Section 26-A3520. REVIEW OF COMPLAINTS BY THE COMMISSIONER

 

3520.1Any person, group, association, corporation, or other entity having exhausted the HMO's internal grievance and appeals procedure, unless no process exists, or exhaustion would be futile, may file a written complaint with the Commissioner regarding an HMO's compliance with the District of Columbia HMO laws and regulations. The complaint shall state the grounds and pertinent underlying facts, the names of all relevant persons involved, the status of all appropriate internal grievances and appeal procedures, and whether those procedures have been exhausted. This subsection shall not apply to appeals and grievances filed pursuant to the Health Benefits Plan Members Bill of Rights Act of 1998, effective April 27, 1999, D.C. Law 12-274, D.C. Code § 32-571.1 et seq.

 

3520.2The Commissioner may initiate investigations when, based on a report, a complaint, or any other information, the Commissioner has reason to believe that an HMO or producer subject to the laws and regulations of the District is not in compliance such provisions. The Commissioner shall notify the HMO or producer in writing that an investigation has been initiated, and shall include in such notice a full statement of the pertinent facts, the matter being investigated, and a statement that the entity may submit a written report concerning such matters to the Commissioner within thirty (30) days from the date of the notice. The Commissioner will obtain any information considered necessary, and may employ site visits, public hearings, or any other procedures considered appropriate.

 

source

Final Rulemaking published at 46 DCR 7291(September 17, 1999).