{"ref":"MO-HC-CMP-01","title":"Participant Grievances and Complaints","category":"Client rights","own":false,"summary":"The Agency's grievance system: how participants learn about it, the many ways to complain, logging and acknowledgment within 5 and resolution within 30 as the Agency's own standard, matters that must go to DHSS first, the right to complain to DSDS at any time and how DSDS handles HCBS grievances, protection from retaliation, and how grievances feed the quality program.","inShort":["Participants may complain about anything, in any way. Listen politely and never argue or discourage them.","Pass every complaint to the office the same day.","The Agency answers within 5 and resolves within 30.","Participants may also complain to DSDS at any time: 1-866-835-3505 (DSDS HCBS Call Center).","No participant may be treated differently because they complained."],"primaryCitation":"19 CSR 15-7.021(18)(P)","citations":["19 CSR 15-7.021(18)(O)4","19 CSR 15-7.021(18)(P)","19 CSR 15-7.010(9)(C)","19 CSR 15-7.010(12)","RSMo 192.2475.9","RSMo 192.2475.15","MO HealthNet Personal Care Provider Manual §2.2","DSDS Home and Community Based Services Manual 8.15"],"federalCitations":["45 CFR §164.530(d)"],"surveyorAsks":["How does a participant make a complaint, and where is it documented that the participant received your grievance procedure?","Show me your grievance log for the last six months and how two of them were resolved.","What do you tell a participant who is not satisfied with your answer?","How do you make sure a participant who complains is not treated differently afterward?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"MO-HC-CMP-01-A","title":"Grievance Form"},{"ref":"MO-HC-CMP-01-B","title":"Grievance Log"}],"sections":[{"heading":"Terms of Reference","body":["This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1."],"table":{"caption":null,"headers":[["Item"],["Detail"]],"rows":[[["Issued by"],["The governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}]],[["Document owner"],[{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"},", ",{"k":"field","name":"people.complaintOfficer.title","text":"Administrator"}]],[["Authority"],["Missouri does not license non-medical in-home services. This policy is adopted under the Agency's in-home services participation agreement with the Missouri Medicaid Audit and Compliance Unit and its MO HealthNet personal care enrollment, and follows 19 CSR 15-7.021(18)(P) and (18)(O)4; 19 CSR 15-7.010(9)(C) and (12); RSMo 192.2475.9 and .15; and the MO HealthNet Personal Care Provider Manual §2.2. The time frames for the Agency's own handling of grievances are the Agency's own standards; Missouri rules set none."]],[["Applies to"],["Every employee, volunteer and contract worker, the complaint officer, the designated manager and the governing body."]],[["Status"],["Mandatory. Adherence is a condition of employment and of any contract for services. No provision may be waived, shortened, or varied by any employee."]],[["Not covered here"],["Abuse, neglect, exploitation, misappropriation and falsification, which are reported to DHSS first under Policies MO-HC-ANE-01 and MO-HC-ANE-03. Appeals of DSDS decisions to deny, reduce or end services, which go through the DSDS appeal and hearing process, not this policy. Employee grievances, which are in the personnel policies."]],[["Review"],["Reviewed by the document owner at least every ",{"k":"field","name":"settings.reviewFrequencyMonths","text":"12"}," months and, as the Agency's own standard, within 30 days of any amendment to a rule or program document cited at Section 14. Each review is recorded at Section 17 whether or not the text changes."]],[["Amendment"],["Any change requires the approval of the governing body and the issue of a new version number. Superseded versions are retained for six years from the date they were last in effect (45 CFR §164.530(j))."]],[["Distribution"],["Master copy held in the policy manual at the Agency's principal place of business at ",{"k":"field","name":"agency.address","text":"100 Example Street, Suite 100, Jefferson City, Missouri 65101"},". Every participant receives Form MO-HC-CMP-01-A and the grievance procedure at the start of service. Every employee receives a copy at orientation."]],[["Questions"],["Direct to the complaint officer, ",{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"},", on ",{"k":"field","name":"people.complaintOfficer.phone","text":"(573) 555-0111"}," or ",{"k":"field","name":"people.complaintOfficer.email","text":"person1@example.com"},"."]]]