1. (a) A member who is dissatisfied with any matter other than an action, as defined in He-W 506.03(a), shall utilize the MCO grievance process exclusively.

2. (b) The MCO grievance process shall address members’ expression of dissatisfaction about any matter other than an action including, but not limited to:

   1. (1) The quality of care or services provided;
   2. (2) Aspects of interpersonal interactions with providers or MCO employees; or
   3. (3) Failure to respect the member’s rights.
3. (c) Actions, as defined in He-W 506.03(a), shall be subject to the MCO appeal process but not subject to the MCO grievance process.
4. (d) A member, or the member’s authorized representative, appointed in accordance with He-W 803.01, shall file a grievance with the MCO either orally or in writing.

5. (e) Members shall be notified of the disposition of grievances as follows:

   1. (1) Either orally or in writing for grievances not involving clinical issues; and
   2. (2) In writing for grievances involving clinical issues.
6. (f) Members shall not have the right to a department fair hearing in regard to the disposition of a grievance.
7. (g) The MCO grievance process shall not preclude a member’s ability to pursue client rights protection under He-M 204.

Source. #10410, eff 9-13-13; ss by #13474, eff 10-24-22