§ 7–761.13. Formal complaints.

(a) The Department shall:

(1) Establish a process for the resolution of formal complaints, including formal complaints filed with a provider, which shall include, at a minimum:

(A) The opportunity for any person, or a third party with the person's consent, to file a formal complaint with DDS or a provider;

(B) Assistance for a person who needs help filing his or her formal complaint, orally or in writing;

(C) The right of a person to be assisted by a family member, friend, attorney, or any other representative throughout the formal complaint process;

(D) Definite time frames for each stage of the formal complaint resolution process;

(E) A requirement that services and supports continue without limitation, reduction, or termination pending the resolution of a formal complaint regarding those services or supports;

(F) Requirements for education and assistance to persons, provider staff, and third parties about individual rights and the formal complaint process;

(G) An explanation of the appeal process available if the person is dissatisfied with the outcome of the formal complaint process; and

(H) Prohibitions on retaliatory actions such as reprisal, restraint, interference, coercion, or discrimination by DDS or a provider against a person who files a formal complaint;

(2) Establish a peer support pilot program to assist people with intellectual or developmental disabilities throughout the formal complaint process; and

(3) Publish an annual report regarding the peer support pilot program described in paragraph (2) of this subsection, which shall include recommendations regarding how to improve the peer support pilot program.

(b)(1) Any formal complaint filed with DDS shall receive a prompt review by the Director, or the Director's designee, who shall refer the formal complaint to an external reviewer in accordance with rules issued pursuant to § 7-761.09(a-2).

(2) If a formal complaint is referred to an external reviewer, the external reviewer shall:

(A) Facilitate informal resolution of the formal complaint; or

(B) If such informal resolution is not possible, determine:

(i) Whether the Director should sustain or deny the formal complaint; and

(ii) If the external reviewer determines that the Director should sustain the formal complaint, how DDS should remedy any problems raised in the formal complaint.

(3) After completing a timely examination of a formal complaint, the external reviewer shall submit a written report to the Director and the person who filed the formal complaint describing the outcome of the external review process.

(c) Nothing in this section shall be construed to restrict or limit the rights, procedures, and remedies available under federal or District law protecting the rights of persons receiving services through DDS or a provider.

(d) Any person aggrieved by an action of DDS taken pursuant to this section may appeal the action of DDS to the Office of Administrative Hearings pursuant to § 2-1831.02(a).

(e) If a person files a formal complaint with DDS pursuant to this section that is substantially similar to a case that the person previously initiated in the Superior Court of the District of Columbia or the Office of Administrative Hearings, DDS shall deny the formal complaint.

(f) For the purposes of this section, the term "provider" means an entity that is responsible for providing residential or day services to people supported by the Developmental Disabilities Administration of DDS.