Section 3.5. Informal complaints

(a) General requirement. Prior to arranging for any formal hearings on complaints or appeals, the Department will require all parties appealing under § 3.3 (relating to opportunities for appeals and fair hearings) to proceed through the informal complaint process provided for in this section.

(b) Submission, form and content of informal complaints.

(1) All informal complaints shall be filed in writing within 30 days following the receipt of the notice of adverse action.

(2) Parties appealing under § 3.3(3) and (4) shall send their informal complaints to the director of the local Area Agency on Aging.

(3) Parties appealing under § 3.3(1) and (2) shall send their informal complaints to the Department’s Bureau of Program and Field Operations.

(4) The complaint shall contain all of the following information:

(i) Name and address of the complainant.

(ii) Party against whom the complaint is made.

(iii) A copy of the notice of adverse action.

(iv) A statement of all relevant facts and the grounds upon which the complaint is based.

(v) A statement of all issues presented.

(vi) The relief or solution requested by the complainant.

(vii) While not required, the complaint may be accompanied by supporting papers.

(c) An informal complaint as an official request for a hearing. The filing of an informal complaint in accordance with subsection (b) shall constitute an official request for a hearing under 45 CFR 1321.51(b) (relating to confidentiality and disclosure of information).

(d) Local efforts to resolve informal complaints filed with Area Agencies on Aging.

(1) Each Area Agency on Aging shall establish a system for seeking local resolutions to informal complaints filed under subsection (b)(2).

(2) The Area Agency on Aging system required under subsection (d)(1) shall, as a minimum, provide for all of the following:

(i) The Area Agency on Aging shall confer with all parties directly involved in the adverse action to determine all pertinent facts, clarify all applicable statutes and regulations and develop an appropriate recommended resolution.

(ii) The Area Agency on Aging shall notify in writing the parties to the complaint of its recommended resolution within a period of not more than 10 working days from the date of its receipt of an informal complaint.

(iii) Written notification of a recommended local resolution shall include instructions for the response of the parties within an additional 10 days.

(iv) The Area Agency on Aging shall utilize the Domicilary Care Review Team to handle all complaints or appeals from domiciliary care providers and applicants for or recipients of domiciliary care services.

(v) The Area Agency on Aging shall place on file written documentation of all steps taken to resolve a complaint at the local level, the recommended resolution and the response to the recommended resolution made by the parties to the complaint.

(vi) If either party to an informal complaint handled under subsection (d) does not accept the resolution recommended by the Area Agency on Aging and so notifies the area agency within the required 10 days, the Area Agency on Aging shall forward a copy of the originally filed complaint to the Department’s Bureau of Program and Field Operations within 3 working days of the receipt of the notification of lack of acceptance. The copy of the complaint submitted to the Department shall be accompanied by a description of the Area Agency on Aging’s efforts to resolve the complaint locally, including the recommended resolution and the response of the parties.

(e) Handling informal complaints filed with the Department.

(1) Investigation by the Department. The Department’s Bureau of Program and Field Operations will investigate each informal complaint with a view toward informal resolution. The investigation will include, but not be limited to, discussions and negotiations with all parties involved. The investigation will be completed within 30 days of the Department’s receipt of the informal complaint.

(2) Notification of recommended resolution. Following the completion of the investigation, the Department will notify all parties concerned of its recommended resolution of the complaint.

(3) Appellate rights.

(i) The parties to the adverse action shall notify the Department of acceptance or rejection of the recommended resolution within 30 days following the receipt of the recommended resolution.

(ii) If either party rejects the recommended resolution, that party may request a formal hearing. All requests for a formal hearing must be made within 30 days following the receipt of the recommended resolution.

(iii) If the Department does not receive any response to the recommended resolution from a complainant within the specified time, the complaint will be declared abandoned and the case closed.

(4) Final report. A final report on each informal complaint transmitted to the Department through an Area Agency on Aging shall be sent by the Department to the Area Agency on Aging at the close of the response period. The report shall include a summary of the investigation, whether the complaint was resolved or not and its resolution.

(f) Cross reference. This section supplements 1 Pa. Code § § 35.5—35.7 (relating to informal complaints).