CLIENT PROBLEM SOLVING PROCEDURE – TENNESSEE SERVICE AREA

Revised 02/15/22

These procedures ensure that individuals being served at Frontier Health have the right to voice grievances to staff of the facility, to a licensing or funding authority, and/or to outside representatives of their choice with freedom from restraint, interference, coercion, discrimination, retaliation or reprisal. All employees, volunteers, consultants, or students of Frontier Health who knows of or has reason to believe that an individual may have been abused, neglected, exploited, or their rights have been violated at any program or facility operated by Frontier Health shall immediately report this information directly to their Supervisor, CEO or others required by legal authorities.

Complaints of discrimination will be completed according to state licensure, governing authorities, and third party

Documentation and reporting of general complaints (includes “inquiry”), complaints of violations of client rights, and payor requirements for each of the services provided. General complaints, complaints related to an “Adverse Action” (a delay, denial, reduction, suspension, or termination of TennCare benefits, as well as any other act or omission that impairs the quality, timeliness or availability of such benefits), complaints of violation of client rights, and complaints of discrimination shall be handled as follows:

While Legally Authorized Representative is specific to Tennessee and Authorized Representative is specific to Virginia, the terms may be used interchangeably in this policy.

I. Procedures for All RTC and Tennessee Clients

(In the “Procedures for All Tennessee Clients, ”Client” refers to individuals served within Frontier Health Programs or court-appointed guardian or committee, or other interested person on behalf of the individual.

A.) Reporting: Any client (or court-appointed guardian or committee, or other interested person on behalf of the client) who has a general complaint, concern, (includes “inquiry”) or problem is encouraged to report the complaint to an employee. Any employee initiating or receiving such report will make a verbal and written notice to their Department Head/Division Director. The Department Head/Division Director will meet as soon as practical with the client and any representative the client may choose. The Department Head/Division Director may also request others to attend the meeting. An attempt will be made to resolve the complaint informally within 5 days. If the complaint is resolved to the individual’s or authorized representative’s satisfaction, no further action is required. If informal resolution does not occur to the satisfaction of the client, the Department Head/Division Director will notify the client of the right to appeal. Procedures specific to TennCare consumers appealing Grier actions can be found in procedure RI 108. Frontier Health will follow the time lines and requirements outlined in the TennCare section of the “Frontier Health Consumer Comment” form (100164(B).

B.) Unresolved General Complaints: If satisfactory resolution of the complaint cannot be reached informally, the client, with or without assistance of another representative, may make a written complaint to the President/CEO of Frontier Health, P.O. Box 9054, Gray, TN 37615. Such complaints must be made within 15 working days of the determination f the Department Head’s/Division Director’s (item #1 above). Failure to make timely appeal under this plan shall in no way prejudice a client’s right to seek other remedies available under applicable law.The President/CEO or designee will conduct an investigation as deemed appropriate and will make final determination regarding the complaint within 15 working days of receiving the complaint. The written determination and plan of action of the President/CEO or designee will be forwarded to the client and appropriate staff. Such determination shall advise the client of the right to appeal.

C.) Unresolved General Complaints and Discrimination – If satisfactory resolution of the complaint cannot be reached informally (item #1 above), or in instances when the complaint is based on claims of discrimination in regard to race, sex, national origin, age, religion, handicap, or ability to pay, the client may make a written complaint to the President or Senior Vice President of Frontier Health, Inc., P.O. Box 9054, Gray, TN 37615. Such complaint must be made within 15 working days of the Department Head’s/Vice President’s determination (item #1 above) or the occurrence, if the complaint is based on discrimination. Failure to make timely appeal under this plan shall in no way prejudice a client’s right to seek other remedies available under applicable law. You may register a complaint of discrimination to the TennCare Office of Civil Rights Compliance at any time. If you require assistance it will be provided to you. The complaint form can be found at TennCare civil rights webpage. The complaint must be completed within 180 days of the alleged act of discrimination.

The President/CEO or designee will conduct an investigation as deemed appropriate and will make final determination regarding the complaint within 15 working days of receiving the complaint. The written determination and plan of action of the President/CEO or designee will be forwarded to the client and appropriate staff. Such determination shall advise the client of the right to appeal to the Office of Consumer Affairs & Advocacy, Tennessee Department of Mental Health/Developmental Disabilities.

