Grievance Procedure

 

William Pierce, Clients Rights and Grievance Specialist, ADA Title II Coordinator

DMHAS Office of the Commissioner,

410 Capitol Ave. 4th Floor P.O. Box 341431 Hartford, CT 06134

(860) 418-6933 (TTY Relay 7-1-1) Email: william.pierce@ct.gov

Revised:  March 28, 2023

The Connecticut Department of Mental Health and Addiction Services (DMHAS) Client Grievance Procedure is used by DMHAS state operated and DMHAS funded providers of direct mental health and substance use disorder services (providers) to address complaints at the lowest possible level. 

Grievances under the DMHAS Client Grievance Procedure are addressed by the provider where the complaint occurred.  Grievances are submitted in writing to a provider’s Client Rights Officer by a person receiving services, seeking services or has received services (client) from that provider or the person’s authorized representative. 

  1. DMHAS CLIENT GRIEVANCES

    DMHAS Client Grievances include complaints a DMHAS state operated or DMHAS funded provider of direct mental health or substance use disorder treatment services: Denied, Involuntarily Reduced or Involuntarily Terminated services or written complaints where the client believes the provider or staff:

    1. Violated a right provided by statute, regulation, or directive of DMHAS.
    2. Treated the person in an arbitrary or unreasonable manner.
    3. Failed to provide services authorized by a treatment plan.
    4. Engaged in coercion, which improperly limits a person’s choice.
    5. Unreasonably failed to intervene to protect the client when their rights were jeopardized by the actions of another client in a setting controlled by the Provider.
    6. Failed to treat the person in a humane and dignified manner.
  2. DMHAS CLIENT GRIEVANCE PROCEDURE
    1. Grievances are submitted in writing to the provider’s designated Client Rights Officer (CRO) no later than forty-five (45) calendar days of when complaint occurred unless the CRO determines good cause for a late submission or the grievance is an Accelerated Grievance under Regulations of Connecticut State Agencies concerning Fair Hearings (Fair Hearing Regulations).
    2. If the client cannot submit a grievance on their own, their authorized representative may do so on their behalf.
      • A client may authorize in writing a representative of their choice to advocate on their behalf in pursuing a grievance unless as stipulated by Fair Hearing Regulations the client’s choice is someone who receives services from the same provider and the provider determines the choice is clinically detrimental to the client.
      • The client’s authorized representative may appear with the client and advocate on behalf of the client at any proceeding under the Grievance Procedure.
      • The client can request access to relevant records necessary to resolve the grievance and can provide their written authorization to the provider for the representative to access records relevant to the grievance.
      • All records regarding a grievance are confidential unless disclosure is authorized, in writing, by the client or the Office of the Commissioner of DMHAS in accordance with applicable law and policy.
    3. A client may withdraw their grievance at any time unless it was submitted on their behalf by their conservator.
      • A conservator cannot withdraw a client’s grievance.
      • Withdrawing a grievance will not affect action begun to investigate alleged or reasonably suspected abuse, neglect and exploitation of a client as well as work rule and agency personnel policies.
    4. Once a grievance is received by the Client Rights Officer the provider has no later than twenty-one (21)calendar days to address the complaint unless the provider’s Executive Official or designee issues written notice to the client authorizing additional fifteen (15) calendar days for good cause or the grievance is an “Accelerated Grievance” as stipulated by Fair Hearing Regulations.
    5. Upon receiving a grievance the Client Rights Officer:
      • Sends an acknowledgement to the client within seven (7) calendar days that includes information on contacting statewide advocacy organizations.
      • Interviews the client as soon as possible (along with their authorized representative if the client has one) and determine what resolutions would the client consider.
      • Interviews other parties as necessary, review relevant records and take other action necessary to have a thorough understanding of the grievance.
      • Reviews documents that are relevant to the grievance.
    6. The CRO immediately notifies the provider’s Chief Executive Officer or designee if the CRO has reasonable reason to believe staff abused, neglected or exploited a client or other protected class or reasonable reason to suspect there was a violation of a DMHAS work rule (for DMHAS facilities), agency personnel policy or criminal statute.
      • The CRO in consultation with the CEO or designee will initiate a referral to the appropriate authority for investigating the alleged action.
