BELOW YOU WILL FIND GRIEVANCE
REPORTS IN SAMPLE FORM
National Alliance for Medication Assisted
Recovery
"Just that you people who are involved in advocacy, keep up the work. I have seen
changes come about because of people becoming involved. It is these who are the real heroes
in all this. Without advocacy, changes will not come about within the present system."
Dr. Vincent Dole
HERE IS THE LINK
http://www.methadone.org/grievance_report.html
Grievance Report
Is Your Program Punitive?
Fill Out a Grievance Report -- It's Time To Educate Them!
Does Your Program Treat Patients With Dignity?
Fill Out a Compliment Report -- Let Them Know They are Appreciated!
The Grievance Report Project is an ongoing project used to educate the Medication
Assisted Treatment (MAT) community about quality treatment. Programs can no
longer hide behind a veil of patient confidentiality or call degrading policies quality
treatment. The new accreditation organizations will be interested in these reports.
The Dole-Nyswander Program worked because it was a caring program with a sense
of community and that is what needs to be brought back to MAT. NAMA Recovery
will use the Grievance Report Process to report programs to various agencies for
further investigation. This project will not work unless patients themselves tell us
about their program. So NAMA Recovery needs you to participate.
Grievance Reports are Not Only for Programs!
A Grievance Report can be filed on any agency, institution, program or professional
that does not treat you with common dignity and respect. Here are some examples of
Grievance Reports that you can file.
hospital
inadequate pain medication
won't accept methadone
school
patients
any involvement because
family court
of your medication
probation or
have to withdraw from
parole officer
your medication
have to withdraw from
social worker or
your medication to receive
clinical psychologist
treatment
There are two kinds of grievance reports: a General Report and an Incident Report.
General Report
A General Grievance Report details the situation at a program, service or agency and
usually involves their policy. A General Report does not always require investigation
or follow up. You are simply reporting the policy or a situation at a program, service,
agency, etc. In some instances these policies are discriminatory towards patients.
When a policy violates the constitution or law NAMA Recovery will notify any
oversight agencies or institutions and begin procedures to end the policy. An example
of this kind of General Report would be a homeless shelter that does not allow MAT
patients. This is a direct violation of the Americans With Disabilities Act.
When NAMA Recovery has collected several General Grievance Reports about a
program an inquiry will be made to confirm if the policy has been changed or not. The
program's reply will be shared with the patients that have made the reports and if
necessary their will be further investigation. This type of report helps to change policy
at your program because it makes program staff re-think policy that may not be doing
what was originally intended.
Incident Report
If you are having trouble with your program you can report a specific incident.
Incident Reports are for specific problems that you are having with your program right
now. Other examples of an Incident Grievance Report include take home medication
schedule or dose change, either increase or decrease. Usually patients are having
trouble because they do not know program policy, state or federal regulations, or
resources that they can use to make the program work for them. NAMA Recovery
believes in empowering patients with information that will help them achieve the
recovery goals they have set for themselves. By filing an Incident Report you will be
assisted in: (1) knowing the regulations that apply, and (2) how to use regulations and
"resources" to get a positive result.
Some Incident Grievance Reports are being filed at a critical point. An example of this
is the patient that is being disharged from their program. If this is the case after filing
the Incident Grievance Report send an email to Claude Hopkins, the Grievance
Coordinator. The sooner that Claude Hopkins starts to intervene with a critical issue
the more likely your chance at having a positive result.
CONFIDENTIALITY POLICY
All information that is provided will be held strictly confidential in the same manner
as the patient protections described in the U.S. Federal Confidentiality Regulations 42
CFR and the Standards for Privacy of Individually Identifiable Health Information
(the Privacy Rule) as established by the Department of Health and Human Services
(HHS) under the Health Insurance Portability and Accountability Act of 1996
(HIPPA). In order to assist you at the maximum level of follow-up and outcome, we
do request certain personal information. However, if you do not want us to disclose
your name for any reason, we will honor your wishes.
