Or. Admin. Code § 411-318-0015

Current through Register Vol. 63, No. 10, October 1, 2024

Section 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) Department staff and program staff addressing or reviewing a complaint may not have a conflict of interest with the complaint or the complainant.

(3) A complaint related to a developmental disabilities service or provider may be filed at any time.

(4) A complaint may include, but is not limited to:

(a) An expression of dissatisfaction with a developmental disabilities service or provider. For example:

(A) The person-centered planning process, including but not limited to people chosen by an individual or an individual's ability to make informed, timely choices.

(B) Service planning as described in OAR 411-415-0070, including but not limited to an individual's choice of providers or additional services meeting an individual's needs, such as protocols, Positive Behavior Support Plans, Career Development Plans, etc.

(C) Home and community-based services as defined in OAR 411-317-0000, including but not limited to an individual's ability to choose their home, desired room decorations, food preferences, and transportation.

(D) Employment services, including but not limited to the choice of being employed, the choice to not be employed, or employment opportunities.

(b) An allegation of circumstances or events that are contrary to law, rule, policy, or otherwise, as determined by a complainant.

(5) The complaint process described in this rule does not apply to a complaint in the following situations:

(a) Anonymous complaints and allegations of discrimination 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 disabilities service or a provider.

(d) The complaint is about the personnel of a local program.

(A) An agency must include policies and procedures for the handling of personnel complaints in accordance with OAR 411-323-0060(9).

(B) A Community Developmental Disabilities Program (CDDP) must include policies and procedures for the handling of personnel complaints in accordance with OAR 411-320-0175(1).

(C) A Brokerage must include policies and procedures for the handling of personnel complaints in accordance with OAR 411-340-0060(1).

(e) The subject matter of the complaint is subject to review under the following:

(A) ORS 419B.005 to 419B.055 for child abuse reports.

(B) OAR chapter 309, division 118 for the Oregon State Hospital.

(C) OAR 407-005-0025 and 407-005-0030 for discrimination on the basis of disability.

(D) OAR 407-005-0100 to 407-005-0120 for staff conduct or customer service received from Department personnel.

(E) OAR chapter 411, division 020 for adult protective services provided by the Department's Aging and People with Disabilities Program.

(F) OAR 410-141-3875 through 410-141-3915 for the Oregon Health Plan.

(G) OAR 413-010-0420 for Department Child Welfare decisions.

(H) OAR 413-010-0700 through 413-010-0750 for Department Child Protective Service dispositions.

(I) OAR 413-120-0060 for Department Child Welfare adoption placement selections.

(J) OAR chapter 582, division 020 for Department Vocational Rehabilitation service determinations.

(K) OAR chapter 839, division 003 for a violation of civil rights investigation conducted by the Bureau of Labor and Industries.

(6) 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:

(a) The Department;

(b) A CDDP;

(c) A Brokerage;

(d) The Office of Training, Investigations, and Safety;

(e) Child Welfare; or

(f) Law enforcement.

(7) If a complaint falls under section (5) of this rule, the local program or Department must offer to assist the complainant with filing the complaint with the appropriate entity.

(8) The local program or Department must ensure there is no punitive action threatened or taken against a complainant.

(9) Information regarding the complaint process must be accessible for people with disabilities and provided in a person's preferred language.

(10) A local program 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, individuals' representatives, providers, and the Department. The policies and procedures must include, but are not limited to, all of the following:

(a) Method used to submit a complaint. For example, form 0946, verbal, email.

(b) When a complaint must be logged in the complaint log.

(c) Process for reviewing and resolving a complaint.

(d) Time frames for responding to a complaint as set forth in this rule.

(e) Documentation to be used in response to a complaint as set forth in this rule.

(f) The process for assisting an individual or an individual's representative with filing a personnel complaint or a complaint with another entity according to section (7) of this rule.

(g) Submission of documents to the Department.

(11) A local program must submit records requested by the Department within three business days from the receipt of the request.

(12) A complaint received on the Complaint Form (0946) constitutes a complaint and must be addressed through the complaint process described in section (17) of this rule.

(13) An expression of dissatisfaction about a developmental disabilities service or provider that is not submitted on the Complaint Form (0946) must be addressed through the complaint process described in section (17) of this rule, upon confirmation by an individual or an individual's representative that they wish to file it as a complaint or expresses the need to escalate it and receive a written outcome.

(14) COMPLAINT LOG.

(a) A local program must maintain a complaint log. At a minimum, the complaint log must include all of the following:

(A) The legal name of the individual for which the complaint is being filed.

(B) The individual's preferred name.

(C) The individual's preferred method of contact.

(D) The name and contact information of the person making the complaint, if known.

(E) The name of the person taking the complaint.

(F) The nature of the complaint, including if there was a request for new or changed developmental disabilities services which may result in a hearing.

(G) The date the complaint was received.

(H) The date the complaint was acknowledged in writing as described in section (17)(a) of this rule.

(I) The date the local program offered the complainant an opportunity to discuss the complaint with the local program, as described in section (17)(b) of this rule, and the date of the discussion, if applicable.

(J) The date of an extension for a written outcome that was mutually agreed upon as described in section (17)(c) of this rule.

(K) The written outcome of the complaint as described in section (17)(c) of this rule.

