Virginia Administrative Code › Title 12 - HEALTH › Agency 35 - DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES › Chapter 115 - REGULATIONS TO ASSURE THE RIGHTS OF INDIVIDUALS RECEIVING SERVICES FROM PROVIDERS LICENSED, FUNDED, OR OPERATED BY THE DEPARTMENT OF BEHAVIORAL › Part V - Complaint Resolution, Hearing, and Appeal Procedures › Section 12VAC35-115-170 - Complaint resolution process

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  Anyone who believes that a provider has violated an individual's rights under
				  these regulations may report it to the director or the human rights advocate
				  for resolution.
1. If the report is made only
				  to the director, the director or his designee shall immediately notify the
				  human rights advocate. If the report is made on a weekend or holiday, then the
				  director or his designee shall notify the human rights advocate on the next
				  business day.
2. If the report is
				  made only to the human rights advocate, the human rights advocate shall
				  immediately notify the director. If the report is made on a weekend or holiday,
				  then the human rights advocate shall notify the director on the next business
				  day.
3. The human rights advocate
				  or the director or his designee shall discuss the report with the individual
				  and notify the individual of his right to pursue a complaint through the
				  process established in these regulations. The steps in the informal and formal
				  complaint process established in these regulations shall be thoroughly
				  explained to the individual. The human rights advocate or the director or his
				  designee shall ask the individual if he understands the complaint process and
				  the choice that he has before asking the individual how he wishes to pursue the
				  complaint. The individual shall then be given the choice of pursuing the
				  complaint through the informal or formal complaint process. If the individual
				  does not make a choice, the complaint shall be managed through the informal
				  process.
4. The following steps
				  apply if the complaint is pursued through the informal process:
Step 1: The director or his designee shall attempt to
					 resolve the complaint immediately. If the complaint is resolved, no further
					 action is required.
Step 2: If the complaint is not resolved within five
					 working days, the director or his designee shall refer it for resolution under
					 the formal process. The individual may extend the informal process five-day
					 time frame for good cause. All such extensions shall be reported to the human
					 rights advocate by the director or his designee.
5. The following steps apply if the complaint
				  is pursued through the formal process:
Step 1: The director or his designee shall try to resolve
					 the complaint by meeting with the individual, any representative the individual
					 chooses, the human rights advocate, and others as appropriate within 24 hours
					 of receipt of the complaint or the next business day if that day is a weekend
					 or holiday. The director or his designee shall conduct an investigation of the
					 complaint, if necessary.
Step 2: The director or his designee shall give the
					 individual and his chosen representative a written preliminary decision and,
					 where appropriate, an action plan for resolving the complaint within 10 working
					 days of receiving the complaint. Along with the action plan, the director shall
					 provide written notice to the individual about the time frame for the
					 individual's response pursuant to Step 3 of this subdivision, information on
					 how to contact the human rights advocate for assistance with the process, and a
					 statement the complaint will be closed if the individual does not
					 respond.
Step 3: If the individual disagrees with the director's
					 preliminary decision or action plan, he can respond to the director in writing
					 within five working days after receiving the preliminary decision and action
					 plan. If the individual has not responded within five working days, the
					 complaint will be closed.
Step 4: If the individual disagrees with the preliminary
					 decision or action plan and reports his disagreement to the director in writing
					 within five working days after receiving the decision or action plan, the
					 director shall investigate further as appropriate and shall make a final
					 decision regarding the complaint. The director shall forward a written copy of
					 his final decision and action plan to the individual, his chosen
					 representative, and the human rights advocate within five working days after
					 the director receives the individual's written response. Along with the action
					 plan, the director shall provide written notice to the individual about the
					 time frame for the individual's response pursuant to Step 5 of this
					 subdivision, information about how to contact the human rights advocate for
					 assistance with the process, and a statement that if the individual does not
					 respond that the complaint will be closed.
Step 5: If the individual disagrees with the director's
					 final decision or action plan, he may file a petition for a hearing by the LHRC
					 using the procedures prescribed in
					 12VAC35-115-180. If the individual
					 has accepted the relief offered by the director, the matter is not subject to
					 further review.