We offer three ways to obtain and/or file a Grievance Report:
1. You can print out a Grievance Report and Authorization to Release
Information from our website.
Click Here to go there.
 You can download a Grievance Report and Authorization to Release Information in
pdf format.
Click below to download:
Grievance Report and Medical Release
Grievance Report
Medical Release
 You fill out the online Grievance Report. However we will still need an
Authorization to Release Information to speak with a program or many agencies.
Click below to download the Medical Release Form:
Medical Release
To go to the Online Grievance Report Click Here.
Grievance Reports can be sent to:
Claude Hopkins, RMA CMA, Grievance Coordinator
ch.grievance@methadone.org
Or mailed to:
National Alliance of Medication Assisted Recovery
435 Second Avenue
New York, NY 10010
Or faxed to:
(212) 595-nama/6262
How to submit feedback or resolve a
complaint with a CARF-accredited
provider
As part of our continuing effort to improve the quality of services of CARF-accredited
providers, feedback from consumers, employees, and others is used to strengthen the
value of CARF accreditation. Anyone can register feedback about a provider that is
accredited by CARF. Remember that it is as important to acknowledge the strengths
of a provider as it is to cite its weaknesses.
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You may summarize your comments or concerns by completing the online
contact form. Please include the name of the service provider, its city and state
or province, and your own name and complete address so that we may
acknowledge your feedback.
You may email your comments or concerns to feedback@carf.org. You must
include the information requested above.
Or you may fax your feedback to:
(520) 318-1129
Or you may mail your feedback on 1 to 3 pages of paper to:
CARF
6951 East Southpoint Road
Tucson, AZ 85756-9407
Or you may call toll free (866) 510-2273 or (866) 510-CARF, which is a
dedicated telephone line for receiving public feedback during business hours.
(Other business calls should continue to be directed to CARF's main number.)
The number is TTY-accessible for persons who are hard of hearing.
CARF's office hours are 8:00 a.m. to 4:30 p.m. (Mountain Standard Time),
Monday through Friday, except holidays.
Tips on resolving a complaint with a provider
In becoming accredited by CARF, a provider demonstrates that it focuses on quality
improvement, the best possible outcomes of its services, and customer satisfaction.
However, even the best providers will receive a complaint from time to time. If you
have a concern about the services you are receiving, you can take several steps.
First, tell a staff member about your concern and ask who can help you resolve it. A
CARF-accredited provider pledges to work hard to resolve concerns about its services.
Then, if you are unable to quickly resolve the concern, ask a staff member to tell you
how to use the formal complaint/grievance process. A CARF-accredited provider
must have a formal complaint/grievance procedure available to the people it serves
and other interested persons.
Finally, if you feel your concern is not resolved through the grievance process, you
may want to contact the Protection and Advocacy agency in your state, province, or
territory. You might also contact the governmental agency that is responsible for
licensing the provider to operate, making referrals, or funding the services.
http://www.samhsa.gov/index.aspx
http://www.carf.org/home/
Civil Rights
The Civil Rights Division (CRD) in the Office for Civil Rights (OCR) promotes and ensures that
people have equal access to and opportunity to participate in certain health care and human
services programs without facing unlawful discrimination. CRD carries out this mission by
enforcing Federal laws and regulations that prohibit discrimination, including health care
provider conscience rights, on the basis of race, color, national origin, disability, age and, in
certain circumstances, sex and religion, in programs and activities that receive financial
assistance from HHS. CRD also enforces a Federal law and regulation that prohibit
discrimination on the basis of disability in health care and social service programs of state and
local governments.
OCR Promotes and Ensures Compliance
with the Civil Rights Laws
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Investigate complaints filed
by individuals alleging that
they have or someone else has
been discriminated against on
a prohibited basis.
Conduct compliance reviews
of covered entities that OCR
believes may not be in
compliance with the law.