D.) Reporting of Complaints of Harm, Abuse, Neglect or Exploitation (Urgent Inquiries): Any client, advocate, employee, or other interested person who has reason to believe the client has been harmed, abused, neglected, or exploited in a program shall immediately report such to the President/CEO or designee. Within 24 hours, the President/CEO or designee will review the complaint and take interim measures if needed to protect the client pending completion of the investigation.

The President/CEO or designee will notify the Tennessee Department of Mental Health/ Developmental Disabilities Office of Consumer Affairs & Advocacy (for MH clients); Assistant Superintendent for Community Services, Greene Valley Development Center (ID clients); Tennessee Department of Children’s Services (DCS Contracted Services) and Tennessee Department of Human Services for all disabilities and any other entities as identified by applicable licensure or accreditation.

The President/CEO or designee will investigate the complaint. A final report from the investigative team will be made within 15 working days of the receipt of the complaint. In the event external investigators (non-Frontier Health staff) initiate an investigation regarding the alleged harm, abuse, neglect, or exploitation during the 15 working days, the President/CEO or designee may suspend the internal investigation in an effort to coordinate and cooperate with external investigators. The client and employee(s) alleged to have been involved will receive written notice of the President/CEO or designee’s determination. Such written determination will advise the client of the right to appeal the decision to the Client Rights Advisor, Tennessee Department of Mental Health/ Developmental Disabilities.

E.) Outside Appeals:

If the client objects to the determination or proposed action of the President/CEO or designee, then he/she may appeal to one of the following:

2. Notification:

The President/CEO or designee will notify the appropriate agency in the event of an unresolved complaint. Notification will be made no later than the date on which the client is notified of the right to appeal.

3. Documentation:

The complaint review process shall be clearly documented and kept on file in the Administration Office.

4. Assurances:

Clients are guaranteed that retaliation or barrier to treatment will not occur against anyone involved in the complaint process.

A.) It is illegal for Frontier Health to “retaliate” against service recipients because they filed a charge of discrimination or because they complained to another entity about program services discrimination, or because they participated in a discrimination proceeding (such as an investigation or lawsuit).

B.) Further, it is illegal for Frontier Health to refuse to provide program services because a service recipient filed a charge of discrimination with an entity such as this agency, or Tennessee Human Rights Commission, or Tennessee Department of Mental Health and Substance Abuse Services, or the Federal Office of Civil Rights, even if later it was determined that no discrimination occurred.

C.) Should a service recipient feel that they are being retaliated, they have the right to submit a complaint

Department of Mental Health and Substance Abuse Services
500 Deaderick Street, 6th Floor Nashville, TN 37243
(800)560-5767 • Email: OCA.TDMHSAS@tn.gov
See more at: https://www.tn.gov/behavioral-health#sthash.2CVT5YQm.dpuf

http://www.tennessee.gov/behavioral-health/topic/title-vi

Tennessee Human Rights Commission
312 Rosa L Parks Ave, 23rd floor Nashville, TN 37243 (800) 251-3589
Email: ask.thrc@tn.gov
See more at: http://tn.gov/humanrights/#sthash.IHGTkATK.dpuf

http://tn.gov/humanrights/section/complaint-standards

Southeast Region – Atlanta (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee)
U.S. Department of Health and Human Services – Office for Civil Rights
Sam Nunn Atlanta Federal Center, Suite 16T70
61 Forsyth Street, S.W. Atlanta, GA 30303-8909 Customer Response Center: (800) 368-1019 • Fax: (202) 619-3818 • TDD: (800) 537-7697

F.) Clinician/Client Review of Client Problem-Solving Procedures

In Tennessee, client refers to client, court-appointed guardian or committee, or other interested person on behalf of the client)

The following steps will be followed to ensure that the client fully understands the Frontier Health Problem-Solving Procedure:

1. The initial review of the Client Rights and the Problem-Solving Procedure will be completed by the Customer Services Representative at the time of admission and annually thereafter.

2. In clinical programs, the mental health or substance abuse clinician conducting the initial intake and/or evaluation session will be responsible for reviewing the Client Problem-Solving Procedure with special emphasis on the section about reporting of harm, abuse, neglect, and/or exploitation. The nature and potential harm of exploitation will be thoroughly covered. This is a repeat of the information provided to the client by the CSR in Step 1 above.