},"edited":false},{"heading":"1. Purpose","body":["This policy sets out how ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}," (the \"Agency\") listens to participants who are unhappy with any part of its services, resolves their concerns fairly and quickly, and protects them from any retribution. Missouri does not license non-medical in-home services; the duty to have a grievance system comes from 19 CSR 15-7 and the MO HealthNet Personal Care Program. Every participant has the right to \"Know the provider's established grievance procedure and how to make a complaint about the service and receive cooperation to reach a resolution, without fear of retribution\" (19 CSR 15-7.021(18)(O)4)."],"edited":false},{"heading":"2. Scope","body":["This policy covers any expression of dissatisfaction by a participant, a representative, a family member or anyone acting for the participant, about the operation of the Agency's in-home service program or the delivery of care: missed or late visits, worker conduct, scheduling, communication, billing, privacy or any other matter."],"edited":false},{"heading":"3. Definitions","body":["For the purposes of this policy:"],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Grievance"],["A complaint \"concerning the operation of the in-home service program and/or delivery of care\" (19 CSR 15-7.021(18)(P)), made in any way. In this policy \"grievance\" and \"complaint\" mean the same thing."]],[["Complaint officer"],["The person who runs the grievance system: ",{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"},", ",{"k":"field","name":"people.complaintOfficer.title","text":"Administrator"},", ",{"k":"field","name":"people.complaintOfficer.phone","text":"(573) 555-0111"},", ",{"k":"field","name":"people.complaintOfficer.email","text":"person1@example.com"},"."]],[["Complainant"],["The participant or the person acting for the participant who makes the grievance. A grievance from someone else about a participant's care is handled the same way, with the participant's agreement."]],[["Resolved"],["The Agency has looked into the grievance, taken the action within its control, and told the complainant the outcome and the reasons."]],[["HCBS grievance process"],["The single statewide grievance process DSDS runs for home and community-based services, through the online grievance portal and the HCBS Call Center (DSDS HCBS Manual 8.15)."]],[["Designated manager"],["The manager the Agency designates to MMAC as responsible for day-to-day operation under 19 CSR 15-7.021(14): ",{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"},". In this manual the designated manager is the Administrator."]],[["Participant"],["An eligible individual who receives one or more services (19 CSR 15-7.005(21)). \"Client\" and \"in-home services client\" (RSMo 192.2400(10)) mean the same person in this manual."]],[["MMAC"],["The Missouri Department of Social Services, Missouri Medicaid Audit and Compliance Unit, which holds the Agency's in-home services participation agreement (Missouri calls it a contract) and its MO HealthNet provider enrollment."]],[["DSDS"],["The Missouri Department of Health and Senior Services (DHSS), Division of Senior and Disability Services, which assesses participants and authorizes in-home services. 19 CSR 15-7.021 calls it \"the division\"."]],[["MO HealthNet provider number"],["The provider number MO HealthNet issues to the Agency on enrollment: ",{"k":"field","name":"agency.licenseNumber","text":"000000"},". Missouri issues no license for non-medical in-home services. This number, not a license number, identifies the Agency in this manual."]],[["Agency's own standard"],["A requirement the Agency sets for itself that goes beyond, or fills a gap in, the rules. This manual labels each one so that it is never mistaken for a requirement of MMAC, DSDS or MO HealthNet."]]]},"edited":false},{"heading":"4. Policy Statement (19 CSR 15-7.021(18)(P))","body":["The Agency must \"Have a system through which participants may present grievances concerning the operation of the in-home service program and/or delivery of care\" (19 CSR 15-7.021(18)(P)), and \"A written complaint procedure through which the participant can communicate to the service provider aspects of the service which impact negatively upon them\" (19 CSR 15-7.010(9)(C)). The provider \"must document the participant's receipt of information regarding the grievance procedures\" (PC Manual §2.2).