Upholding Fairness – Understanding Disputes, Grievances, and Complaints in HCBS Services

Welcome back! At this point in your training, you have explored in detail the fundamental shift in thinking and how we as professionals are responsible for upholding and empowering Member rights.  Now, we turn to an equally important topic: how individuals can exercise their rights when they believe something has gone wrong and advocate for themselves to ensure their rights are upheld.  

Ensuring fairness, transparency, and accountability in service provision means that individuals receiving HCBS services must have a clear way to dispute decisions or file grievances when they feel their rights or access to services are being impacted. 

Every agency providing HCBS services is required to keep current and easily accessible copies of their Grievance and Dispute policies. Additionally, these policies must be made available to all Members in clear, plain language formats that are easy to understand. This ensures that individuals receiving services are fully informed of their rights, the processes available to address concerns, and the steps they can take if they believe their rights have been violated.

Learning Objectives: By the end of this training, you will understand:

• The differences between a dispute and grievance
• The process for filing a dispute related to service eligibility, reductions, or terminations.
• The grievance process for complaints that do not involve service eligibility but impact quality of care, dignity, or fairness.
• Protections against retaliation and intimidation for those who file disputes or grievances.

The role of the Department of Health Care Policy & Financing (HCPF) in resolving appeals.