Sec. 3999.234 - Health Care Grievance and Health Care Grievance Appeal Rejection

ยง 3999.234. Health Care Grievance and Health Care Grievance Appeal Rejection

(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).

(1. Change without regulatory effect renumbering and amending former section 3087.9 to new section 3999.234 filed 8-6-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 32). 2. Amendment of subsection (a) and Note filed 3-12-2019 as an emergency; operative 3-12-2019 (Register 2019, No. 11). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 8-19-2019 or emergency language will be repealed by operation of law on the following day. 3. Certificate of Compliance as to 3-12-2019 order transmitted to OAL 8-14-2019 and filed 9-24-2019 (Register 2019, No. 39).)

Note: Authority cited: Section 5058, Penal Code. Reference: Section 5054, Penal Code; Americans With Disabilities Act, Public Law 101-336, July 26, 1990, 104 Stat. 328; Civil Rights of Institutionalized Persons Act, Title 42 U.S.C. Section 1997et seq., Public Law 96-247, 94 Stat. 349; Section 35.107, Title 28, Code of Federal Regulations; Armstrong v. Newsom (No. C-94-2307-CW), U.S. District Court, Northern District of California; Coleman v. Newsom (No. S 90-0520 LKK JFM P) U.S. District Court, Eastern District of California; and Plata v. Newsom (No. C01-1351 JST), U.S. District Court, Northern District of California.

The following state regulations pages link to this page.