Section He-W 506.07 - MCO Grievance Process(a) A member who is dissatisfied with any matter other than an action, as defined in He-W 506.03(a), shall utilize the MCO or DO grievance process exclusively.(b) The MCO or DO grievance process shall address members' expression of dissatisfaction about any matter other than an action including, but not limited to:(1) The quality of care or services provided;(2) Aspects of interpersonal interactions with providers or MCO or DO employees; or(3) Failure to respect the member's rights. (c) Actions, as defined in He-W 506.03(a), shall be subject to the MCO or DO appeal process but not subject to the MCO or DO grievance process.(d) A member, or the member's authorized representative, appointed in accordance with He-W 803.01, shall file a grievance with the MCO or DO either orally or in writing. (e) Members shall be notified of the disposition of grievances as follows: (1) Either orally or in writing for grievances not involving clinical issues; and(2) In writing for grievances involving clinical issues.(f) Members shall not have the right to a department fair hearing in regard to the disposition of a grievance.(g) The MCO or DO grievance process shall not preclude a member's ability to pursue client rights protection under He-M 204.N.H. Admin. Code § He-W 506.07
Amended by Volume XLII Number 45, Filed November 10, 2022, Proposed by #13474, Effective 10/25/2022, Expires 10/25/2032.Amended by Number 28, Filed July 13, 2023, Proposed by #13670, Effective 6/22/2023, Expires 6/22/2033.