D.C. Mun. Regs. tit. 29, r. 29-5608

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

Rule 29-5608 - GRIEVANCE SYSTEM - MANAGED CARE PROVIDER

5608.1

The managed care provider shall have a grievance system with reasonable procedures for the prompt resolution of complaints initiated by enrolled children and their families.

5608.2

The managed care provider shall submit its proposed grievance system to the Department for written approval prior to implementation.

5608.3

The grievance system shall include a Grievance Committee for reviewing enrolled children's complaints. One (1) or more enrolled children and/or family members shall be members of the Committee.

5608.4

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

5608.5

A written record of each grievance review shall be prepared and shall be maintained by the managed care provider and shall be made available to the Department upon written request.

5608.6

The managed care 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 enrolled children and their families;

(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. 29-5608

Final Rulemaking published at 43 DCR 4833, 4847 (September 6, 1996)