\n\nThe Agency welcomes complaints, makes them easy to make, handles them within the time frames in Section 7, never lets a complaint affect the participant's services or treatment, and uses what it learns to improve."],"edited":false},{"heading":"5. How Participants Learn About This Procedure","body":[],"list":[["At the start of service the administrative supervisor gives and explains the participant rights statement and this procedure, with Form MO-HC-CMP-01-A, to the participant and, when appropriate, the primary caregiver (Policy MO-HC-CR-01), and documents the participant's receipt in the case record (PC Manual §2.2)."],["The information is given in a language and format the participant understands; Spanish versions are available and other languages and formats are provided under Policy MO-HC-CR-02."],["The procedure is reviewed again at the annual on-site visit, and whenever the participant seems unhappy with the service (Agency's own standard)."]],"ordered":false,"edited":false},{"heading":"6. How to Make a Grievance","body":["A participant may complain in any way, and no form is required."],"list":[["By telephone to the office at ",{"k":"field","name":"agency.phone","text":"(573) 555-0100"}," during ",{"k":"field","name":"agency.officeHours","text":"Monday through Friday, 8:00 a.m. to 5:00 p.m. Central"},", or to the after-hours line ",{"k":"field","name":"agency.afterHoursPhone","text":"(573) 555-0199"},"."],["To the complaint officer, ",{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"},", at ",{"k":"field","name":"people.complaintOfficer.phone","text":"(573) 555-0111"}," or ",{"k":"field","name":"people.complaintOfficer.email","text":"person1@example.com"},"."],["In writing, on Form MO-HC-CMP-01-A or in a letter, to ",{"k":"field","name":"agency.address","text":"100 Example Street, Suite 100, Jefferson City, Missouri 65101"},"."],["To any Agency worker, who passes it to the office the same day."],["Through a family member, friend, representative or advocate. Callers who are deaf, hard of hearing or speech-impaired may use ",{"k":"field","name":"fixed.relayMissouri","text":"Relay Missouri 1-800-735-2966 (text) or 1-800-735-2466 (voice)"},"."],["Anonymously. The Agency looks into anonymous complaints as far as it can."]],"ordered":false,"edited":false},{"heading":"7. Handling a Grievance","body":["Missouri rules set no time frames for a provider's own grievance handling. As the Agency's own standard, the Agency handles each grievance as follows."],"list":[["Record it: whoever receives the grievance tells the complaint officer the same day, and the complaint officer enters it on the grievance log, Form MO-HC-CMP-01-B."],["Screen it at once: if the grievance suggests abuse, neglect, exploitation, misappropriation or falsification, it is reported to DHSS immediately, ",{"k":"field","name":"fixed.abuseReportRoute","text":"the Missouri Department of Health and Senior Services Adult Abuse and Neglect Hotline at 1-800-392-0210 (seven days a week, 7:00 a.m. to 8:00 p.m.), or online at any time through the Missouri Adult Abuse and Neglect Online Reporting System at https://moapss.health.mo.gov/"},", and Policies MO-HC-ANE-01 and MO-HC-ANE-03 apply before anything else. A privacy complaint is also handled by the privacy official (Policy MO-HC-PRV-01). A billing concern is also handled under Policy MO-HC-ETH-03."],["Acknowledge it: the complaint officer contacts the complainant within ",{"k":"field","name":"settings.complaintAckDays","text":"5"}," of receipt to confirm the grievance, explain the next steps and ask what outcome the complainant wants."],["Look into it: the complaint officer gathers facts from the complainant, the workers involved, the schedule, EVV records and the case record, and involves the registered nurse for any care concern."],["Resolve it: the complaint officer decides what to do, takes the action within the Agency's control, and tells the complainant the outcome and the reasons, in writing if the complainant wishes, within ",{"k":"field","name":"settings.complaintResolveDays","text":"30"}," of receipt. If more time is needed, the complainant is told why and when to expect an answer."],["Review: a complainant who is not