Home and Community Based Services Manual


8.15 Grievance Process

INTRODUCTION

The Centers for Medicare & Medicaid Services (CMS) require each state to maintain a standardized grievance process for Home and Community‑Based Services (HCBS). This process ensures participants have a formal way to report concerns related to person‑centered planning, service delivery, or HCBS settings requirements. It outlines the ways participants may report concerns and explains how DSDS receives, reviews, and resolves grievances in a consistent, timely, and fair manner.

Missouri uses a single, statewide grievance process covering all HCBS programs operated by:

  • Division of Senior and Disability Services (DSDS) 
  • Division of Developmental Disabilities (DDD) at the Department of Mental Health (DMH)

GRIEVANCE TYPES

Grievances are used when a participant has concerns about how an assessment was completed, how the care plan was developed, how services were delivered or potential violations of the HCBS settings requirements.

Grievances may include but are not limited to the following: 

  • Assessment Process
    • Delays in scheduling or completing the assessment
    • Conduct or professionalism of the assessor
    • Disagreement with how the assessment was performed or how the participant was treated 
  • Care Plan Development
    • Delays in developing or approving the care plan
    • Conduct or professionalism of the care planning specialist
    • Care plan that does not accurately reflect the participant’s goals, preferences, or identified needs
    • Care plan that unnecessarily limits participant choices, privacy, or autonomy
  • Provider‑Related Issues
    • Conduct and professionalism of aide/attendant, including ethical concerns or violation of professional standards.
    • Timeliness, availability, and overall reliability of the aide/attendant
    • Services not delivered as authorized or to an appropriate standard
    • Lack of meaningful choice regarding how or when services are provided
    • Living environment restricts privacy or autonomy

The grievance process also allows participants to raise concerns related to Medicaid eligibility handled by the Family Support Division (FSD) at the Department of Social Services. These grievances may include issues such as Medicaid application processing, spend‑down payment delays, the HCB Medicaid eligibility process, or the Miller Trust process.

PROCESS

REPORTING 

  • Anyone may assist an HCBS participant in filing a grievance; however, the participant or their legally responsible representative must give approval before the grievance review process may begin.
  • Grievances may be submitted using one of the following options:

When DSDS staff receive a grievance outside these formal routes, staff should encourage the participant to submit it through the Grievance Portal or enter the information on the participant’s behalf, selecting “state staff” as the person submitting.

REVIEW AND RESOLUTION 

  • The HCBS Constituent Service (CS) Unit is responsible for reviewing and coordinating the resolution of all grievances submitted to DSDS. 
  • A participant or their legal representative must be contacted within 7 calendar days of the grievance being filed. 
  • The HCBS CS Unit will review the case to determine what action is needed and work with the applicable parties to reach a resolution.  This may include DSDS staff, other state agencies, providers, and/or the participant. 
  • Resolution shall not exceed 90 calendar days. 
  • A grievance is considered resolved when DSDS has completed its review, taken any necessary action within its authority, and provided the participant with notification of the final determination.  Examples of resolution may include, but are not limited to:
    • Education of provider, participant, or DSDS staff
    • Care plan adjustment, including modification of services or provider change 
    • Reassessment to ensure participants' needs are accurately identified and addressed
    • Referral to the appropriate oversight entity when issues fall outside of HCBS (e.g., Missouri Medicaid Audit and Compliance, Family Support Division, Office of Special Investigations). 

RESTRICTIONS

The grievance process should not be used for issues that already have established procedures. Examples include: 

RETALIATION PROHIBITED

Retaliation against anyone for submitting a grievance or participating in the grievance process is strictly prohibited. This includes retaliation by DSDS team members, state designees, provider agencies, or provider employees. Individuals shall not experience negative consequences for raising concerns, asking questions, or exercising their rights. 

Reporting Retaliation: Concerns or allegations of retaliation shall be reported to the HCBS Constituent Services Unit at HCBSConstituentServices@health.mo.gov for review and follow‑up. 

 

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