Complaints and Grievances

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.

Patients and families must be able to raise concerns easily and safely, and get a fair, prompt answer. Complaints also tell the Agency where care needs to improve. This policy is the Agency's written complaint procedure under R 325.45241.

Complaints from a patient, or the patient's legal guardian or designated representative when that person has standing, about any aspect of the Agency's care or services, by anyone furnishing services on the Agency's behalf, including contractors and inpatient facilities the Agency arranges. Complaints from other family members, facilities and members of the public are handled the same way.

The following terms have the meanings given below when used in this policy.

The Agency adopts written policies and procedures "for the initiation, investigation, and resolution of complaints filed by a patient, or the patient's legal guardian or designated representative when that person has standing", and makes the procedure available to the patient at the time of admission and upon request (R 325.45241(1)). Each patient has the right "To voice grievances regarding treatment or care that is (or fails to be) furnished and the lack of respect for property by anyone who is furnishing services on behalf of the hospice" and "To not be subjected to discrimination or reprisal for exercising his or her rights" (42 CFR §418.52(b)(1)(iii)-(iv)). Michigan law also entitles patients to present grievances without fear of reprisal (MCL 333.20201(2)(g)).

At admission each patient or representative receives Form MI-HSP-CMP-01-A (in English or Spanish, and explained in another language or format as needed). It is also given on request and posted in the office. It contains at least (R 325.45241(1)(a)-(d)):

• A notice that a complaint may be made orally or in writing to the Agency, to the Department, or to both.
• The name, title and contact information of the complaint officer.
• The contact information to file a complaint with the Department: Michigan Department of Licensing and Regulatory Affairs (LARA), Bureau of Survey and Certification, Complaint Intake Section, P.O. Box 30838, Lansing, Michigan 48909; toll-free Complaint Hotline 800-882-6006; online complaint form at https://apps.lara.state.mi.us/BscComplaintIntakeForm.
• Resources to help the person write a complaint if needed: any staff member, the social worker or the complaint officer will write it down for them, and interpreters are free.

For Medicaid patients, the grievance procedure is part of the conditions of admission given in writing within ten days of the effective date of admission (Michigan Medicaid Provider Manual, Hospice, Section 3.3). The Agency gives Form MI-HSP-CMP-01-A at the first visit, which meets both rules. If the Agency uses a standard complaint form, a copy is given to the patient or representative on request (R 325.45241(3)).

• Any staff member who receives a complaint listens, thanks the person, deals with any immediate risk to the patient, and passes it to the complaint officer the same day (by telephone after hours through the on-call supervisor). Staff never discourage a complaint or suggest that care could be affected.
• The complaint officer records it in the complaint log and on Form MI-HSP-CMP-01-B with the date and time of receipt, and decides at once whether it is a serious complaint.
• The complaint officer acknowledges the complaint to the complainant within 5 (Agency standard), by telephone or in writing, unless it was anonymous. Acknowledgment does not change the start deadlines below.
• If the complaint alleges mistreatment, neglect, abuse, an injury of unknown source or misappropriation of property by anyone furnishing services for the Agency, the complaint officer tells the Administrator immediately and Policy MI-HSP-ANE-02 also applies. If it suggests abuse, neglect or exploitation, the staff member's own report under Policy MI-HSP-ANE-01 or MI-HSP-ANE-03 is made at once.
• If the patient alleges sexual misconduct by a person employed by, under contract to or granted privileges by the Agency, the records lead flags the patient's clinical record for 15-year retention (MCL 333.20175(2)(b); Policy MI-HSP-REC-01).

Business days exclude Saturdays, Sundays and legal holidays (R 325.45103(1)(j)). These are maximums. The Agency starts the investigation of a serious complaint the same day where possible.

