Wyo. Code R. 048-0077-4
Effective Date: 04/09/2020 to Current
Rule Type: Current Rules & Regulations
Reference Number: 048.0077.4.04092020
(a) This Chapter provides the complaint and investigation 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.
(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 complaint 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 complainant 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 not 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 ten (10) business days of the receipt of a complaint. If 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.
(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 conduct 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 director 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 subsection (b) of this Section, the Department may continue the investigation.
(i) The provider shall allow the Department access to all pertinent information concerning the operations of the provider.
(ii) The Department's investigation may include on-site inspections, off-site reviews, and consultations 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 denials 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 (90) business days of the closure of the investigation. The report must include:
(i) The 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.
(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 served, 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 expects 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 written 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 Department shall verify completion of a resolution plan in writing.