The purpose of the grievance process is to provide a fair and timely process to address written or oral grievances filed by participants, their families, or authorized representatives.

A grievance is a written or oral complaint expressing dissatisfaction with service delivery, or the quality of care furnished. The grievance can be medical or non-medical in nature. All written or oral complaints will receive a response in a timely manner.

Procedure

The procedure to file a grievance includes:

• All individuals enrolled in LIFE PACE will be informed, in writing (this document), upon enrollment and once each year after that of the grievance process.
• Participants can inform any LIFE PACE employee or contracted provider they wish to file a grievance. During non-center operation hours, you may call (918) 949-9969 and file a grievance with the person on call.
• Employee/ contractor will complete a grievance form for you if you wish and submit directly to center manager and/or the social worker. A copy will be provided to the person who files the grievance.
• The center manager and/or social worker will review the grievance information with the IDT members. The LIFE PACE medical director and/or primary care physician are responsible for determining if the grievance is medical in nature.
• All information related to the grievance will be held in strict confidence and will not be disclosed except where appropriate to process the grievance.
• The center manager and/or social worker will directly contact you or your family member in writing within ten working days regarding the resolution of the grievance.
• If you, your family, or authorized representative are dissatisfied with the outcomes of the IDT's proposed resolution, you may contact the LIFE PACE program director within 30 days of the IDT's decision to request a review.

Notices

We encourage you to use LIFE PACE' internal grievance process so that we may address your concerns as soon as possible; however, Oklahoma Medicaid recipients enrolled in LIFE PACE may appeal the decision in writing directly to the Oklahoma Health Care Authority. You or your authorized representative must send a written appeal request within 30 days of receipt of this notification. If you file an appeal before the effective date of this action, you may receive services during the appeal process. However, if this action is upheld by the Appeals Division, you may be required to reimburse the LIFE PACE program for the cost of services paid on your behalf during the appeal period. You may write a letter or complete an Appeal Request Form

Forms are available www.okhca.org. (By clicking this link, you will leave the LIFE PACE web site) Please include a copy of the grievance outcome notification, sign the appeal request, and mail it to:

Oklahoma Health Care Authority Grievance Docket Clerk
Legal Division
P.O. Drawer 18497
Oklahoma City, OK 73154-0497

Upon admission to an assisted living facility or nursing facility, you may have additional grievance rights and processes to follow. These additional rights and processes will be discussed with you, your family, or authorized representative at that time.