• The complaint officer, or a manager not involved in the matter, investigates: talks with the complainant and the patient, the staff involved and witnesses, and reviews the clinical record, schedules, on-call logs and other evidence.
• If a complaint does not allege serious injury, harm, impairment or death and is resolved to the complainant's satisfaction before the investigation is complete, the investigation may be discontinued (R 325.45241(2)). The complaint officer records the resolution and the complainant's agreement.
• The findings, the action taken (for example changing the visit schedule or staff, retraining, a process change) and the date are recorded on Form MI-HSP-CMP-01-B.
• The written results go to the complainant in plain language, in the complainant's language where possible, and state how to contact the Department if the complainant is not satisfied.
• If the complainant is not satisfied, the complainant may ask the Administrator to review the decision; the Administrator answers in writing within 10 business days (Agency standard). This does not delay or replace the right to complain to the Department.

• A patient or anyone else may complain to the Department at any time, instead of or as well as to the Agency: Michigan Department of Licensing and Regulatory Affairs (LARA), Bureau of Survey and Certification, Complaint Intake Section, P.O. Box 30838, Lansing, Michigan 48909; toll-free Complaint Hotline 800-882-6006; online complaint form at https://apps.lara.state.mi.us/BscComplaintIntakeForm. A complaint to the Department is filed within 12 months of the alleged violation (later only if the complainant shows good cause), by the hotline or in writing by mail, email, online form, fax or another method on the Department's website, and may be anonymous (R 325.45243(1), (2), (5)). The Department sends written findings, or instructions for obtaining them, no later than 30 days after the conclusion of its investigation, except for anonymous complaints (R 325.45243(8)). Michigan law also provides for review of the Department's decision on a complaint (MCL 333.20176).
• Medicare patients may raise concerns about the quality of care with the Medicare Quality Improvement Organization named on the patient's Medicare notices, or by calling 1-800-MEDICARE (1-800-633-4227).
• Medicaid patients may call the Medicaid Beneficiary Help Line at 800-642-3195.
• Residents of nursing homes, adult foster care homes and homes for the aged may contact the Michigan Long Term Care Ombudsman Program (advocates for residents in nursing homes, adult foster care homes, and homes for the aged) at 866-485-9393.
• Privacy complaints may also go to the U.S. Department of Health and Human Services, Office for Civil Rights (Policy MI-HSP-PRV-01).

No patient, family member or staff member is treated differently, threatened, or has care changed or ended for making a complaint, to the Agency or to anyone else (42 CFR §418.52(b)(1)(iv)). Any suggestion of reprisal is itself investigated under this policy.

Accountability under this policy is allocated as follows.

The complaint officer keeps the complaint log and, for each complaint, Form MI-HSP-CMP-01-B, the investigation report and all correspondence with the complainant, for at least 3 years (R 325.45241(10)); the Agency's schedule keeps them 7 years. Each quarter the complaint officer reports to the QAPI program the number and types of complaints, whether each investigation started within 3 or 7 business days, was completed within 15 business days (or the delay documented and the complainant told), and whether written results were sent within 10 business days, with trends and actions (Policy MI-HSP-QA-01).

At orientation and every year staff learn how to receive a complaint, the same-day handoff to the complaint officer, the link to abuse reporting, and the patient's right to complain to the Department. The complaint officer and managers who investigate are trained on the Michigan time limits.

This policy implements the following authorities.

• Mich. Admin. Code R 325.45241, complaints filed with the Agency
• Mich. Admin. Code R 325.45243, complaints filed with the Department
• Mich. Admin. Code R 325.45103(1)(j), business day
• MCL 333.20176, complaints to the Department
• MCL 333.20201(2)(g), right to present grievances
• MCL 333.20175(2)(b), 15-year retention of records where a patient complains of sexual misconduct
• Michigan Medicaid Provider Manual, Hospice, Section 3.3, conditions of admission including the grievance procedure
• 42 CFR §418.52(b)(1)(iii)-(iv) and (b)(4), grievances, no reprisal, alleged violations

The following documents are read together with this policy.

This policy is adopted by the governing body of 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.

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 the References section is amended, the amendment is recorded in this table and a new version of this policy is issued.