55 Pa. Code § 52.18 – Complaint management.

(a) The provider shall implement a system to record, respond and resolve a participant’s complaint.
(b) The provider complaint system must contain the following:
1. (1) The name of the participant.
2. (2) The nature of the complaint.
3. (3) The date of the complaint.
4. (4) The provider’s actions to resolve the complaint.
5. (5) The participant’s satisfaction to the resolution of the complaint.
(c) The provider shall review the complaint system at least quarterly to:
1. (1) Analyze the number of complaints resolved to the participant’s satisfaction.
2. (2) Analyze the number of complaints not resolved to the participant’s satisfaction.
3. (3) Measure the number of complaints referred to the Department for resolution.
(d) The provider shall develop a QMP when the numbers of complaints resolved to a participant’s satisfaction are less than the number of complaints not resolved to a participant’s satisfaction.
(e) The provider shall submit a copy of the provider’s complaint system procedures to the Department upon request.
(f) The provider shall submit the information under subsection (c) to the Department upon request.