Complaint Policy and Procedure

Section: Case Management Agency (CMA)
Created: 02/25/2024
Revised:
Effective: 03/01/2024

Purpose

The purpose of the Weld County CMA (WCCMA) Complaint Policy and Procedure is to establish a clear, transparent, and accessible framework for addressing and resolving complaints and grievances related to the services provided by the agency. This policy aims to uphold the highest standards of service and accountability, ensuring that all members, their guardians, and legal representatives are treated with respect, dignity, and fairness.

Contract Section(s)

1.5: The Contractor shall develop and maintain a formal complaints procedure, notify Members annually of the procedures, and make the procedure publicly available.

Relevant Rule(s)

8.7201.D Complaint Process for Individuals and Members

8.7201.C Community Advisory Committee

Definitions

Case Management Agency: A public, private, or non-governmental non-profit agency that meets all applicable state and federal requirements and is certified by the Department to provide Case Management services for Home and Community-Based Services (HCBS) waivers and State General Fund programs.

Complaint: Any statement received from an individual or Member relating to unsatisfactory services provided through the Case Management Agency. This includes, but is not limited to, general business functions, administration, State General Fund program functions, and Case Management functions. Complaints regarding activities outside the scope of work for the Case Management Agency are excluded from this definition.

Community Advisory Committee: A critical forum for public input into the operations of the Case Management Agency. Responsibilities include monthly reviews of the agency's complaint log, receipt of community complaints about the agency during open forums at their meetings, assistance in resolving outstanding complaints, and providing referrals to the Department's escalation process when necessary. The committee also advises on policies and procedures, contributing to the review of service delivery, marketing strategies, resource development, and overall agency operations, focusing on service quality, member satisfaction, and local-level complaint resolution.

Grievance: The formal expression of a Complaint.

Weld County Case Management Agency: The public agency contracted by the Department of Health Care Policy and Financing to provide case management services for HCBS and non-HCBS Long Term Service and Support programs in Weld County.

Uniform Complaint Process: Individuals and/or their Legally Authorized Representatives shall have access to a uniform Complaint system provided for all individuals served by the Case Management Agency

Requirements

  1. WCCMA will provide contact information for a person within the Case Management Agency designated to receive Complaints.
  2. The agency will identify support person(s) who can assist individuals or Members in submitting a Complaint.
  3. An opportunity will be provided to find a mutually acceptable solution to a complaint, potentially including mediation if both parties voluntarily agree.
  4. Timelines for resolving the Complaint will be established.
  5. A process for escalating the complaint to the Agency director or designee for consideration will be in place if the Complaint cannot be resolved at a lower level. This may include the Department's escalation process, if necessary.
  6. WCCMA assures that no Member shall be coerced, intimidated, threatened, or retaliated against for exercising their right to file a Complaint or for participating in the Complaint process. Any suspected instances of coercion, intimidation, threat, or retaliation must be reported immediately to the WCCMA Program Director and/or to HCPF.
  7. WCCMA shall review redacted Complaint logs and resolutions with the Community Advisory Committee.
  8. WCCMA shall not take any action that affects the future provision of appropriate services or supports based on the receipt of a Complaint from a Member or their Parent, Guardian, or representative.

Communication of Complaint Procedures and Process

WCCMA’s complaint process shall be available on our public facing website and provided, orally and in writing and in the communication method of the Member’s or Guardian’s choosing, to all Members, the Parents of a minor, Guardian, and/or other Legally Authorized Representative, as appropriate, at the time of admission, at any time changes to the procedure occur, and as part of the annual service planning process.

Complaint Process

Submission of Complaints to WCCMA Personnel

  • Complaints about WCCMA case managers, case aides, and all other non-supervisory staff may be sent to a Case Management Supervisor. Complaint procedures and contact information are provided to all members at the time if intake, annually at reassessment, and as requested. Complaints can be submitted by phone, email, fax, or in person. Complaints may also be sent to the WCCMA inbox or through the online complaint form: 
  • Complaints pertaining to case management services and supervisory staff should be directed to the Program Manager. These complaints may be submitted by phone, email, fax, or in person.
  • Complaints pertaining to CMA administrative functions, general complaints about the CMA, its operations, and program managers can be directed to the Division and Deputy Division Directors. These complaints may be submitted by phone, email, fax, or in person.

