Frequently Asked Questions

Grievance and Appeal Procedures

Institute for Cognitive Therapy agrees to adopt Medicaid’s grievance and appeal policies and procedures.  They are as follows:

Policy

ICT will address grievances that are not considered an Action filed by a client of ICT in a fair and timely manner.

Definitions:

Grievance is defined as an expression of dissatisfaction about any matter other than an action.  Possible subjects for grievances include but are not limited to, the quality of care or services provided, aspects of interpersonal relationships such as rudeness of providers, staff, etc., or failure to respect the client’s rights.

Action means a denial or limited authorization of a requested service, including the type or level of services; a reduction, suspension, or termination of a previously authorized service; a denial in whole or in part, of payment for a service; or the failure to provide services in designated time frames.

Procedure

Filing a Grievance

1. The client or the provider, on behalf of the client, may file a grievance at any time either orally or in writing.
2. ICT shall give the client any reasonable assistance in completing the form or taking other procedural steps and forward the form to the Contract Compliance Analyst.
3. ICT shall provide communication device services TTY for Medicaid enrollees who are deaf, hard of hearing, or need oral interpretations through Sprint Relay Customer Service at (800) 676-3777, or Spanish Speaking Services through Spanish Relay Utah at (888) 346-3162.
4. ICT shall acknowledge receipt of the Grievance either orally or in writing.
5. ICT shall ensure that the individuals who make the decision on a Grievance are individuals who were not involved in any previous level of the Grievance and have appropriate clinical expertise in treating the client’s condition of the grievance is regarding the denial of a request for expedited resolution of an appeal or grievance that involves clinical issues. (These individuals shall be licensed mental health professionals.)
6. ICT Contract Compliance Analyst shall log/document all Grievances into the Grievance Log for the applicable semi-annual time period in which the Grievance occurred including the following:
7. date the Grievance was received; for oral Grievances, the date it was documented;
8. and method of acknowledgment of the Grievance (i.e., orally or in writing), and for oral Grievances, the name of the person taking the oral Grievance;

iii.  for oral Grievances, a summary of the nature of the Grievance,  including the name of the provider or other staff or individual involved/named in the Grievance, if it involves a person;

1. copies of written notices when extending the timeframe for adjudicating Grievances when UCADDAPT initiates the extension;
2. date of resolution, and summary of the resolution of the Grievance. This information may be documented by using Form 7.59k-N10 – Grievance Resolution Notice if ICT informs the client of the Grievance decision in writing;

NOTE: If the client is informed in writing, ICT includes in the notice that they provide telecommunications device (TTY) services for Medicaid enrollees who are deaf, hard of hearing, or need oral interpretation through Sprint Relay Customer Service at (800) 676-3777, or Spanish speaking services through Spanish Relay Utah at (888) 346-3162.

1. name of the individual(s) resolving the Grievance;

vii.  date the client was notified of the Grievance resolution and how the client was notified (either orally or in writing); and

viii.  if the client was notified of the Grievance resolution in writing, ICT shall maintain a copy of the written Grievance Resolution Notice (form 7.59k-N10),

Timeframe for Grievance Resolution and Notice

Grievances

ICT shall adjudicate each Grievance and provide notice to the affected parties as expeditiously as possible, but not to exceed 45 days from the day ICT receives the Grievance.

Extensions

ICT may extend the timeframe for making a decision on the Grievance by up to 14 additional calendar days if:

1. 1. 1. the client requests an extension; or
      2. ICT justifies a need for additional information and how the extension is in the

               client’s best interest. If ICT extends the timeframe, and the extension was not requested by the client, ICT shall give the client written notice of the reason for the delay.

If ICT does not resolve a Grievance within the required timeframe, this constitutes an Action as covered in Policy 1.48 – Actions, Appeals, and State Fair Hearing.