Kan. Admin. Regs. § 129-8-3

Current through Register Vol. 44, No. 2, January 9, 2025

Section 129-8-3 - MCE member grievance

(a) Any enrollee may submit a grievance about any MCE matter other than an adverse benefit determination.

(b) Any enrollee may submit an oral or written grievance to the MCE at any time. Any enrollee may submit a grievance in person, by telephone, by U.S. mail, or by facsimile. Each written grievance delivered by the postal service or submitted by facsimile to the MCE shall be date-stamped when received by the MCE as proof of receipt.

(c) The MCE shall acknowledge each oral or written grievance received from the enrollee in writing within 10 days of receipt.

(d) The MCE shall resolve enrollee grievances and issue a notice of grievance resolution within 30 days from the date the MCE receives the grievance from the enrollee. The notice of grievance resolution shall meet with the requirements specified by the secretary.

(1) The MCE may extend this 30-day resolution time period up to 14 days, if the enrollee requests the extension or the MCE shows to the satisfaction of the secretary, upon the secretary's request, that there is need for additional information and how the delay is in the enrollee's interest.

(2) If the MCE extends the time frames not at the request of the enrollee, the MCE shall perform the following:

(A) Make reasonable efforts to give the enrollee prompt oral notice of the delay;

(B) within two days, give the enrollee written notice of the reason for the decision to extend the time frame and inform the enrollee of the right to submit a grievance if the enrollee disagrees with that decision; and

(C) resolve the grievance as expeditiously as the enrollee's health condition requires and no later than the date the extension expires.

(e) Any enrollee may submit a request for grievance to the secretary if the enrollee is unable to obtain medical care that accommodates the member's culturally based attitudes, beliefs, and needs. The enrollee shall complete the MCE's grievance process before submitting a request for grievance to the secretary.

(f) The enrollee's right to submit a grievance shall not be limited or interfered with by the secretary or the MCE.

(g) The MCE shall cooperate with the state, the state's fiscal agent, or representatives of either, to resolve all enrollee grievances. Cooperation may include providing internal enrollee grievance information to the state.

Kan. Admin. Regs. § 129-8-3

Authorized by and implementing K.S.A. 65-1,254 and 75-7403; adopted by Kansas Register Volume 43, No. 50; effective 12/27/2024.