§ 9.710. Approval of plan enrollee complaint and enrollee and provider grievance systems.

 (a)  The Department will review the plan’s enrollee complaint and grievance systems under its authority to review the operations of the plan and its quality assurance systems, and complaint and grievance resolution systems to ensure that they meet the requirements of Act 68 and this chapter.

 (b)  If changes are made by the plan that have the potential to impact the complaint or grievance process or the outcome of cases, the plan shall submit a copy of the proposed changes to the Department for prior review 60 days before the plan intends to implement the changes.

 (c)  Complaint and grievance procedures for special populations, such as Medicaid and Medicare HMO enrollees, shall comply with Act 68 to the extent permitted by Federal law and regulation.

Authority

   The provisions of this §  9.710 issued under Article XXI of The Insurance Company Law of 1921 (40 P. S. § §  991.2101—991.2193); the HMO Act (40 P. S. § §  1551—1568); and section 630 of the PPO Act (40 P. S. §  764a).

Cross References

   This section cited in 28 Pa. Code §  9.702 (relating to complaints and grievances).



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