Section 441.88.8. Grievance procedures.

         88.8(1) Written procedure. The PHP must have a written procedure by which enrolled recipients may express grievances, complaints, or recommendations, either individually or as a class and which:

            a.               Is approved by the department prior to use.

            b.               Acknowledges receipt of a grievance to the grievant.

            c.               Sets time frames for resolution including emergency procedures which are appropriate to the nature of the grievance and which require that all grievances shall be resolved within 30 days.

            d.               Ensures the participation of persons with authority to require corrective action.

            e.               Includes at least one level of appeal.

            f.                Ensures the confidentiality of the grievant.

         88.8(2) Written record. All grievances, including all informal or verbal complaints, which must be referred or researched for resolution must be recorded in writing. A log of the grievances must be retained and made available at the time of audit and must include progress notes and method of resolution.

         88.8(3) Information concerning grievance procedures. The PHP’s written grievance procedure must be provided to each newly enrolled recipient not later than the effective date of coverage.

         88.8(4) Appeals to the department. A recipient who has exhausted the grievance procedure of the PHP may appeal the issue to the department under the provisions of 441—Chapter 7. Instances where the substance of the grievance relates to department policy shall be appealed directly to the department.

         88.8(5) Periodic report to the department. The PHP shall make quarterly reports to the department summarizing grievances and resolutions as specified in the contract.

[ARC 2358C, IAB 1/6/16, effective 1/1/16]