Or. Admin. R. 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 to
419B.050 for child abuse
reports;
(B) OAR chapter 309,
division 118 for state institutions operated by the Oregon Health Authority;
(E) OAR chapter 411, division 020 for adult
protective services;
(G) OAR 413-010-0420 for
Department child welfare decisions;
(I) OAR 413-120-0060 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.
(D)The written outcome issued by the OHA is
the final response.
(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.
Notes
Stat. Auth.: ORS 409.050, 427.107
Stats. Implemented: ORS 183.411-471, 409.010, 427.107, 427.109
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