Sec. 3999.230 - Headquarters' Level Health Care Grievance Appeal Review

ยง 3999.230. Headquarters' Level Health Care Grievance Appeal Review

(a) The headquarters' level is for review of appeals of institutional level health care grievance dispositions.

(b) Health care staff at a level no less than a Registered Nurse, utilizing clinical expertise within the scope of his or her licensure, shall:

(1) Triage each health care grievance appeal within one business day of receipt and:

(A) Determine if the health care grievance appeal identifies a health care issue that may require clinical intervention.

(B) Determine if the health care grievance appeal warrants continued expedited processing as requested by the grievant pursuant to section 3999.229(a)(4).

(2) Determine if a clinical review is warranted.

(3) Review the grievant's health record and applicable clinical and/or custodial information, as necessary, to aid in drafting the headquarters' level response and coordinate with the appropriate health care discipline as necessary, when an accepted health care grievance appeal is determined to warrant a clinical review.

(c) All submitted health care grievance appeals shall be screened to identify whether the health care grievance appeal complies with the requirements under sections 3999.227 and 3999.229 and may be rejected pursuant to section 3999.234.

(d) Any health care grievance appeal received outside the time limits pursuant to sections 3999.227 and 3999.229 may be accepted at the discretion of the HCCAB if it is determined that the health care grievance appeal should be subject to further review for reasons including, but not limited to:

(1) Good cause exists for untimely submission of the health care grievance appeal.

(2) Issues stated in the health care grievance appeal allege facts that warrant further inquiry.

(e) If determined to be necessary by HCCAB staff, an interview with the grievant may be conducted.

(f) Time limits for processing a health care grievance appeal commence on the day it is received by the HCCAB and shall be completed and returned to the grievant within 60 business days, unless processed as an expedited health care grievance appeal pursuant to section 3999.233(b).

(g) Headquarters' level health care grievance appeal responses shall be approved and signed pursuant to section 3999.225(x).

(h) The headquarters' level review constitutes the final disposition on a health care grievance and exhausts administrative remedies but does not preclude amending a response previously made at the headquarters' level.

(i) At its sole discretion, HCCAB may address new issues not previously submitted or included in the original health care grievance.

(j) A headquarters' level disposition addressing new issues exhausts administrative remedies.

(k) Amendments. HCCAB shall notify the HCGO and grievant when it is determined a health care grievance response requires amendment.

(1) The HCGO shall complete the amended response and return the health care grievance package to the grievant within 30 calendar days of notice issuance.

(2) The grievant shall have 30 calendar days plus five calendar days for mailing from the amended health care grievance response issue date to resubmit the entire original health care grievance package for a headquarters' level grievance appeal review.

(l) Headquarters' level directive. When it is determined intervention is appropriate, HCCAB may issue a headquarters' level directive to the institutional level reviewing authority; the headquarters' level directive shall be completed within 60 calendar days of the health care grievance appeal disposition. The 60 calendar day period may be extended by HCCAB after notification from the HCGO that there is a delay in the completion of a headquarters' level directive and the estimated completion date.

(1. Change without regulatory effect renumbering and amending former section 3087.5 to new section 3999.230 filed 8-6-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 32). 2. Change without regulatory effect amending Note filed 4-15-2019 pursuant to section 100, title 1, California Code of Regulations (Register 2019, No. 16).)

Note: Authority cited: Section 5058, Penal Code. Reference: Section 5054, Penal Code; Americans With Disabilities Act, Public Law 101-336, July 26, 1990, 104 Stat. 328; Civil Rights of Institutionalized Persons Act, Title 42 U.S.C. Section 1997 et seq., Public Law 96-247, 94 Stat. 349; Section 35.107, Title 28, Code of Federal Regulations; Section 1013(a), California Code of Civil Procedure; Armstrong v. Newsom (No. C-94-2307-CW), U.S. District Court, Northern District of California; Coleman v. Newsom (No. S 90-0520 LKK JFM P) U.S. District Court, Eastern District of California; and Plata v. Newsom (No. C01-1351 JST), U.S. District Court, Northern District of California.

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