2005 Idaho Code - 41-3918 — GRIEVANCE SYSTEM

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 39
                             MANAGED CARE REFORM
    41-3918.  GRIEVANCE SYSTEM. (1) Every  managed care organization shall
establish a grievance system to resolve grievances initiated by members
concerning health care services. The system shall provide reasonable
procedures for the resolution of grievances, and shall include an appeals
process which affords the member the right to a prompt review  by a grievance
panel before whom the member has the right either to appear or be heard, or
both. A managed care organization offering a managed care plan for which a
certificate of authority is required shall have its grievance system approved
by the director and shall submit to the director an annual report in a form
prescribed by the director which shall include:
    (a)  A description of the procedures of the grievance system; and
    (b)  The total number of grievances handled through the grievance  system
    and a compilation of causes underlying the grievances filed.
    (2)  Every managed care organization shall maintain records of grievances
filed with it concerning health care services and each managed care
organization for which a certificate of authority is required shall submit to
the director a summary report at such times and in such form as the director
may require. Grievances involving other persons shall be referred to such
persons with a copy to the director.
    (3)  The director may examine a grievance system of a managed care
organization for which a certificate of authority is required, subject to the
limitations concerning health records of individuals set forth in section
41-3909(3), Idaho Code.
    (4)  Every managed care organization must show evidence that such
grievance procedures have been reviewed and approved by the member
representatives through their participation on advisory panels as set forth in
section 41-3916(2), Idaho Code.