D.C. Mun. Regs. tit. 29, r. 29-5309

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-5309 - GRIEVANCE SYSTEM - PREPAID, CAPITATED PROVIDERS

5309.1

Each prepaid, capitated provider shall have a grievance system with reasonable procedures for the prompt resolution of complaints initiated by enrollees.

5309.2

Each prepaid, capitated provider shall submit its proposed grievance system to the Department for written approval prior to implementation.

5309.3

The grievance system shall include a Grievance Committee for reviewing enrollee complaints with one or more AFDC and AFDC -related Medicaid enrollee(s) on the Committee.

5309.4

An enrollee may pursue a grievance with the assistance of a personal representative of his or her choice.

5309.5

A written record of each Grievance review shall be prepared and shall be maintained by the prepaid, capitated provider and made available to the Department upon written request.

5309.6

Each prepaid, capitated provider shall submit to the Department an annual report of grievances within ninety (90) days of the close of its fiscal year. The Annual Report shall include the following:

(a) The total number of grievances initiated by enrollees;

(b) A summary description of the types of grievances initiated; and

(c) A summary description of any action taken to resolve grievances.

D.C. Mun. Regs. tit. 29, r. 29-5309

Final Rulemaking published at 42 DCR 1566, 1580 (March 31, 1995)