|
Arizona Non-Medical
Home Care Association
The Association's Consumer
Complaint/Dispute Process
Complaints or issues of abuse, mistreatment, neglect or exploitation should
referred to the appropriate governmental agency. Click on the button to find
the appropriate agency.
If you
believe you are a victim of consumer fraud, we encourage you
to click on this link
http://www.azag.gov/consumer/ for information regarding
what you can do about it.
CLICK
ON ANY OF THE LINKS BELOW TO GO TO THAT SECTION OF THE
ASSOCIATION'S COMPLAINT/DISPUTE PROCESS
OVERVIEW
DISPUTES WITHIN THE
ASSOCIATION'S SCOPE OF REVIEW
DISPUTES OUTSIDE THE ASSOCIATION'S SCOPE OF REVIEW
AzNHA'S
PEER REVIEW PROCESS
PROCEDURES FOR PEER REVIEW
PROCEDURES FOR APPEAL
CONFIDENTIALITY
COMPLAINT/DISPUTE
FORM
OVERVIEW
The nature
of Non-Medical Home Care Services requires that a
relationship of trust and confidence exist among Non-Medical
Home Care Providers, their employees and the public.
Non-Medical Home Care Providers and their employees are
expected to exercise their best judgment in the
performance of their duties while interacting with all
persons with whom they provide care in an honest,
respectful, and civil manner.
However, in
the course of regular business activities, misunderstandings
and problems will occur. We believe consistent, open, and
honest communication between Non-Medical Home Care Providers
and their clients will minimize the risks of difficulties.
Nonetheless, problems do occur. If a consumer has problems,
issues, or other difficulties with a Non-Medical Home Care
Provider Business, the Association advocates that the
consumer has a responsibility to contact that business in an
effort to inform the Business Provider of the difficulties
and to give the Provider Business an opportunity to correct
the situation. If a Non-Medical Home Care Provider Business
has been apprised of a perceived problem by a consumer, the
Association holds that the Provider Business has a duty to
respond to that issue in a timely manner.
If, for
whatever reason, a consumer cannot resolve a problem with a
Non-Medical Home Care Provider Business, after following the
procedures on the Association’s Complaint/Dispute Form and
submitting a completed copy of said form and associated
documents, then the Association will become involved at the
consumer's request through its peer review process. The
Association will only address issues or complaints that are
within the Association's scope of review.
DISPUTES WITHIN THE ASSOCIATION'S SCOPE OF REVIEW
The
following types of disputes may be reviewed by a Peer Review
Committee:
A.
Disputes concerning whether services for
which a fee was charged were
rendered.
B.
Disputes concerning alleged breaches of the
Association's Code of Business
Ethics.
C.
Disputes concerning the quality of care
services rendered.
DISPUTES OUTSIDE THE ASSOCIATION'S SCOPE OF REVIEW
-
The Association will not
consider any dispute for which a lawsuit of any type has
been filed or if there is pending legal action concerning
the matter. If a suit is filed or there is legal action
initiated concerning the matter after the Peer Review has
been initiate, the review process shall immediately
terminate.
B. The Association will not consider any
disputes concerning the following:
1. Employment issues
2. Labor or labor law issues
3. Criminal or potential criminal
issues such as theft, negligence, abuse, fraud, etc.
If you
believe that any of the items in “B.” above applies to your
situation, click on the following link: http://www.azag.gov/consumer/complaintformintro.html
for further assistance.
AzNHA'S
PEER REVIEW PROCESS
The purpose
of the Association’s Peer Review Process is to maintain a
process wherein unresolved disputes that arise in the
delivery of non-medical home care services to the public,
may be addressed and resolved in an unbiased, objective and
timely manner.
Peer Review
is not a court and its intention is not to have a
disciplinary function. It merely provides an alternative
dispute resolution mechanism, at no cost to either party.
The Peer Review is a process by which the Association’s Peer
Review Committee reviews and attempts to assist in resolving
non-medical home care service problems and
misunderstandings. The Association's Peer Review Committee
is comprised of a Board Member(s) of the Association and
other Members of the Association that are in the non-medical
home care profession
Participation in the peer review process is purely voluntary
for consumers and non-member Provider Businesses. Members of
the Association are required to participate in any Peer
Review process that involves the Member or Member’s company.
The decisions of peer review bodies, whether original or on
appeal, are advisory only. The Peer Review Committee shall
have no disciplinary powers over the participants in peer
review. The decisions of peer review bodies and the
information gathered in the course of peer review
investigations are confidential to the extent allowed by law
and are not disclosed to the general membership of the
Association, or the general public. Peer Review Committees
may make recommendations to the Board of Directors regarding
a specific action they believe appropriate to be taken
against a Member as a result of a Peer Review Process.
PROCEDURES FOR PEER
REVIEW
1.
In order for a consumer to initiate the Association’s Peer
Review Process, that consumer must follow the steps of, and
complete, the Association’s Consumer Complaint Form.
2.
When the Association receives a Consumer Complaint/Dispute
Form, a member of the Association’s Peer Review Committee
reviews the form for completeness and verifies that copies
of the appropriate documents are attached. Only completed
Consumer Complaint Forms, signed and dated by the consumer,
with all the required copies of documentation will be
processed. Incomplete forms will be returned to consumers
for completion.
3.
No unsigned, incomplete or anonymous complaints will be
accepted by the Association
4.
