☰ Revisor of Missouri

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 1997 bottom

  376.1382.  First- and second-level grievance review for managed care plans, first-level procedures. — 1.  A health carrier that offers managed care plans shall establish a first-level and second-level grievance review process for its managed care plans.  A grievance may be submitted by an enrollee, an enrollee's representative or a provider acting on behalf of an enrollee.

  2.  Upon receipt of a request for first-level grievance review, a health carrier shall:

  (1)  Acknowledge receipt in writing of the grievance within ten working days;

  (2)  Conduct a complete investigation of the grievance within twenty working days after receipt of a grievance, unless the investigation cannot be completed within this time.  If the investigation cannot be completed within twenty working days after receipt of a grievance, the enrollee shall be notified in writing on or before the twentieth working day and the investigation shall be completed within thirty working days thereafter.  The notice shall set forth with specificity the reasons for which additional time is needed for the investigation;

  (3)  Within five working days after the investigation is completed, have someone not involved in the circumstances giving rise to the grievance or its investigation decide upon the appropriate resolution of the grievance and notify the enrollee in writing of the health carrier's decision regarding the grievance and of the right to file an appeal for a second-level review.  The notice shall explain the resolution of the grievance and the right to appeal in terms which are clear and specific;

  (4)  Within fifteen working days after the investigation is completed, notify the person who submitted the grievance of the carrier's resolution of said grievance.

­­--------

(L. 1997 H.B. 335)


---- end of effective   28 Aug 1997 ----

use this link to bookmark section  376.1382


In accordance with Section 3.090, the language of statutory sections enacted during a legislative session are updated and available on this website on the effective date of such enacted statutory section. Revisor Home    

Other Information
 Recent Sections Editorials May Be Cited As Tables & Forms Multiple Enact
Repeal & Transfer Definitions

Site changes Pictures Contact

Other Links
Oversight MOLIS Library MO WebMasters
Senate
Missouri Senate
State of Missouri
MO.gov
House
Missouri House

@00:33:50.4 27 :)