Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 482 - NEBRASKA MEDICAID MANAGED CARE
Chapter 7 - RIGHTS AND RESPONSIBILITIES
Section 482-7-003 - GRIEVANCE PROCESS
Current through September 17, 2024
The health plan or dental benefits manager must inform the member, in writing, of the grievance process for issuing a complaint involving access to care, quality of care, or communication issues with the plan or primary care provider. The member, or legal representative, must file the grievance with the health plan or dental benefits manager, according to the same plans' internal grievance procedure, pursuant to 1931(b)(4) of the Social Security Act.
(A) A member may file a grievance either orally or in writing;
(B) A provider may file a grievance when acting as the client's authorized representative;
(C) The health plan must resolve each grievance and provide notice, as expeditiously as the member's health condition requires, not to exceed 90 days from the day the plan receives the grievance;
(D) The plan must provide notice of the grievance resolution in writing in a language and format which is easily understood by the member. The plan must make reasonable effort to notify the member orally of the grievance resolution; and
(E) All contacts with the health plan regarding grievances must be documented and submitted to the Department.
