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5.3.1
Introduction
A grievance and request for investigation process has been established
for persons determined to have a serious mental illness who are
enrolled in the ADHS/DBHS behavioral health system. The grievance
and request for investigation process for persons determined to
have a serious mental illness focuses on situations in which:
- The rights
of a person determined to have a serious mental illness have been
violated;
- The person
has been abused or mistreated;
- There is
a death of a person.
The intent of
this section is to describe behavioral health provider responsibilities
related to grievances and requests for investigations involving
persons who have been determined to have a serious mental illness.
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5.3.2
References
The following citations can serve as additional resources for this
content area:
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5.3.3
Scope
To whom does this apply?
This applies to all persons who have been determined
to have a serious mental illness and are enrolled in the ADHS/DBHS
behavioral health system.
5.3.4
Definitions
Abuse
Condition
Requiring Investigation
Dangerous
Grievance
or Request for Investigation
Illegal
Inhumane
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5.3.5
Objectives
To ensure that behavioral health providers allow persons
determined to have a serious mental illness appropriate access to
the grievance and request for investigation process.
5.3.6
Grievance and Requests for Investigation Principles
It is ADHS’/DBHS intent that the grievance and request
for investigation process for persons determined to have a serious
mental illness must:
- Resolve
in an expeditious and equitable manner any allegations that a
rights violation or a condition requiring investigation has occurred
with regard to persons determined to have a serious mental illness;
- Maintain
confidentiality and privacy of the grievance matters and records
at all times;
- Take the
necessary steps to protect the health, safety and security of
any person determined to have a serious mental illness, witness
or individual filing the grievance;
- Communicate,
as appropriate, timely information on matters and decisions related
to the grievance and investigation to affected parties;
- Involve
the active cooperation and participation as deemed appropriate
of providers with a direct interest in the matter under review;
and
- Serve as
a means for identifying system deficiencies and developing corrective
action plans to resolve any deficiencies identified.
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5.3.7
Procedures
5.3.7-A.
Filing grievances and requests for investigations
A grievance or request for investigation may be submitted orally
or in writing (see
PM Form 5.3.1 Appeal or SMI Grievance Form) by a person determined to have a serious mental illness
who is enrolled with a T/RBHA or by any other concerned person in
situations in which it is alleged that:
- A violation
of the person’s rights may have occurred; or
- A condition
requiring investigation currently exists or has occurred.
If asked, a
behavioral health provider must assist a person in initiating an
oral or written grievance or request for investigation.
If a behavioral
health provider has reason to believe that a rights violation or
condition requiring investigation has occurred, they must ensure
that a grievance or request for investigation is filed. When requested,
failure of an employee or individual under contract with a provider
to file a grievance or request for investigation may be grounds
for corrective action against the employee.
All grievances
or requests for investigation must be:
- Submitted
orally or in writing to ADHS/DBHS at:
150 North 18th Avenue, Suite 210
Phoenix, AZ 85007
- Reduced
to writing on the ADHS/DBHS grievance or request for investigation
form (see
PM Form 5.3.1) by either the person filing the grievance
or request for investigation or by the provider to whom the grievance
or request for investigation is made.
- Filed orally
or in writing within one year of the alleged rights violation
or condition for investigation occurred.
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5.3.6-B.
Grievance and request for investigation resolution process
The entity initially responsible for resolving grievances or requests
for investigation differs depending on the nature of the grievance
or request for investigation:
- Allegations
of rights violations involving abuse or the death of a person
determined to have a serious mental illness are investigated by
ADHS/DBHS; and
- Allegations
of rights violations other than abuse or death are investigated
by:
- The Arizona
State Hospital if the violation occurred at the Hospital;
- The RBHA
if the violation occurred at the RBHA or at one of its providers;
or
- ADHS/DBHS
if the violation occurred at the TRBHA or at one of its providers.
The process
for resolving grievances or requests for investigation may also
vary in length; ranging from:
- Immediate
disposition without investigation;
- An investigation
and final decision;
- An administrative
appeal; or
- An administrative
hearing.
How is time
computed?
When computing any period of time associated with this process:
- The period
begins the day after the act, event or decision occurs and includes
all calendar days and the final day of the period. If the final
day of the period is a weekend or legal holiday, the period is
extended until the end of the next day that is not a weekend or
a legal holiday;
- If the period
of time is not designated as calendar days and is less than 11
days, then intermediate Saturdays, Sundays and legal holidays
must not be included in the computation.
What are
the responsibilities of a behavioral health provider?
Behavioral health providers are not directly responsible for the
resolution of the grievance or request for investigation, but are
required to actively participate in the process as follows:
- Cooperate
in the investigation by participating in any private face-to-face
interviews the investigator requests. Failure to cooperate may
lead to corrective action;
- Provide
information requested by the RBHA or ADHS/DBHS designated investigator;
- Continue
to cooperate and participate as necessary in any subsequent appeal
proceedings relating to the grievance or request for investigation;
and
- Implement
any immediate, reasonable action required to protect the health
and safety of any person determined to have a serious mental illness
or involved staff.
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5.3
Grievance and Requests
for Investigation for Persons Determined to have a Serious Mental
Illness (SMI)
Last Revised: 05/19/2004
Effective Date: 08/01/2004
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