Common use of CHIP Perinatal Program Member Complaint and Appeal Process Clause in Contracts

CHIP Perinatal Program Member Complaint and Appeal Process. CHIP Perinatal Program Member Complaints and Appeals are subject to disposition consistent with the Texas Insurance Code and any applicable TDI regulations. HHSC will require the HMO to resolve Complaints and Appeals (that are not elevated to TDI) within 30 days from the date the Complaint or Appeal is received. Any person, including those dissatisfied with a HMO’s resolution of a Complaint or Appeal, may report an alleged violation to TDI. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.7 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-1, Section 7 Revision 1.1 June 30, 2006 Contract amendment to include STAR+PLUS program. No change to this Section. Revision 1.2 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.7 July 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.7

CHIP Perinatal Program Member Complaint and Appeal Process. CHIP Perinatal Program Member Complaints and Appeals are subject to disposition consistent with the Texas Insurance Code and any applicable TDI regulations. HHSC will require the HMO to resolve Complaints and Appeals (that are not elevated to TDI) within 30 days from the date the Complaint or Appeal is received. Any person, including those dissatisfied with a HMO’s resolution of a Complaint or Appeal, may report an alleged violation to TDI. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – - HHSC Joint MedicaidMedicia/CHIP HMO RFP, Section 9 Version 1.7 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-1, Section 7 Revision 1.1 June 30, 2006 Contract amendment to include STAR+PLUS program. No change to this Section. Revision 1.2 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.7 July 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.8 September 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.9 December 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.10 March 1, 2008 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.11 September 1, 2008 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.12 March 1, 2009 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.7.

CHIP Perinatal Program Member Complaint and Appeal Process. CHIP Perinatal Program Member Complaints and Appeals are subject to disposition consistent with the Texas Insurance Code and any applicable TDI regulations. HHSC will require the HMO to resolve Complaints and Appeals (that are not elevated to TDI) within 30 days from the date the Complaint or Appeal is received. Any person, including those dissatisfied with a HMO’s resolution of a Complaint or Appeal, may report an alleged violation to TDI. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – - HHSC Joint MedicaidMedicia/CHIP HMO RFP, Section 9 Version 1.7 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-1, Section 7 Revision 1.1 June 30, 2006 Contract amendment to include STAR+PLUS program. No change to this Section. Revision 1.2 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.7 July 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.8 September 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.9 December 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.10 March 1, 2008 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.7.

CHIP Perinatal Program Member Complaint and Appeal Process. CHIP Perinatal Program Member Complaints and Appeals are subject to disposition consistent with the Texas Insurance Code and any applicable TDI regulations. HHSC will require the HMO to resolve Complaints and Appeals (that are not elevated to TDI) within 30 days from the date the Complaint or Appeal is received. Any person, including those dissatisfied with a HMO’s resolution of a Complaint or Appeal, may report an alleged violation to TDI. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – - HHSC Joint MedicaidMedicia/CHIP HMO RFP, Section 9 Version 1.7 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-1, Section 7 Revision 1.1 June 30, 2006 Contract amendment to include STAR+PLUS program. No change to this Section. Revision 1.2 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.7 July 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.8 September 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.9 December 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.10 March 1, 2008 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.11 September 1, 2008 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.7.

CHIP Perinatal Program Member Complaint and Appeal Process. CHIP Perinatal Program Member Complaints and Appeals are subject to disposition consistent with the Texas Insurance Code and any applicable TDI regulations. HHSC will require the HMO to resolve Complaints and Appeals (that are not elevated to TDI) within 30 days from the date the Complaint or Appeal is received. Any person, including those dissatisfied with a HMO’s resolution of a Complaint or Appeal, may report an alleged violation to TDI. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.7 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-1, Section 7 Revision 1.1 June 30, 2006 Contract amendment to include STAR+PLUS program. No change to this Section. Revision 1.2 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.7 July 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.8 September 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions 2Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.71.8

CHIP Perinatal Program Member Complaint and Appeal Process. CHIP Perinatal Program Member Complaints and Appeals are subject to disposition consistent with the Texas Insurance Code and any applicable TDI regulations. HHSC will require the HMO to resolve Complaints and Appeals (that are not elevated to TDI) within 30 days from the date the Complaint or Appeal is received. Any person, including those dissatisfied with a HMO’s resolution of a Complaint or Appeal, may report an alleged violation to TDI. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – - HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.7 1.6 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-1, Section 7 Revision 1.1 June 30, 2006 Contract amendment to include STAR+PLUS program. No change to this Section. Revision 1.2 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – - Turnover Requirements Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – - Turnover Requirements Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – - Turnover Requirements Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – - Turnover Requirements Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.7 July 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – - Turnover Requirements 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.7.

CHIP Perinatal Program Member Complaint and Appeal Process. CHIP Perinatal Program Member Complaints and Appeals are subject to disposition consistent with the Texas Insurance Code and any applicable TDI regulations. HHSC will require the HMO to resolve Complaints and Appeals (that are not elevated to TDI) within 30 days from the date the Complaint or Appeal is received. Any person, including those dissatisfied with a HMO’s resolution of a Complaint or Appeal, may report an alleged violation to TDI. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – - HHSC Joint MedicaidMedicia/CHIP HMO RFP, Section 9 Version 1.7 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a Initial version Attachment B-1, Section 7 Revision 1.1 June 30, 2006 Contract amendment to include STAR+PLUS program. No change to this Section. Revision 1.2 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.3 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.4 September 1, 2006 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.5 January 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.6 February 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.7 July 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.8 September 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements Revision 1.9 December 1, 2007 Contract amendment did not revise Attachment B-1 Section 9 – Turnover Requirements 1 Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions 2 Revisions should be numbered in accordance according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision. 3 Brief description of the changes to the document made in the revision. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment B-1 – HHSC Joint Medicaid/CHIP HMO RFP, Section 9 Version 1.7.