Provide technical assistance
to covered entities to help
them understand how they can
voluntarily comply with the
law.
Conduct outreach
nationwide to help individuals
and covered entities
understand rights and
obligations under the laws that
OCR enforces.
Regulation for the Enforcement of
Federal Health Care Provider
Conscience Protection Laws
HHS has issued a new regulation for
the Enforcement of Federal Health
Care Provider Conscience Protection
Laws. Read the new regulation,
overview, Fact Sheet, and Power
Point. OCR is empowered to enforce
these important regulations.
To learn about other Federal civil
rights laws enforced by OCR.
Office for Civil Rights
Federal civil rights
laws and the Health Insurance Portability and Accountability Act
(HIPAA) Privacy Rule, together protect your fundamental rights of
nondiscrimination and health information privacy. Civil Rights help to
protect you from unfair treatment or discrimination, because of your
race, color, national origin, disability, age, sex (gender), or religion.
Federal laws also provide conscience protections for health care
providers.
The Privacy Rule protects the privacy of your health information; it
says who can look at and receive your health information, and also
gives you specific rights over that information. In addition, the Patient
Safety Act and Rule establish a voluntary reporting system to enhance
the data available to assess and resolve patient safety and health care
quality issues and provides confidentiality protections for patient
safety concerns.
Health Information Privacy
Civil Rights
Rights
OCR helps to protect you from
By enforcing the Privacy and
discrimination in certain health
Security Rules, OCR helps to
care and social service programs. protect the privacy of your health
Some of these programs may
information held by health insurers
include:
and certain health care providers
and health insurers. Some of these
providers and insurers may include:
 Hospitals, health clinics,
nursing homes
 Medicaid and Medicare
 Doctors and nurses
agencies
 Pharmacies
 Welfare programs
 Hospitals, clinics, and
 Day care centers
nursing homes
 Doctors’ offices and
 Health insurance companies
pharmacies
 Health maintenance
 Children’s health
organizations (HMOs)
programs
 Employer group health plans
 Alcohol and drug
 Certain government
treatment centers
programs that pay for health
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Adoption agencies
care, such as Medicare and
Mental health and
Medicaid
developmental disabilities
agencies
OCR also enforces the
confidentiality provisions of the
Learn more about civil rights>> Patient Safety Act and Rule.
Learn more about health
information privacy>>
What Does OCR Do To Protect Your Rights?
 OCR teaches health and social service workers about civil
rights, health information privacy, and patient safety
confidentiality laws that they must follow.
 OCR educates communities about civil rights and health
information privacy rights.
 OCR investigates civil rights, health information privacy and
patient safety confidentiality complaints to find out if there is
discrimination or violation of the law and takes action to correct
problems.
What Can You Do If You Believe Your Federal Health Care Rights
Are Violated?
 You can file a civil rights, health information privacy, or patient
safety confidentiality complaint with OCR, or someone else can
file for you. Some complaints must be filed within 180 days of
when you believe your rights were violated. Learn more about
filing a complaint
Health Information Privacy
The Office for Civil Rights enforces the HIPAA Privacy Rule, which
protects the privacy of individually identifiable health information; the
HIPAA Security Rule, which sets national standards for the security of
electronic protected health information; and the confidentiality
provisions of the Patient Safety Rule, which protect identifiable
information being used to analyze patient safety events and improve
patient safety.
The Health
Insurance
Portability
and
Accountability
Act of 1996
(HIPAA)
Privacy and
Security Rules
Learn about the Rules'
protection of individually
identifiable health information,
the rights granted to
individuals, OCR’s
enforcement activities, and
how to file a complaint with
OCR.
The Patient
Safety and
Quality
Improvement
Act of 2005
(PSQIA)
Patient
Safety Rule
Learn about the Patient
Safety Rule's protection of
confidential patient safety
work product, the permitted
disclosures of patient safety
work product,
OCR's enforcement
activities, and how to file a
complaint with OCR.