Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part I - Administration
Subpart 3 - Managed Care for Physical and Behavioral Health
Chapter 37 - Grievance and Appeal Process
Subchapter A - Member Grievances and Appeals
Section I-3705 - General Provisions
Current through Register Vol. 50, No. 9, September 20, 2024
A. The MCO must have a system in place for member's that includes a grievance process, an appeal process, and access to the state fair hearing process once the MCO's appeal process has been exhausted.
B. Filing Requirements
C. Grievance Notice and Appeal Procedures
D. Grievance and Appeal Records
E. All state fair hearing requests shall be sent directly to the state designated entity.
F. The MCO will be responsible for promptly forwarding any adverse decisions to the department for further review and/or action upon request by the department or the MCO member.
G. The department may submit recommendations to the MCO regarding the merits or suggested resolution of any grievance or appeal.
H. Information to Providers and Subcontractors. The MCO must provide the information about the grievance system as specified in federal regulations to all providers and subcontractors at the time they enter into a contract.
I. Recordkeeping and Reporting Requirements. Reports of grievances and resolutions shall be submitted to the department as specified in the contract. The MCO shall not modify the grievance system without the prior written approval of the department.
J. Repealed.
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.