Code of Maine Rules › 14 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 197 - OFFICE OF AGING AND DISABILITY SERVICES › Chapter 8 - Grievance Process for Persons with an Intellectual Disability, Autism Spectrum Disorder or Acquired Brain Injury › Section 197-8-03 - PROCEDURES

Current through 2024-29, July 17, 2024
1.
Right of Review
: Persons
				Receiving Services and/or their Representatives have the right to submit a
				Grievance to the Department for review and resolution. The Person Receiving
				Services or their guardian, if applicable, must consent to any Grievance
				submitted to the Department.
2.
Notice of Right
: On all notices or decisions made or issued,
				including notices relating to the personal planning process or under a personal
				plan of the Person Receiving Services, the Department shall plainly state that
				the Person Receiving Services has a right to bring a Grievance and the deadline
				for doing so. This right shall be stated in language that is easily understood
				and in bold print and shall include the address and telephone number of the
				Protection and Advocacy Agency.
3.
Deadline
: The Grievant must submit their Grievance for Level I
				review one hundred eighty (180) days when the subject of the Grievance is an
				action or an inaction. Action means something that is done. Inaction means the
				failure to act. In the event that the Grievant does not become aware of an
				inaction within the above deadline, the Grievant must file their Grievance
				within one hundred eighty (180) days of when they first learn about the
				inaction complained of.
4.
Savings Clause
: Grievances based on an action or inaction prior to
				the effective date of this rule must be submitted within six (6) months of the
				effective date of this rule.
5.
Mediation
: The Grievant may elect mediation at any point, which
				election suspends applicable deadlines. A Grievant may submit a request for
				mediation by emailing the OADS designated email account.
6.
Grievance Resolution by
				Providers
: Persons Receiving Services and Providers are encouraged to
				resolve disputes informally whenever possible. When a Provider is made aware
				that a Person Receiving Services has a Grievance, the Provider must document
				the Grievance. Providers must make reasonable efforts to resolve Grievances and
				disputes as they arise and shall have up to ten (10) calendar days to resolve
				any Grievance or dispute. The Department may require Providers to maintain
				written policies and procedures for Grievance resolution.
If the Grievance has not been resolved within ten (10)
				  calendar days, the Provider shall notify the person's Case Manager in writing,
				  who shall in turn document the Grievance in the person's record and commence
				  the Department's Level I Grievance resolution process described below.
Nothing in this rule requires a Person Receiving Services to
				  attempt to resolve their Grievance with the Provider. If they so desire, a
				  Person Receiving Services may directly invoke the Department's Grievance
				  resolution procedure described below.
7.
Grievance Resolution by the
				Department
A. Informal Review
(1) Informal Review is offered to provide
				Persons Receiving Services with supportive and non-confrontational mechanisms
				for resolving their Grievances. Providers, Case Managers, and the Department
				shall seek, whenever possible, to resolve Grievances in a supportive and
				non-confrontational manner. Consistent with informal review, deadlines stated
				in this subsection may be extended as needed, except for the deadline in
				paragraph (A)(2)(e) for submitting a Level II Grievance.
(2) Level I Resolution - Case Manager
				Responsibilities
(a) Case Managers must make
				reasonable efforts to ensure that Persons Receiving Services and their
				Representatives, if any, are aware of their Grievance and appeal rights. A
				Grievance made by a Person Receiving Services and/or their Representative need
				not be in writing.
(b) When a
				Person Receiving Services has a Grievance, the Case Manager shall immediately
				document the Grievance in the person's record and notify the Protection and
				Advocacy Agency. If the person's Grievance is related to their Case Manager,
				the Persons Receiving Services shall notify the Case Manager's supervisor of
				the Grievance, who shall immediately document the Grievance in the person's
				record and notify the Protection and Advocacy Agency.
(c) The Grievant and/or their Representative
				may engage the services of the Protection and Advocacy Agency at any time
				during the Grievance process without attempting to resolve the Grievance with
				the Case Manager.
(d) It is the
				obligation of the Case Manager to work expeditiously toward resolving the
				Grievance. If the Grievance is resolved, the resolution will be noted in the
				Grievant's record. If the Grievance cannot be resolved within sixteen (16)
				calendar days, the Case Manager shall immediately notify the Office of Aging
				and Disability Services (OADS) with an email sent to the designated email
				account. The Grievance will be referred to a designated OADS staff member for
				review and resolution. The Case Manager shall also notify the Grievant, the
				Grievant's Representative and the Protection and Advocacy Agency in writing
				that the matter has been referred to Level II.
(e) If the Case Manager fails to respond to a
				Grievance within eight (8) calendar days, the Grievant may proceed to the
				Department's Level II. Notwithstanding anything to the contrary in this rule,
				the Grievant must submit their Grievance to OADS for Level II Resolution no
				later than sixty (60) calendar days after submitting the Grievance for Level I
				Review.
(3) Level II
				Resolution - OADS Responsibilities
(a) It is
				the responsibility of OADS to attempt to resolve Grievances which have not been
				responded to or resolved at Level I. Upon request, the Case Manager shall
				supply OADS' designated staff member, the Grievant and/or the Grievant's
				Representative with documents or information which may be necessary to a fair
				understanding of the Grievance.
(b)
				OADS shall have thirty (30) calendar days to review, attempt to resolve, if
				appropriate, and issue a Level II Decision on the Grievance. The Grievant and
				the Department may agree to extend this deadline. The agreement must be made in
				writing. In conducting this review, OADS' designated staff member may consult
				with the Department's Program Manager for Developmental Disabilities and Brain
				Injury Services and may, in their sole discretion, speak to the Grievant and/or
				their Representative in order to clarify the nature of the problem or to seek
				out other information which may be necessary to a fair understanding of the
				issue presented. The OADS designated staff member may review any reportable
				events, Adult Protective Services (APS) records, and available, recent
				electronic medical records and services of the Grievant. If the Grievant has
				designated any Representative(s), OADS must include the Representative(s) in
				all discussions. Although alternative dispute resolution, such as mediation, is
				not mandatory, OADS may recommend such procedures to the parties.
(c) If OADS identifies a possible resolution
				of the Grievance, OADS will propose such resolution in writing to the Grievant
				and, as applicable, to their Representative and Case Manager. OADS shall ask
				that the Grievant respond within twelve (12) calendar days. If the Grievant
				fails to respond within twelve (12) calendar days, OADS shall issue a decision
				stating the Department's position on the Grievance within twelve (12) calendar
				days from the date the response was due by.
(d) OADS' written decision stating the
				Department's position on the Grievance must be written in language that is
				easily understood and shall state:
i. The
				nature of the Grievance;
ii. OADS'
				understanding of the issue;
iii.
				OADS''s position on the Grievance; and
iv. The reason(s) for OADS'
				decision.
(e) The written
				proposal or decision shall also state in bold print and in easily understood
				language that the Grievant and/or their Representative has the right to appeal
				the decision by requesting a Level III administrative hearing. If there is no
				written decision within the mandated time period, the Grievant may proceed to
				Level III. To proceed to Level III, the Grievant, their Representative, or
				their Case Manager requests a hearing.