Upon receipt of all of the above from a consumer, the
executive director will immediately make a determination if
the complaint is within the Association's scope of review.
If it is within the scope of review the executive director
will refer the complaint to the Peer Review Committee. If
the complaint is outside the scope of review, the executive
director will dismiss the complaint and return the materials
to the consumer with a letter explaining why the complaint
is dismissed.
5.
Upon receipt of the complaint materials, the Peer Review
Committee shall immediately mail a copy of the complaint to
the party or parties about whom the complaint is made. The
committee shall advise all concerned in writing that they
have a right to appeal the final decision of the Peer Review
Committee to the Board of Directors of AzNHA. The Committee
shall inform the party about whom the complaint is made that
there is a ten (10) day “cooling-off period” wherein the
parties are encouraged to use that time to take the
necessary measures to resolve the issues between themselves.
6.
At the end of the “cooling-off period,” the Peer Review
Committee will contact both parties to determine if the
issues have in fact been resolved. If they have, the Peer
Review Process ends and the Association considers the issues
resolved.
7.
If the issues have not been resolved at the end of the
“cooling-off period,” the Committee shall notify all parties
to the dispute of the names of the persons appointed to the
Review Committee conducting their review. Any party to a
dispute may challenge any member of the Review Committee
upon a showing of good cause. Challenges shall be determined
by the Review Committee. The member challenged shall not
vote. In case of a tie vote, the member challenged shall not
serve. Members so displaced from the committee shall be
replaced by new appointment made by the Board of Directors
of AzNHA.
8.
The committee shall appoint one of its members to conduct a
preliminary investigation. This member shall thoroughly
review the complaint to determine if a bona fide dispute
exists. When necessary, he shall contact all parties to the
dispute and determine their positions. When the preliminary
investigation is completed, the investigating member shall
report to the committee in writing and shall attach to the
report all documents and other pertinent materials gathered
by him.
9.
Upon receipt of the written report from the investigating
member, the committee shall determine if a formal hearing is
necessary. If it determines that a formal hearing is
necessary, all parties to the dispute will be notified by
certified mail at least 10 days in advance of the hearing.
10.
If a hearing is called, the committee shall determine that
all necessary parties are present. Each party may submit
such information and testimony that it wishes to have
considered in support of its position.
11.
If the
committee desires or deems necessary the opinion of a
specialist, a specialist Peer Review Board, or other
consultants, in its investigation, it may call upon such
specialist, specialist review board, or other non-medical
home care consultants that will voluntarily, and without
compensation, investigate and receive their opinion and the
committee shall receive that opinion before rendering its
judgment. If a party to the dispute desires that the
committee receive the opinion of a specialist, specialist
review board, or other consultant, designated by the party,
and that or those persons will not volunteer their time and
efforts to the review process, then the committee will not
receive an opinion from that or those persons.
12.
The Review Committee shall consider its decision in closed
session. The members of the Committee shall base their
decisions on the facts and circumstances of the particular
case, using their own individual experience, training and
judgment. In disputes concerning fees, the Committee shall
not use fee schedules or relative value guides in arriving
at its decision. A majority vote shall constitute the
decision of the Committee. Upon reaching a decision, the
committee shall render a written opinion. If the decision is
not unanimous, a written minority opinion may be rendered by
the dissenting Member(s).
13.
The decision of the committee should be specific and concise
and should state the reasons and evidence on which it is
based. Each decision shall state that it is purely advisory.
14.
The Review Committee shall forward its decision and the peer
review file to the executive director of AzNHA immediately
upon completion of its review. The Review Committee shall
complete its review and render its decision with reasonable
promptness.
15.
The executive director shall immediately send a copy of the
Review Committee's decision to all parties to the dispute.
He or she shall further notify the parties of their right to
appeal the Review Committee's decision to AzNHA=s Board of
Directors.
PROCEDURES FOR APPEAL
After the
Review Committee makes their decision, any party to the
dispute may appeal the Review Committee's decision to
AzNHA's Board of Directors on any of the following grounds:
l) Proper
procedure was not followed by the Review Committee,
2)
Information not available at the time of the Review
Committee's decision has since been developed, or
3) The
Review Committee's decision on its face is contrary to the
evidence presented.
4) Appeals
must be in writing to the executive director of AzNHA, and
they must be mailed or delivered within 30 days of the
party's receipt of the Review Committee's decision. The
executive director shall transmit the written appeal and the
peer review file to AzNHA=s Board of Directors.
5) Within
15 days of receipt of a bone fide appeal, the Board of
Directors will convene a special closed meeting at which
time the Appeal will be reviewed. The Board will vote, and
simple majority rules, on the merits of the Appeal and
decide whether the Review Committee’s decision will be
upheld or overturned. The Board’s decision is final.
6) After
the Board makes a determination of the appeal, a written
explanation of that determination will be sent to all
parties involved.
CONFIDENTIALITY
Decisions of the Peer Review Committees and of AzNHA's Board
of Directors, as well as all information and communications
developed in the course of their investigations or
deliberations, are confidential to the extent allowed by
law. Peer review decisions and related information shall not
be disseminated among the general membership of the Arizona
Non-Medical Home Care Association nor to the general public.
Disclosure of peer review decisions and related information
within AzNHA shall be limited to the extent necessary to
permit appeals and administration of the peer review system.
|
