Participant Grievances and Complaints

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.

This policy sets out how 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).

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.

For the purposes of this policy:

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).

The 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.

• 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).

A participant may complain in any way, and no form is required.

• By telephone to the office at (573) 555-0100 during Monday through Friday, 8:00 a.m. to 5:00 p.m. Central, or to the after-hours line (573) 555-0199.
• To the complaint officer, Pat Sample, at (573) 555-0111 or person1@example.com.
• In writing, on Form MO-HC-CMP-01-A or in a letter, to 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 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.

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.

1. 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.
2. Screen it at once: if the grievance suggests abuse, neglect, exploitation, misappropriation or falsification, it is reported to DHSS immediately, 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.
3. Acknowledge it: the complaint officer contacts the complainant within 5 of receipt to confirm the grievance, explain the next steps and ask what outcome the complainant wants.
4. 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.
5. 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 30 of receipt. If more time is needed, the complainant is told why and when to expect an answer.
6. Review: a complainant who is not satisfied may ask the designated manager, 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).
7. Close it: the complaint officer records the outcome, the date closed and any corrective action on the log.

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.

• 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.

• 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.

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.

Accountability under this policy is allocated as follows.

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 5 and resolved within 30, and records the reason for any that were not.

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.

This policy implements the following authorities.

• 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)

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 Section 14 is amended, the amendment is recorded in this table and a new version of this policy is issued.