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§ 10:37-4.6 - Client complaint/agency ombuds procedure

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:37-4.6 - Client complaint/agency ombuds procedure

Jurisdiction: NJ
CMHC (60%) OUTPATIENT (60%)
Plain-English summary

This section establishes client complaint and ombudsperson procedures for all State-funded mental health programs in New Jersey. Each agency must create an internal complaint process, designate an Agency Ombudsperson to receive and advocate on complaints, and inform clients of both internal and external advocacy resources. Complaints may escalate from the agency level to the County Mental Health Board and ultimately to the Division of Mental Health and Hospitals for State-level review. These procedures supplement, rather than replace, any other legal or administrative remedies available to clients.

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Regulation text
N.J. Admin. Code § 10:37-4.6 - Client complaint/agency ombuds procedure 

 State Regulations 

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(a)
 This
 section shall apply to all State-funded mental health programs. Any questions
 related to service delivery, denial or termination of services shall be an
 appropriate subject for review. Any client, applicant, or person who has been a
 client within the last three months or his/her designee, parent or guardian,
 shall have the right to seek review. Such persons shall be identified below as
 "clients."

(b)
 Establishment of
 complaint procedure: Each agency shall establish internal client complaint
 procedures which will be subject to Division review and approval at the time of
 the agency's annual request for State funding.
 
1.
 Explanation to clients: Each client shall
 be made aware of the existence of a complaint procedure at second,
 non-emergency contact. Written notice, as well as a verbal explanation of
 agency complaint procedures, and external advocacy services which are directly
 available to clients at all times, shall be given to each client at the
 earliest appropriate opportunity. Under all circumstances, clients not accepted
 for services shall be informed immediately of the State-wide advocacy services
 available to them. Information regarding external advocacy services shall
 minimally include the: 
i.
 Community Mental
 Health Law Project (if one exists in the client's county);

ii.
 County Mental Health Administrator in the
 county;

iii.
 Division of Mental
 Health and Hospitals' Ombudsperson;

iv.
 Division of Mental Health
 Advocacy;

v.
 Division of Youth and
 Family Services (for child abuse and/or neglect);

vi.
 County Welfare Agency (for adult
 abuse).

2.
 Posting: The
 information contained in the written notice required above shall be posted in a
 prominent place in the agency's facilities.

(c)
 Designation of Agency Ombudsperson: The
 Agency Director shall designate a staff person to function as Agency
 Ombudsperson, on an as needed basis. Small agencies may choose to share staff
 for this function.

(d)

 Responsibilities of Agency Ombudsperson: 
1.

 The responsibilities of the Agency Ombudsperson shall be:
 
i.
 To receive client complaints;

ii.
 To act as an advocate for clients who
 make complaints; and

iii.
 To
 attempt to negotiate resolutions of issues raised by clients (Complaints shall
 be investigated and negotiated within five working days.)

2.
 The Agency Ombudsperson shall submit a
 written report of findings, resolutions and/or recommendations to the Agency
 Director and to the client within seven working days of the complaint. If the
 complaint has been resolved to the client's satisfaction, the grievance process
 shall end at this point.

(e)
 Optional establishment of Internal Agency
 Review Committee: The Agency may develop, by the Director's appointment or by
 staff/client election, an interdisciplinary review committee. It is suggested
 that such a Committee include an equal number of staff or Agency Board members
 and clients of the Agency. If established, such a Committee should:
 
1.
 Receive and review complaints within three
 working days of a request by a client or Agency Director;

2.
 Submit a written report of its findings
 and recommendations to the Agency Director within five working days of
 complaint.

3.
 Report to the
 Division of Youth and Family Services complaints or allegations of abuse and/or
 neglect, in accordance with
 
N.J.S.A.
 
9:6-8.10
.

(f)
 Internal Agency complaint resolution:
 
1.
 The Agency shall permit and encourage
 clients who object to a decision of a therapist, counselor, or service
 procurer, to consult with, and to obtain the opinion of, a second such person
 either within or without the Agency.

2.
 If a complaint has not been resolved by
 the Agency Ombudsperson to the client's satisfaction, the client may request
 review by the Agency Director. If an Internal Agency Review Committee has been
 established in the Agency, either the client or the Agency Director may request
 review by that Committee. The Director shall make the final Agency-level
 decision regarding the complaint, in a due process manner, as quickly as
 possible.

3.
 If the complaint has
 still not been resolved to the client's satisfaction, the client may request
 review by the County Mental Health Board.

(g)
 Responsibility of the County Mental
 Health Board: 
1.
 The County Mental Health
 Board, through its Administrator, shall receive and review complaints referred
 from Agency Directors within five working days.

2.
 The County Mental Health Board shall make
 its findings and recommendations known to the Agency Director and to the client
 within seven working days of complaint. If the client is not satisfied with the
 recommendations of the Board, or the Agency's response to these
 recommendations, the client may request review by the Division.

(h)
 State-level review by the
 Division:
1.
 A client may request a review by
 the Division directly, and in confidence, at any time. Clients shall be
 encouraged by the Division, however, to seek an Agency-level review first and
 will be asked to justify the omission of an Agency or a County-level review.
 The Division will advise the Agency and the County Mental Health Board of all
 complaints received directly, unless the client, on notice, refuses to consent
 to such disclosure.

2.
 The Division
 may convene a Professional Review Committee, when needed, consisting of an
 interdisciplinary team appropriate to the subject of the complaint. The
 designees shall receive and review complaints referred by clients within five
 working days and shall submit a written report of its findings and
 recommendations to the Division Director within two more days.

3.
 The Division Director shall review this
 report and submit recommendations to the Agency Director and the client within
 seven working days. The Division shall determine if any formal State
 remediation/funding compliance action is necessary based on the Agency's
 response to these recommendations.

(i)
 Procedures not to limit access to other
 remedies: These procedures are intended to be in addition to, rather than in
 replacement of, any other remedies available to clients for the negotiation or
 redress of complaints services delivery. It is not the intention of the
 Division that clients be required to exhaust these procedures before seeking
 negotiation or redress for complaints in any judicial or administrative
 forum.

(j)
 No suspension of Agency
 action during review: An Agency action which is the subject of a client
 complaint need not be suspended pending review under these procedures. A
 client, however, may request expedited, direct review by the Division at any
 time, and such review shall be completed within 72 hours of the
 request.

(k)
 Confidentiality: A
 client who requests assistance with or review of a complaint by an Agency
 Ombudsperson, Internal Agency Review Committee, Agency Director, County Mental
 Health Board or the Division, shall be required to consent to the disclosure of
 relevant records, in order to authorize persons providing assistance or review
 to discuss the subject of the complaint with relevant Agency staff if
 necessary.

Notes

N.J. Admin.
 Code §
 
10:37-4.6

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