Grievance
Participant Rights & Protection: Objection to Services
POLICY:
A person receiving services, his/her parent, legal guardian, correspondent, advocate, other responsible party or Mental Hygiene Legal Services may object to any plan of services, including an individualized service plan/Life Plan, or any part of an ISP/Life Plan, or any change proposed to an ISP/Life Plan; plans for placement; a proposal initiated by the agency/facility to discharge; or a proposal to reduce, suspend or discontinue HCBS waiver services. Objections may be brought at any time. Objections may be raised in direct conversation, in writing, or by telephone.
The person receiving services and his or her parent, guardian, correspondent and advocate as applicable will be advised of the mechanism to resolve an objection: upon admission to a facility or enrollment in HCBS waiver services, as changes occur and upon any substantive change in the Part 633.12 regulations.
A capable adult person receiving services may refuse the initiation of an objection or subsequent appeal on his or her behalf.
A person, and his or her parent, guardian, correspondent and advocate, as applicable, may select a representative of his or her choice to provide assistance and /or representation, including legal counsel. A person receiving services shall not be denied the opportunity to participate in any meetings related to the objection to services as listed above.
VALUES:
Person Centered, Commitment
PROCEDURE:
Person(s)/Responsibility:
Intake Coordinator: Advises individuals receiving services and their families, correspondents, advocates of their right to object to services proposed or being provided and/or any component thereof. Has individual sign-off on Ontario ARC Statement of Rights.
Habilitation Coordinator: At time of enrollment in HCBS waiver services, as changes occur, and at the time of any major changes in the regulations, informs person receiving services, his/her parent, legal guardian, correspondent, advocate of right to object to services and process to resolve an objection. Documents informing person in the case file.
Processes to Resolve Objection
POLICY:
Informal Process
Informal objections to service may be brought to the attention of the supervisor, coordinator, manager, director at any time, in direct conversation, by telephone or in writing. Once received, this staff person will inform the appropriate Program Director, who will assist in initiating action to bring the objection to an acceptable resolution. In many cases, objections or concerns can be dealt with easily on an informal level, especially if details or issues simply need further clarification for an understanding to be reached. The process shall include the person, their Care Coordinator, Habilitation Coordinator, involved family and/or advocate, as applicable.
If the objection is not able to be resolved at this level, it may be brought to the attention of the Associate Executive Director, or the Executive Director. This may be done through direct conversation, by telephone or in writing.
Written confirmation of resolution or inability to reach a resolution shall be sent to the objecting party by the Executive Director or his designee.
If an objection cannot be resolved through this informal process the person receiving services or objecting party should be reminded of the formal procedure for objection to services.
Formal Process
The objecting party shall be advised of the opportunity to submit a written objection requesting a hearing to the Director, Finger Lakes DDSO. Within five days of receipt of a formal written objection, a hearing shall be scheduled, to take place before a hearing officer appointed by the Director, Finger Lakes DDSO. There shall be no less than 10 days notice to the involved parties. Following the hearing, a written decision by the hearing officer shall be sent to the involved parties within 14 days of that hearing.
If any party to the proceeding is not satisfied with the decision, it may be appealed to the Commissioner of OMRDD within 10 days. The Commissioner of OMRDD will issue a final written decision to all parties within 14 days of receipt of the appeal. The commissioner, may at his discretion send the matter back to the hearing officer for further review.
During the period that an objection is undergoing administrative review, a person shall participate in programming mutually agreeable to the objecting party, the agency, the person, and his or her parent, guardian, correspondent or advocate. Every effort shall be made to maintain the person in at least his or her current level of programming.
In order to protect a person’s health, safety , or welfare of others, nothing shall preclude a change in programming or the relocation or discharge of a person. While an objection to placement or discharge is undergoing administrative review, relocation or discharge shall only take place with the commissioner’s approval.
Person(s)/Responsibility:
Supervisor, Coordinator, Manager, Director: Receives objection, concern. Attempts to informally resolve objection or concern. If objection cannot be resolved informally, reminds person objecting of formal process for objection to services.
Associate Executive Director, Executive Director: Attempts to resolve objection or concern on an informal level. Sends written confirmation of resolution or inability to reach a resolution to the objecting party. Reminds objecting person of formal process for resolving objection if appropriate.
Reduction, Suspension or Discontinuance of HCBS Waiver Services
HCBS Waiver Services may not be reduced, suspended, or discontinued by the agency without written notice to the individual, his/her parent, service coordinator, correspondent, advocate. This process is not applicable when an individual requests changes to his or her waiver services.
Written notice must be in the required format, Form #1:Notice of Proposed Change. A discussion of the proposed changes will occur. Results of the discussion will be documented in the person’s record. If there is no objection, services may be changed with no delay.
Informal Process
Informal objections to service may be brought to the attention of the supervisor, coordinator, manager, director at any time, in direct conversation, by telephone or in writing to the ------------------------------------------------. Once received the ------------------------------------------ will inform the--------------------- Director, who will assist in initiating action to bring it to an acceptable resolution. In many cases, objections or concerns can be dealt with easily on an informal level, especially if details or issues simply need further clarification for an understanding to be reached. The process shall include the person’s service coordinator and/or advocate, as applicable.
If the objection is not able to be resolved at this level, it may be brought to the attention of the ---------------Associate Executive Director, or the Executive Director. This may be done through direct conversation, by telephone or in writing. Written confirmation of resolution or inability to reach a resolution shall be sent to the objecting party by the Executive Director or his designee.
Documentation of the result of the informal process shall be included in the person’s record.
