GRIEVANCE PROCEDURES UNDER CMS ROPs AND OCR REGULATIONS

CMS Requirements for SNFs 81 Fed. Reg. 68688 (see 42 CFR 483.10Q))

OCR Nondiscrimination in Health Programs and Activities 45 CFR Part 92, 81 Fed. Reg. 31376 (see 92.7) ("Section 1557")

Application SNFs Any covered entity that employs 15 or more persons. A "covered entity" means: 1) An entity that operates a health program or activity, any part of

which receives Federal financial assistance; 2) An entity established under Title 1 of the ACA that administers a

health program or activity; and 3) The U.S. Department of Health and Human Services.

Scope of Grievances Covered

Grievances include those with respect to care and treatment, behavior of staff and other residents, and other concerns regarding their SNF stay.

Compliance with Section 1557, which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in health programs and activities (includes compliance with LEP provisions).

Appointment and Responsibilities of Grievance Official/Coordinator

Grievance Official must be identified in grievance policy and is responsible for: • Overseeing the grievance process, • Receiving and tracking grievances to conclusion, • Leading any necessary investigations, • Maintaining the confidentiality of all information

associated with grievances, • Issuing written grievance decisions, • Coordinating with state and federal agencies as necessary

in light of specific allegations.

Estimates 10% of FTE social worker.

Grievance Coordinator is responsible for compliance with Section 1557, including investigation of any grievance. • Function may be combined with other duties so long as there is no

conflict of interest.

Entities that already have a designated Compliance Coordinator and a written process in place for handling grievances with respect to disability or sex discrimination may use that individual to coordinate efforts to comply with Section 1557

Estimates 1% of a FTE for designated grievance officials

1 Paula G. Sanders, Esq. | Post & Schell, P.C. | 717.612.6027 | psanders@postschell.com

P°ST.N ^QCHELL.,

ATTOM N CYSi AT LAW

D°ST. KSCHELL GRIEVANCE PROCEDURES UNDER CMS ROPs AND OCR REGULATIONS

CMS Requirements for SNFs 81 Fed. Reg. 68688 (see 42 CFR 483.10(j))

OCR Nondiscrimination in Health Programs and Activities (Section 1557) 45 CFR Part 92

Reprisal/retaliation provision

Resident has the right to voice grievances to the SNF, or other agency or entity that hears grievances, without discrimination, reprisal, or fear of discrimination or reprisal.

SNF cannot prevent or discourage a resident from communicating with federal, state, or local officials including, but not limited to federal and state surveyors, other federal or state health department employees, including representatives of the Office of the State Long-Term Care Ombudsman and of the protection and advocacy system.

Grievance policy requirements

SNF must make prompt efforts to resolve grievances and establish a grievance policy, which must include: 1) Notifying the resident individually or through posting of the right to file grievances orally or in

writing, the right to file grievances anonymously, the contact information of the grievance official, a reasonable expected time frame for completing review of the grievance, the right to obtain a written decision, the contact of independent entities to whom grievances may be filed (state agency, quality improvement or, state survey agency, state LTC ombudsman);

2) Identifying a grievance official responsible for overseeing the grievance process, receiving and tracking grievances to conclusion, leading any necessary investigations, maintaining the confidentiality of all information associated with grievances, issuing written grievance decisions, and coordinating with state and federal agencies as necessary in light of specific allegations; (continued)

Compliance with Section 1557, which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in health programs and activities.

Paula G. Sanders, Esq. | Post & Schell, P.C. | 717.612.6027 | psanders@postschell.com 2

DOST. ^QCHELL

ATTOHNCYI AT LAW

GRIEVANCE PROCEDURES UNDER CMS ROPs AND OCR REGULATIONS

CMS Requirements for SNFs 81 Fed. Reg. 68688 (see 42 CFR 483.10(j))

Grievance policy requirements (continued)

3) Taking immediate action necessary to prevent further potential violations of any resident right;

4) Immediately reporting all alleged violations involving neglect, abuse, including injuries of unknown source, and/or misappropriation of resident property by anyone furnishing services on behalf of the provider, to the administrator of the provider and as required by State law;

5) Ensuring that all written grievance decisions include the date the grievance was received, a summary statement of the resident's grievance, the steps taken to investigate the grievance, a summary of the pertinent findings or conclusions regarding the concern, a statement as to whether the grievance was confirmed or not confirmed, and any corrective action taken, and the date the written decision was issued;

6) Taking appropriate corrective action in accordance with State law;

7) Maintaining evidence demonstrating the results of all grievances for no less than 3 years from issuance of the grievance decision

8) Notifying the resident individually or through posting of the right to file grievances orally or in writing, the right to file grievances anonymously, the contact information of the grievance official, a reasonable expected time frame for completing review of the grievance, the right to obtain a written decision, the contact of independent entities to whom grievances may be filed (state agency, quality improvement or, state survey agency, state LTC ombudsman);

9) Identifying a grievance official responsible for overseeing the grievance process, receiving and tracking grievances to conclusion, leading any necessary investigations, maintaining the confidentiality of all information associated with grievances, issuing written grievance decisions, and coordinating with state and federal agencies as necessary in light of specific allegations

Paula G. Sanders, Esq. | Post & Schell, P.C. | 717.612.6027 | psanders@postschell.com 3