3. At this time, the client will be requested to sign another acknowledgement form designed for this purpose.

4. In Foster Care or Group Home programs the Clients Rights and Problem Solving Procedure will be completed by the assigned Specialist (Foster Care) or Residential Manager or designee (Group Home).

G.) Internal Recording of Client Concerns, Grievances and Compliments

1. Any Frontier Health staff receiving a written or verbal concern will document the information on the “Frontier Health Consumer Comment“ form (100164)
2. The fully completed form will be forwarded to the Site Director (in Tennessee) of the location where the client is receiving services.
3. The individual in “2” above will review the form and take any appropriate action within their job description and discuss with their respective the individual Site Director in Tennessee.
4. The form will then be forwarded to the respective Senior Vice President or designee with any action taken clearly documented on the form.
5. The Senior Vice President or designee will sign and forward the completed form to the Grievance Coordinator/Director of Performance Improvement and Quality Management Department.
6. An exception to the above process may occur in adolescent residential and foster care programs, where informal programmatic complaints / concerns will initially be handled by the House Manager or Assigned Specialist. Complaints and concerns that are not easily resolved by the House Manager or Specialist, will be considered as general complaints and will be forwarded to the Division Director of Children’s Continuum Services for further follow up. The individual Site Director of Children’s Continuum Services will then follow the steps delineated in items 1-5 above for processing and reporting of these complaints
7. The Grievance Coordinator/Director of Performance Improvement and Quality Management Department will compile all concerns, grievances, and compliments, and provide a quarterly summary to the Performance Improvement Committee.

H.) Procedure for the Use of Frontier Health Comment Box

All clinical sites are to have a suggestion/comment box. All boxes are placed in a location that is easily viewed by consumers. Each site will have a designated staff member to check the box on a regular basis and to maintain a supply of suggestions cards in front of the box. Documenting suggestions taken from the box is handled in the following manner:

1. The Frontier Health staff receiving the suggestion from the box will document the information on the “Frontier Health Consumer Comment” form (100164) and staple the comment card from the box to the form.
2. The fully completed form will be forwarded to the Site Director (in Tennessee) of the location where the client is receiving services.
3. The individual in “B” above will review the form and take any appropriate action within their job description and discuss with their respective Division Director in Tennessee.
4. The form will then be forwarded to the respective Senior Vice President or designee with any action taken clearly documented on the form.
5. The Senior Vice President or designee will sign and forward the completed form to the Grievance Coordinator/Director of Performance Improvement and Quality Management Department.
6. The Grievance Coordinator/Director of Performance Improvement and Quality Management Department will compile all concerns, grievances, and compliments, and provide a quarterly summary to the Performance Improvement Committee.

II. Procedures for all Clients Served in PD1 Service Area and at SunHouse

(In the “Procedures for Clients served in PD1 Service Area and at Sunhouse” client refers to the client, family as appropriate, authorized representative, guardian or other person on behalf of the client)

If any client, family authorized representative, guardian or other person on behalf of the client has a complaint, concern, or problem with the way the client has been treated by any staff while a client at Frontier Health, the following procedures shall be followed with full assurance that under no circumstances will the client or family suffer any reprisals, or be penalized in any way.

A.) Complaints resolution process

Human Rights Complaint Process

1. Each individual has a right to:

A. Make a complaint that the provider has violated any of the rights assured under the Human Rights Regulations;
b. Have a timely and fair review of any complaint in accordance with the regulations and the program’s human rights complaint resolution policies and procedures;
c. Have someone file a complaint on his behalf;
d. Use these and other complaint procedures; and
e. Make a complaint under any other applicable law, including to the protection and advocacy agency.

2.) The individual shall:

a. Be contacted by the Sr. Vice President or designee regarding the complaint within 24 hours;
b. Have access to a human rights advocate for assistance with the complaint;
c. Be protected from retaliation and harm;
d. Have the complaint reviewed, investigated, and resolved as soon as possible;
e. Receive a report with the decision of the Sr. Vice President and action plan within 10 working days; and
f. Be notified in writing of his right to and the process for appealing the Sr. Vice President’s decision and action plan to the LHRC.

