Missouri Code of State Regulations
Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE
Division 400 - Life, Annuities and Health
Chapter 10 - Health Carrier Utilization Review Activities
Section 20 CSR 400-10.100 - Minimum Time Allowed for a Consumer to File a Grievance
Universal Citation: 20 MO Code of State Regs 400-10.100
Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule sets forth the minimum amount of time a health carrier that offers a managed care plan can require an enrollee o rmember to file an appeal. This rule is promulgated pursuant to section 376.1399, RSMo, and implements sections 376.1382 and 376.1385, RSMo.
(1) Definitions.
(A) "Adverse determination" shall have the
same meaning as found in section
376.1350,
RSMo.
(B) "Grievance" shall have
the same meaning as found in section
376.1350,
RSMo.
(C) "Health carrier" shall
have the same meaning as found in section
376.1350,
RSMo.
(D) "Managed care component"
shall mean a plan that offers an incentive to use specific providers or
requires the use of utilization review.
(E) "Utilization review" shall have the same
meaning as found in section
376.1350,
RSMo.
(2) Minimum Time to File a Grievance.
(A) No health carrier
that offers a plan with a managed care component shall limit the time that a
first level grievance may be filed to less than one hundred eighty (180) days
from the date that written notice was sent from the health carrier to the
enrollee informing the enrollee of the adverse determination.
(B) In the case of a grievance filed for
reasons other than an adverse determination, the health carrier shall not limit
the time a first level grievance may be filed to less than one hundred eighty
(180) days from the date the health carrier sent notice to the enrollee
informing the enrollee of the event that gave rise to the grievance.
(C) No health carrier that offers a plan with
a managed care component shall limit the time that a second level grievance may
be filed to less than one hundred eighty (180) days from the date the carrier
allows to file the first level grievance or less than one hundred eighty (180)
days from the date the health carrier sent notification to the person who
submitted the grievance of the carrier's resolution of said first level
grievance, whichever is later.
(D)
Nothing in this section shall limit or supersede any statute of limitations
found in the Revised Statutes of Missouri.
*Original authority: 374.045, RSMo 1967, amended 1993, 1995 and 376.1399, RSMo 1997, amended 1997.
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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