Grievances and Appeals

Portland Mental Health & Wellness (PMHW) is committed to providing quality services designed to meet patients’ needs and to respect patients’ rights. If you or any person acting on your behalf believes that your needs are not being met within the scope of treatment or that your rights have been violated, you may file a grievance with the provider, your coordinated care plan, or the Health Systems Division regarding any aspect of your treatment.

If you have a concern or complaint, ask your clinician to help you resolve the problem. If your clinician is not available, ask administrative staff to help you. If you are not satisfied with the resolution, write a formal grievance. These grievances can be submitted to our Grievance Response Team and they are logged the day they are received. An investigation will be conducted within 30 calendar days or sooner, if possible. The individual submitting the grievance will receive updates at least every 7 days and the final outcome within 45 days of the original grievance.

The written grievance must include a statement of the problem, the date(s) of occurrence, a list of persons involved, and any other pertinent details that will clarify the nature and circumstances of the grievance. You may suggest potential resolutions.

The Grievance Response Team will speak with you and all other appropriate parties in investigating your grievance within 30 calendar days. The Grievance Response Team will discuss with you possible resolutions, and will then take action to resolve all valid aspects of the grievance. The resolution will be pursued in a timely manner. The Grievance Response Team will place in your record a copy of the grievance, a summary of investigation results, and a description of actions taken. You have a right to review this information. Aspects of this information that could violate the privacy rights of staff or other patients may be withheld from your record.

Expedited Grievances: In circumstances in which the matter of the grievance is likely to cause harm to the individual before the grievance procedures outlined in these rules are completed, the individual, or guardian of the individual, may request an expedited review. The Executive Director will review and respond in writing to the grievance within 48 hours of receipt of the grievance. The written response must include information about the appeal process.

Retaliation: A grievant, witness, clinician, supervisor or staff member of PMHW clinics must not be subject to retaliation by a provider for making a report or being interviewed about a grievance or being a witness. Retaliation may include, but is not limited to, dismissal or harassment, reduction in services, wages or benefits, or basing service or a performance review on the action.

Immunity: The grievant is immune from any civil or criminal liability with respect to the making or content of a grievance made in good faith.

Appeals: Individuals and their legal guardians have the right to appeal entry, transfer, and grievance decisions as follows:
● If you are unsatisfied with the decision, you can file an appeal in writing within 10 working days of the date of the Grievance Response Team’s response to the grievance or notification of denial for services.
● If your treatment is paid for by public or private insurance, you can also file an appeal with your insurance company. If you are covered by a CCO, such as HealthShare of Oregon, you can appeal to HealthShare of Oregon.
● PMHW representatives will be available to assist in responding to the appeal, if requested.
● Health Systems Division at the Oregon Health Authority must provide a written response within 10 working days of the receipt of the appeal.
● If the individual or guardian is not satisfied with the appeal decision, they may file a second appeal in writing within 10 working days of the date of the written response to the Health Systems Division Director at the Oregon Health Authority.

Contact information for appeals:
● Healthshare of Oregon: 503-416-8090
● Oregon Health Plan: 503-947-5804
● Disability Rights Oregon: Voice: 503-243-2081; TTY users: dial 711
● Health Systems Division  at the Oregon Health Authority: 503-945-5763
● Governor’s Advocacy Office: 503-945-6904