[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR438.228]



[Page 230]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 438_MANAGED CARE--Table of Contents

 

        Subpart D_Quality Assessment and Performance Improvement

 

Sec.  438.228  Grievance systems.



    (a) The State must ensure, through its contracts, that each MCO and 

PIHP has in effect a grievance system that meets the requirements of 

subpart F of this part.

    (b) If the State delegates to the MCO or PIHP responsibility for 

notice of action under subpart E of part 431 of this chapter, the State 

must conduct random reviews of each delegated MCO or PIHP and its 

providers and subcontractors to ensure that they are notifying enrollees 

in a timely manner.



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