Backlog Reduction & Escalation

Case Management Agency Backlog Reduction Plan

The purpose of the Backlog Reduction Plan is to identify tangible actions and timelines to reduce a CMA’s backlog and meet caseload ratio requirements no later than December 31, 2024. A backlog exists when a CMA is not meeting contractual and/or regulatory requirements within the timelines

TRE has conducted and participated in many activities over the past 6 months to better understand the causes of the backlogs within TRE’s control and to engage in external review support.

For more information, consult the full backlog reduction plan here: TRE Backlog Reduction Plan 7.6.24
Plan was approved by HCPF October 25, 2024: TRE Backlog Reduction Plan Approval Letter

Escalation Plan

If you have an immediate need requiring attention, please contact the Colorado Springs’ Main Line at 719-380-1100 or Pueblo’s Main Line at 719-601-9991.

TRE Hours of Operation:

Monday – Thursday 7:30am – 5:00pm
Friday 7:30am-11:30am

Submit a complaint

Complaint definition-TRE will Document and track any complaint as it relates to services provided by the CMA to include general business functions, administration, state general funded programs, case management functions to include Level of Care (LOC) & Supports Intensity Scale (SIS) assessments. All complaints received will be reviewed and demonstrated to be substantiated or unsubstantiated at the discretion of department managers and in compliance with agency policies, and all regulating rules and contracts. A complaint is deemed unsubstantiated if it falls outside the control of the employee or agency, does not align with TRE’s standard response timeframes for returned phone calls and communications, grievances that are repetitively submitted by the same individual, or lack legitimate grounds. Complaints received outside of this scope should not be included.

1. Escalation Process-TRE’s outlined process for responding to and resolving member or potential member complaints includes a clear, structured approach to addressing issues promptly and efficiently:
   1. Initial response: TRE staff members should make a meaningful attempt to resolve the issue. TRE staff members should respond to all member or potential member complaints within 2 business days. The member should understand the issue has been received and is being engaged with the TRE team.
   2. Escalation to Supervisor: If staff members are unable to resolve the issue, they should escalate it to their supervisor for further review, assistance, and resolution.
   3. Supervisor Intervention: The supervisor should make an effort to resolve the member or potential member issue. If unable to do so, they should seek advice from the assigned manager on the best action plan moving forward.
   4. Manager Discretion: The manager, using discretion, will determine whether to take over the resolution based on the complexity of the issue and other factors contributing to the member or potential member complaint.
   5. Manager collaboration: If the manager is still unable to resolve the issue, the manager will take over as lead on the complaint, engaging with agency, governing agency (HCPF), or other community leadership partners as appropriate. At this state, the manager will ensure resolution.
2. Complaint log management- At TRE, it is the responsibility of each manager to ensure that the complaint log is updated, completed, and properly formatted monthly for complaints received by their perspective team members. Managers have the discretion to either undertake the task themselves or delegate it to a supervisor, team lead or staff member. Regardless of the assigned personnel, all updates must be fully completed by the 5th of each month for the previous month’s complaints. This process ensures timely and accurate record-keeping of member feedback and resolution efforts.
3. Complaint log trend management-Two dedicated managers with oversight from a director are responsible for completing quarterly trend analysis of the complaint log. Trend analysis includes:
   1. A comparison of complaint types and number of complaints over a quarterly timeframe.
   2. Number of complaints against the contractor, time, location, individual involved, staff involved.
   3. Examination of potential reasons for the increase or decrease in complaints by total number, subcontractor, individual or staff.
   4. An examination of preventative measures that can be implemented to reduce the frequency of future complaints.
   5. Implementation of a plan of action or any future actions to take place.
   6. An analysis of whether the plan of action and changes made were effective or if additional changes need to occur.
   7. Complete quarterly trend analysis for deliverable (by October 15, January 15th, April 15th and June 15th.
4. Training- The training director at TRE will oversee the comprehensive training of all staff members on all aspects of TRE’s member feedback and resolution protocol, including proper entries in the complaint log. All staff will have access to the necessary training materials to fully understand the protocol and responsibilities. This training initiative aims to ensure all staff have the knowledge and skills to effectively handle member complaints and adhere to procedures, promoting consistent and exceptional customer service across the organization. The training objectives include but are not limited to:
   1. Complaint definitions
   2. Customer service best practices and expectations
   3. Best practices for engaging with members and complaint resolution.
   4. Understanding when a complaint needs escalation.
   5. Responding to a complaint vs. Resolving a complaint
   6. Documenting in activity logs (including timeframes)
   7. Interacting with and updating the complaint log

FINAL-Complaint Policy and Procedure