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CARE
Act Training Guide - 2003 Version |
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Topic
5
Grievance Procedures
| • |
To
be able to identify and describe existing planning body grievance
procedures. |
| • |
To be
able to differentiate major types of grievances that a planning
body may need to address.
|
| • |
To
be able to explain legislative requirements on grievances with
respect to funding. |
| • |
To be
able to describe ways to prevent or informally resolve grievances.
|
Discussion
of this topic should differentiate between different types of grievances:
client grievances related to services and grievances with respect
to funding. It should emphasize CARE Act requirements and HAB/DSS
expectations regarding grantee and planning body procedures for
handling funding-related grievances, and how these are being met
by the planning body. It should emphasize ways to prevent or informally
resolve concerns and problems before they become formal grievances.
Differing
Legislative Requirements
TOP
| • |
Title
I is legislatively mandated by the CARE Act to establish a grievance
process with respect to funding decisions. |
| • |
Title
II grievance procedures are not specifically required by the
CARE Act or HAB/DSS. However, Title II grantees and consortia
are strongly encouraged to have grievance procedures in place.
Having a written set of procedures for resolving grievances
provides an orderly and fair process for addressing dissatisfactions.
Having a grievance process also deters individuals from airing
their complaints inappropriately. |
| • |
HAB/DSS
has developed model grievance procedures to guide local efforts
in adequately addressing potential grievances. Many localities
had such procedures in place long before CARE Act requirements.
Areas are urged to use or adapt them. There should be periodic
local review of grievance procedures and their implementation
to ensure that grievances are being resolved in a timely and
appropriate manner. |
Defining
and Understanding Grievances and Grievance Procedures:
TOP
| • |
A
grievance is a complaint or dispute that has reached
the stage where the affected party seeks a formal approach to
its resolution. It involves dissatisfaction with some aspect
of implementation of the CARE Act, which might include the planning
body’s, grantee’s, or a provider’s activities,
that is brought to the attention of the entity’s leadership.
The concern can be raised and addressed informally, or may become
a formal grievance when it is officially written down and filed
with the affected entity. |
| • |
A
grievance procedure within a planning body is a process
that enables individuals or entities to formally express their
dissatisfaction or concern to a responsible and responsive party
(either the full planning group or a committee or individual
representing it) and to obtain a fair assessment and a decision.
Formal procedures typically involve the filing of a written
complaint, some degree of investigation or fact finding, the
involvement of internal or outside mediators, and sometimes
arbitration in which the findings of the arbitrator must be
accepted by both parties. |
| • |
Grievance
procedures can address a wide range of topics and can come from
a wide range of sources. Among the most common grievances
are the following: |
| |
– |
Client
or client advocate complaints about access to, or quality of,
services—brought initially to the provider but sometimes
later to the planning body, grantee, or lead agency |
| |
– |
Complaints
from consumers or other entities challenging the legitimacy,
or representativeness, of the planning body membership. |
| |
– |
Provider
agency appeals of Title I grantee or Title II consortium or
lead agency funding decisions, based on perceived inequities
in the RFP or awards process. |
| |
– |
Provider
complaints about the legitimacy of planning body decision-making
processes such as needs assessments or priority setting and
resource allocations. |
| • |
The
best way to resolve grievances is to prevent them, by using
appropriate decision-making processes, making decisions in the
public view, and using a variety of informal methods to resolve
potential problems before they become grievances. Informal methods
can be time saving and useful for building positive relationships
between consumers and planning body members. |
| |
– |
Examples
of informal methods for addressing potential grievances
include: |
| |
- Open
forums.
- Hotlines
for complaints.
- "Early
intervention groups" to seek out and address concerns.
- Client
surveys.
- Patient
advocates.
- Case
management and quality assurance reviews.
