If you believe your privacy rights have been violated, you may file a complaint with the Agency or with the Secretary of the Department of Health and Human Services. To file a complaint with the Agency, call (802) 229-1399 and ask to speak with our Privacy Officer. All complaints must be submitted in writing. Complaint forms are available at each location including the reception area at the Agency’s main office. You will not be penalized for filing a complaint.

The Secretary of the Department of Health and Human Services can be contacted through their regional office at Office of Civil Rights, U.S. Department of Health and Human Services, Government Center, J.F. Kennedy Federal Building – Room 1875, Boston, Massachusetts 02203, voice phone (800) 368 1019, fax (202) 619-3818, TDD (800) 537-7697.

Grievances and Appeals

Complaints, Grievances and Appeals 

Under Vermont Global Commitment to Health, the Department of Vermont Health Access (DVHA) has established a process for you to resolve problems about your care at Washington County Mental Health Services, Inc.  For example, you might be dissatisfied because your treatment or service team changes the kind or amount of services you receive, or you might tell your case coordinator that another staff member was rude to you.

Washington County Mental Health Services, Inc. (WCMHS) serves as the initial point of response for grievances and appeals.  The agency has a Grievance and Appeal Coordinator and the staff at WCMHS will help you understand how the process works. 

• You can file a complaint or grievance with any WCMHS staff member.

• You have a right to file a grievance without retaliation.

• You can ask any WCMHS staff member for information on how to file a grievance or appeal.

Grievance and Appeal:

There may come a time when you are not satisfied with your services and want to take steps to address your concerns. You may do so in a formal or informal manner. To address your concerns informally, you could talk to the WCMHS Director of Quality & Risk Management or any staff member about a complaint you have. If you are not satisfied with the WCMHS response, you can then file a formal grievance or appeal. The definitions below will help you understand the difference between grievance and an appeal.

Grievance examples may include:

• Aspects of interpersonal relationships such as rudeness of employee

• Dissatisfaction with management or program decision

• Failure to respect the individual’s rights

• Dissatisfaction with the quality of care or services provided

Adverse Benefit Determination (Appeal) examples may include:

• Denial, in whole or in part, of payment for a service

• Failure to provide services in a timely manner

• Failure to provide clinically indicated covered services

• Denial of request for covered services outside Medicaid network

The overall goal of the grievance and appeal process is to resolve disputes fairly, to enhance confidence in the equity and integrity of the service system, to ensure access to medically necessary, covered services.

Procedure for filing a grievance:

• Contact the agency to express a concern.  If the concern can be resolved with that initial contact no further action is required

• If you wish to file a grievance this may be expressed orally or in writing

• You will receive a letter acknowledging the grievance within 5 calendar days.

• Grievances will be addressed as soon as possible but not more than 90 days of receipt

• If you are dissatisfied with the response, you may file a grievance review within 10 calendar days

• You will be notified of findings of review within 90 days

Procedure for filing an appeal:

• Appeals may be filed orally or in writing for any Medicaid program adverse benefit determination.

• Appeals must be filed within 60 days of the notice of adverse benefit determination.

• Letter of acknowledgement mailed to you within 5 days of receipt of appeal.

• Decisions require written notice within 30 days.

• If you do nor agree with the appeal decision you have 120 days to file a Fair hearing.

If you need help understanding the Consumer Complaint, Grievance, and Appeal Procedure, please ask to speak to the WCMHS Compliance Officer at (802) 229-1399.

Unprofessional Conduct

Unprofessional conduct and filing a complaint about a licensed and non-licensed psychotherapists,

licensed and non-licensed clinical mental health counselors, marriage and family therapists and psychotherapists practice is governed by the Rules of the Board of Allied Mental Health Practitioners and it is unprofessional conduct to violate those rules. The regulations for professional practices can be obtained at https://www.sec.state.vt.us/professional-regulations.aspx. A copy of the statutory definitions of unprofessional conduct (3 V.S.A. §129a and 26 V.S.A. § 4093) can be obtained for the Board of Allied MH Practitioners or online at http://vtprofessionals.org/

The Vermont Office of Professional Regulation has a procedure for receiving, investigating, and acting on complaints of unprofessional conduct. Consumers who have inquires or wish to obtain a form to register a complaint may do so by calling (802) 828-1505, or by writing to the Director of the Office, Secretary of the State’s Office, 89 Main Street, 3rd Floor Montpelier, VT 05620-3402 or online at https://www.sec.state.vt.us/professional-regulation.aspx

If you need help understanding the Consumer Complaint, Grievance, and Appeal Procedure, please ask to speak to the WCMHS Compliance Officer at (802) 229-1399.