediately reported to the appropriate protective service entity, such as the Department, CDDP, Support Services Brokerage, CIIS, Office of Adult Abuse Prevention and Investigations, child welfare, or law enforcement.(5)
If an individual or the representative of the individual makes a complaint identified in section (3) of this rule, the local program or Department must assist the individual or the representative of the individual with filing the complaint with the appropriate entity, if requested by the individual or the representative of the individual.(6)
The local programs must have and implement written policies and procedures regarding individual complaints and the complaint process. A copy of the policies and procedures for resolving complaints must be maintained on file at the office of the local program and must be available to staff, individuals, representatives of the individuals, providers, and the Department. The policies and procedures must include, but are not limited to:(a)
Method and form used to submit a complaint (form SDS 0946 may be used);(b)
Process for reviewing and resolving a complaint;(c)
Time frames for responding to a complaint as set forth by this rule; and(d)
Documentation to be used in response to a complaint as set forth in this rule.(7)
COMPLAINT LOG.(a)
The local programs must maintain a complaint log. At a minimum, the complaint log must include:(A)
The name of the individual for which the complaint is being filed;(B)
The name of the person making the complaint, if known;(C)
The name of the person taking the complaint;(D)
The nature of the complaint, including if there was a request for new or changed developmental disability services which may result in a hearing;(E)
The date the complaint was received;(F)
The date the complaint was acknowledged in writing;(G)
The written outcome of the complaint; and(H)
The date that the written outcome was mailed.(b)
Complaints regarding personnel issues and allegations of abuse must be maintained separately from the complaint log.(c)
The complaint log for the local program documents only complaints pertaining to the local program.(A)
In the event that an individual or the representative of the individual has a complaint against another agency or program, the local program must assist the individual or the representative of the individual with filing the complaint against the other agency or program.(B)
The local program does not document complaints against another agency or program in the complaint log for the local program, but does document the support provided by the local program in the progress notes for the individual.(8)
SCREENING OF COMPLAINTS. The local programs must screen all complaints for potential hearing related issues. In the event that a complaint appears to allege a denial, reduction, suspension, or termination of a developmental disability service, the local program must issue a Notification of Planned Action and advise the individual or the representative of the individual of the right to a hearing and assist the individual or the representative of the individual with filing a hearing request, if so desired. In the event that the individual or the representative of the individual decides to file a complaint rather than a hearing request, the decision of the individual or the representative of the individual must be documented in the file for the individual.(9)
FILING A COMPLAINT.(a)
Complaints may be made orally, in writing, or on a complaint form (SDS 0946 may be used).(b)
A complaint regarding dissatisfaction with the services of a provider organization may be filed with the Department or directly with the provider organization, Support Services Brokerage, or CDDP.(c)
A complaint regarding dissatisfaction with the services of a Support Services Brokerage or CDDP may be filed with the Department or directly with the Support Services Brokerage or CDDP.(d)
A complaint regarding dissatisfaction with CIIS may be filed with the Department or directly with the CIIS program.(e)
A complaint regarding dissatisfaction with the Department must be filed with the Department.(10)
PROCESS FOR ADDRESSING COMPLAINTS.(a)
The local program or Department must provide written acknowledgement of a complaint to the individual or the representative of the individual within five business days from the receipt of the complaint.(b)
The written acknowledgement must inform the individual or the representative of the individual of the opportunity for an informal discussion.(A)
Choosing to engage in an informal discussion does not preclude the individual or the representative of the individual from receiving a written outcome following review of the complaint by the local program or Department.(B)
The informal discussion includes a conversation between the individual or the representative of the individual and the Program Director of the local program or the Director of the Department.(C)
The informal discussion must occur within 10 business days of the written acknowledgement of the complaint.(D)
In the event that a resolution is reached during the informal discussion, the local program or Department must mail a written outcome to the individual and the representative of the individual within 10 business days of the informal discussion. A copy of the written outcome must be maintained in the file for the individual.(c)
The local program or Department must complete a review of the complaint and issue a written outcome to the individual and the representative of the individual within 45 days from the receipt of the complaint, unless both parties mutually agree to extend the timeframe. The extension may not exceed an additional 45 days.(A)
The review of the complaint must include, but is not limited to, an investigation and records review of the complaint by the Program Director of the local program or the Director of the Department.(B)
The written outcome of the complaint may be issued on the complaint form or may be issued in a separate document. The written outcome must include:(i)
The rationale for the outcome;(ii)
The reports, documents, and other information relied upon in deciding the outcome of the complaint, or a summary of the reports, documents, and other information relied upon;(iii)
Information about the right of the individual or the representative of the individual to review the documents relied upon in determining the outcome (Notification of Rights SDS 0948); and(iv)
Information about the right of the individual or the representative of the individual to request a review of the written outcome (Notification of Rights SDS 0948).(11)
REQUEST FOR REVIEW.(a)
An individual or the representative of the individual may request a review of a written outcome issued by a local program within 30 days of the date identified on the written outcome.(A)
If a provider organization issued the written outcome, the individual or the representative of the individual may request a review of the written outcome by:(i)
The local CDDP, Support Services Brokerage, or CIIS program; or(ii)
The Department.(B)
If a CDDP, Support Services Brokerage, or CIIS program issued the written outcome, the individual or the representative of the individual may request a review of the written outcome by the Department.(C)
If the Department issued the written outcome, the individual or the representative of the individual may request a review of the written outcome by OHA.(b)
The local CDDP, Support Services Brokerage, CIIS program, Department, may uphold, alter, or overturn a written outcome issued by a provider organization.(c)
The Department may uphold, alter, or overturn a written outcome issued by a provider organization, local CDDP, Support Services Brokerage, or CIIS.(d)
OHA may uphold, alter, or overturn a written outcome issued by the Department.(12)
PROCESS FOR ADDRESSING AND RESOLVING A REQUEST FOR REVIEW.(a)
The receiving entity of a request for a review of a written outcome must acknowledge receipt of the request by issuing a written acknowledgement to the individual and the representative of the individual within five business days from the receipt of the request for a review.(b)
The written acknowledgement must inform the individual and the representative of the individual of the opportunity for an informal discussion.(A)
Choosing to engage in an informal discussion does not preclude the individual or the representative of the individual from pursuing a review of the written outcome by the receiving entity.(B)
The informal discussion includes a conversation between the individual or the representative of the individual and the Program Director of the local program or Director of the Department.(C)
The informal discussion must occur within 10 business days of the written acknowledgement of the request for a review.(D)
In the event that a resolution is reached during the informal discussion, the local program, the Department, or OHA must mail a written determination to the individual and the representative of the individual within 10 business days of the informal discussion. A copy of the written determination must be maintained in the file for the individual.(c)
The local program, the Department, or OHA must review the written outcome and issue a written determination to the individual and the representative of the individual within 45 days from the receipt of the request for a review unless both parties mutually agree to extend the timeframe. The extension may not exceed an additional 45 days.(A)
The review of the written outcome must include, but is not limited to, an investigation and records review by the Program Director of the local program or the Director of the Department or OHA.(B)
The written determination must include:(i)
The rationale for the determination;(ii)
The reports, documents, and other information relied upon in making the determination or a summary of the reports, documents, and other information relied upon; and(iii)
Information about the right of the individual or the representative of the individual to review the documents relied upon in making the determination.
Source:
Rule 411-318-0015 — Complaints, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-318-0015.