1. (a) The CE or DBM shall have written grievance and appeal policies and procedures for an Enrollee, or an Enrollee's authorized representative, to appeal a CE's or DBM's action and/or file a grievance. The policies must address contractual requirements, including performance standards, and federal funding requirements, including 42 C.F.R. § 438 Subpart F and OAC 317:2-3-3.
2. (1) Timeframes, pursuant to OAC 317:2-3-2;
3. (2) Grievances, pursuant to OAC 317:2-3-4;
4. (3) Appeals, pursuant to OAC 317:2-3-5;
5. (4) Grievance and appeal notices, pursuant to OAC 317:2-3-8;
6. (5) State fair hearings, pursuant to OAC 317:2-3-12;
7. (6) Recordkeeping, pursuant to OAC 317:2-3-11; and
8. (7) Continuation of benefits, pursuant to OAC 317:2-1-2.6 and 317:2-3-5.1.
9. (b) If the CE or DBM fails to meet performance standards, the OHCA may impose any or all the CE intermediate sanctions, found at OAC 317:55-5-10 and the CE Contract, or DBM administrative remedies, found at OAC 317:55-5-11 and the DBM Contract.

Added at 39 Ok Reg 450, eff 12-21-21 (emergency)

Added at 39 Ok Reg 1628, eff 9-12-22

Amended at 41 Ok Reg, Number 23, effective 9-1-24