Phone: 970-400-6950
Fax: 970-400-6671
Email: WeldCountyCMA@weld.gov
www.weld.gov/Go/CMAcomplaints

Initial Response and Resolution of Complaints

When a complaint is received, either the Case Management Supervisor or the Program Manager will reach out to the member or individual who lodged the complaint within two business days. During initial contact, WCCMA will collect information and feedback to understand the nature and specifics of the complaint.

Once initial contact is complete, if necessary and depending on the complaint, either the Supervisor or Program Manager will investigate it internally. Any updates and follow-up communications with the member or individual will happen within two business days.

WCCMA will make every effort to satisfactorily resolve the issue within thirty days of receipt of the complaint. In cases where a resolution satisfactory to all parties is not attained, WCCMA will offer an opportunity to find a mutually acceptable solution, which may include mediation, provided both parties agree voluntarily.

Escalation Process for Unresolved Complaints

In instances where a resolution is not achieved and escalation becomes necessary, the following process should be followed:

  • In cases where the Case Management Supervisor's resolution is deemed unsatisfactory, the matter will be further escalated to the Program Manager.
    • If necessary, the Program Manager may seek complaint resolution assistance from the Community Advisory Council.
  • Complaints that remain unresolved at the Program Manager level may be advanced to either the WCCMA Administrators, such as the HCSD Division Director, HCSD Deputy Division Director, or to HCPF, at the discretion of either the member or the Program Manager.

Guidelines for Filing and Escalating Complaints to HCPF

Members and individuals are advised to submit their complaints regarding WCCMA to either the Supervisors, Program Managers, and/or CMA Administrators, thereby starting the review and resolution process with agency staff. If a member or individual is hesitant to raise their complaint with WCCMA staff, they can address it directly to the Department of Health Care Policy and Financing (HCPF). Additionally, if a complaint submitted to WCCMA is not resolved to the members’ satisfaction, they may initiate or request escalation to HCPF:

Department of Health Care Policy and Financing
303 E. 17th Avenue
Denver, CO 80203
Phone: 1-800-221-3943
Fax: 303-866-2828
State Relay: 711
Email: hcpf_membercomplaints@state.co.us
Online Complaint Form: hcpf.colorado.gov/county-member-complaints

Confidentiality

In accordance with Section 26-1-114(3)(a)(I), C.R.S, WCCMA shall safeguard the confidentiality of all records pertaining to individuals who seek and receive services.

Assistance Options for Filing a Complaint

If a member or individual requires help in filing a complaint about WCCMA, they can seek assistance from various sources including:

Documentation and Tracking of Complaints

WCCMA is committed to documenting and tracking every complaint. This applies to complaints related to services provided under the case management contract, encompassing areas such as general business functions, administration, State General Funded Programs, and case management tasks specified in the Case Management Agency contract. Documentation will involve maintaining a comprehensive complaint log that records the date of the complaint, the complainant's name, the nature of the complaint, and details of the resolution. All activities associated with complaints will be documented in the Department's prescribed system within five days of each activity.

Review and Reporting of Complaints by Community Advisory Committee

The Community Advisory Committee of WCCMA plays a crucial role in overseeing the complaint process. This Committee is responsible for conducting a quarterly review of the complaint log to monitor and assess the handling of complaints. Furthermore, quarterly, the Committee will compile and present a report to the governing body of WCCMA. These reports will include trends in case management complaints and detail the actions taken in response to the recommendations and complaints received. To maintain transparency and public trust, these reports will be made available to the public.

Review and Update of Complaint Policy and Procedure

The WCCMA will ensure this policy and procedure remains effective, relevant, and compliant with current standards and regulations. To achieve this, the policy and procedure will undergo regular reviews and updates, which will be guided by the following considerations:

  1. Recommendations from the Community Advisory Committee: Input and recommendations from the Community Advisory Committee will play a vital role in the review process. The Committee's insights, derived from their oversight of complaint trends and responses, will inform potential modifications.
  2. Changes to Rules and Regulations: The Complaint Policy and Procedure will be reviewed in consideration of any changes to state and federal rules and regulations. This ensures that our practices are not only compliant with legal requirements but also reflect the best practices in case management and client care.
  3. Updates to the CMA Contract: Any amendments or updates to the CMA contract that may impact the management of complaints will necessitate a review of the current policy and procedure.
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