satisfied may ask the designated manager, ",{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", to review the decision; the designated manager may refer it to the governing body. The complainant is also told about the right to contact DSDS (Section 8)."],["Close it: the complaint officer records the outcome, the date closed and any corrective action on the log."]],"ordered":true,"edited":false},{"heading":"8. Complaints to DSDS and Other Agencies","body":["A participant may complain to the state at any time, before, during or instead of using this procedure. The Agency gives this information in Form MO-HC-CMP-01-A and never discourages its use."],"list":[["DSDS describes its own process this way: the participant or legal representative must be contacted within 7 calendar days of the grievance being filed, and resolution shall not exceed 90 calendar days (DSDS HCBS Manual 8.15). These are DSDS's time frames, not the Agency's."],["The participant or legally responsible representative must approve before DSDS's review begins (DSDS HCBS Manual 8.15). Agency staff may help a participant file with DSDS if the participant asks."],["When DSDS or the HCBS Constituent Services Unit contacts the Agency about a grievance, the complaint officer responds promptly and fully, and enters the grievance on the Agency's log."]],"ordered":false,"table":{"caption":["Table 1.  Outside routes"],"headers":[["Route"],["For"],["Source"]],"rows":[[["DSDS: ",{"k":"field","name":"fixed.complaintBlock","text":"the Missouri Department of Health and Senior Services, Division of Senior and Disability Services, through the HCBS Call Center at 1-866-835-3505 or the online HCBS grievance portal at https://moexperience.qualtrics.com/jfe/form/SV_0uk09RI3KapdsGi"}],["Any concern about the assessment, the care plan, service delivery by the Agency or its workers, or HCBS settings. DSDS advises in-home services clients of \"the right to call the department for any reason, including dissatisfaction with the provider or services\""],["RSMo 192.2475.15; DSDS HCBS Manual 8.15"]],[["DHSS Adult Abuse and Neglect Hotline: ",{"k":"field","name":"fixed.abuseReportRoute","text":"the Missouri Department of Health and Senior Services Adult Abuse and Neglect Hotline at 1-800-392-0210 (seven days a week, 7:00 a.m. to 8:00 p.m.), or online at any time through the Missouri Adult Abuse and Neglect Online Reporting System at https://moapss.health.mo.gov/"}],["Abuse, neglect, exploitation, misappropriation or falsification only, not service complaints"],["RSMo 192.2410; Policy MO-HC-ANE-01"]],[[{"k":"field","name":"fixed.ltcOmbudsman","text":"Missouri Long-Term Care Ombudsman Program, 912 Wildwood Drive, P.O. Box 570, Jefferson City, MO 65102-0570, 1-800-309-3282, LTCOmbudsman@health.mo.gov"}],["Participants who live in a long-term care facility"],["Policy MO-HC-ANE-01"]],[["U.S. Department of Health and Human Services, Office for Civil Rights"],["Privacy complaints and discrimination complaints"],["45 CFR §164.530(d); Policy MO-HC-CR-02"]],[["DSDS appeal and hearing process"],["Disagreement with a DSDS decision to deny, reduce or end services"],["DSDS HCBS Manual 8.15"]]]},"edited":false},{"heading":"9. No Retaliation","body":[],"list":[["No participant is treated differently, has services reduced, delayed or ended, or is threatened, because the participant or a family member complained to the Agency, to DSDS or to anyone else (19 CSR 15-7.021(18)(O)4)."],["No person who directs or exercises authority in the Agency may harass, dismiss or retaliate against a participant or employee because he or she or a family member made a report of a suspected violation of laws, standards or regulations (RSMo 192.2475.9). DSDS also prohibits retaliation by provider agencies or provider employees against anyone who submits a grievance or takes part in the grievance process (DSDS HCBS Manual 8.15)."],["As the Agency's own standard, the complaint officer checks with the complainant within 30 days after closing a grievance that services and treatment have not changed because of it."]],"ordered":false,"edited":false},{"heading":"10. Learning From Grievances","body":["The Agency must obtain the views of participants about the services they receive (19 CSR 15-7.010(12)). As the Agency's own standard, the complaint officer reports the number, type, time to resolve and outcome of grievances to the quality program each quarter (Policy MO-HC-QA-01), and the governing body reviews a summary at least twice a year."],"edited":false},{"heading":"11. Responsibilities","body":["Accountability under this policy is allocated as follows."],"table":{"caption":["Who is accountable for what"],"headers":[["Role"],["Responsibility under this policy"]],"rows":[[["Governing body"],["Reviews grievance summaries, decides grievances the designated manager refers, and makes sure no one is penalized for complaining."]],[[{"k":"field","name":"people.complaintOfficer.name","text":"Pat Sample"},", ",{"k":"field","name":"people.complaintOfficer.title","text":"Administrator"}," (complaint officer)"],["Owns this policy. Keeps the log, acknowledges and resolves grievances within the Agency's time frames, screens for matters that must go to DHSS, and reports trends."]],[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}," (designated manager)"],["Reviews decisions a complainant does not accept, and acts on grievances about the complaint officer."]],[[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}],["Looks into grievances about care, and makes any needed report to DSDS."]],[["Administrative supervisor"],["Gives and documents the grievance information at the start of service, and reviews it at annual visits."]],[["Every worker"],["Accepts complaints politely, passes them to the office the same day, and never argues with or discourages a complainant."]]]},"edited":false},{"heading":"12. Records and Compliance Monitoring","body":["Forms MO-HC-CMP-01-A, the grievance log (Form MO-HC-CMP-01-B), investigation notes, responses and correspondence with DSDS are kept for the period in Policy MO-HC-REC-01. Privacy complaints and their disposition are also documented as 45 CFR §164.530(d) requires. As the Agency's own standard, the complaint officer checks each quarter that every grievance was acknowledged within ",{"k":"field","name":"settings.complaintAckDays","text":"5"}," and resolved within ",{"k":"field","name":"settings.complaintResolveDays","text":"30"},", and records the reason for any that were not."],"edited":false},{"heading":"13. Staff Training","body":["Every worker is trained on participants' right to complain, how to accept a complaint, and the rule against retaliation at orientation (Policy MO-HC-HR-05, Session B). Office staff and the complaint officer are trained on Sections 7 and 8."],"edited":false},{"heading":"14. References","body":["This policy implements the following authorities."],"list":[["19 CSR 15-7.021(18)(O)4, (18)(P) (amended effective August 30, 2023)"],["19 CSR 15-7.010(9)(C), (12)"],["RSMo 192.2410, 192.2475.9, 192.2475.15"],["MO HealthNet Personal Care Provider Manual §2.2 (published August 10, 2026)"],["DSDS Home and Community Based Services Manual 8.15, Grievance Process"],["45 CFR §164.530(d)"]],"ordered":false,"edited":false},{"heading":"15. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Form MO-HC-CMP-01-A"],["Grievance Form"]],[["Form MO-HC-CMP-01-B"],["Grievance Log"]],[["Policy MO-HC-CR-01"],["Participant Rights and Grievance Information"]],[["Policy MO-HC-CR-02"],["Nondiscrimination, Accessibility, and Language Access"]],[["Policy MO-HC-ANE-01"],["Recognizing and Reporting Abuse, Neglect, and Exploitation of Adults"]],[["Policy MO-HC-ANE-03"],["Misappropriation, Falsification, and Protecting Participants During an Investigation"]],[["Policy MO-HC-PRV-01"],["HIPAA Privacy and Confidentiality of Participant Information"]],[["Policy MO-HC-ETH-03"],["Compliance Program: Preventing and Detecting Improper Conduct"]],[["Policy MO-HC-GOV-03"],["Office, Telephone Contact, Business Hours, and Change Notices"]],[["Policy MO-HC-QA-01"],["Quality Improvement and Participant Feedback"]]]},"edited":false},{"heading":"16. Approval","body":["This policy is adopted by the governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},". The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below."],"edited":false},{"heading":"17. Revision History","body":["Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a rule cited in Section 14 is amended, the amendment is recorded in this table and a new version of this policy is issued."],"edited":false}],"missing":[],"editedCount":0,"pack":"mo-hca","state":"Missouri","service":"Home care","guides":[{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"}],"sample":true,"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}