D.C. Mun. Regs. tit. 22, r. 22-A308

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-A308 - EXTERNAL REVIEW OF GRIEVANCES

308.1

DMH shall contract with one or more external reviewer(s) to provide timely, neutral, and impartial review of grievances that have not been resolved to the consumer's satisfaction. The Director or his or her designee shall select the external reviewer. External reviewers shall serve at the pleasure of the Director of DMH. DMH shall provide consumers with written notice of the method, date, and time of external review, a list of participants, and contact information for the independent peer advocacy program.

(a) A consumer has the right to representation by a peer advocate, an attorney or a person of the consumer's choice throughout the external review process but DMH shall not appoint, assign or compensate a consumer's representative.

(b) A consumer, employees or representatives of providers, witnesses, or other participants in a grievance proceeding shall not be compensated by DMH for their time.

308.2

All external reviewers shall have experience or appropriate training in mediation, arbitration, and/or alternative dispute resolution.

308.3

The external reviewer may manage an assigned grievance in one of the following ways:

(a) The external reviewer may attempt to mediate a consensual resolution to the grievance. Mediation may be conducted via individual telephone calls or meetings with interested parties or via a joint meeting. The consumer has the right to representation during mediation. Necessary representatives from the MH provider, as determined by the external reviewer, shall be required to attend the mediation. The consumer may terminate the mediation at any time. If mediation is unsuccessful at resolving the grievance to the consumer's satisfaction, an external reviewer shall prepare a written advisory opinion at the request of any party to the mediation. The external reviewer who prepares a written advisory opinion pursuant to this subsection may or may not be the mediator.

(b) The external reviewer may conduct a fact-finding hearing and issue a written advisory opinion. Necessary representatives from the MH provider, as determined by the external reviewer, shall be required to attend the hearing. The consumer has the right to representation during the hearing, and may call witnesses. The MH provider also has the right to representation during the hearing at its expense, and may call witnesses. In some instances, and with the consent of the parties, the external reviewer may attempt to mediate a consensual resolution to a grievance prior to issuing an advisory opinion.

(c) The external reviewer may conduct a fact-finding process and issue a written advisory opinion without a hearing, if the consumer elects not to have one. In this case the external reviewer may request written information from the consumer or the MH provider to supplement the record. The external reviewer shall prepare a written advisory opinion based upon the information submitted and any informal conversations held with parties to the grievance.

308.4

Within five (5) business days of receipt of a consumer's request for external review, DMH shall assign an external reviewer and secure the earliest practicable date for a mediation or hearing. If a hearing is held, the external reviewer shall submit a written advisory opinion within five (5) business days of the completion of the hearing. An external reviewer may extend the time period for submission of an opinion with the express consent of all parties to the hearing.

308.5

Any written advisory opinion prepared by an external reviewer shall include:

(a) A summary of the evidence gathered during the hearing or document review;

(b) Applicable federal or District laws and regulations;

(c) Findings of Fact; and

(d) Conclusions and recommendations.

308.6

A written advisory opinion prepared by the external reviewer shall be forwarded to the Director of DMH, the chief executive officer of the MH provider (if the grievance originated at or involved the MH provider), and the consumer. A copy of the written advisory opinion shall be provided to the consumer's representative, if authorized pursuant to the Mental Health Information Act of 1978, D.C. Official Code §§ 7-1201.01 et seq. Any party to the external review, including the chief executive officer of the MH provider, may, within five (5) business days of receipt of the written advisory opinion, communicate their reaction to the opinion to the Director. The Director shall, in writing, accept in full, accept in part, or reject the recommendations of the external reviewer and set time limits and responsible parties for carrying out any accepted recommendations, within ten (10) business days of receipt of the advisory opinion.

308.7

Any agreement reached in mediation shall be forwarded to the Director of DMH and/or the chief executive officer of the MH provider where the grievance originated, according to which entity has authority over the actions specified in the agreement. The Director or chief executive officer shall set any necessary time limits and responsible parties for carrying out the actions specified by the agreement, within ten (10) business days of receipt of the agreement.

308.8

The external reviewer shall report such information on each grievance as DMH may require and shall provide such information within the time limits and in the manner that DMH requires, except that statements made by parties to mediation shall not be reported.

308.9

Any party to a grievance dissatisfied with the grievance's final determination by DMH may request a fair hearing, pursuant to the D.C. Administrative Procedure Act and federal regulations.

D.C. Mun. Regs. tit. 22, r. 22-A308

Final Rulemaking published at 50 DCR 8480 (October 10, 2003)