Or. Admin. R. 410-141-3915 - Grievances & Appeals: System Recordkeeping
Current through Register Vol. 60, No. 12, December 1, 2021
(1) Each MCE shall maintain records of
grievances and appeals and shall review the information as part of its ongoing
monitoring procedures, as well as for updates and revisions to the state
quality strategy as stated in
42 CFR
438.416 and in alignment with contractual
requirements.
(2) Consistent with
record retention requirements in OAR 410-141-3520, MCE's must maintain yearly
logs of all appeals and grievances for 10 years, which must include information
about the reasons for each grievance or appeal, as well as the resolution and
supporting reasoning.
(3) The MCE
must review the log monthly for completeness, accuracy, and compliance with
required procedures.
(4) MCE's
shall submit for the Authority's review the Grievance and Appeals Log, samples
of Notices of Adverse Benefit Determination, and other reports as required
under the MCE contract.
(5) The
Grievance System Report and Grievance and Appeals Log shall be forwarded to the
MCE's Quality Improvement committee to comply with the Quality Improvement
standards as follows:
(a) Review of
completeness, accuracy, and timeliness of documentation;
(b) Compliance with written procedures for
receipt, disposition, and documentation; and
(c) Compliance with applicable OHP
rules.
Notes
Statutory/Other Authority: ORS 413.042 & ORS 414.065
Statutes/Other Implemented: ORS 414.065 & 414.727
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