Participant Feedback (Grievances)
Rocky Mountain PACE shares responsibility for assuring that our participants are satisfied with the care they receive. We encourage our participants to express any feedback (grievances) at the time and place that any dissatisfaction occurs. If a participant does not speak English, please let us know, and an interpreter will be appointed to facilitate the grievance/feedback process. During the participant’s annual re-assessment, we will also review the Feedback and Appeals process and notify the participant of any changes that may have occurred.
A feedback, also known as a grievance, is a complaint, either written or oral, expressing participant dissatisfaction with service delivery or the quality of care furnished. The process to resolve a grievance is as follows:
- The participant and/or his/her caregiver may either write or discuss feedback with any staff member at Rocky Mountain PACE or a member in the Quality and Compliance Department.
- Feedback forms are located with the secured Feedback boxes in the lobby and the Day Center. Or they can be handed to any staff member who will deliver to the Quality and Compliance department.
- The feedback will be logged and followed by the Quality and Compliance Department at Rocky Mountain Health Care Services.
- The Quality and Compliance staff will determine which staff should be involved to resolve the feedback. The person assigned to determine the feedback resolution will contact the participant and/or caregiver regarding their feedback and solicit suggestions or ideas toward resolving the problem or issue to consider.
- We make every attempt to reach the participant/caregiver by phone to discuss the proposed resolution. All participants/caregivers will receive a letter of resolution outlining regardless of whether we were able to reach them by phone. Our policy outlines that we must contact the participant and/or caregiver with the proposed resolution within 30 days; however, our goal is to resolve any feedback much sooner.
- If the participant and/or caregiver is unhappy with the resolution, they may contact the Quality and Compliance Department of Rocky Mountain Health Care Services at 719.314.2327/ TTY 800.659.2656, Ext. 393 to learn more about next steps which includes the appeal process.
- During the feedback/grievance process, Rocky Mountain PACE will continue to furnish the participant with all required services as included in their Plan of Care.
Rocky Mountain Health Care Services
Attn: Quality & Compliance Department
2502 East Pikes Peak Ave Suite 100
Colorado Springs, CO 80909
Phone: (719) 314-2327 Ext. 856
TTY 800-659-2656 Ext. 393
Fax: (719) 314-0077
Anonymous Feedback Reporting:
If the participant and/or his/her caretaker prefers to contact Rocky Mountain PACE anonymously, separate from filing a feedback or grievance, they may call Rocky Mountain PACE’s compliance hotline number at (844) 986-1433 to start the reporting process.
Standard Appeals Process:
All of the staff at Rocky Mountain PACE share responsibility with you, your family or caregiver in providing you the comprehensive health care services identified in your Plan of Care as authorized by the Interdisciplinary Team. You, your family or caregiver are encouraged to contact a member of the Interdisciplinary Team when you have a disagreement with Rocky Mountain PACE’s noncoverage of, or nonpayment for, a service including denials, reductions, or termination of services.
If we deny your request for a noncoverage of, or nonpayment for, a service including denials, reductions, or termination of services, we will give you a written copy of this information on the appeals process, including a form that you may use to request your appeal. You may also make your appeal known verbally, and PACE staff will document and submit your request for an appeal.
The Rocky Mountain PACE Quality Assurance Manager or designee will respond to you in writing within two working days, stating that your appeal has been received.
A person not involved in our initial decision to deny your request for a service or to pay a claim will reevaluate your appeal. The reviewer will be an appropriately credentialed and impartial individual who was not involved in the original action and does not have a stake in the outcome of the appeal.
You or your authorized representative may present or submit to us relevant facts and/or evidence for review, either in person or in writing for consideration during the appeal process.
Within thirty (30) calendar days of receiving the appeal, Rocky Mountain PACE will notify you by certified mail of the appeals decision. A copy of the notification will be kept in your file.
Rocky Mountain PACE may not stop or reduce services while your appeal is pending. If the appeal is not resolved in your favor, you may be charged for the cost of the services.