This policy describes how to complain about medical treatment and services provided and how to file a grievance. Please review it carefully.
Hopebridge LLC (“Hopebridge” or “HB”) is committed to the quality and satisfaction of services provided for Patients receiving medical treatment and services. We acknowledged that differences or disagreements may arise during the medical treatment process and wishes to resolve such instances in an expeditious and prudent manner for the benefit of the patient and their parents, legal guardians or authorized representative (collectively the “representatives”).
Any patient receiving medical treatment and services, including their persons, will be informed of and may use the patient grievance process. The patient grievance process is in place to ensure fair hearing of complaints and quick resolution of problems regarding medical treatment and services provided, without fear of reprisal on the part of persons receiving services, their families, etc. Additionally, a copy of this Patient Grievance Policy (the “Policy”) is posted in a public area easily accessible at the clinic.
I. How to Complain About Medical Treatment and Services
To complain, recommend, or provide an opinion regarding the medical treatment and services received, please speak with the Clinic Manager at the clinic in which the patient received services. If the complaint cannot be resolved with the Clinic Manager, the patient or representative (collectively the “Complainant”) can file a formal grievance with HB. If a Complainant articulates a grievance or poses questions about filing a grievance, the Clinic Manager is responsible to provide the Complainant with the name and availability of the Patient Rights Representative.
The Chief Clinical Officer (“CCO”) will act as the primary Patient Rights Representative (“Representative”), who has the responsibility for overseeing the grievance process, and the Chief Operating Officer (“COO”) as the secondary Representative. The Representatives will provide such assistance as may be necessary for a Complainant to file a grievance. Should either Representatives be the subject of a grievance, the Director of Applied Behavior Analysis and the Chief Compliance Officer will function as alternate Representatives and will work with the Complainant to explain and aid with filing a grievance.
The Representatives will be available during routine clinic operating hours, 8:30 AM to 5:00 PM, to meet with any Complainant desiring to initiate a grievance. If the Representative is unavailable when a Complainant makes contact to initiate a grievance, either the Representative or, in the case of extended unavailability, the Representative will contact the Complainant within three (3) business days.
Upon expressing to the Representatives, a desire to file a grievance, the Complainant is entitled to a private conference with the Representatives. Such conference shall be scheduled by the Representatives within three (3) business working days of contacting the Complainant. During this conference, the Representatives will provide a copy of this Policy and will review and explain said Policy. This Policy serves as notification that all grievances must be submitted in writing, and that the Representatives are available to assist the complainant in preparing a written grievance.
A written decision including the rationale by the Representatives will be submitted to the Complainant within thirty (30) days after filing a grievance. If the Complainant does not agree with the decision of the Representatives, the Complainant may file a grievance with the State’s Department of Health Services to review the complaint. The State’s recommendation will constitute the final recommendation to all parties.
II. How to Complete a Formal Written Grievance
All formal written grievances are to be submitted to the Representative noted in Section V below and should include the following information:
- Date, time and location the grievance or alleged violation occurred.
- Name or description of individuals involved in the incident or situation being grieved.
- A brief narrative of the incident or grievance.
- The name of the Complainant filing the grievance.
- The date of grievance filing verified by the signatures of both the Complainant and the Representatives. If third-party files the grievance on behalf of the Complainant, the signature of that third-party should also be included with the date of grievance filing.
Following receipt of a grievance from a Complainant, within three (3) business working days, the Representative will acknowledge receipt of the grievance in writing to the Complainant responsible for the filing. The written acknowledgment will include, at minimum, the following information:
- Date the grievance was received.
- Summary of the grievance.
- Overview of the grievance investigation process including a timetable for completing the investigation and notifying the Complainant of the proposed resolution.
- Contact name, address and telephone number of the Representative.
In addition to this initial acknowledgment, written notification and explanation of the disposition of any grievance will be supplied to the Complainant at any stage of the grievance process within the time frames specified in this Policy.
The Representative shall investigate the grievance and provide the Complainant with a written decision including the summary of any findings and the proposed resolution within thirty (30) days after formally filing a grievance. A copy of any such findings will also be provided to the Chief Executive Officer (“CEO”). Any extenuating circumstances indicating extension of this period must be documented in a written notice of such extension and provided to the Complainant.
If the proposed resolution is not satisfactory to the Complainant, they, accompanied by the Representative, will meet with the CEO to promote resolution of the grievance. Such meeting must be requested within ten (10) business working days of the notification of findings and will be scheduled within five (5) business working days of the request. Following this meeting, the CEO will investigate the grievance and will render a decision within five (5) business working days from the time of the meeting. The CEO’s decision will constitute the final recommendation to all parties.
If the Complainant does not agree with the decision of the CEO, the Complainant may file a grievance with the Department of Human and Health Services for Kentucky and Ohio or the Attorney General’s Office for Indiana to review the complaint. The state’s recommendation will constitute the final recommendation to all parties.
If the resolution of the grievance involves the termination of services, or to provide, change, reduce or deny services set forth in the Complainants plan of care, a written notice shall be provided to the Complainants at least ten (10) business days prior to the effective date. All written reports of the grievance will be made part of the patient administrative record.
If a grievance is filed, it is the strict policy of HB that the grievance will not result in retaliation toward the Complainant, create a barrier to the provision of medical treatment and services, or the refusal to provide the availability or assistant of the Complainant seeking an advocate.
V. Contact Persons for Patient Grievance
If you feel your rights may have been violated or you disagree with the medical treatment and services received, contact our Patient Rights Representative using the toll free number at 1-855-540-0188, email at email@example.com, or a letter to the Representative as listed below.
Attn: Kim Strunk, Chief Clinical Officer
3500 Depauw Boulevard, Suite 3070
Indianapolis, IN 46268
You may also file a complaint with the Attorney General’s Office and/or Department of Human and Health Services for services and treatment received by Hopebridge in any state where Hopebridge provides services.
- To file a complaint with the Arizona Department of Health Services, please follow the instructions at: https://app3.azdhs.gov/PROD-AZHSComplaint-UI
You will not be penalized if you file a complaint.
VI. Changes to This Policy
We reserve the right to change this Policy and make the new Policy apply to our services as we already have as well as any services provided in the future. We will post a copy of our current Policy at our clinics with the effective date on the last page as stated in Section VII.
VII. Effective Date
This Policy was effective on 3/1/2018. Updated in February 2021. Updated in November 2021