Section 22-A304. GRIEVANCE PROCEDURE - GENERAL PROVISIONS

 

304.1A grievance is the expression by any individual of his or her dissatisfaction with either DMH or a MH provider, including the denial or abuse of any consumer right or protection provided by applicable federal and District laws and regulations. A grievance will not be entertained if it complains of a specific action that occurred more than six (6) months prior to the filing of the grievance, absent extenuating circumstances.

 

304.2DMH shall establish a grievance procedure (Grievance Procedure) that complies with applicable federal and District laws and regulations and that is available to all consumers and other interested parties. As part of the Grievance Procedure, each MH provider shall establish and adhere to an internal grievance procedure for its consumers (MH Provider Grievance Procedure) that has been approved by DMH according to § 301.2.

 

304.3Consumers are not required to utilize the Grievance Procedure. Consumers may pursue other legal, administrative, or informal relief in lieu of or concurrently with filing a grievance.

 

304.4Any consumer who believes he or she has been denied a service for which the consumer is eligible under Medicaid may file a grievance with the Office of Fair Hearings at the Department of Human Services, pursuant to D.C. and federal law. A Medicaid consumer who has a grievance regarding the receipt, termination, amount, kind, or conditions of Medicaid services is not required to go through DMH or MH Provider Grievance Procedures before filing a grievance with the Office of Administrative Review and Appeals, which is part of the Department of Human Services.

 

304.5A MH provider's continuing obligations to safeguard the welfare of consumers, including the filing of Unusual Incident reports and other reports of allegations of abuse or neglect, are not affected by the Grievance Procedure.

 

304.6Mental health services and mental health supports shall continue without limitation, reduction, or termination pending resolution of grievances regarding such mental health services and mental health supports.

 

304.7Neither DMH nor a MH provider shall retaliate against the consumer or his or her representative in any way because the consumer filed a grievance. An allegation of retaliation shall be treated and filed as a new grievance against the MH provider or DMH.

 

304.8DMH may institute proceedings to revoke or suspend a MH Provider's certification and/or licensure or to impose other sanctions if:

 

(a)DMH substantiates an allegation that the MH provider retaliated against a consumer, or his or her representative, for filing a grievance;

 

(b)The MH provider fails to obtain approval of either its MH Provider Grievance Procedure or changes to its MH Provider Grievance Procedure as required by § 301.2;

 

(c)The MH provider fails to abide by or implement a final decision by DMH in response to a grievance;

 

(d)The MH provider fails to take actions identified to rectify situations that have lead to abuse or neglect of consumers; or

 

(e)The MH provider evidences a pattern of untimely or incomplete responses to consumer grievances, or fails to complete action promised by the MH provider in response to a grievance.

 

304.9The written explanation of the DMH Grievance Procedure and of each MH Provider Grievance Procedure shall include the language in § 304.7 in a type size and style that stands out from the surrounding text.

 

source

Final Rulemaking published at 50 DCR 8480 (October 10, 2003).