3.) Upon receipt of the complaint, providers shall:

a. Notify the department of the complaint as soon as possible, but no later than the next business day;
b. Ensure that the Sr. Vice President or designee contacts the individual regarding the complaint within 24 hours;
c. Initiate an impartial investigation into, or resolution of, the complaint as soon as possible, but not later than the next business day;
d. Take all steps necessary to ensure that individuals involved in the complaint are protected from retaliation and harm;
e. Assist the individual making a complaint in understanding the human rights complaint process, the Frontier Health complaint resolution policies and procedures, and the confidentiality of involved information
f. Ensure that all communications to the individual are in the manner, format, and language most easily understood by the individual
g. Adhere to the reporting requirements in 12VAC35-115-230; and
h. Report the Sr. Vice President’s decision and action plan within 10 working days to the individual, authorized representative, if applicable, and human rights advocate

4.) Frontier Health complaint resolution policies and procedures are in writing and have been approved by DBHDS. The policies and procedures shall:

a. Ensure that anyone who believes that a Frontier Health has violated an individual’s rights under the Human Rights Regulations can report it to the Sr. Vice President or the human rights advocate for resolution;
b. Ensure that employees shall not take, threaten to take, permit or condone any action (i) to punish or retaliate against anyone filing a complaint or (ii) to prevent anyone from filing or helping an individual file a complaint with under the regulations or with an outside entity;
c. Ensure that every attempt is made to receive an individual’s complaint as quickly as possible;
d. Provide opportunities for timely negotiation and resolution for all complaints, including the additional requirements related to abuse, neglect or exploitation in subsection 5 of this section;
e. The complaint review or investigation process, will include (i) specific actions the program will take to protect the individual and gather and document relevant information and (ii) how and when the individual and his authorized representative, if applicable, will receive updates on the progress of the review;
f. The complaint notification process will include:

1. The complaint procedures will be provided to all individuals and authorized representatives at admission to services, and
2. Written notification to the individual regarding his right to and the process to appeal the Sr. Vice President’s decision and action plan to the LHRC; and

g. Staff will receive competency based training on Human Rights at hire and at least annually. Documentation of this competency will be maintained in the employees personnel file.

5.) Additional requirements for complaints involving abuse, neglect, or exploitation:

a. The Sr. Vice President or designee shall take immediate steps to protect the individual until the investigation is complete, including appropriate personnel actions.
b. Any instance of restraint that does not comply with the Human Rights Regulations or an approved variance to that results in injury to an individual, shall be reported to the authorized representative, as applicable, and the department in accordance with the requirements for reporting allegations of abuse and neglect.
c. The Sr. Vice President or designee shall notify the department and authorized representatives, if applicable, of an allegation of abuse or neglect within 24 hours of the receipt of the allegation.
d. The Sr. Vice President shall ensure that the investigation is conducted by a person trained to do investigations and who is not involved in the issues under investigation.
e. The investigator shall provide a written report of the results of the investigation of abuse or neglect to the Sr. Vice President and to the human rights advocate within 10 working days from the date the investigation began unless an extension has been granted.
f. The Sr. Vice President shall decide, based on the investigator’s report and any other available information, whether the abuse, neglect, or exploitation occurred. Unless otherwise provided by law, the standard for deciding whether abuse, neglect, or exploitation has occurred is the preponderance of evidence.
g. The Sr. Vice President shall submit his final decision and action plan, if applicable, to the individual, authorized representative, of applicable, and the human rights advocate within 10 working days of its completion.
h. The Sr. Vice President and designee will fully cooperate with any abuse or neglect complaint investigation conducted by VA DSS and DBHDS .Cooperate with the human rights advocate and the LHRC to investigate and correct conditions or practices interfering with the free exercise of individuals’ human rights and make sure that all employees cooperate with the human rights advocate, the LHRC, and the SHRC in carrying out their duties under this chapter. Provide the human rights advocate unrestricted access to an individual and his services records whenever the advocate deems access is necessary to carry out rights protection, complaint resolution, and advocacy on behalf of the individual;

• If at any time the Sr. Vice President has reason to suspect that the abusive, neglectful, or exploitive act is a crime and that it occurred on the program premises, The Sr. Vice President or designee shall immediately contact the appropriate law-enforcement authorities and fully cooperate with any investigation that may result.

i. Provide the human rights advocate unrestricted access to an individual and his services records whenever the advocate deems access is necessary to carry out rights protection, complaint resolution, and advocacy on behalf of the individual.
j. Ensure the availability of records and employee witnesses upon the request of the LHRC or SHRC.
k. Ensure appointment of a designated liaison to, and appropriate staff participation with, the LHRC, as required.

