Adams School of Dentistry: Procedure for Resolving Patient Grievances

Unit Procedure

Title

Adams School of Dentistry: Procedure for Resolving Patient Grievances

I. Introduction

A. Purpose

The UNC Adams School of Dentistry maintains an internal procedure providing for the prompt and equitable resolution of patient-initiated complaints and grievances relating to patient care, including any civil rights grievances arising under applicable Federal law.

B. Scope

This Procedure applies to all Adams School of Dentistry personnel.

II. Definitions

1. Complaint: Any patient-initiated issue or concern about patient care, a care provider, access to care, or service quality. Complaints may be expressed verbally or in writing.
2. Grievance: Any complaint that cannot be resolved to the satisfaction of the patient by Adams School of Dentistry personnel on the spot. The term “grievance” excludes complaints that are made anonymously or solely as a response to a patient satisfaction survey.
   1. General Grievance: Any grievance other than a Section 1557 grievance. Examples of general grievances include those relating to quality of care, billing, or professionalism.
   2. Section 1557 Grievance: Any grievance that alleges that the Adams School of Dentistry has discriminated against someone on the basis of race, color, national origin, sex, age, or disability in its health programs or activities, as prohibited by Section 1557 of the Affordable care Act (42 U.S.C. § 18116) and its implementing regulations at 45 CFR part 92.

III. Procedure

All complaints should first be addressed by those persons directly involved in the patient’s care. If a prompt resolution of the compliant is not possible, then grievances will be investigated and resolved in the following manner:

A. General Grievances

1. Student or Resident Clinics

If a concern cannot be satisfactorily resolved by those directly involved in the patient’s care, the employee or student involved must contact the Office of Clinical Education to act as an objective liaison to handle the general grievance. Patients or those involved in their care may also contact the Office of Clinical Education to communicate their concerns directly. The Director of Patient Relations will facilitate the investigation and resolution process and maintain documentation relating to the reporting, investigation, and resolution of all general grievances.

2. Dental Faculty Practice

If a concern cannot be satisfactorily resolved by those directly involved in the patient’s care, the faculty or staff member involved must contact the Director of Patient Relations to act as an objective liaison to handle the general grievance. The Director of Patient Relations will facilitate the investigation and resolution process and maintain documentation relating to the reporting, investigation, and resolution of all general grievances.

B. Section 1557 Grievances

1. Any person who believes someone has been subjected to discrimination in the Adams School of Dentistry’s health programs and activities on the basis of race, color, national origin, sex, age, or disability, may file a grievance under this Procedure. It is against the law for the Adams School of Dentistry to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance.
2. Section 1557 grievances must be submitted to the Section 1557 Coordinator (see "Contact Information" below) within 60 calendar days of the date the person filing the grievance becomes aware of the alleged discriminatory action.
3. Section 1557 grievances must be in writing and must contain:
   1. the name and address of the person filing it;
   2. the problem or action alleged to be discriminatory; and
   3. the remedy or relief sought
4. The Section 1557 Coordinator shall conduct an investigation of the 1557 grievance. The investigation may be informal, but it will be thorough, affording all interested persons an opportunity to submit relevant evidence.
5. The 1557 Coordinator shall issue a written decision, based upon a preponderance of the evidence, no later than 30 calendar days after its initial written filing. This decision shall include a notice informing the complainant of his or her right to pursue further administrative or legal remedies.
6. The person filing the Section 1557 grievance may appeal the Section 1557 Coordinator’s decision:
   1. the appeal must be made in writing, and submitted to the Section 1557 Coordinator no later than 14 calendar days of receiving the decision;
   2. the Section 1557 Coordinator will forward the appeal to the Dean;
   3. the Dean shall issue a written decision in response to the appeal no later than 30 calendar days after its filing.
7. The Section 1557 Coordinator shall maintain the files and records of the Adams School of Dentistry relating to 1557 grievances.
8. To the extent practicable and in accordance with applicable laws, the Section 1557 Coordinator shall take appropriate steps to preserve the confidentiality of files and records relating to 1557 grievances.
9. The Adams School of Dentistry will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided free auxiliary aids and services in order to meaningfully participate in the 1557 grievance process.
10. The availability and use of this grievance procedure does not prevent a person from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age, or disability in court or with the U.S. Department of Health and Human Services (HHS), Office for Civil Rights. For more information on initiating this process, visit the HHS "How to File a Civil Rights Complaint" website.

IV. Related Requirements

A. External Regulations and Consequences

1. Patient Protection and Affordable Care Act § 1557
2. Final Rule on Nondiscrimination in Health Programs and Activities

B. Unit Policies, Standards, and Procedures

1. Adams School of Dentistry: Policy on Nondiscrimination in Health Programs and Activities
2. Adams School of Dentistry: Procedure for Language Access

V. Contact Information