(a) A health care grievance or health care
grievance appeal may be rejected for reasons, which include, but are not
limited to:
(1) The grievant did not submit
the health care grievance or health care grievance appeal pursuant to
Subchapter 2, Article 5.
(2) The
health care grievance concerns an anticipated action or decision.
(3) The grievant submitted the health care
grievance without a prior attempt to obtain health care services through
approved processes. In this case, HCGO staff shall submit a request for health
care services, if medically necessary, to the appropriate facility clinic on
behalf of the grievant.
(4) An
individual submitted a health care grievance or health care grievance appeal on
behalf of another person.
(5) The
grievant is temporarily outside health care jurisdiction for an indeterminate
amount of time, including, but not limited to, out-to-court or at an offsite
hospital, and not expected to return before the time limits for responding to
the health care grievance or health care grievance appeal have
expired.
(6) The health care
grievance duplicates the grievant's previous health care grievance upon which a
decision was rendered or is pending and the grievant has not provided any new
information that would indicate additional review is warranted.
(7) A health care grievance is submitted as a
group grievance by more than one grievant related to a policy, decision,
action, condition, or omission affecting all members of the group.
(b) When a health care grievance
or health care grievance appeal is rejected, a response to the grievant shall
provide written instruction regarding further action the grievant must take to
qualify the health care grievance or health care grievance appeal for
processing and the timeframe necessary, as determined by the HCGO or HCCAB, to
correct and resubmit the health care grievance or health care grievance appeal
to the identified office.
(1) If the grievant
submits a health care grievance or health care grievance appeal more than twice
without complying with the written instruction, the health care grievance or
health care grievance appeal will be adjudicated based on available
information. Adjudication of a health care grievance or health care grievance
appeal without complying with written instruction to correct submission does
not preclude consideration for abuse pursuant to section
3999.236(a)(2).