Formal Process
If an objection cannot be resolved through this informal process the person receiving services or objecting party should be reminded of the formal procedure for objection to services. Written notice of the parties’ inability to resolve the objection shall be sent to the objecting party by the Executive Director. The notice shall be in the form and format approved by the Commissioner of OMRDD, Form #2:Notice of right to Administrative Review. It shall be sent by certified mail, return receipt requested, or such means that the time of receipt of the information can be documented. The objecting party may submit a written objection to the DDSO Director requesting administrative review of the reduction, suspension or discontinuance, within 14 days after the receipt of the notice. The agency shall not reduce, suspend or discontinue the HCBS waiver services at issue during such 14-day period, unless otherwise agreed to by the parties.
Upon receipt of a written objection requesting an administrative review, the DDSO Director or his or her designee shall contact the objecting party and the agency providing the services to mediate resolution of the objection. If there is no resolution within 14 days of receipt of the objection, a hearing shall be conducted by a hearing officer appointed by the DDSO Director. The objecting party and the agency may mutually agree to extend the time periods.
The hearing officer shall issue a written decision to the objecting party and the agency within 14 days after the conclusion of the hearing. Either party may appeal the decision to the Commissioner and submit a written reply to the decision within 14 days of receipt. The Commissioner may at his or her discretion, send the matter back to the hearing officer for further review.
During the period that an objection is undergoing administrative review (including expedited review) the agency shall not reduce, suspend or discontinue the HCBS Waiver Services at issue, unless otherwise agreed to by both parties.
Person(s)/Responsibility :
Supervisor, Coordinator, Manager: Sends Form 1: Notice of Proposed Change to person receiving services, when agency wishes to reduce, suspend or discontinue waiver services. Sets up meeting with person receiving services, his/her family, service coordinator, advocate, correspondent to discuss change. Meets with individual, family to discuss proposed changes, seeking agreement through informal means.
Director, Associate Executive Director, Executive Director: Meets with individual family, service coordinator, advocate, correspondent, to informally resolves objection. If person receiving services, family, correspondent or advocate object to change sends Form 2: Notice of Right to Administrative Review to the person, his/her parent, service coordinator, advocate.
Service Coordinator: Documents results of meeting(s) to discuss proposed change.
Expedited Hearing Process
Under some circumstances the agency may determine the need to reduce, suspend or discontinue services to prevent immediate risk to the health or safety of the person. In this event the individual or his/her parent, service coordinator, advocate or correspondent will be notified immediately of the proposed change and the reasons for it. If there is agreement regarding the change it will go into effect without delay. If there is an objection to the proposed change an expedited hearing may be requested by the agency or objecting party.
A written request for the hearing shall be sent by the agency or objecting party to the Commissioner of OMRDD. If the agency initiates the request is shall also immediately notify the person, parent, guardian, service coordinator, correspondent and advocate, as applicable of the request.
If the Commissioner determines that an expedited hearing is warranted, the appropriate DDSO Director will schedule a hearing within 7 days of the Commissioner’s determination. The hearing will be held before a hearing officer appointed by the DDSO. The parties involved in the objection will receive at least 3 days notice of the hearing.
The hearing officer’s recommendation shall be sent to the parties and to the Commissioner within 5 days of the conclusion of the hearing. The hearing officer shall advise the parties of their opportunity to send a written reply to the recommendation directly to the Commissioner. The Commissioner will issue a final written decision as soon as practicable.
No person, or objecting party or representative of either shall be denied the opportunity to participate in any hearings pursuant to this section. They may offer information and ask relevant questions of any parties participating in the hearing.
No communication concerning the objection shall occur between either the agency or the objecting party and either the hearing officer or the Commissioner during the period the objection is undergoing review.
The Commissioner’s decision is final. Further appeals may be done in accordance with the provisions of Article 78 of the Civil Practice Law and Rules.
In a situation where treatment is deemed necessary to avoid serious harm to life or limb of that person or others, the Executive Director may authorize treatment for which informed consent is required despite objection. This authorization will be contingent upon clinical recommendation and documentation. Authorization of the Executive director shall be in writing.
Monitoring and Oversight
POLICY:
Monitoring and Oversight will be the responsibility of the Quality Assurance Director. The Quality Assurance Director will receive copies of Form 1: Notice of Proposed Change and Form 2: Notice of Right to Administrative Review and will maintain a roster of persons for whom forms have been received. The Part 633.12 Committee will meet quarterly to review adherence to the procedure. Any concerns about adherence to the procedure should be made known to the Director of the program/service and the Quality Assurance Director.
PROCEDURE:
Person(s)/Responsibility
Supervisor, Coordinator, Manager, Director: Meets with supervisor on a regular basis. Informs supervisor of proposed reduction, suspension or discontinuation of HCBS Waiver Services. Sends Copy of Form 1: Notice of Proposed Change to Quality Assurance Director when HCBS Waiver Services are to be reduced, suspended or discontinued.
Quality Assurance Director: Maintains yearly roster of individuals whose HCBS Waiver Services are to be reduced, suspended or discontinued.
Associate Executive Director of Participant Services, Quality Assurance Director, Residential Director, Day Treatment Director, Community Services Director, Director Abbey Industries: Meet on a quarterly basis to review roster of people with reduced, suspended or discontinuation of service to assure adherence to procedure and accuracy of process. Determine any trends, significant changes noted.
Director of Program/Service: If a Service Coordinator or others feel the objection process is not being followed in a particular program or service, brings this to the attention of the supervising Director in that area. Following that, brings it to the attention of the Quality Assurance Director.