(L) The date and method the written outcome was provided to the complainant.

(b) Personnel complaints and allegations of abuse must be maintained separately from the complaint log.

(c) A local program must only document complaints about their local program in their complaint log. In the event a complaint is against another agency or program, the local program must:

(A) Help the individual or the individual's representative file the complaint with the other agency or program; and

(B) Document the support provided by the local program in the individual's progress notes.

(15) SCREENING OF COMPLAINTS. A local program must screen all complaints for potential hearing related issues.

(a) In the event that a complaint appears to allege a denial, reduction, suspension, or termination of a developmental disabilities service, the local program must issue a Notification of Planned Action and advise the complainant of the right to a hearing and assist the complainant with filing a hearing request, if so desired.

(b) In the event a complainant decides to file a complaint rather than a hearing request, the local program must document the complainant's decision in the individual's progress notes.

(16) FILING A COMPLAINT.

(a) Complaints may be made orally, in writing, or on a Complaint Form (0946).

(b) A complaint regarding dissatisfaction with the services of a provider organization may be filed with the Department or directly with the provider organization, Brokerage, or CDDP.

(c) A complaint regarding dissatisfaction with the services of a Brokerage or CDDP may be filed with the Department or directly with the Brokerage or CDDP.

(d) A complaint regarding dissatisfaction with the Department, including complaints about the Stabilization and Crisis Unit (SACU), children's intensive in-home services (CIIS), and children's 24-hour residential services and settings, must be filed with the Department.

(17) PROCESS FOR ADDRESSING COMPLAINTS.

(a) The local program or Department must provide written acknowledgement of a complaint to an individual or the individual's representative within five business days from the receipt of the complaint. A copy of the written acknowledgment must be maintained in the individual's file.

(b) The written acknowledgement must inform the complainant about the opportunity to discuss the complaint with the Program Director of the local program or the Director of the Department, or their designee.

(A) This discussion does not preclude the complainant from receiving a written outcome after the local program or Department has reviewed the complaint.

(B) This discussion must occur within 10 business days from the date of the written acknowledgement. The local program or Department must document all offers for a discussion in the complaint log.

(C) In the event that a resolution is reached during the discussion, the local program or Department must provide a written outcome to the complainant within 10 business days from the date of the discussion. A copy of the written outcome must be maintained in the individual's file.

(c) The local program or Department must complete a complaint investigation and issue a written outcome to the complainant within 45 calendar days from the receipt of the complaint, unless both parties mutually agree to extend the timeframe. The extension may not exceed an additional 45 calendar 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, or their designee.

(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 all of the following:

(i) The rationale for the outcome, including the outcome of conferences or discussions with the complainant, individual, providers, or others.

(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 complainant's right to review the documents relied upon in determining the outcome (Notification of Rights form 0948).

(iv) Information about the complainant's right to request a review of the written outcome (Notification of Rights form 0948).

(C) Notice that retaliation or discrimination, as a result of the outcome, is not tolerated.

(D) A copy of the written outcome must be maintained in the individual's file.

(18) REQUEST FOR REVIEW.

(a) A complainant may request a review of a written outcome within 30 calendar days from the date identified in the written outcome.

(A) If a provider organization issued the written outcome, the complainant may request a review of the written outcome by:

(i) The local CDDP or Brokerage; or

(ii) The Department.

(B) If a CDDP, Brokerage, CIIS, or SACU issued the written outcome, the complainant may request a review of the written outcome by the Department.

(C) If the Department issued the written outcome, the complainant may request a review of the written outcome by the Director of the Department or the Director's designee. The written outcome issued by the Director, or the Director's designee, is the final response.

(b) The Department may uphold, alter, or overturn a written outcome issued by a provider organization, CDDP, Brokerage, CIIS, or SACU.

(19) 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 complainant within five business days from the receipt of the request for a review.

(b) The written acknowledgement must inform the complainant about the opportunity to discuss the complaint with the Program Director of the local program or the Director of the Department, or their designee.

(A) This discussion does not preclude the complainant from receiving a written determination after the receiving entity has reviewed the complaint.

(B) This discussion must occur within 10 business days from the date of the written acknowledgement.

(C) In the event that a resolution is reached during the discussion, the local program or Department must provide a written determination to the complainant within 10 business days from the date of the discussion. A copy of the written determination must be maintained in the individual's file.

(c) The local program or Department must review the written outcome and issue a written determination to the complainant within 45 calendar 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 calendar 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 their designee.

(B) The written determination must include all of the following:

(i) The rationale for the determination, including the outcome of conferences or discussions with the complainant, individual, providers, or others.

(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.

(iii) Information about the complainant's right to review the documents relied upon in making the determination.

(C) Notice that retaliation or discrimination, as a result of the determination, is not tolerated.

(D) A copy of the written determination must be maintained in the individual's file.

Or. Admin. Code § 411-318-0015

APD 22-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14; APD 40-2014, f. 12-26-14, cert. ef. 12/28/2014; APD 26-2024, amend filed 06/05/2024, effective 6/10/2024

Statutory/Other Authority: ORS 409.050, 427.104, 427.107 & 430.662

Statutes/Other Implemented: ORS 183.411-183.471, 409.010, 427.007, 427.101, 427.104, 427.107, 427.109, 430.215, 430.610 & 430.662