- Planning
body committee meetings to hear and address informal problems
or concerns.
|
Grievances
With Respect to Funding
TOP
| • |
The
CARE Act requires both Title I planning councils and grantees
to establish procedures for addressing grievances with respect
to funding. |
| |
– |
Procedures
must include binding arbitration as the final step in the grievance
process for disputes that cannot be resolved by other means. |
| |
– |
Procedures
must be included in the bylaws of the planning council, in whole
or by reference. |
| |
– |
HRSA/HAB
has developed model grievance procedures for grantees and planning
councils to use as a guide in developing their own grievance
procedures. These procedures must describe the elements that
must be addressed in establishing local grievance procedures
and provide grantees with flexibility in the design of local
procedures. |
| |
– |
HRSA/HAB
will review locally developed procedures to ensure that they
adequately address potential conflicts and grievances, and to
provide technical assistance in their development and implementation. |
HRSA/HAB
Model Grievance Procedures for Planning Councils
TOP
| • |
Planning
council and grantee grievance procedures must address the following
components: |
| |
1. |
Who
may bring a grievance. |
| |
2. |
Types
of grievances covered. |
| |
3. |
Non-binding
procedures for resolving conflicts. |
| |
4. |
Use
of binding arbitration for conflicts that cannot be resolved
using non-binding procedures. |
| |
5. |
Rules
governing the grievance process. |
1. Who Can
Grieve
| • |
Individuals
or entities directly affected by the outcome of a decision
related to funding (as described above) can initiate a grievance
with a planning council or grantee. At a minimum, these include:
|
| |
– |
Providers
eligible to receive CARE Act funds. |
| |
– |
Consumer
groups/PLWH coalitions and caucuses. |
| |
– |
Other
affected individuals as determined locally. |
In Relation to Planning Council Actions
(Priority-Setting and Resource-Allocations Process)
| • |
Grievance
procedures must be defined to allow directly affected parties
to grieve: |
| |
– |
Deviations
from an established, written priority-setting or resource-allocations
process (e.g., failure to follow established conflict of interest
procedures). |
| |
– |
Deviations
from an established, written process for any subsequent changes
to priorities or allocations. |
In relation to grantee actions
(Procurement Process)
| • |
Grievance
procedures must be defined to allow directly affected parties
to grieve: |
| |
– |
Deviations
from the established contracting and awards process (e.g., the
selection of a particular provider in a manner inconsistent
with the grantee’s established procurement process). |
| |
– |
Deviations
from the established process for any subsequent changes to the
selection of contractors or awards. |
| • |
Grievance
procedures must be defined to allow planning councils to grieve:
|
| |
– |
Contracts
and awards not consistent with priorities (including any language
regarding how best to meet those priorities) and resource allocations
made by the planning council. |
| |
– |
Contract
and award changes not consistent with priorities and resource
allocations made by the council. |
2. Types of Grievances
HRSA expects local
grievance procedures developed by planning councils to address the
following:
| • |
Grievances
related to the following planning council processes: priority
setting, the allocation of funds to priorities, and any subsequent
process to change or modify the priorities or allocations. For
example, these processes might be challenged as flawed because
they excluded or did not adequately consider specific consumer
needs or service categories, or failed to follow established
conflict of interest procedures. |
| • |
Grievances
related to the following grantee procedures: processes used
to select and award funding to particular service providers,
to redistribute funds among providers, or terminate a provider
contract. For example, the selection of a particular provider
in a manner inconsistent with the grantee’s established
procurement process might be challenged, as might contracts
and awards not consistent with planning council priorities (including
any language regarding how best to meet those priorities) or
with resource allocations made by the planning council. |
3. Non-Binding
Procedures
Grievance procedures
must specify non-binding approaches to resolving disputes. Non-binding
procedures are techniques in which the parties attempt to agree to
a solution. These may include:
| • |
Designate
a person or organization to receive grievances of behalf of
the planning council or grantee. |
| • |
A
form to initiate non-binding dispute settlement. This form
should, at a minimum, include the following information: |
| |
– |
Names
and contact information of the parties involved. |
| |
– |
The issue(s)
to be resolved and how the grievant has been directly affected
by the planning council or grantee decision. |
| |
– |
The remedy
sought. |
| |
– |
The place
where or person to whom the form should be delivered. |
| |
– |
A designated
person to register the form and notify the grievant of any decisions
made. |
| |
– |
A statement
of any reasonable administrative fee to be paid by the grievant,
and whether payment must be included with the filing of the
form. |
| • |
Rules
that will apply to non-binding dispute settlement processes.
