Participant Grievance and Appeals Process All of us at Fresno PACE share responsibility for your care and your satisfaction with the services you receive. Our grievance procedures are designed to enable you or your representative to express any concerns or dissatisfaction you have so that we can address them in a timely and efficient manner. You also have the right to appeal any decision about our failure to approve, furnish, arrange for or continue what you believe are covered services or to pay for services that you believe we are required to pay. The information in this Chapter describes our grievance and appeals processes. You will receive written information of the grievance and appeals processes when you enroll and annually after that. At any time you wish to file a grievance or an appeal, we are available to assist you. If you do not speak English, a bilingual staff member or translation services will be available to assist you. You will not be discriminated against because a grievance or appeal has been Fresno PACE will continue to provide you with all the required services during the grievance or appeals process. The confidentiality of your grievance or appeal will be maintained throughout the grievance or appeal process and information pertaining to your grievance or appeal will only be released to authorized individuals. Grievance Procedure Definition: A grievance is defined as a complaint, either written or oral, expressing dissatisfaction with the services provided or the quality of participant care. A grievance may include, but is not limited to: The quality of services a PACE participant receives in the home, at the PACE Center or in an inpatient stay (hospital, rehabilitative facility, skilled nursing facility, intermediate care facility or residential care facility); Waiting times on the telephone, in the waiting room or exam room; Behavior of any of the care providers or program staff; Adequacy of center facilities; Quality of the food provided; Transportation services; and A violation of a participant’s rights Filing of Grievances The information below describes the grievance process for you or your representative to follow should you or your representative wish to file a grievance.
Participant Grievance and Appeals Process All of us at Fresno PACE share responsibility for your care and your satisfaction with the services you receive. Our grievance procedures are designed to enable you or your representative to express any concerns or dissatisfaction you have so that we can address them in a timely and efficient manner. You also have the right to appeal any decision about our failure to approve, furnish, arrange for or continue what you believe are covered services or to pay for services that you believe we are required to pay. The information in this Chapter describes our grievance and appeals processes. You will receive written information of the grievance and appeals processes when you enroll and annually after that. At any time you wish to file a grievance or an appeal, we are available to assist you. If you do not speak English, a bilingual staff member or translation services will be available to assist you. You will not be discriminated against because a grievance or appeal has been Fresno PACE will continue to provide you with all the required services during the grievance or appeals process. The confidentiality of your grievance or appeal will be maintained throughout the grievance or appeal process and information pertaining to your grievance or appeal will only be released to authorized individuals. Grievance Procedure Definition: A grievance is defined as a complaint, either written or oral, expressing dissatisfaction with the services provided or the quality of participant care. A grievance may include, but is not limited to: The quality of services a PACE participant receives in the home, at the PACE Center or in an inpatient stay (hospital, rehabilitative facility, skilled nursing facility, intermediate care facility or residential care facility); Waiting times on the telephone, in the waiting room or exam room; Behavior of any of the care providers or program staff; Adequacy of center facilities; Quality of the food provided; Transportation services; and A violation of a participant’s rights Filing of Grievances The information below describes the grievance process for you or your representative to follow should you or your representative wish to file a grievance.
Participant%20Grievance%20and%20Appeals%20Process.docx