CR 3: Grievance Procedures*
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The organization maintains a formal mechanism through which applicants, clients, and other stakeholders can express and resolve grievances, including denial of service, which includes:
- the right to file a grievance without interference or retaliation;
- timely written notification of the resolution and an explanation of any further appeal, rights or recourse;
- at least one level of review that does not involve the person about whom the complaint has been made or the person who reached the decision under review; and
- the right of the consumer or a family member to be heard by a panel or person delegated to review responsibility.
Update: Added First Interpretation - 06/01/10
Added First Interpretation
Interpretation: Organizations providing Adult Guardianship should ensure that an advocate is appointed to assist the individual in navigating the grievance process.
Interpretation: For networks, grievance
procedures for persons served by the network include provisions for filing and appealing grievances related to the network
management entity, owner and provider organizations, and independent practitioners.
Note: For networks, appeals or denials of service authorizations are addressed in Utilization Management standards NET 7.08 and NET 7.09. An appeal of a denial of service authorization is, in effect, a request for a second opinion, and as such, does not imply that a person's rights were denied. However, if the appeal is denied, the person making the appeal might file a complaint or grievance if they believe the network's prcocedures or criteria for placement were not followed. For example, if the appeal was not addressed within the network's time requirements, or if the person believes that the criteria were misapplied, then the person may resort to the complaint or grievance process.