C.M.R. 10, 144, ch. 101, ch. VI, 144-101-VI-01, subsec. 144-101-VI-01.09

Current through 2024-51, December 18, 2024

Subsection 144-101-VI-01.09 - COMPLAINTS

1.09-1Members with a Complaint

Members with a complaint may make a request to MaineCare Member Services to have it resolved. MaineCare Member Services will:

A. Keep a record of each complaint;

B. Investigate the complaint and issue a verbal/written decision to the member within fifteen (15) calendar days of the request. The decision must contain a clear, concise statement of the decision, reasons for the decision, right of the member to access all records pertaining to resolution of the complaint and help available from MaineCare Member Services to obtain these records;

C. Assist, upon request, the member in obtaining all records pertaining to the resolution of the complaint. Members will have access to all records pertaining to the complaint. Members will also be notified of their right to grieve a decision. Instructions on how to file a grievance are described in Section 1.10.

1.09-2PCPs With a Complaint

MaineCare's Primary Care Provider Network Services will accept either verbal or written requests for complaint resolution from PCPs and will maintain a record of each such request.

MaineCare's Primary Care Provider Network Services will investigate and provide the PCP with verbal/written notice of its findings within fifteen (15) calendar days of the request. The notice will include an explanation of the PCP's right to request an informal conference if the complaint is not resolved to the PCP's satisfaction.

C.M.R. 10, 144, ch. 101, ch. VI, 144-101-VI-01, subsec. 144-101-VI-01.09