|
| • |
A
mechanism to inform grievants of rules that will apply to the
process. |
| • |
Outlining
steps the grievant should take if there is no resolution within
the appropriate time period and the grievant wishes to initiate
binding arbitration. |
4. Binding
Arbitration
| • |
Arbitration
involves the submission of a dispute to an impartial individual
or panel for a binding determination; it is the final stage
in the dispute resolution process. |
| • |
Grievance
procedures must specify the use of arbitration to resolve disputes
when other methods have failed. |
Arbitration procedures must include the following information:
| • |
Designate
a person/organization to receive a request for binding arbitration
on behalf of the planning council or grantee. |
| • |
A
form to initiate binding arbitration. This form should,
at a minimum, include the following information: |
| |
– |
Names
and contact information of the parties involved. |
| |
– |
The issue(s)
to be resolved and how the grievant has been directly affected
by the planning council or grantee decision. |
| |
– |
The remedy
sought by the grievant. |
| |
– |
The place
where, or person to whom, the form should be delivered. |
| |
– |
A designated
person to register the form and notify the grievant of any decisions
made. |
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– |
The previous
steps taken that have not resulted in agreement. |
| |
– |
An acknowledgment
of the binding nature of the process. |
| |
– |
A statement
of any reasonable administrative fee to be paid by the initiator,
and whether payment must be included with the filing of the
form. |
| • |
Rules
that will apply to the binding arbitration process. |
| • |
A
mechanism to inform grievants of rules that will apply to the
process. |
5. Rules for
the Grievance Process
Rules for the
grievance process must address the following:
| • |
Timing.
Grievance procedures must address specific time periods to ensure
the effective implementation of the process without resulting
in undue delays. The time periods specified shall include, but
are not limited to the following: |
| |
– |
The length
of time after a planning council of grantee decision is made
for a grievant to bring a grievance. |
| |
– |
Time periods
for the conduct of non-binding processes. |
| |
– |
A maximum
amount of time to complete any non-binding process that is initiated,
including the maximum time allowed to complete the process once
initiated. |
| |
– |
The time
period for the conduct of the arbitration process. |
| • |
Cost.
Grievance procedure should specifically address issues relating
to the costs of administering the process, including but not
limited to the following: |
| |
– |
A statement
of reasonable costs that may be involved for administering the
process, and for services of the third party, how they will
be allocated between the parties, and when they are due. |
| |
– |
Costs
or transfers of funds that may be called for in any settlement
agreed to by the parties or a decision of the arbitrator. |
| • |
Funding
of projects after a grievance is filed. Local procedures
should state whether any settlements reached should be “retrospective”
(require changes in approved funding decisions or expenditures)
or “prospective” (apply only to future decisions).
|
| • |
Reviewing
grievance requests. Rules may specify the process to determine
whether or not a grievance is within the scope of the procedures,
or that the grievant is eligible to bring that grievance. |
| • |
Selecting
third parties. Grievance procedures must delineate ways
to identify and select third parties for dispute settlement
processes. Some factors to consider in the third party selection
procedure are: |
| |
– |
Conflicts
of interest. |
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Training
and experience. |
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Cost. |
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Availability
during the required time period. |
| • |
Third
parties should not have a direct interest in the decision that
is the subject of the grievance. |
| • |
Rules
must specify the time period and process for selecting the third
parties for both non-binding processes and for arbitration.
