Grievance Policy

Grievance Procedure Summary

Filing of Grievances

  1. A Participant and/or his/her Representative may voice a Grievance to a PACE Staff Member in person, by telephone, or in writing to a PACE location. 
  2. Any FHCN PACE staff member can assist the Participant and/or his/her Representative in filing a Grievance in the event; assistance is required.
  3. The Grievance Report Form is available from the PACE Quality Improvement Coordinator.  The PACE Social Worker shall provide the Participant and/or his/her Representative with a report form if requested, (either in-person, by telephone, or in writing).   
  4. In addition to the Grievance Report, the PACE Social Worker shall provide the Participant and/or his/her Representative with Information for Participants about the Grievance Process.

FHCN PACE will Document all grievances by written notification to the participant and conduct an investigation.  

  1. FHCN PACE Staff Members shall notify the PACE Quality Improvement Coordinator within one (1) working day of receipt of the Grievance.
  2. The PACE Quality Improvement Coordinator shall:
    1. Be responsible for coordinating the investigation, designating the appropriate PACE staff member(s) to take corrective actions, and reporting the Grievance to the Interdisciplinary Team (IDT). 
    2. Acknowledge receipt of the Participant’s Grievance in writing, within five (5) calendar days of receipt of the Grievance and document this step in the Grievance Log.  When necessary, the PACE Quality Improvement Coordinator shall also acknowledge receipt of the Grievance by telephone.
    3. Notify the FHCN PACE management or supervisory staff responsible for the services or operations that are the subject of the Grievance.
    4. Immediately submit to the FHCN PACE Medical Director Grievances related to medical quality of care for appropriate action.
  3. When Grievances related to services provided by a FHCN PACE contract provider arise, the PACE Quality Improvement Coordinator shall notify the contract provider’s Quality Improvement staff.
  4. FHCN PACE shall resolve Grievances within thirty (30) calendar days from the day the Grievance is received.  The PACE Quality Improvement Coordinator shall make reasonable efforts to contact the Participant and/or his/her Representative by telephone or in-person to advise him/her of the outcome of the Grievance investigation and determine his/her satisfaction or dissatisfaction with the outcome of the investigation.  

Grievance Review Options 

  1. After a Participant completes the Grievance process or participates in the Grievance process for at least thirty (30) calendar days and the Participant is dissatisfied with the resolution of the Grievance, the Participant may pursue other options as described in this Policy.  If the situation represents a serious health threat, the Participant and/or his/her Representative need not complete the entire Grievance process nor wait thirty (30) calendar days pursue to the options described below.
  2. If the Participant is eligible for Medi-Cal only or for Medi-Cal and Medicare, he or she is entitled to pursue the Grievance with the California Department of Health Care Services (DHCS) by contacting or writing to:

    Ombudsman Unit
    Medi-Cal Managed Care Division
    Department of Health Care Services
    P.O. Box 997413
    Mail Station 4412
    Sacramento, CA 95899-7413

    Telephone: 1-888-452-8609
    TTY: 1-800-735-2922
  3. At any time during the Grievance process, whether the Grievance is resolved or unresolved the Participant and/or his/her Representative may request a State Hearing from the California Department of Social Services by contacting or writing to:

    California Department of Social Services
    State Hearings Division
    P.O. Box 944243
    Mail Station 19-17-37
    Sacramento, CA 94244-2430

    Telephone: 1-800-952-5253
    Facsimile: 1-916-651-5210 or 1-916-651-2789
    TDD: 1-800-952-8349
  4. If a Participant and/or his/her Representative decide to pursue a State Hearing, he or she must request the State Hearing within ninety (90) calendar days from the date of the resolution letter.  A Participant and/or his/her Representative may speak at the State Hearing, or have someone else speak on the Participant’s behalf, including a relative, friend, or an attorney.