N.J. Admin. Code § 10:74-11.1

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:74-11.1 - Grievance procedure

(a) The contractor shall establish a grievance procedure for the receipt and adjudication of any and all complaints from enrollees or managed care providers on behalf of enrollees, with the enrollees' consent, relating to quality, scope, nature and delivery of services.

(b) The grievance procedure shall be communicated to the enrollees in writing and shall provide for expeditious resolution of grievances by the contractor's personnel who shall be at a decision-making level with authority to require corrective action.

(c) The contractor shall review the complaint procedure at reasonable intervals, but no less than annually, for the purpose of improving the procedure.

(d) Any amendment to the procedure shall be presented to the Division prior to the implementation of any change, and the Division's written approval shall be obtained, in accordance with 42 CFR Part 438, Subpart F incorporated herein by reference, as amended and supplemented, in order to assure that enrollees are afforded an opportunity to be heard.

N.J. Admin. Code § 10:74-11.1

Amended by R.2000 d.287, effective 7/3/2000.
See: 32 New Jersey Register 1345(a), 32 New Jersey Register 2498(a).
In (a), inserted "or managed care providers on behalf of enrollees with the enrollees' consent," following "enrollees".
Amended by R.2006 d.17, effective 1/3/2006.
See: 37 New Jersey Register 2787(a), 38 New Jersey Register 294(d).
In (d), updated incorporation by reference of C.F.R. standards.