      • The CRO will assist in any investigation, as requested by the investigating authority, and will report to the client of the status of such an investigation without violating confidentiality rights of any individual.
      • The CRO will defer taking action addressing a grievance until the outside investigation is completed except when the CRO can address those portions of a grievance separate of the investigation without interfering with that investigation.
    7. The Client Rights Officer addresses the grievance by:
      • Meeting the client with their representative to discuss the grievance and consider resolutions.
      • Meeting parties involved as appropriate and acting as a mediator if the CRO determines such a meeting could resolve the grievance.
      • Maintaining documents concerning a grievance and their confidentiality
      • Authorizing, if necessary, another staff to assist in addressing a grievance while retaining responsibility for its response
    8. A Client Rights Officer who believes a resolution to a grievance is possible submits a written proposed informal resolution to the client, which summarizes the grievance and includes the CRO’s recommended resolution.
      • Proposed resolutions do not contain information that violates the confidentiality rights of other persons.
    9. Once the proposed resolution is issued, the Client Rights Officer will inform the client:
      • They [the client] has ten (10) business days to review the proposed resolution and either sign an acceptance which will resolve the grievance and terminate the Grievance Procedure or to notify the CRO in writing they do not agree with the resolution
      • The grievance will be considered withdrawn if the client does not respond with their decision within ten (10) business days
      • The ten (10) business days does not count towards the twenty-one (21) calendar days the provider has to resolve the grievance
    10. If the Client Rights Officer believes a resolution to a grievance is not possible or if the client rejects the proposed resolution the Client Rights Officer will:
      • Prepare a written report summarizing the grievance and efforts to reach a resolution for the provider’s Chief Executive Officer (CEO) or designee and client along with the client’s authorized representative
      • Notify the client and their authorized representative the CEO or designee who will conduct a separate review of the grievance and they can present additional material or request a meeting with the CEO or designee.
    11. Once the CEO or designee receives the CRO’s report, the official will conduct a separate review of the grievance including additional material provided by the client in writing or information gathered during a meeting with the client.
    12. The CEO or designee issues a Formal Decision which includes a statement of any actions to be taken and notice the client may submit a written request to the DMHAS Commissioner or designee for a Commissioner’s Review.
  3. COMMISSIONER’S REVIEW
    1. A client who does not agree with the provider’s Formal Decision may submit a written request for a Commissioner’s Review within fifteen (15) business days of receiving the Formal Decision to the DMHAS Office of the Commissioner unless the Commissioner or their designee provides an extension for good cause.
    2. A client may also request a Commissioner’s Review when:
      • The provider’s written response to a grievance is more than seven (7) calendar day past the twenty-one (21) calendar days the provider had to address the grievance, unless the grievance was an Accelerated Grievance or the provider notified the client of an extension
      • The provider failed to implement a resolution agreed to by the client and CRO
      • The provider issued a denial that a complaint was a grievance covered by the Grievance Procedure
    3. Upon receiving the request the Commissioner’s designee (designee) conducts such an inquiry the designee deems necessary to have a thorough understanding of the grievance and provider’s response which may include:
      • Requesting and reviewing additional information from the client parties.
      • Interviewing the client and other parties
      • Convening an informal conference of the parties involved in the grievance
    4. The designee issues a Final Determination of the grievance to the client and provider’s Executive Official (or designee) within twenty-one calendar days after receiving the request for a Commissioner’s review and/or no later than fifteen (15) calendar days from the date of the conference if one is held.
    5. The Final Determination serves as the Department’s final administrative decision in the Grievance Procedure.
    6. If the grievance concerns a Denial, Involuntary Reduction or Involuntary Termination of services, the client may submit a written request to the DMHAS Commissioner for a Fair Hearing by mail within thirty (30) calendar days from the date the Final Determination was mailed.
      • The client’s request will identify the services that have been denied, involuntarily reduced, or terminated
