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Medicaid managed care grievance and appeal processes, Colo. Code Regs. § 10-2505-10 (§ 8.209)

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Medicaid Managed Care Grievance and Appeal Processes
Establishes the Medicaid Managed Care Grievance and Appeal Systems as a means of handling grievances and appeals for Medicaid members enrolled in a Managed Care Organization (MCO), Prepaid Inpatient Health Plan (PIHP), or Prepaid Ambulatory Health Plan (PAHP). Requires each MCO, PIHP, and PAHP to give contractors and subcontractors a description of their grievance and appeals procedures, maintain grievance records, and to submit quarterly grievance reports to the Department of Health Care Policy and Financing. Specifies the information that must be included in these reports (e.g., description of the grievance or appeal, date of review, resolution, etc.). Establishes standards and procedures for MCO, PIHP, and PAHP grievances and appeals that address items such as notice of adverse benefit determinations, time frames for making decisions, and notice of decisions.