6.) Frontier Health will require employees to:

a. Employees of the provider shall, as a condition of employment Providers shall require their employees to:
b. Become familiar with this chapter, comply with it in all respects, and help individuals understand and assert their rights;
c. Protect individuals from any form of abuse, neglect, or exploitation by:

1. Not abusing, neglecting, or exploiting any individual;
2. Using the minimum force necessary to restrain an individual;
3. Not permitting or condoning anyone else abusing, neglecting, or exploiting any individual;
4. Reporting all suspected abuse, neglect, or exploitation to the director;

d. Cooperate with any investigation, meeting, hearing, or appeal. Cooperation includes giving statements or sworn testimony.

B.) Outside Appeals for Client Problem Solving:

If the client’s authorized representative or guardian objects to the determination or proposed action of the President/CEO or designee, then he/she may appeal to one of the following:

a. Virginia residents may appeal to the following:

Regional Advocate
Regional Human Rights Advocate
SW Satellite Office
340 Bagley Circle
Marion, VA 24354
(434) 713-1621 or

Executive Director
Planning District 1 Behavioral Health Services
1941 Park Ave. S. W.
Norton, VA 24273
(276) 679-5751

b. Notification: The President/CEO or designee will notify the appropriate agency in the event of an unresolved complaint. Notification will be made no later than the date on which the client is notified of the right to appeal.
c. Documentation: The complaint review process shall be clearly documented and kept on file in the Administration office.
d. Assurances: Clients are to be guaranteed that retaliation or barriers will not occur against anyone involved in the complaint process.

C.) Clinician/Client Review of Client Problem-Solving Procedures

(In Virginia, client refers to the client, family as appropriate authorized representative guardian or other person on behalf of the client.

The following steps will be followed to ensure that the client fully understands the Frontier Health Problem-Solving Procedure:

1. The initial review of the Client Rights and the Problem-Solving Procedure will be completed by the Customer Services Representative at the time of admission and in Virginia, annually thereafter.
2. In clinical programs, the mental health or substance abuse clinician conducting the initial intake and/or evaluation session will be responsible for reviewing the Client Problem-Solving Procedure with special emphasis on the section about reporting of harm, abuse, neglect, and/or exploitation. The nature and potential harm of exploitation will be thoroughly covered. This is a repeat of the information provided to the client by the CSR in Step 1 above.
3. At this time, the client will be requested to sign another acknowledgement form designed for this purpose.

D.) Internal Recording of Client Concerns, Grievances and Compliments

1. Any Frontier Health staff receiving a written or verbal concern will document the information on the “Frontier Health Consumer Comment“ form (100164)
2. The fully completed form will be forwarded to the individual Site Director of the location where the client is receiving services.
3. The individual in “2” above will review the form and take any appropriate action within their job description and discuss with their respective Division Director or Sr. Vice President in Virginia.
4. The form will then be forwarded to the respective Senior Vice President or designee with any action taken clearly documented on the form.
5. The Senior Vice President or designee will sign and forward the completed form to the Grievance Coordinator/Director of Performance Improvement and Quality Management Department.
6. The Grievance Coordinator/Director of Performance Improvement and Quality Management Department will compile all concerns, grievances, and compliments, and provide a quarterly summary to the Performance Improvement Committee.

E.) Procedure for the Use of Frontier Health Comment Box

All clinical sites are to have a suggestion/comment box. All boxes are placed in a location that is easily viewed by consumers. Each site will have a designated staff member to check the box on a regular basis and to maintain a supply of suggestions cards in front of the box. Documenting suggestions taken from the box is handled in the following manner:

1. The Frontier Health staff receiving the suggestion from the box will document the information on the “Frontier Health Consumer Comment” form (100164) and staple the comment card from the box to the form.
2. The fully completed form will be forwarded to the Site Director and to the Division Director of the location where the client is receiving services.
3. The individual in “B” above will review the form and take any appropriate action within their job description and discuss with their respective Division Director or Sr. Vice President in Virginia.
4. The form will then be forwarded to the respective Senior Vice President or designee with any action taken clearly documented on the form.
5. The Senior Vice President or designee will sign and forward the completed form to the Grievance Coordinator/Director of Performance Improvement and Quality Management Department.
6. The Grievance Coordinator/Director of Performance Improvement and Quality Management Department will compile all concerns, grievances, and compliments, and provide a quarterly summary to the Performance Improvement Committee.