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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 29-56. REQUIREMENTS FOR THE MEDICAID MANAGED CARE PROGRAM FOR CHILDREN AND YOUTH WITH DISABILITIES |
Section 29-5608. GRIEVANCE SYSTEM - MANAGED CARE PROVIDER
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5608.1The managed care provider shall have a grievance system with reasonable procedures for the prompt resolution of complaints initiated by enrolled children and their families.
5608.2The managed care provider shall submit its proposed grievance system to the Department for written approval prior to implementation.
5608.3The grievance system shall include a Grievance Committee for reviewing enrolled children’s complaints. One (1) or more enrolled children and/or family members shall be members of the Committee.
5608.4An enrolled child may pursue a grievance with the assistance of a personal representative of his or her choice.
5608.5A written record of each grievance review shall be prepared and shall be maintained by the managed care provider and shall be made available to the Department upon written request.
5608.6The managed care 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 enrolled children and their families;
(b)A summary description of the types of grievances initiated; and
(c)A summary description of any action taken to resolve grievances.