N.J. Admin. Code § 10:37-4.6

Current through Register Vol. 56, No. 19, October 7, 2024

Section 10:37-4.6 - Client complaint/agency ombuds procedure

(a) This section shall apply to all State-funded mental health programs. Any questions related to service delivery, denial or termination of services shall be an appropriate subject for review. Any client, applicant, or person who has been a client within the last three months or his/her designee, parent or guardian, shall have the right to seek review. Such persons shall be identified below as "clients."

(b) Establishment of complaint procedure: Each agency shall establish internal client complaint procedures which will be subject to Division review and approval at the time of the agency's annual request for State funding.

1. Explanation to clients: Each client shall be made aware of the existence of a complaint procedure at second, non-emergency contact. Written notice, as well as a verbal explanation of agency complaint procedures, and external advocacy services which are directly available to clients at all times, shall be given to each client at the earliest appropriate opportunity. Under all circumstances, clients not accepted for services shall be informed immediately of the State-wide advocacy services available to them. Information regarding external advocacy services shall minimally include the:

i. Community Mental Health Law Project (if one exists in the client's county);

ii. County Mental Health Administrator in the county;

iii. Division of Mental Health and Hospitals' Ombudsperson;

iv. Division of Mental Health Advocacy;

v. Division of Youth and Family Services (for child abuse and/or neglect);

vi. County Welfare Agency (for adult abuse).

2. Posting: The information contained in the written notice required above shall be posted in a prominent place in the agency's facilities.

(c) Designation of Agency Ombudsperson: The Agency Director shall designate a staff person to function as Agency Ombudsperson, on an as needed basis. Small agencies may choose to share staff for this function.

(d) Responsibilities of Agency Ombudsperson:

1. The responsibilities of the Agency Ombudsperson shall be:

i. To receive client complaints;

ii. To act as an advocate for clients who make complaints; and

iii. To attempt to negotiate resolutions of issues raised by clients (Complaints shall be investigated and negotiated within five working days.)

2. The Agency Ombudsperson shall submit a written report of findings, resolutions and/or recommendations to the Agency Director and to the client within seven working days of the complaint. If the complaint has been resolved to the client's satisfaction, the grievance process shall end at this point.

(e) Optional establishment of Internal Agency Review Committee: The Agency may develop, by the Director's appointment or by staff/client election, an interdisciplinary review committee. It is suggested that such a Committee include an equal number of staff or Agency Board members and clients of the Agency. If established, such a Committee should:

1. Receive and review complaints within three working days of a request by a client or Agency Director;

2. Submit a written report of its findings and recommendations to the Agency Director within five working days of complaint.

3. Report to the Division of Youth and Family Services complaints or allegations of abuse and/or neglect, in accordance with N.J.S.A. 9:6-8.1 0.

(f) Internal Agency complaint resolution:

1. The Agency shall permit and encourage clients who object to a decision of a therapist, counselor, or service procurer, to consult with, and to obtain the opinion of, a second such person either within or without the Agency.

2. If a complaint has not been resolved by the Agency Ombudsperson to the client's satisfaction, the client may request review by the Agency Director. If an Internal Agency Review Committee has been established in the Agency, either the client or the Agency Director may request review by that Committee. The Director shall make the final Agency-level decision regarding the complaint, in a due process manner, as quickly as possible.

3. If the complaint has still not been resolved to the client's satisfaction, the client may request review by the County Mental Health Board.

(g) Responsibility of the County Mental Health Board:

1. The County Mental Health Board, through its Administrator, shall receive and review complaints referred from Agency Directors within five working days.

2. The County Mental Health Board shall make its findings and recommendations known to the Agency Director and to the client within seven working days of complaint. If the client is not satisfied with the recommendations of the Board, or the Agency's response to these recommendations, the client may request review by the Division.

(h) State-level review by the Division:

1. A client may request a review by the Division directly, and in confidence, at any time. Clients shall be encouraged by the Division, however, to seek an Agency-level review first and will be asked to justify the omission of an Agency or a County-level review. The Division will advise the Agency and the County Mental Health Board of all complaints received directly, unless the client, on notice, refuses to consent to such disclosure.

2. The Division may convene a Professional Review Committee, when needed, consisting of an interdisciplinary team appropriate to the subject of the complaint. The designees shall receive and review complaints referred by clients within five working days and shall submit a written report of its findings and recommendations to the Division Director within two more days.

3. The Division Director shall review this report and submit recommendations to the Agency Director and the client within seven working days. The Division shall determine if any formal State remediation/funding compliance action is necessary based on the Agency's response to these recommendations.

(i) Procedures not to limit access to other remedies: These procedures are intended to be in addition to, rather than in replacement of, any other remedies available to clients for the negotiation or redress of complaints services delivery. It is not the intention of the Division that clients be required to exhaust these procedures before seeking negotiation or redress for complaints in any judicial or administrative forum.

(j) No suspension of Agency action during review: An Agency action which is the subject of a client complaint need not be suspended pending review under these procedures. A client, however, may request expedited, direct review by the Division at any time, and such review shall be completed within 72 hours of the request.

(k) Confidentiality: A client who requests assistance with or review of a complaint by an Agency Ombudsperson, Internal Agency Review Committee, Agency Director, County Mental Health Board or the Division, shall be required to consent to the disclosure of relevant records, in order to authorize persons providing assistance or review to discuss the subject of the complaint with relevant Agency staff if necessary.

N.J. Admin. Code § 10:37-4.6