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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-53. STANDARDS FOR MANAGED CARE PROVIDERS THAT ARE PAID ON A FIXED, PREPAID, CAPITATED BASIS FOR SERVICES RENDERED TO AFDC AND AFDC-RELATED MEDICAID RECIPIENTS |
Section 29-5309. GRIEVANCE SYSTEM - PREPAID, CAPITATED PROVIDERS
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5309.1Each prepaid, capitated provider shall have a grievance system with reasonable procedures for the prompt resolution of complaints initiated by enrollees.
5309.2Each prepaid, capitated provider shall submit its proposed grievance system to the Department for written approval prior to implementation.
5309.3The grievance system shall include a Grievance Committee for reviewing enrollee complaints with one or more AFDC and AFDC -related Medicaid enrollee(s) on the Committee.
5309.4An enrollee may pursue a grievance with the assistance of a personal representative of his or her choice.
5309.5A written record of each Grievance review shall be prepared and shall be maintained by the prepaid, capitated provider and made available to the Department upon written request.
5309.6Each prepaid, capitated provider shall submit to the Department an annual report of grievances within ninety (90) days of the close of its fiscal year. The Annual Report shall include the following:
(a)The total number of grievances initiated by enrollees;
(b)A summary description of the types of grievances initiated; and
(c)A summary description of any action taken to resolve grievances.