GRIEVANCE NOTICE
If you have a concern or complaint, please bring it to the attention of your counselor or another staff member with whom you feel. Our staff will help you address your concerns. If your services are paid for by Medicaid/OHP, you can also contact your CCO directly.
After speaking with our staff, if you or the person acting on your behalf feel the matter is still unresolved, please write your concern on a grievance form and submit it to the Associate Director or the Clinical Director. Please include all the information that will help our staff in understanding your concern and your suggestion for resolution. Within 30 days our staff will communicate with you and/or your representative in writing regarding the decision on the grievance and information explaining the appeal process.
If you would like assistance putting your grievance in writing, please ask a staff member for assistance.
If you would like a grievance form, please ask for one.
If you would like more information on the grievance process, requesting an expedited grievance, appeals, immunity or retaliation, please request a copy of the grievance and appeals policy and procedure.
Telephone numbers:
Oregon Health Authority, Health Systems Division: 503-945-5763 http://www.oregon.gov/OHA/healthplan/pages/complaints-appeals.aspx
Disability Rights Oregon: 503-243-2081 Governor’s Advocacy Office: 503-945-6904
Policy
Grievance means a formal complaint submitted to the agency verbally, or in writing, by an individual, guardian, or the individual’s chosen representative, pertaining to the denial or delivery of services and support. PNF & TPC will protect the rights of individuals, encourage the open discussion of dissatisfaction, and will work to resolve concerns, complaints, and grievances of any nature.
Affected Parties
Individuals, their families and guardians, and PNF & TPC staff.
Procedure
Individuals receiving services will be made aware of their grievance rights at entry and reminded of these rights should concerns/ complaints arise that are not resolved by direct care staff and/or supervisory staff.
Individual Rights including the right to grieve and appeal treatment services will be posted in plain sight in every PNF & TPC direct service location.
A Grievance Process Notice informing individuals of their options to file a grievance with local and State entities will be posted in plain sight in every PNF & TPC direct service location.
Grievance Rights specific to the individual’s HIPAA and or 42 CFR Part 2 privacy will be included in the PNF & TPC Notice of Privacy Practices provided to the individual at Intake.
The following procedures apply for any individual grievance
The individual or person acting on their behalf are encouraged to approach the staff member concerned and specify the nature of their concern/ complaint. The staff person will attempt to resolve the concern/complaint at that time.
Should the individual, or person acting on their behalf, feel the matter is still unresolved or wish to not speak directly to the staff in question, the grievance should be put in writing. Grievances may also be submitted through conversation with the Associate Director, who will document the information on a grievance form on behalf of the individual or guardian.
Grievances shall be submitted to 1785 NE Sandy Blvd. Ste. 200 Portland, OR 97212
The Director will meet and discuss the grievance with the Associate Director who has investigated the specifics of the grievance. Within 30 days of receiving the complaint, the Director will communicate to the individual in writing the outcome of the grievance and attach a copy of the Grievance Appeals Notice.
Documentation of the receipt, investigation, and action taken regarding the Grievance will be placed in the service record and the program’s file to be retained for at least seven years.
The provider shall post a Grievance Process Notice in a common area stating the telephone numbers of: The Division; Disability Rights Oregon; any applicable coordinated care organization; and The Governor’s Advocacy Office.
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In circumstances where the matter of the grievance is likely to cause harm to the individual before the grievance procedures are completed, the individual or guardian of the individual may request an expedited review. This option shall be noted on the Grievance Form. The program administrator shall review and respond in writing to the grievance within 72 hours of receipt of the grievance. The written response shall include information about the appeal process.
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A grievant, witness, or staff member of a provider may not be subject to retaliation by a provider for making a report or being interviewed about a grievance or being a witness. Retaliation may include but is not limited to dismissal or harassment, reduction in services, wages, or benefits, or basing service or a performance review on the action.
The grievant is immune from any civil or criminal liability with respect to the making or content of a grievance made in good faith.
Individuals and their legal guardians may appeal entry, transfer, and grievance decisions as follows:
If the individual or guardian is not satisfied with the decision, the individual or guardian may file an appeal in writing within ten working days of the date of the program administrator's response to the grievance or notification of denial for services. The appeal shall be submitted to the Division;
If requested, program staff shall be available to assist the individual; The Division shall provide a written response within ten working days of the receipt of the appeal; and if the individual or guardian is not satisfied with the appeal decision, they may file a second appeal in writing within ten working days of the date of the written response to the Division Director.
Official Complaint or Grievance Form
If you are very unhappy with an experience you had with your healthcare services, or your provider with something else at Portland Neurofeedback & The PATH Center PNF & TPC, you can complain or file a grievance with us by filling out this form.
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Today’s Date: _________________Your Name: __________________________________________
Your Phone Number: _____________________ Date of Birth: ______________________________
Member’s Name (if you are not the member): ____________________________________________
What happened? When did it happen? Who was involved? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What do you want us to do about this? ____________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________
We must solve your complaint and call or write to you in 5 workdays from the date we get the complaint. If we can’t solve it in 5 workdays, we will send you a letter within 5 workdays to explain why. We may take up to 30 days to address your complaint. We will not tell anyone about your complaint unless you ask us to. We do need the client’s permission to look into this grievance. Please sign this form if you want us to investigate this complaint. If you are a representative signing either for the client or on behalf of the client, include documents showing that you may act on behalf of the client. Contact us if you have questions about getting the documents.
I, _________________________________________ want __________________________________
Name or Representative Name to act for me in my Grievance
________________________________________ _____________________________________
Signature of Client Relationship to Client
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Date: ______________________
For more information or to ask for this information in another language or format, please call PNF & TPC. Client services are available to answer your call directly 9am to 5pm, Monday through Friday (except on holidays). Our answering service is available anytime to take voice messages and those are reviewed hourly and responded to within one business day.
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Do you think PNC & TPC has treated you unfairly? PNC & TPC must follow state and federal civil rights laws. It cannot treat people unfairly in any of its programs or activities because of a person’s:
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• Age • Gender identity • Race • Sexual orientation • Sex
• Color • Marital status • Religion • Disability • National Origin
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You have a right to enter, exit, and use buildings and services. You have the right to get information in a way you understand. PNF & TPC will make reasonable changes to policies, practices, and procedures by talking with you about your needs. To report concerns or to get more information, please contact PNF & TPC at: info@thepathcenter.org or 971-940-2601 Monday through Friday 9:00 to 5:00. You can leave a message at other times, including weekends and federal holidays. We will return your call the next business day. You have a right to file a civil rights complaint with these organizations:
U.S. Department of Health and Human Services Office for Civil Rights (OCR) Web: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf Phone: (800) 368-1019, (800) 537-7697 (TDD) Email: OCRComplaint@hhs.gov Mail: Office for Civil Rights, 200 Independence Ave. SW, Room 509F, HHH Bldg., Washington, DC 20201
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Oregon Health Authority (OHA) Civil Rights Web: www.oregon.gov/OHA/OEI | Email: OHA.PublicCivilRights@state.or.us Phone: (844) 882-7889, 711 TTY Mail: Office of Equity and Inclusion Division, 421 SW Oak St., Suite 750, Portland, OR 97204
Bureau of Labor and Industries Civil Rights Division
Phone: (971) 673-0764 Email: crdemail@boli.state.or.us
Mail: Bureau of Labor and Industries Civil Rights Division, 800 NE Oregon St., Suite 1045, Portland, OR 97232 Page 4 of 5 You can get this letter in another language, large print, or another way that is best for you. You can also have a language interpreter. Call 1-877-600-5472 (TTY/TDD 711