Angels Service 

 

Policy and Procedure for Dispute Resolution

It is the policy of Angel’s Service LLC that all persons receiving services, parents, or legal guardians shall be offered a means for a timely resolution of conflicts as appropriate. The use of this procedure shall not prejudice the future provision of appropriate services to the individual in need of and/or receiving services. This conflict resolution procedure shall be explained by the provider to all persons receiving services or applicants for services and their parents, guardian, or authorized representative at the time an application for service is made and any time changes to the procedure occur.

• Situations where an individual or guardian would file an agency dispute including:
  • The applicant is not eligible for services or supports
  • The person receiving services is no longer eligible for services or supports
  • Services or supports are to be terminated
  • Services in the Individualized Plan are to be modified, reduced or denied
    • If the reason for the dispute is coming from the community center board then the dispute needs to be filed with the community center board.
    • If the reason for the dispute is coming from the agency or a provider, then the dispute needs to be filed with Angels Service LLC.

The following is the process for disputes filed with Angels Service LLC.

• If the provider receives the dispute, then the provider is to forward it to the owner of the agency or the current person designated as manager.
  • The owner will respond within 3 business days (Angels Service LLC has a four day a week work week) with a copy of the grievance procedure, the dispute resolution  procedure, and a personal response to the dispute.
  • If the owner / manager is on holiday and then it will happen within 3 business days of their return date.
• The response will include that the intended action will not occur until after reasonable notice has been provided to the person/guardian along with an opportunity to utilize the dipute resolution[GK2]  process except situations where there is not another option due to provider availability or safety.
  • Example, services are ceased because a provider is unavailable to provide services.
  • Example, services are ceased because the situation is no longer safe for the provider and / or the client.
• The individual shall not be coerced, intimidated, threatened or retaliated against because that individual has exercised his or her right to file a complaint or has participated in the dispute resolution process
• When at all possible, notice of the proposed action, as defined in Section 8.600.4 shall be provided to the person receiving services/guardian at least 15 days prior to the date of action.
  • Exceptions include, if a provider become available to provide the services or there is a safety issue for the provider or client.
• If the person receiving services/guardian is dissatisfied with the decision or action of the agency
• Step 1: Informal Negotiation

• The agency shall provide an opportunity for resolution through an informal negotiation which may be waived by mutual consent through communicating with the family. Any outcomes will be documented in writing.
  • A meeting of all parties shall be scheduled within 15 days of the receipt of the complaint.
  • If informal negotiation has been attempted or waived the following provisions shall be initiated
  
  

• Step 2: Formal Negotiation

• 
  
  • 
    
    • An opportunity to present information and evidence to an impartial decision maker
    • Notification of the meeting at least 10 days prior to the meeting unless waived by the objecting parties
    • Representation by council, authorized representative or another individual if the objecting party desires
    • The opportunity to respond to questions
    • Recording of the proceeding by electronic device or reporter
    • Written decision within 15 days of the meeting
    • Notification that if the dispute is not resolved, the objecting party may request that the Executive Director of the Department or a designee review the decision

• Step 3: Review by the Department of Health Care Policy and Financing

• 
  
  • 
    
    • 
      
      • The request to review the outcome of the dispute resolution process shall be submitted to the Department within 15 days from which the decision was postmarked
      • Community centered board, regional center or the program approved service agency or other party shall be afforded the opportunity to respond within fifteen (15) working days
      • The Department has a right to request additional information or may request an oral argument or a hearing
      • The Department shall render a decision within 10 working days of the submission of all relevant information
      • The decision of the Department shall constitute final agency action on the dispute

• A statement that the agency will keep a written record of all proceedings
• The statement that no person receiving services be terminated from such services or supports during the resolution process

Revision History:

Published 12/29/2016 by Serena Akinahew