New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 500 - MEDICAL ASSISTANCE
Part He-W 506 - MEDICAID CARE MANAGEMENT (MCM)
Section He-W 506.07 - MCO Grievance Process

Universal Citation: NH Admin Rules He-W 506.07

Current through Register No. 40, October 3, 2024

(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.

#10410, eff 9-13-13

Disclaimer: These regulations may not be the most recent version. New Hampshire 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.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.