048.0077.4.04092020

Mental Health and Substance Use Disorder Services — Chapter 4: Complaints

This chapter establishes the complaint filing and investigation process for behavioral health service providers certified by the Wyoming Department of Health's Behavioral Health Division. Providers must allow Department access to all pertinent information during investigations, respond to complaints within 20 business days, and submit resolution plans addressing any corrective actions identified in final investigation reports. Non-compliance may result in sanctions including suspension of contract payments or decertification.

Health, Department of

Mental Health and Substance Use Disorder Services

Chapter 4: Complaints

Effective Date: 
04/09/2020 to Current

Rule Type: 
Current Rules & Regulations

Reference Number: 
048.0077.4.04092020

Download

C
hapter
 
4

Complaints

Section 1.
 
Purpose and Applicability
.

(a) 
 
Th
is Chapter provides the 
complaint and investig
ation processes 
regarding
 
providers of 
behavioral health
 
services
 certified by the 
Department
. 

(b) 
 
This Chapter applies to all clients and providers of behavioral health services certified by the 
Department
.

Section 2.
 
Filing Complaints
.

(a) 
 
If an entity or individual has exhausted a provider's established client grievance procedure and is not satisfied with the resolution, the entity or individual may file a complaint with the Department. 

(b) 
 
A c
omplai
nt filed with the 
Department
 
must 
be in writing. The complaint 
must 
be filed within one 
(1) 
year of the alleged violation and 
must 
provide
 the following information:

(i) 
 
The name, address and telephone number of the complaining party;

(ii) 
 
The party, individual
, or agency the complaint is against;
 and

(iii) 
 
A clear and complete statement of the alleged violation of the law, order, rule
,
 or standard, together with the facts which give the 
Department
 a clear and full understanding of the nature of the alleged violation.

(c) 
 
The Department shall confirm 
with the co
mplainant and provider that the 
complaint was 
originally 
filed with the provider, with an unsatisfactory resolution for the complainant.
 
The Department shall refer an individual or entity to the provider if the complaint was no
t originally
 filed with the provider.

(d) 
 
The 
Department
 shall ensure that complaints are properly evaluated, documented, acknowledged
,
 and handled in a timely and appropriate manner
, to include 
notification by the 
Department
 to 
the complainant and the provider in writing within t
en (10) business days of the receipt of a complaint.
 
I
f the nature of the complaint is not related to certification or contracting requirements, the 
Department
 shall refer the complainant to the appropriate authority
, if any,
 
including
 Wyoming Medicaid, the Wyoming Mental Health Professions Licensing Board, or an ombudsman program.

Section 3.
 
Investigations
.

(a) 
 
The 
Department
,
 on its own initiative or
 upon receipt of a complaint
 
including
 
substantive 
information
 
alleging 
detriment to the health, safety or welfare of clients
,
 
fraud, 
or ethical misconduct
,
 may 
condu
ct an investigation of a provider.
 
If an investigation is initiated 
by 
the 
Department
, 
the 
Department
 shall provide 
a 
summary of the 
Department
's concerns 
to 
the 
provider
 in writing within ten (10) business days of initiating the investigation.

(b) 
 
The 
executive 
dire
ctor of the provider
 against whom the 
investigation is being conducted 
shall file a response to the complaint with the 
Department
 no later than twenty (20) business days after receipt of 
the copy or summary of the complaint
 from the 
Department
. 
If the executive director provides the 
Department
 with
 good cause, the 
Department
 may extend the time to respond to the complaint.

(c) 
 
If the 
Department
 determines that the
 provider has failed to respond or the
 
complaint is not 
sufficiently 
resolved by the provider's response 
under s
ubsection 
(b
)
 of this Section
, the 
Department
 may continue 
the 
investigation
. 

(i) 
 
The provider shall allow the 
Department
 
access
 to
 
all pertinent information concerning the operation
s
 of the 
provider. 

(ii) 
 
The 
Department
's investigation may
 include on-site inspection
s
, 
off-site reviews, and 
consultation
s
 with the executive director, governing board, program staff, the complainant, and other 
pertinent 
sources of information. 

(d) 
 
If a
 provider 
fails 
to 
comply with this Chapter
, the 
Department
 may sanction the provider
. 
 
Sanctions 
may include, but 
are 
not limited to, adverse inferences related to any deni
als made by the provider
, the immediate suspension of contract payments
 to the provider
, 
and 
decertification.

(e) 
 
The 
Department
 shall issue a
 final written report 
and disposition 
of the investigation 
to the provider 
within 
ninety 
(
9
0) business days of the cl
osure of the investigation. 
 The report must include
:

(i) 
 
T
he 
Department
's 
findings
 and the
 
corrective actions
 required
,
 if any;
 
and 

(ii) 
 
A
 determination whether each deficiency relates to the health, safety, welfare, or rights of clients
. 

(f) 
 
The 
Department
 shall provide a 
written 
summary of the results and disposition of the investigation to the complainant within ninety (90) business days of the closure of the investigation.

Section 4.
 
Resolution Plans
.

(a) 
 
A
 
provider shall submit to the 
Department
 a 
resolution 
plan for each corrective action required in the final written report of an investigation.

(i) 
 
If 
the 
Department
's final report notes 
a deficiency 
relating 
to
 the
 health, safety, welfare
,
 or rights of clients serv
ed, the provider shall submit a
 
resolution 
plan to the 
Department
 
within 
ten (10
) business 
days of receipt of the written report from the 
Department
.

(ii) 
 
If the 
Department
's final report does not note a deficiency relating to the health, safety, welfare, or rights of clients served, 
the provider shall submit a
 
resolution 
plan to the 
Department
 within thirty (30) business days of receipt of the written report from the 
Department
.

(iii) 
 
A
 resolution plan must provide the following information
:

(A) 
 
Who will be charged with the responsibility to correct each deficiency;

(B) 
 
What will be done to correct each deficiency;

(C) 
 
How the corrective actions will be incorporated into the provider's quality management program;

(D) 
 
Who will be charged with monitoring to ensure each deficiency does not occur again; and 

(E) 
 
The deadline by when the provider expe
cts to correct all deficiencies.

(b) 
 
The Department
 shall notify the provider in writing 
of the approval or disapproval of the provider's 
resolution 
plan 
within 
thirty (
30
)
 business days after receipt
 of the plan
.

(c) 
 
If the 
Department
 disapproves of a
 
resolution 
plan, 
the Department
 shall provide the provider written 
notification of the reasons for the disapproval
. The provider shall
 submit a revised plan within 
ten (
10
)
 
business days of receipt of the writt
en disapproval from the Department
.

(d) 
 
The Department
 shall monitor
 the provider
 to assure the actions identified in the provider's 
resolution 
plan have been completed within the specified time frame
.
 
The Departmen
t shall verify completion of a
 resolution plan in writing. 

For questions regarding the content or application of a specific rule, please contact the agency responsible for the rule. A directory of 
agencies
 is also available online. For questions about the rulemaking process, please send your questions and comments to 
Rules@wyo.gov
.