New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 308 - MANAGED CARE PROGRAM
Part 15 - GRIEVANCES AND APPEALS
Section 8.308.15.12 - MCO MEMBER GRIEVANCE PROCESS

Universal Citation: 8 NM Admin Code 8.308.15.12

Current through Register Vol. 35, No. 18, September 24, 2024

A. The MCO shall provide to its member or his or her authorized representative reasonable assistance in completing grievance forms and completing procedural steps, including but not limited to:

(1) providing interpreter services; and

(2) providing toll-free numbers that have adequate TTY/TTD and interpreter capability.

B. The MCO shall ensure that the individuals who make decisions related to grievances are not involved in any previous level of review or decision-making as to the matter that is grieved.

C. The MCO shall provide the member or his or her authorized representative with written notice:

(1) when a MCO member grievance request has been received;

(2) of the expected date of resolution which cannot be greater than 30 calendar days from the date of receipt of the grievance; and

(3) of the final resolution of the grievance.

D. The MCO shall ensure that punitive or retaliatory action is not taken against any member or authorized representative that files a grievance, or the member's provider that supports the member's grievance.

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