§ 991.2161. Internal grievance process
Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. InsuranceEffective: January 1, 2024
Effective: January 1, 2024
40 P.S. § 991.2161
§ 991.2161. Internal grievance process
(a) An MA or CHIP managed care plan shall establish and maintain an internal grievance process with one level of review and an expedited internal grievance process by which an enrollee, an enrollee's authorized representative or a health care provider, with the written consent of the enrollee or the enrollee's authorized representative, shall be able to file a written grievance regarding the denial of payment for a health care service. An enrollee or an enrollee's authorized representative who consents to the filing of a grievance by a health care provider under this section may not file a separate grievance.
(2) A written notification to the enrollee or the enrollee's authorized representative of the decision of the review committee within thirty (30) days of receipt of the grievance unless the time frame for deciding the grievance has been extended by up to fourteen (14) days at the request of the enrollee or the enrollee's authorized representative.
(e) Should the enrollee's life, health or ability to regain maximum function be in jeopardy, an expedited internal grievance process shall be available which shall include a requirement that a decision with appropriate notification to the enrollee, enrollee's authorized representative and health care provider be made within forty-eight (48) hours of the filing of the expedited grievance.
Credits
1921, May 17, P.L. 682, No. 284, § 2161, added 1998, June 17, P.L. 464, No. 68, § 1, effective Jan. 1, 1999. Amended 2022, Nov. 3, P.L. 2068, No. 146, § 6, effective Jan. 1, 2024.
40 P.S. § 991.2161, PA ST 40 P.S. § 991.2161
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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