|
| • |
Methods
for selecting third parties include: |
| |
– |
Selecting
named independent and impartial third parties in advance. |
| |
– |
Designating
an organization in advance that identifies and provides independent
and impartial third parties. |
| |
– |
The CEO
appointing of an independent and impartial third party (A third
party designated by the administrator of the process should
execute a statement concerning any conflict of interest that
might exist with the parties to the grievance, and the parties
should be given the opportunity to review the statement). |
| |
– |
Submitting
names of a number of third parties and asking each party to
cross off unacceptable names. If after several lists, no third
party has been selected, a designated person or organization
should select the third party. |
• Rules
for Non-Binding Procedures
Rules regarding
non-binding procedures must include the:
| – |
Degree
of confidentiality of the process. |
| – |
Maximum
time period between filing the form and response from the other
party. |
| – |
Process
and time period for designating a third party. |
| – |
Time
period for holding a meeting of the parties, if necessary. |
| – |
Designating
a place for that meeting. |
| – |
Maximum
length of time that a non-binding process can continue without
agreement after which a third party must end the process and
inform the parties of any additional steps (e.g., arbitration)
which are available. |
• Rules
for Arbitration Procedures
Rules regarding
arbitration must include the following:
| – |
The
steps in the arbitration process. |
| – |
The
maximum time period between filing the form and response from
the other party. |
| – |
The
time period for holding a hearing, if necessary. |
| – |
Designating
a place for the hearing. |
| – |
The
time period for the arbitrator to render a decision. |
| – |
How
the decision will be presented. |
| – |
Whether
the decision will apply retrospectively to the decision that
led to the grievance or only the future decisions. |
Client
Grievances
TOP
| • |
The
planning body’s role in resolving client grievances is
different for Title I planning councils and Title II consortia.
|
| • |
The
planning council’s role in resolving client grievances
is not specified in the legislation. However, HAB/DSS encourages
planning councils and grantees to work together to develop grievance
procedures to resolve consumer complaints brought against providers
as well as other PLWH grievances. HAB/DSS urges grantees to
require funded service providers to develop client grievance
procedures and ensure that their clients are aware of these
procedures. |
| • |
Consortia
that have incorporated, and that provide direct client services,
are required to develop and make known a formal procedure for
handling client grievances. In cases where a consortium
is not a direct service provider, it should avoid involvement
in disputes between a service provider and its clients. However,
the consortium can: |
| |
– |
Require
its funded service providers to define grievance procedures
and ensure that their clients are aware of and know how to use
these procedures. |
| |
– |
Inquire
into the frequency of client complaints, and consider these
factors when evaluating a service provider’s performance,
and when deciding on which providers to fund. |
Characteristics
of Effective Grievance Procedures
TOP
A grievance
process typically works best when it has the following characteristics:
| • |
People
know it exists and how to access it. |
| • |
It
is applied consistently and impartially. |
| • |
People
feel using it is meaningful-it is viewed as fair, impartial,
and responsive. |
| • |
The
same people that are involved in the problem are also involved
in the solution. |
| • |
It
attempts to ensure that each grievance is described clearly
and specifically so that it can be resolved through the grievance
process-unlike vague concerns which offer no basis for action.
|
| • |
It
is decision- or solution-oriented—it is unlikely to leave
a grievance unresolved. |
| • |
It
includes clear timeframes for each step in the process. |
| • |
It
focuses on determining what is right, not who is right; the
procedure does not personalize the conflict. |
| • |
It
is accompanied by appropriate orientation and training, so that
those responsible for implementing it have the necessary knowledge
and skills. |
| • |
Prompt
follow-through is a high priority in its implementation. |
| • |
It
is reviewed periodically by program administrators and by “consumers”
of the process and revised if it is not working. |
Attachment
8: Grievances and Grievance Procedures
Attachment
9: HRSA Model Grievance Procedures—Title I
Attachment
10: Rules for the Grievance Process
Attachment
11: Client Grievances
Attachment
12: Characteristics of an Effective Grievance Process
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