    7. In response to a client’s or their authorized representative’s request for a Fair Hearing the DMHAS Commissioner appoints a hearing officer who schedules the hearing no later than forty-five (45) calendar days after the request is received.
      • Parties are contacted and hearings are held under Chapter 54 of the Uniform Administrative Procedure Act (§§4-166 to 4-189 Inclusive)
  4. ACCELERATED GRIEVANCE, FAIR HEARING REGULATIONS:
    1. A client or authorized representative may submit an Accelerated Grievance to a provider when that provider involuntarily reduces or terminates Opioid Substitution therapy or terminates inpatient treatment scheduled for thirty (30) days or less.
    2. The Accelerated Grievance is submitted in writing to the provider within five (5) business days of being notified of the reduction or termination.
    3. The provider has five (5) business days to issue a written Formal Decision.
    4. A client may submit a written request for a Commissioner’s Review of the grievance upon receiving the provider’s Formal Decision.
  5. REQUEST FOR CONTINUATION OF SERVICES, FAIR HEARING REGULATIONS:
    1. Providers are required by Fair Hearing Regulations to notify clients of an involuntary reduction or involuntary termination including:
      • Nature of the action and reason for the action.
      • Information on submitting a grievance under the DMHAS Client Grievance Procedure.
      • The right to submit a request for a continuation of services to the DMHAS Commissioner if the provider fails to notify the client of modified services.
    2. A client who does not receive notice of modified services when involuntarily discharged from a DMHAS service, program or DMHAS contracted provider may submit a written request to the Commissioner of the DMHAS within five (5) calendar days of being notified of the involuntary termination
      • The request includes the service being terminated, the reason why the client wants the service continued and that the client has submitted a grievance to the provider.
    3. The Commissioner’s designee will review the request and issue a response after considering safety and clinical concerns of the client and others who may be affected. The response may:
      • Direct the provider to continue providing services that were involuntarily terminated.
      • Direct the provider to offer the client modified services
      • Support the decision of the provider
    4. Decisions made in response to a Request for Continuation of Services may be modified or terminated at anytime by the Commissioner or designee but they are meant to continue in effect until the client’s grievance is resolved either by the provider, Commissioner’s Review or Fair Hearing.
  6. EXCEPTIONS
    1. Exceptions to the DMHAS Client Grievance Procedure include:
      • Matters under the exclusive jurisdiction of the Psychiatric Security Review Board (PSRB), which are addressed by PSRB procedures.
      • Suspected allegations of abuse, neglect and exploitation, DMHAS work rule violations and/or violation of law, which are referred to outside authorities.
      • Complaints regarding DMHAS funded providers, which receive less than 20% of their funding from DMHAS that the DMHAS Commissioner finds to have an acceptable complaint resolution procedure.
      • DMHAS programs, which do not provide direct mental health or substance use disorder services or which are not funded by DMHAS and which, have a complaint resolution procedure.
      • Client to Client, complaints unless the complaint occurs in a setting controlled by the provider where a grievance can be submitted that the provider failed to reasonably intervene to address the complaint.
      • Complaints concerning entities, which do not receive DMHAS funding.
    2. Title II ADA Complaints concerning DMHAS state operated programs, services and activities from persons with disabilities who receive DMHAS services, or who are visitors and guests of DMHAS programs and activities are submitted in writing to and addressed by the DMHAS ADA Title II Coordinator (Title II of the ADA and DMHAS).
  7. NOTICES AND RESOURCES

NOTICES

  1. DMHAS state-operated and DMHAS funded providers:
    • Designate Client Rights Officers
    • Provide information on the Grievance Procedure and contact information for state-wide advocacy organizations.
    • Post DMHAS Client Grievance Procedure Summary notices in English and Spanish, in a format provided by the DMHAS Office of the Commissioner in every unit, ward, program location and client lounge.
  2. The DMHAS Office of the Commissioner maintains a list of Client Rights Officers on the DMHAS website and provides information and training to providers and the community on request concerning Rights and the DMHAS Client Grievance Procedure.
  3. Requests for copies of the DMHAS Client Grievance Procedure Summary in other languages and formats can be made to the provider’s Client Rights Officer or by contacting the DMHAS Office of the Commissioner.

DMHAS Office of the Commissioner, 410 Capitol Ave. 4th Floor P.O. Box 341431 Hartford, CT 06134  Phone 860-418-7000 (TTY Relay 7-1-1).  www.ct.gov/dmhas

RESOURCES

Information on the DMHAS Client Grievance Procedure:

DMHAS Client Grievance Procedure Forms: