North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 27 - MENTAL HEALTH, COMMUNITY FACILITIES AND SERVICES › Subchapter G - RULES FOR MENTAL HEALTH, DEVELOPMENTAL DISABILITIES, AND SUBSTANCE ABUSE FACILITIES AND SERVICES › Section .7000 - LOCAL MANAGEMENT ENTITY RESPONSE TO COMPLAINTS › Section 27G .7002 - LOCAL MANAGEMENT ENTITY REQUIREMENTS CONCERNING COMPLAINTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A Local Management Entity shall respond
				  to complaints received concerning the provision of public services pertaining
				  to all provider categories, as defined in
				  10A NCAC
				  27G .0602, in its catchment area. This Rule
				  does not govern complaints pertaining to utilization review
				  decisions.
(b) The Local Management
				  Entity shall:
(1) establish a written
				  notification procedure to inform each client of the complaint process
				  concerning the provision of public services. The procedure shall include the
				  provision of written information explaining the client's right to contact the
				  Local Management Entity, the Division of Mental Health, Developmental
				  Disabilities and Substance Abuse Services, the Division of Health Service
				  Regulation, the Division of Social Services and The North Carolina Protection
				  and Advocacy system known as Disability Rights North Carolina;
(2) seek to resolve issues of concern through
				  informal agreement between the client and the provider and document the
				  attempts at resolution;
(3) develop
				  and implement written policies including those safeguards and procedures listed
				  below:
(A) safeguards for protecting the
				  identity of the complainant;
(B)
				  safeguards for protecting the complainant and any staff person from harassment
				  or retaliation;
(C) procedures to
				  receive and track complaints;
(D)
				  procedures to assist a client in initiating the complaint process;
(E) procedures for encouraging the
				  complainant to communicate with the provider to allow for resolution of the
				  issue;
(F) methods to be used in
				  investigating a complaint;
(G)
				  procedures for responding to complaints and options to be considered in
				  resolving a complaint, including corrective action and referral to the Division
				  of Mental Health, Developmental Disabilities and Substance Abuse Services, the
				  Division of Health Service Regulation, the Division of Social Services or other
				  agencies as required;
(H)
				  procedures governing complaints and appeals made by a provider and a
				  complainant;
(I) procedures for
				  notifying the home Local Management Entity, if different, of the complaint and
				  actions taken; and
(J) procedures
				  for the Local Management Entity Director to convene an ad hoc appeal review
				  committee to review client and provider appeals. The client rights committee,
				  as defined in
				  10A NCAC
				  27G .0504, shall approve policy and
				  procedures regarding the formation of the appeal review committee including
				  assurance of the review committee's lack of conflict of interest, composition,
				  disability affiliation(s) and other experience or qualifications relevant to
				  the issue(s) in the complaint. The committee's recommendations shall be by
				  majority vote;
(4)
				  review the complaint and communicate to the complainant within five working
				  days of receipt whether the complaint will be addressed informally or by
				  conducting an investigation; and
(5) notify the complainant in writing of the
				  results of the informal process in a letter dated within 15 working days from
				  receipt of the complaint. If the need for an investigation is revealed during
				  the informal process, the Local Management Entity shall begin the investigation
				  or refer the matter to the appropriate State or local government agency. If the
				  complainant is not satisfied with the informal process, the complainant may
				  file an appeal in writing to the Local Management Entity Director. The appeal
				  must be received within 15 working days from the date of the informal
				  resolution letter. The Local Management Entity Director shall:
(A) convene an appeal review committee
				  according to Part (b)(3)(J) of this Rule; and
(B) issue an independent decision after
				  reviewing the appeal review committee's recommendation. The decision shall be
				  dated and mailed to the appellant by the Local Management Entity within 20
				  working days from receipt of the appeal.